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The Alabama Department of Mental Health(ADMH)- Making Employment Option #1

The Alabama Department of Mental Health(ADMH)- Making Employment Option #1. How ADMH is Transforming Itself and Working with Other Agencies to Make Employment a Reality for People with Disabilities By Courtney W. Tarver Associate Commissioner, Division of Developmental Disabilities, ADMH

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The Alabama Department of Mental Health(ADMH)- Making Employment Option #1

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  1. The Alabama Department of Mental Health(ADMH)-Making Employment Option #1 How ADMH is Transforming Itself and Working with Other Agencies to Make Employment a Reality for People with Disabilities By Courtney W. Tarver Associate Commissioner, Division of Developmental Disabilities, ADMH June 19, 2014

  2. Where We’ve Been

  3. Institutional Settings NASDDDSNational Association of State Directors of Developmental Disabilities Services

  4. Work Farms

  5. We’ve Come A Long Way

  6. DEINSTITUTIONALIZATION DMH Legal Mandates(Both State & Federal Law)

  7. Where We Are

  8. ADMH Services

  9. ADMH Services

  10. Dartmouth Behavioral Health Model • ADRS & DMH/MHSA Personnel Trained on Model • 2 Pilot Sites Identified for Implementing Model • Includes Employment Supports and Clinical/PeerSupports for Recovery for Individuals • Potential Expansion of Future Sites to Build on Success

  11. Map, DD Services

  12. DD Services Overview • I.D. Waiver—5,260 • Living at Home Waiver—569 • FY 2013 Between TCM, Waiver Svcs. & A Few State Dollars Only The Division Served with its Budget, 6,007 Individuals • Currently, 266 Children/Adolescents Are Enrolled • FY 2013 I&FS Councils Served 1001 with mini-grants

  13. Budget • $ 324 M • Of This • $ 109M= State Dollars

  14. Staff • Currently 113 • 24 In Central Office • Remainder in 5 Regions

  15. Regions & Providers • 133 Providers • Of these 26 also do case management • 3 others do case management only

  16. Community Group Living

  17. Roommates We May Want & Some We May Not

  18. How We Spend Our Days

  19. Day Habilitation Classrooms

  20. Sheltered Work Primarily & Pay At Lowest Levels

  21. Work Crews

  22. Where We’re Headed

  23. What We Have Done To Add Options • Sought & Received Stakeholder Input • Sought & Received Employment Technical Assistance • Added Flexibility in Choices By Adding Services to HCBS-Waivers that Support Work • Changed Per Diem Services that Lock Individuals Into One Place Only, to Adding Hourly or 15 Minute Units • Amended Program Regulations to Focus on the Individual & Family Choices • Coordinated with Other Agencies

  24. Stakeholder Input

  25. ADMH Service Divisions’Organization

  26. Advisory Organization of ADMH and Its Divisions

  27. DD Subcommittee Workgroups • Services (Including Assessments/Eligibility/Case Management, Rates) • Employment (Work/Day Related Services & Rates) • Individual and Family Advisory Workgroup (Legislative Advocacy/Community Awareness, Self-Directed Services, Transition to Work, Expansion to DD Services)

  28. Employment Technical Assistance • State Employment Leadership Network • Collaboration of NASDDDS & ICI • Office of Disability Employment Policy (ODEP/USDOL) • Employment First State Leadership Mentoring Program • Vision Quest • Impetus for DEI Grant

  29. SELN • Approximately 30-State Members • State Initiative for 10+ Years of NASDDDS & ICI • Focused on states use of DD Agency/Medicaid HCBS, • Vocational Rehab Agency Services • Employment First Approach • Data Driven on Wages, Services, Collaboration, Outcomes of Work for People With Disabilities • Webinars and On Site Stakeholder Input & Briefing • Just finished 1st Year

  30. ODEP/USDOL--Employment First State Leadership Mentoring Program • 40+States in Webinars on Employment Topics • State Interagency Team Required: • ADMH/DDD, ADMH/MHSA (Community & Facilities), ADRS/VR-Supported Employment, ADRS/Benefits Planning, ALSDE-WIA, ALDPE-WIA, AMA, AL DD Council, ADECA • Requesting in Expansion: Commerce, Labor, Senior Services, ALSDE-Special Ed. • Vision Quest: Focused Webinars on AL & 3 other States on Maximizing Medicaid For Employment + AL Focus • Disability Employment Initiative: $3 M Demonstration Grant

  31. Results

  32. New HCBS Waiver Services • Long Term Supports Before & After VR Services: • Hourly/Sub-hourly Services to Blend Community Integration, Day Hab. & Work • Self-Direction ++++++++++++++++++++++++++++++++++ • Benefits Planning (to be Developed with ADRS) • Job Development • Job Coaching • Personal Care at Worksite • Supported Employment Emergency Transportation

  33. New Integrated Day Services When Not Working • Community Specialist Services • Community Experience • Specialized Medical Equipment & Supplies • Personal Emergency Response System • Housing Coordination

  34. Existing Services Fostering Independence • Day Habilitation (various levels based upon need) • Prevocational Services • Small Group Employment • Specialized Medical Supplies • Environmental Accessibility Adaptations • Refocusing Case Management • Emphasis on Personal Outcomes for Individuals & Family In-Home Supports

  35. Concerns • Alabama Medicaid Managed Care Coming • Adequate Medical/Dental Care • New HCBS Regs. Requiring Integration/Independence-Changes on a Planned Schedule • Resulting Provider Agency Realignment to Meet Compliance

  36. Needs • Public & Stakeholder Understanding that Existing Resources are Still Present for Individuals & families Despite Changes • Advocacy for Additional Resources for People Waiting for ID Services • Advocacy for Additional Resources for People with other Developmental Disabilities, TBI, etc. • Maximizing Existing Resources & Blending Better

  37. Seven Medicaid Waiver Programs Plus • ID--ADMH • Living at Home--ADMH • E & D—Senior Services • HIV/AIDS—Senior Services • SAIL (Independent Living)—ADRS • Technology Assisted Waiver—ADRS • ACT (Community Transition)—ADRS • Coming: MFP/ACT II (Nursing Home to Home for PW/DD)--ADMH

  38. Other DMH Initiaitives with Partners (ADRS, ALSDE, ACDD, Local School Boards, ADRS/ADMH Providers: Arcs, UCPs, Easter Seals, VOA & Especially Employers) • Project SEARCH • Montgomery—Baptist South Hospital • Shelby County—Baptist Shelby Hospital • Mobile—Mobile Infirmary • Baldwin County—Thomas Hospital • Birmingham—Birmingham Southern College • Huntsville—Huntsville Hospital • Coming: Tuscaloosa—VA Hospital

  39. Gaining Access to Employment (GATE) Adult Transition from Sheltered Work to Integrated Employment Vocational Training in Employer Environment ADRS—Payment/Insurance/Milestones DMH—Long Term Follow-up Waiver Services Arc of Jackson County Job Development/Job Coaching Supportive Employer—Sanoh America Corporation 100% Employment Rate for Pilot Participants—5 at host; 1 at other chosen Employer

  40. DEI Grant • $3 M over 3 yrs. To ADECA as Grantee Agency w/renewal (?) • DMH=Project Lead • Pilot Sites in N. AL Employment Area w/Control Sites • Career Center Hosts (Jasper, Alabaster, Hanceville, Anniston, Gadsden, Talladega, & Opelika) • Trained by USDOL--Disability Resource Coordinators (DRCs) with Disability/Employment Backgrounds • Broker Employment and Disability Support Services to PW/Disabilities seeking work • State Interagency Team will look to expand & build on success

  41. New Resource Possibilities w/o New Taxes • Blending & Braiding Interagency Team $$ • Formalizing with Interagency MOA/MOU in Coming Months • Expand State Employment Network Revenue • Examining Past Lack of Success from Provider EN’s • DMH and/or Others where ADRS Leaves Off • Educating on Ticket To Work Program and other Benefits Planning Resources

  42. Summary: Transform our Medicaid Waiver Service Model & Weight Funding For What We Value • Individual & Family Driven Plans • Flexible Services to Support Them • Less Separate, Fixed Sites • More Supports (From Provider Staff and Use of Technology) to Promote Independence and Building Community Relationships with Neighbors, Friends, & Co-workers; Not Just Family, Staff & Others with Disabilities • Develop Expectations of Work and Owning/Renting Own Home Like Everyone Else with K-12 & Post-Secondary Job Training Emphasis • Fade Supports as Independence is Gained vs. Culture of Dependence

  43. WHY?--ADA Intent Was For All • The ADA was as much enacted to end discrimination against people with disabilities and support them with reasonable accommodations to be successful in life as it was to dispel stigma, and educate people without disabilities that all people have value, talent, uniqueness and that we all learn and thrive from having contact and relationships with each other; • Hence, mandating that we all interact and not be separated from each other.

  44. OLMSTEAD Rules: If an individual being served by the state desires to live, work, have a life in a more integrated setting, Treating professionals agree that the person should be able to do so, and With the state, considering the needs of all with disabilities, it won’t create a fundamental alteration of the state services system (significant economic hardship/redesign), then the individual must be served In the most integrated setting

  45. ENFORCEMENT is ACTIVE! Federal or National Directives that Support a National Employment First Strategic Policy Framework • CMS Informational Bulletin (September 2011) • Office on Special Education Programs July 2012 Letter reaffirming IDEA Provisions for LRE extend to Transition • National Council on Disabilities Report & Position Statement advocating for Repeal of FLSA Section 14(c) • NGA Chairman’s Disability Employment Initiative • Congressional action • Release of “Unfinished Business” Report (July 2012) • Senate HELP Committee Call to Governors • Introduction of Fair Wages for Workers with Disabilities (2011) BIPARTISAN/BICAMERAL AGREEMENT ON NEW WIA BILL (2014)!!!!

  46. Immediate Next Steps Submit ID Waiver Renewal to the Alabama Medicaid Agency (AMA) –Done 1st Week of June Put on DMH/DD Community Services Website for Public Comment—Done 1st Week of June Submit Draft HCBS Compliance Plan to Medicaid Make AMA Additions/Address Any Comments Submit to CMS Around July 1, 2014 Address Any CMS Concerns Train on & Implement Anticipated Renewed ID Waiver 1stQrtr. FY’15 Implement MFP w/AMA Draft & Implement ACT II DD/MI Waiver

  47. What All This Means • State and Local Collaboration Are Critical to Maximize Resources and Coordinate Planning/Seamless Transitions • Creative Thinking on Braiding/Repurposing Existing $$ to Maximize Resources Across Agencies • Transition Programs Expanded like Project Search (Already at 6 Alabama Programs with a Seventh being Developed) • Including People With Disabilities in all Programs for School Work Experiences As With Children Without Disabilities

  48. BOTTOM LINE:Creating/Fulfilling the Expectation That People with Disabilities Will Work and Live Like Everyone Else!! • IEP’s focused early on, on skills needed to learn and work, beyond school, just like all other children & youth. • Developing Work or Job-Training Focused Plans to Meet All Students’ Goals • Discontinue Practice of Only Thinking and Referring to Mental Health Agencies for “Residential Placement and/or Day Habilitation Programs • Focus on Molding Supports (Medicaid Waiver, VR, Special Ed/IDEA, State Funds) to Fit the Individual’s Goals, Not Fitting the Person into a Preset Program or Site • Take Services to Where Individuals Live or Will Work or Spend Their Days, BUILDING RELATIONSHIPS WITH PEOPLE OTHER THAN THOSE WITH DISABILITIES

  49. FRIENDS WORK PLAY

  50. Questions

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