Today, one in every three people in the United States—and nearly half of all people of color—are economically insecure, meaning they have a household income at or below 200 percent of the federal poverty level. The Administration for Children and Families (ACF) within the U.S. Department of Health and Human Services supports economic stability and mobility for families in part by evaluating innovative education and training approaches.
One such approach is the use of education and training programs that utilize a career pathways framework, in which post-secondary education and training is organized as a series of manageable steps leading to successively higher credentials and employment opportunities in growing sectors. Participants start on the step aligned with their current skills. Other features of this framework include academic and non-academic supports, innovative instructional approaches that target an adult-learner population, and connections to employment. Following completion of a step, the participant can proceed to the next training step or seek employment at that level.
ACF supported career pathways models through two rounds of Health Profession Opportunity Grants (HPOG 1.0 and 2.0) and evaluations to assess their impact on employment and participants’ earnings. HPOG programs focused on providing training in the healthcare field to Temporary Assistance for Needy Families (TANF) recipients and other adults with low incomes. Grantees had flexibility to design the specifics of their HPOG 2.0 programs to meet the needs of their target populations and local employers, and thus differed in the types of training they offered, the availability of basic skills training, and academic and nonacademic supports participants could access.
What Have We Learned from HPOG about Program Design Considerations?
Abt Global and our partners, including the Urban Institute, evaluated both rounds of HPOG grants under contract to ACF’s Office of Planning, Research, and Evaluation (OPRE). This blog summarizes three recent papers that describe various program design differences and their correlation with HPOG participant outcomes1:
The key lessons from these papers are described below.
Longer healthcare trainings provided greater benefits, but were harder to access for many.
- HPOG programs offered a range of trainings, from short-term trainings (such as for Certified Nursing Assistant) to long-term trainings (such as for Registered Nurse). Participants who completed a long healthcare training (12 months or more) on average had higher earnings than participants who completed medium training (four to 11 months), more than 50 percent higher five years after completing training. Those who completed medium-term training had higher earnings than those who completed short trainings (less than four months), but the difference was more modest, about 20 percent higher. Those completing long trainings nearly tripled their pre-HPOG quarterly earnings over a five-year period after training.
- Despite the advantages conferred by longer-term trainings, short trainings were the most common type of training accessed by HPOG participants. Analysis also revealed disparities in who was able to complete longer trainings. Over half of participants who completed long trainings identified as white, while a larger share of short training completers identified as Black. Those who completed long trainings also entered training with advantages–they had more prior education and were more likely to already be employed in the healthcare industry than other participants.
- Programs may want to explore strategies – in addition to basic skills activities provided under HPOG – that better prepare participants for entry into longer, higher-level training as well as provide additional supports to help them persist to completion. Once enrolled in training, financial support beyond tuition assistance—such as stipends—could help reduce the need for participants to combine school and work, thus promoting full-time enrollment and increasing program completion2. Programs may also consider emphasizing some of the medium-length trainings that lead to strong outcomes relative to their length.
Multiple entry-level (and shorter-term) trainings do not appear to provide the same earnings boost as mid- or high-level trainings.
- While mid- and high-level healthcare trainings (trainings for occupations paying $15/hour or more) were most likely to lead to a higher-paying job, far more HPOG participants accessed one or more entry-level trainings than higher level trainings. Although stacking credentials is a practice in some parts of the healthcare industry, it is not clear that this strategy – particularly at the entry-level – improves participants’ employment and earnings prospects.
- Participants who completed multiple entry-level trainings and earned multiple credentials as an alternative to longer, mid- or high-level trainings did not meaningfully improve their wages relative to those who completed only one entry-level training. Obtaining multiple entry-level credentials also did not improve participants’ wages relative to one credential or no credentials.
- Given the time and cost associated with additional trainings, programs may want to understand what value participants will get out of them. Specifically, programs should determine whether the local labor market will provide a positive return for multiple entry-level trainings or credentials.
Offer support services and help participants access them; provide additional support to participants who need to meet pre-training requirements.
- Participants who received wraparound services were more likely to start and complete healthcare trainings. These services provided by HPOG programs included pre-training workshops and activities, such as college readiness, digital literacy, or healthcare careers workshops. Additionally, logistical support services (e.g., for transportation or childcare), academic supports, and employment assistance supports were helpful for participants who accessed them. Both pre-training activities and support services were associated with a higher likelihood of participants’ starting and completing healthcare training.
- Basic skills training and course prerequisites can be an impediment to starting healthcare training. Programs may want to accelerate entry into training by providing workshops and basic skills instruction at the same time as—or integrated into—healthcare training, as some HPOG programs did, in order to retain participants who otherwise drop out early before progressing onto training.
- Participants who have not completed high school, in particular, struggled to start and complete healthcare training. These individuals may need different programmatic options tailored to their skill levels.
Looking Ahead
Education and training programs—within a career pathways framework—have the potential to address the dual goals of increasing opportunities for economic mobility and increasing the supply of skilled healthcare workers. But program design choices need to support successful and equitable outcomes. So how do we move ahead? Two of Abt’s Racial Equity Core Principles—specifically “leading with those most impacted” and “co-create and shift power”—could be helpful. Partnering and co-creating programs with those most impacted is one way to understand participants’ needs, and the systemic barriers that thwart them.
1All results from these papers are descriptive outcomes and should not be interpreted as causal impacts. The HPOG 2.0 Impact Evaluation uses an experimental design to conduct these types of impact analyses.
2Grantees were prohibited from offering stipends under HPOG’s authorizing legislation for the two rounds of grants (HPOG 1.0 and 2.0).