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The San Diego County Bridge to Employment in the Healthcare Industry Program: Implementation and Early Impact Report

July 12, 2017
Self-Sufficiency, Welfare & Employment
Pathways for Advancing Careers and Education (PACE), 2007-2018 | Learn more about this project
Report cover that shows the title of the report along with four images of young people between the age of 18 - 28 working in the medical field
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  • File Size 2mb
  • Pages 87
  • Published 2017


This report documents the implementation and early impacts of the Bridge to Employment in the Healthcare Industry program, designed by the San Diego Workforce Partnership and operated by three community-based organizations in San Diego County, California. Bridge to Employment is one promising effort to help low-income, low-skilled adults access and complete occupational training that can lead to increased employment and higher earnings. It is one of nine career pathways programs being evaluated under the Pathways for Advancing Careers and Education (PACE) study sponsored by the Administration for Children and Families.

The Bridge to Employment program consisted of five components:

  1. Assessments to determine eligibility for training programs;
  2. Navigation and case management services to help students choose their training and address barriers to participation;
  3. Individual training account (ITA) vouchers to cover the cost of training;
  4. Supportive services for transportation, child care, and other services; and
  5. Employment services to help participants find employment after training.

Using a rigorous research design, the study found that Bridge to Employment increased the credentials its participants received and increased employment in a healthcare occupation within the 18-month follow-up period. Future reports will examine whether these effects translate into economic gains in the workplace in the longer term.

Research Questions

  1. 1 Was the intervention actually implemented as designed?
  2. 2 How did services received differ between study participants who could access the Bridge to Employment program versus those who could not?
  3. 3 What were the effects of the program on credentials received?


The federal government projects that over the next 10 years, the fastest-growing occupations are in healthcare. Almost all jobs in healthcare require some level of postsecondary education or training. But many low-income, low-skilled adults face barriers to completing even short-term training for entry-level jobs.

Career pathways programs are designed to address barriers by providing well-defined training steps targeted to locally in-demand jobs, combined with a range of financial, academic, employment, and personal supports and services. The Bridge to Employment program gave students ITA vouchers they could use at any accredited training provider in San Diego, along with case management, supportive services, and employment services. To assess the effectiveness of this program, the PACE evaluation used an experimental design in which program applicants were assigned at random to a “treatment” group who could access the program or a “control” group who could not, and then compared their outcomes.

Key Findings and Highlights

  • More than 80 percent of treatment group members enrolled in a healthcare training program using an ITA from the Bridge to Employment program. The most popular programs included training to become certified nursing assistants, phlebotomists, medical assistants, and medical records and health information technicians.
  • Most treatment group members who attended training (more than 75 percent) chose to enroll in training offered by for-profit private schools. Bridge to Employment participants could use their ITAs at any accredited training provider. More participants chose private for-profit schools instead of community colleges because they could generally enroll in the training more quickly and complete the training programs in less time. Additionally, community colleges did not accept ITAs, thus participants would need to pay upfront and get reimbursed.
  • Bridge to Employment increased the percentage of its participants who received a credential. After 18 months, 64 percent of treatment group members received a credential compared with 34 percent of control group members, a 29-percentage point impact.
  • Bridge to Employment produced positive impacts on employment. The program increased the proportion of study participants working in a job requiring at least mid-level skills. Also, more treatment group members than control group members were working in a healthcare occupation. The program did not increase the percentage of treatment group members who were working in a job paying at least $12 per hour.


The Bridge to Employment evaluation’s implementation study examined the design and operation of the program and the treatment group’s participation patterns, and its impact study measured differences in education and training and employment outcomes.

From July 2012 to October 2013, more than 1,000 program applicants were randomly assigned to either the treatment or the control group. The impact study used data from a follow-up survey at 18 months after random assignment.

Prior to estimating program impacts, the research team published an analysis plan that organized and disciplined the number of statistical tests conducted so as to avoid the problem of “multiple comparisons” in which a potentially large number of the tests could reach conventional levels of statistical significance by chance. To address this issue, the team established three categories of hypotheses (confirmatory, secondary, and exploratory) and publicly registered confirmatory and secondary outcomes prior to starting analyses.


Farrell, M., and K. Martinson (2017). The San Diego County Bridge to Employment in the Healthcare Industry Program: Implementation and Early Impact Report, OPRE Report # 2017-41, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services

Last Reviewed: September 17, 2018