Path to Positive Change: How Three States Improved their Employment Results

1. Path to Positive Change: How Three States Improved their Employment Results

2. 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 Employment Leadership Network (SELN)

4. State success in integrated employment varies widely 2009 2009 – ICI ID/DD Agency Survey

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

6. Strategy Policy & Goals Financing Training & TA Service Innovation Outcome Data Catalysts Integrated Jobs Leadership Values Interagency Collaboration Hall et al (2007)

7. 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

8. 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

9. 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.

10. 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

11. Interagency Collaboration andPartnership • 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

12. 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

13. 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.

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

15. 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.

16. Washington Division of Developmental Disabilities 10 essential elements to full employment 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…

17. 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.

18. 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.

19. 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.

20. 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

21. Employment Security Data April 29, 2010 David Mancuso Senior Research Supervisor Washington State Department of Social and Health Services Performance, Planning, and Accountability Research and Data Analysis Division

22. Employment Security Data April 29, 2010 David Mancuso Senior Research Supervisor Washington State Department of Social and Health Services Performance, Planning, and Accountability Research and Data Analysis Division

23. Employment Security Data April 29, 2010 David Mancuso Senior Research Supervisor Washington State Department of Social and Health Services Performance, Planning, and Accountability Research and Data Analysis Division

24. The most recent (very) fine print snapshot 4,472 DDD clients earned wages between January-March 2011

25. 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.

26. What is the Return on Investment? For every Houra staff member invests in Individual Employment Supports Services: a client in the CONTINUOUS EMPLOYMENT group works 12 hours 1 Hour Investment a client in the INTERMITTENT EMPLOYMENT group works 5 hours a client in the RECENT EMPLOYMENT group works 2 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.

27. 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.

28. Contact Information: Jane Boone Employment Partnership Washington State Division of Developmental Disabilities Jane.Boone@dshs.wa.gov 206-568-5628 http://www.dshs.wa.gov/ddd/

29. Michigan’s Department of Community HealthPath to IncreaseCompetitive EmploymentfromLeadership > ARR > Interagency Agreement > SELN > MIG/MCESG > Improved Data > Employment Works! > Employment 1st! Joe Longcor, Project Manager, Michigan MIG longcorj@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.

30. 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...

31. 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.

32. 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. 

33. 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

34. 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

35. 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

36. Average Employment Percent46 Community Mental Health Agencies

37. Number of Agencies by Percents

38. 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

40. 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.

41. 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.

42. 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.

43. 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.

44. 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

45. 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

47. 2010 NEVADA Employment Policy Summit “Supporting individuals with developmental disabilities by facilitating employment and independence through informed choice”

48. 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

49. 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

50. Funded Objectives Summit Objectives: • Increase statewide collaboration • Identify barriers to community-based employment • SELN Report & NCED-MIG Needs Assessment as foundation • Develop a specific work plan