Employment First Developments In Alabama

1. Employment First Developments In Alabama What’s Being Done and Next Steps By Members of Alabama’s E-1st Team Courtney Tarver Tina Dortch Byron White

2. What is Employment First? Employment First • Employment First is a concept to facilitate the full inclusion of people with the most significant disabilities in the workplace and community. Under the Employment First approach, community-based, integrated employment is the first option for employment services for youth and adults with significant disabilities. Employment First?

3. What Employment First Is Not • Closing Down Day Programs and Sending People Home with No Supports or Services • Setting People up for Failure or Exploitation • Taking Away Choice • A Guarantee that Everyone becomes Employed in the Community. What Employment First Is Not

4. History Demonstrates that Sheltered Work Almost Never Leads to Competitive Employment. • Studies have consistently shown that segregated environments do not prepare people to live, work, or participate in integrated environments. • Only 3.5% of people in sheltered workshops move into competitive employment in a given year www.accessiblesociety.org What History Tells Us

5. Why Become an Employment First State? I. Today, Americans with disabilities are facing disproportionately high rates of unemployment compared to Americans without disabilities. As America confronts broader challenges around developing our workforce and creating jobs, it is important to keep in mind that not everyone is affected equally. Individuals with disabilities should have, to the maximum extent possible, the same opportunities as all others do: to live close to family and friends; to live independently and in safe communities; to engage in productive employment; and to participate in community life. --Intro to 2012-13 NGA (National Governors Association) Chair Gov. Jack Markell's Initiative It’s The Right Thing To Do!

6. Why Become an Employment First State? • II. The Rehabilitation Act and the American’s With Disabilities Act presume that everyone with a Disability, with the right supports, can work, and should not be discriminated against or segregated from people without disabilities. • The ADA requires that people live, work, recreate, etc. in “the most integrated setting”. It’s the Law.

7. Why Become an Employment First State? • Federal funding to support segregated settings is ending. A. CMS has already stated its funds for sheltered workshops are ending. In Alabama, that means 2/3 of the gov’t. dollars funding them will be eliminated. B. Proposals in Congress are to discontinue sub- minimum wage for people with disabilities. C. Enforcement of existing sub-minimum wage rules is increasing unlike previous years. The U.S. is Ending Funding for Sheltered Workshops.

8. Why Become an Employment First State? • Washington 72% • Alabama 5% In a new report, supported by the Federal Administration on Developmental Disabilities, and written by the University Center for Excellence in Developmental Disabilities (UCEDD) in Massachusetts, Alabama has only 5% of persons with developmental and intellectual disabilities in integrated employment. Alabama is Worst State on I/DD Employment

9. What Happens If We Change to Make The Most Integrated Living and Working the Priority? Results of Shifting to Integration

10. Re-evaluating current services – How many could we serve? Data Source: Lakin, K.C. MSIS and NCI data from 4 states (1,240 Individuals) NASDDDSNational Association of State Directors of Developmental Disabilities Services

11. Thinking for the Long Term NASDDDSNational Association of State Directors of Developmental Disabilities Services

12. Thinking for the Long Term Estimated figures – use your own figures and do the math NASDDDSNational Association of State Directors of Developmental Disabilities Services

13. So Where Are We Now In Alabama? Alabama’s Status

14. People in Day Habilitation and its Costs • 4,499 • Average Annual Cost $10,882.27 • Range of Day Hab Rates: $38.27 - $95.47 • Range of Annual Cost/Client for Day Services for 2013: $9,452 to $23,581 Day Hab in Alabama

15. Number Preparing for Work in Pre-Vocational Services • 82 Recipients • Pre-Voc Rate: $53.87 • Annual Cost/Client in Total Dollars for PreVoc: $9,238.65 • We are learning that this service can be invaluable when appropriately utilized in helping an individual “prepare” for a competitive job Pre Voc in Alabama

16. Number of People in Small Group Work or Supported Employment • 219 Recipients*** • Per Diem for Supported Employment: $69.47 • Average Annual Cost in Total Dollars: $11,223.86 *** Not Sure if Numbers are accurate due to coding and billing errors Supported Employment in Alabama

17. NO ONE is Billing Waiver Services for Job Coaching or Job Development • 0 • $0.00 Job Coaching & Job Development in Alabama

18. What Other States Are Doing On Employment • 35+ states have some type of “Employment First” movement; variable impacts • About 2/3 of efforts are directed by state policy units or are legislatively based • About 1/3 of efforts are grassroots based – i.e., outsiders working to influence state policy and practice • 24 states have official Employment First legislation and/or polices

19. So…What Are We Doing in Alabama About Changing to Emphasize Employment?!?! Inter-agency Planning For Jobs

20. Making EF Official in Alabama • Initial Statute Introduced in 2013 • Favorable Review • Session Ended without Passage • State Employment Leadership Network (SELN) Member to develop strategic plan for increased employment outcomes. (While no specific # is indicated, goad is to move one person at a time until at least the national average is achieved • Employment First State Leadership Mentoring Program Member (ODEP) • DMH-DD • DMH-MH/SA • ADRS-VR • Medicaid • ADECA-WIA • SDE-K-12 • DPE • others likely to be added ADMH--- Vision & Direction

21. Elimination of Medicaid Funding for Sheltered Employment • Tentative Date: October 1, 2015 • Pre-Voc services better utilized to create a pathway for employment. Along this pathway, individuals receive informed choice about work and life in their communities (Determination to be made regarding time limits for pre voc service) • Families are educated and supported on employment • Housing is also on the radar screen where more individuals receive support in their own homes Changes & Pre Voc

22. Individuals are referred to VR when appropriate • Once individuals express interest in work and are also “ready” to move into competitive employment, referral made to the VR. VR

23. Partnering with ADRS • Vocational Rehabilitation • Supported Employment • Competitive work in an integrated setting with ongoing support services for an individual with a most significant disability • Competitive work has not traditionally occurred or has been interrupted or intermittent as a result of their disability • Need intensive support services and extended services ADRS

24. Milestones • ADRS payment system for supported employment that is outcome based! • Milestones I • Milestones II • Milestones III • Milestones IV Milestones

25. Better Utilization of Waiver Funding to Support Work • Supported Employment Per Diem (Small Group Placements) • Supported Employment Individual • Job Coaching • Job Development • Personal Care at the Worksite Waiver Services

26. Utilization of Partial Days • Day Hab • Pre Voc Waiver Changes

27. Continue to work with stakeholders, self-advocates and family members, policymakers to build a system that works for everyone • Service Providers • Individuals • Families • State Agency Personnel • Others DMH Workgroup

28. Day Habilitation Level 1:  Day support is intended to serve people that want and need to maintain skill level, socialize with friends, are “retired” and no longer interested in work, decide that work is not a current objective.     • Day Habilitation Level 2:  Day support is intended to serve people that want and are able to work through job readiness skill development, pre-vocational type training, volunteering in the community to build job skills and network, conduct mock interviews, resume development, and community experience.  The outcome of this day support will be a developed path for employment and VR referral. • Day Habilitation Level 3 (Partial):  Day support is intended to augment a person’s competitive and integrated work schedule.  A person can access this service only if he/she is working in an integrated site and receiving competitive pay.  • Add On:  Add on dollars will be determined by an assessed need.  If a person has documented need for additional support due to either medical or behavioral concerns then additional dollars will be added to the current rate. Workgroup Agenda

29. Employment (Supports)  Level 1:  Employment support intended for work crews or enclaves (Small Work Groups) in integrated worksites making competitive wages.  This service should lead to the development of a path for employment and is time limited with the desired outcome of individual employment.  • Employment (Supports) Level 2:  Employment support is intended to be used for job development (Job Developer), as well as support achieving self-employment through the operation of a business.  This includes aiding an individual in identifying business opportunities, assisting in the development of a business plan, identifying necessary supports, and on-going assistance.  This service can overlap traditional day habilitation service but the person must have been referred to VR first.  Additionally, this service is intended to be time limited.    • Employment (Supports) Level 3:  Employment support is intended to be used for job coaching (SE Individual) which requires mostly face to face time with an individual assisting.  Other components of this service include participating in team meetings, tracking employment data, coordinating transportation, and progress notes.  This service is intended to fade and therefore is time limited.  • Employment (Supports) Level 4:  Employment support is intended for follow-up with individuals that are employed and may need support but not as intensive as Level 3.  This support can also include personal assistance to the person on-site if that meets the person’s need and is desired over personal care on worksite waiver service.  Travel is included in this rate and time spent traveling to sites, communicating via telephone or emails, and time follow-up is a billable component of this service. Employment Supports

30. Get on Board • Non Negotiable • CMS Says so • DOJ • Multiple Suits and settlements pending • Nationally People Need to be Part of Their Community Bus is Leaving

31. Project SEARCH • Mobile • Baldwin County • Montgomery • Shelby County • Birmingham • Huntsville • Alabama State Team Members • ACDD • ADMH • ADRS • SDE Partners: Local School System Provider Agency Business Other DMH Initiatives

32. Customized Employment • Taking Supported Employment to Another Level • The Customized approach is a flexible process designed to personalize the employment relationship between a job candidate and an employer in a way that meets the needs of both. It is based on an individualized match between the strengths, conditions, and interests of a job candidate and the identified business needs of an employer. Customized Employment utilizes an individualized approach to employment planning and job development — one person at a time . . . one employer at a time. Positive Outcomes

33. The Success Stories • Brian • Quinten • Mattie • Kerry • Chris The Success

34. Improvements • Making More Flexible Waiver Service Definitions • Adjusting Rates to Provide Correct Priorities and Incentives, Outcome Driven • Coordinating Plans & Operations to Braid Dollars & Services with All Relevant Agencies & Partners • Others Coordinating and Making Flexible, Services and Dollars

35. http://www.dol.gov/odep/ietoolkit/index_video.htm

36. Panel Questions Questions?

37. Contacts: • Tina.Dortch@rehab.alabama.gov • Byron.White@mh.alabama.gov • Courtney.Tarver@mh.alabama.gov • WWW.APSE.ORG • WWW.THEARC.ORG (Employment) • WWW.DOL.GOV/ODEP Contacts