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Expanding GetCalFresh to SSI Recipients
Updates and key learnings from the GetCalFresh research team on how to improve GetCalFresh for low-income seniors and adults with disabilities.
For decades, people who receive Supplemental Security Income (SSI) have been unable to receive SNAP food benefits in California. Now this policy has been reversed. An estimated 400,000 low income seniors and people with disabilities are newly eligible for food assistance. Questions? Contact us at firstname.lastname@example.org
We’ve learned that SSI recipients often get help from friends, family, care workers, housing coordinators, and more and believe this is going to happen for food benefits as well.
For this reason, we tested some digital prototypes today with 5 people who routinely help seniors or adults with disabilities with everyday activities. We especially hoped to get their feedback on the first versions of new screens that would allow CalFresh applicants to give helpers special permissions on their application for food benefits.
Some responses we got:
“I want them both (text and email reminders) for me & him”
“At doctor's appointments I am the one asking questions.”
Feedback on new ideas at Resources for Independent Living, Sacramento
May 02, 2019
Recently, we made a digital version of a simplified GetCalFresh.org application (that included a few additional features for SSI recipients) and went to test it at Resources for Independent Living (RIL), an independent living center serving Sacramento and Yolo counties.
Asking potential applicants (i.e., adults with disabilities) to give us feedback on a realistic version of our application is a crucial step in identifying confusing areas in order to improve them.
April Wick, RIL’s executive director, greatly helped us by bringing in people with a range of disabilities and experiences with technology so that we could get a realistic understanding of how our application performs for a wide spectrum of experiences.
We talked to 15 people and observed them struggling in 3 common situations:
Getting immediatelyoverwhelmed. In this situation, a participant would stop within the first few screens due to a lack of familiarity with digital applications and interfaces, the complexity of the content or language used, questions about the complicated CalFresh process, or concerns about security or scams.
Becoming too tired to finish. In this situation, a participant would experience cognitive fatigue; stopping after the complexity of the process, the length of their path through the application, or the unfamiliar terminology or interface elements made them too tired to finish.
Struggling at first, but learning. In this situation, a participant would experience some confusion early on but found enough support in the application to continue.
Participants who did not struggle or only minimally struggled, still provided a lot of helpful feedback about the sequencing of the screens as well as improvements to terminology.
While some applicants in the SSI community or elsewhere will continue to want or need assistance with digital applications, we want GetCalFresh.org to be an application that is usable to everyone who wants to use it. Digging into usability factors like cognitive fatigue and learnability helps us make more informed and inclusive design and product development decisions.
A big thank you to April and the RIL community who were so generous with their time and advice!
So far, we've talked to almost 50 people, with a range of disabilities and evenly split across gender. We've conducted research in urban, suburban, and more rural contexts across California and we're still going!
Visiting Tulare and Merced
April 15, 2019
Resources for Independence, Central Valley has offices in Fresno, Merced, and Visalia. We met with the Office Coordinators in those two locations to get a better sense for the work they do in the counties they serve and challenges that people face. We also sat down with both and walked through a version of our GetCalFresh simplified application for a SSI-only household.
A couple learnings stood out:
Cost of living is really high, affordable housing is hard to find and SSI recipients need help securing it.
Lifeline phones (Obama phones) have lost service in the past due to a regional outages, disconnecting low-income clients from services.
Clients may come in to the RICV offices for help navigating services and to use the computer; they find the time limits at the library computers discouraging.
Here's a few photos from our visit to Visalia and Merced.
Here's one of many examples of how folks with disabilities often have to contend with systems that aren't designed for them. Imagine having to fill out a government application on a computer with a 15 minute time limit! Though most people can apply for CalFresh benefits on GetCalFresh in about 10 minutes, most applications aren't as quick. A time limit like this can be stressful for people who already struggle with anxiety or may need a little more time as a general rule.
Fresno feedback session
April 12, 2019
We headed to the Central Valley to understand a bit more about the experience of SSI recipients in Tulare, Merced and Fresno counties. We visited Resources for Independence Central Valley, an Independent Living Center serving people throughout the region. In Fresno we invited 11 consumers of RICV to talk to us about their experience of SSI and SSA, their use of technology, and we showed them our work in progress.
We feel so lucky to be able to learn from people with varying abilities. We are inspired by the way they approach and adapt to the world around them, and we are honored by the chance to make GetCalFresh not just usable, but empowering for range of people who may have been disempowered by technology and government services in the past.
Here’s a few photos from our focus group:
Here’s a few quotes from our insightful participants:
“If I haven’t gotten it done in that time (20 minutes), it’s not getting done that day.”
Thanks to everyone for participating and special thanks to Larry and Suzy from RICV for bringing people together for us.
Workshop with the GetCalFresh team
March 25, 2019
The GetCalFresh product team consists of different disciplines: software engineering, program and partnership management, customer success, product management, and design and research. When we return from field research it’s important to make our learnings real and tangible for rest of the team responsible for GetCalFresh. We do this in a variety of ways including workshops like this. Activities like this also give us a great opportunity to solicit ideas and brainstorm with each other; sharing unique cross-disciplinary perspectives on what the research could mean for GetCalFresh.
This working session started with a research “walk-through”. Each major learning got a “wall” filled with facts, quotes, and pictures to stimulate team members’ thinking.
Then we brainstormed what these learnings could mean for the application:
SSI Research Insights (to date)
March 22, 2019
We synthesized our findings from the research so far over several afternoons, eventually ending up with important learnings that we can dig into and validate further with our next round of research. See each insight below along with some quotes that illustrate them.
Barriers are inequitable for people with disabilities
Common hassles in application processes are magnified for those with disabilities. Resources and services may be available but take effort, energy, and certain abilities to access. Often this is effort that people experiencing a diversity of disabilities don’t have.
“My hands limit me about ½ time. Some days I am fine and some days it is just hard to do something simple like open a jar or juice, other days it will be a disaster... I save my passwords... I use the mouse... It is the tips of my fingers that have the needle pain.”
“You have to stand outside in line. Sometimes they treat you like a 2nd class person, and I suffer from anxiety so all those people makes me really nervous.”
“To be honest with you... I don’t eat 3 meals a day cause my money doesn’t last like that. I don’t go (to the food bank) cause sometimes it’ll be far and you gotta pack and it’s just too much sometimes. I’m just tired sometimes.”
“What i think is gonna happen is that there’s gonna be a lot people with mental health issues who bounce in and out of office and don’t follow through with the process.”
SSI recipients are experienced benefits clients and wary of the process ahead.
People have had first-hand and long-term experiences with a variety of benefits and government programs. The application and enrollment processes, as well as what is required to stay on these programs is described in negative terms. Even after navigating these programs, there is still confusion about what happened, the associated rules and regulations, and the processes in general.
“They are just a pain and when you go in they just give you a hard time with everything. Usually you don’t want to talk to them, cause its a huge mess... You are on social security, you worked all your life, but they give you a hard time.”
“They raised it $21 recently. They had an increase 10 years ago too, they raised it $40 then, but then the state deducted $40.”
“There's no chance to say what you need to say, cause if you’re on the phone they interrupt you. It's rude. They are trying to rush you off the phone.”
“I think (they are) trying to discourage people, cause a lot of people aren’t going to go through the process of getting a lawyer and all that... (they) know they’re not going to keep on trying.”
“Never seen so much paperwork in my entire existence... They want it hard, they want you to give up”
Helpers provide various levels of care, but all stand to benefit from the client receiving more support.
Helpers are often family and friends who give so much of their money, energy and time that they often need care and support themselves. Participants with cognitive impairments often needed help accessing, applying for, and managing benefits processes. Helpers play a bigger role for SSI recipients than previous CalFresh applicants.
“My brother keeps it [Direct Express Card] with him, cause I can’t manage my finances. He makes sure my rent is paid, my food, I have clean clothes.”
“I had a friend helping me, but when (my son) got old enough to understand, he took over... I trust my son more.”
“I was trying to help her at a young age. It’s my mom so…”
Without enough money for food, people get what they can and suffer the health consequences.
Housing expenses are high for people on SSI. The most fortunate have low income housing or vouchers, but many pay far more than 50% of their income in rent, leaving them little to no extra money for higher quality food, modest toiletries, or over-the-counter items.
People want to eat healthy food, but it’s often unattainable because of cost, transportation, or their ability to prepare it. Eating whatever is available is the norm, the result is a variety of unhealthy trade-offs.
“Sacrificing is still not enough. I have $40 left after paying rent - It’s frustrating.”
“I’m hungry at home, but happy I can pay my rent.”
“I have a friend who is a manager of Carl’s Jr. so if I have $1 or $2 I go to her and get a combo meal.”
March 18, 2019
We’ve spent hours this week going through everything we learned in the last couple of weeks. We do this as a group of researchers, clarifying ideas and checking each others' assumptions. Other designers and researchers joined us at different points, asking questions and getting early clues for their own work.
Later on, we stopped by a local Farmer’s Market, where we got to see HALA’s “Market Match” program in action. Funded by local donations, HALA has been matching SSI recipients farmer’s market dollars to help stretch the healthy food budgets of low-resourced Los Angelenos.
Hunger Action LA Workshop
March 01, 2019
We had a great focus group co-organized by Frank Tamborello of Hunger Action Los Angeles (HALA). We invited 6 people who currently receive SSI, and who have been active in the cash-out reversal policy change, to share with us what living on SSI is like in Los Angeles.
We shared our paper prototypes and talked about the questions and fears that people may have about the process. Participants in the workshop shared how food insecurity affects their health and wellness, provided honest feedback on our prototypes, and also relayed what their various communities have been talking about.
Here’s a few quotes from the day:
“How much do you think we’ll get? Some people were saying they’re not gonna give me more than $20…”
“Are they gonna take it out of our checks, that’s what a lot of my grandmothers are worried about.”
“(In the 90's) they were gonna cut General Relief entirely. I didn’t believe the government would get that cold– but they did. Yeah, they said they would give out $2000 a piece but then cut General Relief forever, so we don’t doubt what they’ll do now…. Finally we got them to put a few million in until there was a settlement, and finally we won out… we still have General Relief today. If we didn’t have General Relief we’d never get SSI cause people would die before they got it.”
“They are spending $50k a year sometimes (on hospital visits), but if you give me $200-300 a month, I can eat better and I would not be in the hospital… You could send me $3600 a year and I’ll save you $40,000 a year. Think about that: millions and millions of people that (have my condition). Take that and times it, they're gonna save a fortune.”
Interviews in Los Angeles and Riverside
March 01, 2019
Focusing on adults with disabilities, we recruited and conducted hour-long interviews with 25 people on SSI throughout Los Angeles and Riverside. We learned a lot about different disabilities and what they may mean for the CalFresh process and our app in general, as well as the services that folks have had to rely on in Southern California.
February 12, 2019
We like to take ideas into the field to show potential users as early as possible. While we get a lot of helpful information from posing open-ended questions like we’ve done so far, putting something tangible in front of a research participant can elicit different kinds of responses. In offering their opinion of an early prototype, a participant can be an expert and often suggests changes in phrasing or design that simply works better for them.
Often, the designs that we bring so early into research are just sketches on paper, or black and white printouts of early screen designs. Paper is ideal because it doesn’t have an intimidation factor and because its just on paper, participants feel comfortable giving us constructive feedback. It costs very little to draw out an idea on a piece of paper and put it in front of a potential user, so we try to do this as much as we can.
Here’s some of the prototypes we took into the field, marked up with feedback:
Research with Meals on Wheels
January 31, 2019
We’ve been focusing this first phase of work on the senior experience on SSI and got an opportunity to team up with Meals on Wheels volunteers as they delivered meals to seniors at a low income senior housing site in the bay area. We went door to door, handed out pre-packaged hot meals, and shared the news of CalFresh expansion, asking if we could cycle back around after the route and do interviews.
We spent the afternoon in the living rooms of 5 seniors currently on SSI talking about how they budget, the expenses they have, the community resources they rely on, and their helper networks.
Some of the things that stuck out today
In-home help was common. Participants' helpers, sometimes a family member, sometimes also an IHSS (In-home supportive service) worker, assisted them with various tasks like cleaning, laundry, cooking, grocery shopping, and taking them to the doctor or other appointments.
Most of the people we talked to relied on food pantries in addition to Meals on Wheels and they still run out of food. Most were trying to eat healthy foods because of a chronic health condition, but often felt they were hard to get or more expensive. Often, it meant going without food, especially healthy food, self-care items, and never being able to save for anything extra like a robe for a church choir or a nicer walker.
They spent many years of their life contributing to the community. People told us about their paid - and unpaid - working lives as secretaries, school employees, hospital workers, community garden activists, church members, and moms.
They were surprised they could get food benefits.
Many of the people we talked to today were familiar with food stamps: many had been on it in the past and became ineligible when they enrolled in SSI. But none of them knew they would be eligible in June, and all were interested in applying.
They had no significant medical expenses, but high rent. Most of the medical expenses we asked about were covered by MediCal. Participants’ rent and utility expenses, however, were often more than 50% of their income.
Research Intercepts: Lunch at a local Senior Center
January 29, 2019
We visited a local senior center that hosts low cost lunches. It was a popular event and we were able to sit down with a few seniors who currently receive SSI. We asked them questions about budgeting, about their use of the internet, how they hear about services, and how they might get documents to prove income and expenses when it comes time to apply for CalFresh food benefits.
"My granddaughter always tells me (about the internet), ‘Grandma, I just showed you how to do that...I don’t like it, but you gotta change with the world”
“When I don’t eat I’m off balance, light-headed”
“No, I like to get rid of all clutter and paper”
“My rent and PG&E bill is really high, but I don’t have any medical expenses because MediCal pays for everything.”
Subject Matter Experts
January 29, 2019
Subject matter experts help us frame and reframe our knowledge by sharing with us the current issues of concern in their area of expertise. Some of the advocates and CBOs we’ve talked to are experts in public benefit policy, but we’ve also talking to academics studying senior enrollment in benefit programs across the county, social workers who help people apply for SSI after a disabling life event, community health workers and organizers, while others run independent living centers in rural areas or organize farmers markets and food access for low income folks in inner cities. GetCalFresh already has a vast network of California advocates who support and strengthen our work and so we reached out to them first, asking for referrals to other experts who could help us build a picture of the varying life experiences of SSI recipients.
Research Intercepts: Food Banks
January 14, 2019
Lots of food banks use GetCalFresh.org to help people apply for CalFresh benefits. We have lots of great relationships with food banks and often go to food bank distribution sites to conduct research intercepts with people standing in line or signing up for CalFresh. This is often one of our first activities; it helps us get outside, try out our interview questions, and start conversations.
We had a number of short 15-20 minutes conversations with SSI recipients at locations in Richmond and Sacramento. Asking questions like, “how do you budget?” and “how do you hear about services?”, we're starting to learn about life on SSI.
Services (like the food bank) can be an important lifeline for people on SSI, one participant who lived alone told us,
“Survival is kinda hard when you’re by yourself.”
Who are SSI recipients and who are our users?
January 12, 2019
We were able to start with data about who might be applying for CalFresh benefits this summer. CDSS released a great dataset showing the age ranges and counties of eligible recipients, while one of our quantitative researchers compared this with census data to give us a good, preliminary understanding of the breakdown of the SSI population by characteristics like age, geography, language, and disability.
Though it's nearly impossible to categorize the diverse range of people who receive SSI we began our research by thinking broadly about 3 groups of potential users of GetCalFresh:
Adults with disabilities
People who help other people.
Though these categories overlap and may not end up being the most important categories in which to understand experiences on SSI, they help us structure and begin our research.
How we work: research cycles
January 11, 2019
GetCalFresh and Code for America practice user centered design. We believe that government programs and services should meet the many and varied needs of people who use them. In the 21st century, this means integrating user centered design practices into the work and design of government software and services. With the expansion of CalFresh benefits to SSI recipients this summer and the state-wide promotion of our application, GetCalFresh.org, for that purpose, we have the opportunity to make improvements and design new features that center on the experience, expectations, and needs of SSI recipients.
Our research team chose to conduct research in phases. In each phase we collect information through different qualitative methods such as observational research, intercepts in the community, focus groups, and longer interviews with carefully selected participants who represent an accurate sampling of the population we are trying to understand. After each phase we synthesize what we heard into insights. Then we analyze the gap between what we have learned and what we still need to know, and begin the cycle again. Early on we begin to work with design, to bring sketches and prototypes out into the field to rapidly collect feedback on work in progress.
We made this handy graphic to show how we think it all fits together.
About Code for America
January 01, 2019
Code for America believes government must work for the people, and by the people, in the digital age, starting with the people who need it most. Our goal: a 21st century government that effectively and equitably serves all Americans.
We aim to transform the way government delivers services to those in need of food access. Key examples of our work include; GetCalFresh, an online service that helps Californians through the process of getting CalFresh benefits with a friendly and respectful experience, and The Integrated Benefits Initiative, which simplifies how Americans access safety net services when they need them most.