Path to Positive Change: How Three

States Improved their Employment

Results

State Employment Leadership Network (SELN)Multi-state technical

assistance collaborative

Improving employment outcomes among individuals with developmental disabilities

Managed jointly by:National Association of

State Directors of Developmental Disabilities Services

Institute on Community Inclusion at University of Mass/Boston

State success in integrated employment varies widely 2009

2009 – ICI ID/DD Agency Survey

“There is a time to let things happen and a time to make things happen.”

Hugh Prather

Integrated Jobs

StrategyPolicy & Goals

FinancingTraining & TA

Service Innovation

Outcome Data

Leadership

Values

Catalysts

Interagency CollaborationHall et al (2007)

Leadership Clear and unambiguous commitment to

employment in individual community jobs Local and State level champions for employment.

Identified lead employment staff.

Regular messaging about employment.

There is a network of stakeholders within the state who advocate for employment

Strategic Goals and Operating Policies

Employment is identified as the preferred outcome in state DD policy

State has measureable goals

Operating practices including individual service plans and case management emphasize employment

Expectations for employment outcomes are placed on providers

Financing and Contracting Methods

The outcome of employment in integrated community jobs is emphasized and supported through the state’s resource allocation formulas, reimbursement methods and rate setting practices.

State service definitions encourage a pathway to employment.

Training and Technical Assistance

High performing employment systems invest in the development and maintenance of a strong, competent workforce, building the skills of job coaches and developers, first line supervisors and key employment staff.

Meaningful minimum qualification requirements exist for employment staff

Outreach and training is targeted

across stakeholders including job seekers, families, schools, case managers

Interagency Collaboration and

Partnership Relationships with key state and local partners

DD partners with VR, education, mental health, Medicaid to foster employment outcomes

Interagency policy and processes support employment outcomes

Smooth transition between funding streams

 

Services and Service Innovation

State supports and encourages innovation in employment services and options

The state disseminates information about creative strategies and outcomes

Supports encourage individuals who may not elect to participate in community employment to pursue a pathway to employment

Performance Measurement and Data

Management Comprehensive data on employment

outcomes measure progress, benchmark performance, and document outcomes.

Information is used to evaluate and track results, inform policy, and improve provider contracts and service agreements.

Data are shared with stakeholders.

“Obstacles are those frightful things you see when you take your eyes off your goals.”Sydney Smith

Washington

Total State Population: 5,894,143 Number of job seekers with intellectual disabilities earning wages in individual

integrated jobs? At last count, April of 2011, 2,639. Not yet everybody.

•Clear mission and vision of everyone working in good jobs•Strong leadership and continual stakeholder involvement•Supporting providers to be innovative and competent•Funding & contracting strategies promoting valued jobs•Availability of training and technical assistance •Collaboration with schools so youth start work at typical age•Partnerships leveraging every possible resource/opportunity•Promoting public and private sector employment•Getting the word out and telling the story•Evaluating results and expecting to continually do better…

What’s the clear vision? Everyone can work.

Everyone.

Building on thirty+ years of assuming earning a living wage is both possible and valuable for everybody, Washington’s Working Age Adult Policy was signed in July 2004 with full implementation in July of 2006.

What role does evaluation and data contribute?

We need monthly data to tell us each person’s: employment setting type of job phase of employment wages earned and hours worked service hours provided and billing costs

Why? So we know how many people relying on us for support are earning a living wage, for quality assurance and monitoring information and to measure the benefit of public investment.

Data measures stuff. What stuff? We want to know if people relying on us are….

Earning a living wage (making good money): The amount of earned wages needed to enable an individual to meet or exceed his or her living expenses.

Pursuing gainful employment (trying to get a good or better job ): Employment or other activities that demonstrate steady movement toward gainful employment over time.

Obtaining gainful employment (got the good job): Employment that reflects achievement of or progress towards a living wage.

Maintaining gainful employment (kept the good job): Supports required to sustain gainful employment and increase earned income.

So, does having a having an “employment first” policy in place since 2004 make any

difference in the outcomes?

Let’s see what the data tells us for the 7,000+ people who are DDD clients

and relying on us for employment or day services in Washington….

Source: Washington RDA/Employment Security Department First Quarter, 2011

Employment Security Data April 29, 2010David Mancuso Senior Research SupervisorWashington State Department of Social and Health ServicesPerformance, Planning, and Accountability Research and Data Analysis Division

Employment Security Data April 29, 2010David Mancuso Senior Research SupervisorWashington State Department of Social and Health ServicesPerformance, Planning, and Accountability Research and Data Analysis Division

Employment Security Data April 29, 2010David Mancuso Senior Research SupervisorWashington State Department of Social and Health ServicesPerformance, Planning, and Accountability Research and Data Analysis Division

The most recent (very) fine print snapshot 4,472 DDD clients earned wages between

January-March 2011

So, what are all 7,989 of Washington’s DDD clients in employment and day services doing and earning? The

lovely folks at Institute for Community Inclusion Umass/Boston built this reporting system. We thank

you.

What is the Return on Investment?For every

Hour a staff member invests in Individual

Employment Supports Services:

a client in the RECENT EMPLOYMENT group

works 2 hours

a client in the INTERMITTENT

EMPLOYMENT group

works 5 hours

a client in the CONTINUOUS EMPLOYMENT group

works 12 hours

The ratio of service hours to employment hours was calculated based on 12 months in the study period. For every hour of individual employment support service received, recently

employed clients worked two hours, intermittently employed worked five hours and continuously employed worked 12 hours.

3

6

9

12

6

9

12

3

3

6

9

12

1 Hour Investment

In general, what does data tell us about how we are

doing? More people are working in individual jobs than 10

years ago, or even 5 years ago, and the trend line for recent job loss mirrors or is slightly better than the general public.

The public cost benefit appears to be very high – we have a stronger workforce, more dollars in our tax base, and the cost benefit on the investment is almost 8 hours of work for every hour of support

The bad news? Not everyone is working. Yet.

Contact Information: Jane Boone

Employment Partnership Washington State Division of

Developmental DisabilitiesJane.Boone@dshs.wa.gov

206-568-5628 http://www.dshs.wa.gov/ddd/

Michigan’s Department of Community Health

Path to IncreaseCompetitive Employment

fromLeadership > ARR > Interagency Agreement > SELN > MIG/MCESG > Improved Data > Employment Works! >

Employment 1st!

Joe Longcor, Project Manager, Michigan MIGlongcorj@michigan.gov

This presentation is funded under the Michigan Medicaid Infrastructure Grant Award Number: 1QACMS030532-02-00 from the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services received by the Michigan

Department of Community Health.  However, the presentation does not necessarily represent the policy of the U.S. Department of Health and Human Services and the Michigan Department of Community Health.

New Leadership led to…2009 - APPLICATION FOR RENEWAL

AND RECOMMITMENT (ARR) TO QUALITY AND COMMUNITY IN THE

MICHIGAN PUBLIC MENTAL HEALTH SYSTEM

Expanding Opportunity for Integrated Employment

It is expected that, as one of the highest priorities, public mental health agencies will actively assist adults served to obtain competitive work in integrated settings* and provide the supports and accommodations that are necessary.

*“Competitive work in integrated settings means work in the community for which anyone (with or without a disability) can apply and that pays at least minimum wage.”

Pre-Paid Inpatient Health Plans (PIHP) must regenerate their partnerships with other entities providing employment supports to all...

2009 – ARR focus on QUALITY AND COMMUNITY IN THE MICHIGAN

PUBLIC MENTAL HEALTH SYSTEM)Expanding Opportunity for Integrated Employment Involvement of local business must be garnered; and local

barriers to employment for persons with mental illness or a developmental disability must be explicitly addressed as a community project.

The PIHP must have adequate staff who are trained and charged with job development; assigned to assist individuals in retaining supported employment opportunities; and assigned to assist people with Social Security benefits to understand and use work incentives to start or return to work.

System-wide adoption of the evidence-based practices for supported employment for persons with mental illness is also expected. Other existing programs must have an active focus on competitive employment.

April 2009INTERAGENCY AGREEMENT for the EMPLOYMENT of PERSONS

with DISABILITIES Michigan Rehabilitation Services (MRS), Michigan

Department of Community Health (MDCH), & Michigan Commission for the Blind (MCB) enter into this agreement for the purpose of endorsing and promoting the competitive employment of people with disabilities, served jointly by our organizations, in accordance with the guiding principles noted below.  This document also serves as the template for use by local parties. 

April 2009 – Interagency Agreement Guiding

principles Person-centered Assume that each individual is employable Encourage maximum use of natural supports Expedite assessments Value timely placement in community-based work settings Provide follow-along supports and services Embrace community employers as customers/stakeholders Value employment as a means to achieve independence and

community integration Support development of efforts toward meaningful careers

2010 Interagency Work Data Report of Jointly Supported Customers

About a 22% successful closure rate Questions re: high and low success rates Potential to use SELN to compare with prior report

Nine Regional meetings Best Practices and Challenges

Now focusing on “local/regional” topics

SELN RecommendationsNovember 2009

Establish a permanent state level staff member who has responsibility for employment policy and development and for managing implementation of PIHP responses to the employment expectations of the ARR Led to an Employment Works! Policy for 2011

Strengthen employment policy and goals using the ARR structure as a base. Develop an enforcement/follow-through strategy for PIHP responses to the ARR related to employment.

Establish specific employment goals at the PIHP and state levels

Establish pilot projects and a technical assistance structure that support and demonstrate organizational change at the provider level

Develop standards and a model systems approach to transition and establish pilot initiatives to demonstrate coordinated transition services

Average Employment Percent46 Community Mental Health

Agencies

00.050.10.150.2

average

2007 2008 2009 Threeyear

MI

DD

Dual

Number of Agencies by Percents

0

5

10

15

20

MI

DD

Dual

Increase Expectations - Employment Outcomes…

For persons with serious mental illness: <15% to increase 7% over base number >15% & <20% to increase by 5% >20% to increase by 3%

For persons with developmental disabilities: <10% to increase 7% >10% <15% to increase 5% >15% <25% to increase 3% > 25% to increase 2%

For persons with a dual diagnosis: <8% to increase 7% >8% <16% to increase 5% >16% <30% to increase 3% >30% to increase 2% Medicaid managed Specialty Supports & Services Concurrent 1915(b)/( c) waiver FY 2011

MDCH Employment Works! Policy

(paraphrased) MDCH recognizes that employment is an essential element of quality of life for most people,

including individuals with a serious mental illness or a developmental disability; including persons with the most significant disability. Therefore, it is the policy of MDCH that:

Each eligible working age individual over 14 years old and ongoing to the age of their chosen retirement will be supported to pursue his or her own unique path to work and a career. All individuals will be afforded the opportunity to pursue competitive work. (“Competitive work in integrated settings means work in the community for which anyone - with or without a disability - can apply and that pays at least minimum wage.” – Stakeholder Task Force)

Each time a pre-planning meeting is held to prepare for a person’s plan of service (at least annually); a person’s options for work will be encouraged and will be documented during the pre-planning meeting. After exploration of competitive employment options, it is recognized that some individuals may choose other work options such as Ability One contracts, transitional employment, crews, (ideally in the most community integrated setting possible), volunteering, education/training, or unpaid internships as a means leading to future competitive work.

MDCH Employment Works! Policy

(paraphrased conti.) This proposed policy shall support persons with serious

mental illness and developmental disabilities to receive services and supports to achieve and maintain competitive employment.

MDCH will compare baseline numbers to competitively employed numbers at the end of each fiscal year. It is anticipated that the percentage of consumers employed will increase over time. This policy supports the incentive for increased competitive employment for people with disabilities, as written into contract language.

MDCH Employment Works! Policy

(paraphrased)Expectations for MDCH:

Establish a permanent state-level staff member who has responsibility for further development & overseeing its implementation of the Employment Works! Policy

Provide technical assistance to field for program implementation & sustainability Review…establish a strategy for collecting & sharing accurate employment

outcome data with stakeholders. Establish specific employment goals for the PIHP system data. Strengthen the strategy & agreements with MRS&MCB (VR) to improve

consistency of PIHP individuals. Encourage & promote the use of best employment practices, including

employment practices recognized in the most current Medicaid Provider Manual (examples provided)

Identify PIHPs with best employment outcomes, learn from their successes, and highlight these practices.

Assist PIHPs in developing expertise in benefits planning. Strengthen the role of existing employment working group(s) by establishing a

standing employment leadership team.

MDCH Employment Works! Policy (paraphrased)

Expectations for PIHPs:

Designate a local staff member who shall be responsible for implementation of the Employment Works! Policy. Designate this staff member and an alternate to participate in a standing employment leadership team.

Provide timely and accurate employment outcome data to MDCH to review and determine employment strategies at least annually.

Achieve established employment goals/increases. Establish strategies & enhance agreements, &/or other strategies with MRS &

MCB to improve consistency of supports for PIHP individuals. Embrace and promote use of best employment practices. Share local best employment practices across the PIHP network through

conferences, webinars, conference calls, newsletters, cross-agency presentations, etc.

Designate at least one (preferably two) staff with proven expertise in benefits planning or clear capacity to access timely and accurate information to address immediate employment interests of persons with disabilities.

2011 Statewide Strategic PlanEmployers, Individuals, & Multi-agency

FIVE STRATEGIC PRIORITIES Expand outreach and partnership with employers Earlier implementation of School-to-Work Transitions Planning Expand collaboration and partnership between departments and agencies Develop and employ a sustainable data system. Remove transportation barriers to employment for people with disabilities

Definition of Competitive Employment Competitive Employment is work that occurs in an integrated setting for which

anyone can apply, which is full or part time, with or without supports, in which the individual is paid at or above minimum wage but not less than the customary wage and level of benefits of all workers in that setting. Note: This definition applies for the purposes of this document only.

Promote, engage and implement an Employment First initiative

Currently… Seeking Employment 1st! Statewide

Legislation or Policy to advance emphasis on competitive employment

Using past MDCH, SELN, and joint employment data to create effective strategies to increase employment outcomes

2010 NEVADA Employment Policy

Summit

“Supporting individuals with developmental disabilities by facilitating employment and independence through informed choice”

NEVADA HISTORY Many organization and agencies that have been

working on developing a systematic change to find meaningful employment for people with disabilities for so long, but they never worked together as one united front. (Worked in Silo’s)

Large facility based programs in Nevada. (Three Regional DD Centers

VR regulations – Closure Resources/budget cuts/ Unemployment rate Funding structure doesn’t enhance supported

employment opportunities- Transition Program limited

NCED Proposal Requested $98,880 from the DD Council to organize and

host an STATEWIDE Employment Summit

Scheduled April 5-6, 2010 to be held in Reno Nevada Approximately 130 persons to attend from the state.

30% of funding for travel, lodging and participant support.

Travel was restricted --- Did three Regional Summits.

Reno/ Las Vegas/ Elko – Total Participants - 231

Funded ObjectivesSummit Objectives:

Increase statewide collaboration Identify barriers to community-based

employment SELN Report & NCED-MIG

Needs Assessment as foundationDevelop a specific work plan

Summit OrganizationLetter of Invite to Steering Committee- Hand Picked

Agencies & Programs that serve persons with disabilities (statewide): Regional Centers, Medicaid, BVR

Providers (i.e., Community Training Centers) Parents (i.e., PEP), Advocates (i.e., NDALC) Persons with Disabilities (i.e., People First) Policymakers -Elected Officials, (Federal & State) Education Representatives: NDE, CCSD, ECSD,

WCSD Business Leaders

CollaborationScott Harrington (NCED)Todd Butterworth (Aging & Disability Services)LaVonne Brooks (HSI-WARC)Wendy Firestone (HSI-WARC)Santa Perez (People First)Hinda Brush (Mental Health)Melissa Pegg (CCSD)Jennifer Kane (NDE)Karen Taycher (PEP)Robin Renshaw (PEP)John Butterworth (ICI-SELN)Rie Kennedy (ICI-SELN)Suzzanne Freeze (SELN)Bob Niemiec (Consultant-MN)John Lund (Consultant-WA)Susan Lisagor (Senator Reid’s Office)Korri Ward (Parent, DD Council)

Sherry Manning (DD Council) Deborah Tyler (DD Council)Deborah Braun (DETR-Rehab)Howard Castle (DETR-Rehab)Pamela June (DETR-ODEP)Ed Guthrie & Tracy Brown - (Opportunity Village)Rosie Melarkey (MHDS)Jane Gruner (MHDS)Dan Olsen (Medicaid)Steve Rock (NCED)Brandi Berryman (NCED)Cheryl Katzmark (NDALC)Mary Zabel (NSHE-UNR)Lynda Crawford, Nevada Works) (Peggy Cullinane (WCSD-Transition)Len White (Self-representative)

Summit Overview-Day I Welcome to Summit Dr. Harrington/Senator Reid SELN-ICI Presentation (Dr. John Butterworth)

Status of employment in NV and US Agenda & Matrix of Events (LaVonne Brooks)

Orientation to Bidders (Glossary, Waivers, Resource Information

Off to color coordinated groups –diverse groups organize by work committee. Everyone came with their own prospective but their prospective would become pieces to the puzzle. The employment puzzle.

Methodology Used (modified) Nevada’s State

Employment Leadership Network (SELN) Report – Key Findings and Observation from self assessment of seven focus areas/site visit.

The FINDINGS AND OBSERVATION report was identified as a valuable tool that could be used as the foundation for the Summit.

We collapsed two areas and added on (EMPLOYER ENGAGEMENT)

COLLOBRATIVE METHODS

Nevada hybrid model (combination of Thin Slicing, World Café and Future Search models)

This system is comprised of: large pieces of paper, Sharpies, candy, little orange sticky dots and a ton of sticky notes of all colors, actually the candy is optional , but help keeps the brain flowing.

Two facilitators per group ( Need people who know the area.

30 minutes to read, digest, report, clarify, categorize, group in themes, clarify more, regroup, then vote.

DAY 1 ACTIVITIESTHE POWER OF THE STICKY

NOTES Write on a 3”x #’ color sticky note - what

are the key points or what they felt was important from the SELN report? (read each sticky note out loud and then post)

Identify any findings not identified in the report? (what was missing)?

Participants identify the key focus points – themes /combining similarities

Participants were asked what they though were solutions to the barriers.

DAY ONE CONT. Common themes were clustered together through group process,

identified as a priority items (only with person permission.

Participants were provided with three small sticky dots, each worth one vote to be placed on what was the most important.

Across the six, 30 minutes groups, and their frequencies tallied to generate the most frequent identified focus area or “OUTCOME STATEMENTS”

Real time data collections.

Day II Presented data from Day I

Preliminary findings and common themes, and identified Outcome statement.

Defined Work Plan and “viability” required at least 8 persons for group Identified area of passion and caucus for those in groups <8

Entire day spent on designing work plan in area of personal interest This session highlighted strategies developed by the working

group (report out their outcome statements, priorities, action steps for results, share timelines, and establish schedules for reporting activities and accomplishment

Outcomes The most collaboration NV has seen in employment for

persons with DD/ID

Allowed for an open environment that allowed for different voices to be heard and respect with merit.

Offered a fresh perspective for the disability community. (Equal playing ground)

A specific statewide work plan for six (6) prioritized areas designed and voted by the NV constituency;

OUTCOMES CONT. Facility-based program partnered with community-

based programs, government agencies partnered with private agencies, with all partners are working toward efficiency as a goal.

Social Security Administration’s Area Work Incentive Coordinator training in VR Counselors on the Plan to Achieve Self Sufficiency.

VR collaboration on State Purchasing Program gaining new opportunities for employment.

MORE OUTCOMES MIG grant took summit report and continued work by providing

funding in employment priorities.

Vocational Rehab/Nevada Center for Excellence/ Division of Developmental Disabilities have a MOU to place 30 individuals with DD into customized employment.

DD Regional Center/ Community Provider working together on one universal contract

Community Provider receives money to provide job skill classes.

University receives moneys to do a Assistance Technology Summit.

It Takes Teamwork –COLLABORATION

…success comes from collaboration; when people with multiple and different collectively focus on achieving a goal. When we work together, listen to each other, learn from each other, and figure out how to support each other—we accomplish more! You bring a value to our team that no one else could, and for that we are thankful.

We ‘re a better Nevada because of you

SELN – netWORK

Contact Information:

Rosie MelarkeyNevada Division of Mental Health &

Developmental Servicesrmelarkey@src.state.nv.us

775. 688.1930