Employment First Developments In Alabama

What’s Being Done and Next StepsBy Members of Alabama’s E-1st Team

Courtney TarverTina Dortch

Byron White

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Employment First?

What is Employment First?

Employment FirstEmployment 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.

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What Employment First Is Not

What Employment First Is Not

Closing Down Day Programs and Sending People Home with No Supports or Services

Setting People up for Failure or ExploitationTaking Away ChoiceA Guarantee that Everyone becomes

Employed in the Community.

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What History Tells Us

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

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It’s The Right Thing To Do!

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

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It’s the Law.

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”.

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The U.S. is Ending Funding for Sheltered Workshops.

Why Become an Employment First State?

III. 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.

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Alabama is Worst State on I/DD Employment

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.

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Results of Shifting to Integration

What Happens If We Change to Make The Most Integrated Living and Working the Priority?

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Re-evaluating current services – How many could we serve?

Type of Service

Cost per Person

Cost to Serve the Waiting

List 122,870

People Served

with $5 M

ICF/MR $128,275 $15,761,114,925 39

Non-familyHCBS $70,133 $8,617,24

1,710 71

Host Family $44,122 $5,421,270,140 113

Own Family $25,072 $3,080,596,640 200

Data Source: Lakin, K.C. MSIS and NCI data from 4 states (1,240 Individuals)

NASDDDSNational Association of State Directors of Developmental Disabilities Services

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Thinking for the Long Term

Type of Service Cost per Person

20 yrs.Cost

30 yrs.Cost

ICF/MRInstitution

$128,275 $2,565,600 #3,848,250

HCBS24hr staffedResidential

$70,133 $1,402,660 $2,103,990

Shared Living (Adult Foster Care)

$44,122 $882,440 $1,323,660

Supports in Own or Family

Home$25,072 $502,440 $752,160

NASDDDSNational Association of State Directors of Developmental Disabilities Services

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Thinking for the Long Term

Type of Service

1 yr.Cost

3 yrs.Cost

10 yrs.Cost Experience

Sheltered Work /Day Habilitatio

n

$15,000 $45,000 $150,000

No moneySegregationDependence

Employment Services

$20,000

$50,000($20,000 yr. 1$20,000 yr. 2$10,000 yr. 3)

$75,000($50,000 1-3 yrs.$25,000 3-10 yrs.)

Makes moneyPays Taxes

Meets PeopleSense of

Independence and Accomplishment

NASDDDSNational Association of State Directors of Developmental Disabilities Services

Estimated figures – use your own figures and do the math12

Alabama’s Status

So Where Are We Now In Alabama?

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Day Hab in Alabama

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

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Pre Voc in Alabama

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

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Supported Employment in Alabama

Number of People in Small Group Work or Supported Employment

219 Recipients***

Per Diem for Supported Employment: $69.47Average Annual Cost in Total Dollars:

$11,223.86

*** Not Sure if Numbers are accurate due to coding and billing errors

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Job Coaching & Job Development in Alabama

NO ONE is Billing Waiver Services for Job Coaching or Job Development

0$0.00

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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

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Inter-agency Planning For Jobs

So…What Are We Doing in Alabama About Changing to Emphasize Employment?!?!

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ADMH--- Vision & Direction

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

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Changes & Pre Voc

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

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VR

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.

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ADRS

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

Milestones

Milestones ADRS payment system for supported employment

that is outcome based!

Milestones I Milestones II Milestones III Milestones IV

Waiver Services

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

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Waiver Changes

Utilization of Partial Days◦Day Hab◦Pre Voc

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DMH Workgroup

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

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Workgroup Agenda

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.

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Employment Supports

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.

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Bus is Leaving

Get on BoardNon Negotiable

CMS Says soDOJ

Multiple Suits and settlements pending

Nationally People Need to be Part of Their Community

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Other DMH Initiatives

Project SEARCH Mobile Baldwin County Montgomery Shelby County Birmingham Huntsville

◦ Alabama State Team Members ACDD ADMH ADRS SDE

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Partners:Local School SystemProvider AgencyBusiness

Positive Outcomes

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.

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The Success

The Success Stories◦Brian◦Quinten◦Mattie◦Kerry◦Chris

Coordinating and Making Flexible, Services and Dollars

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

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

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Questions?

Panel Questions

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Contacts

Contacts:

Tina.Dortch@rehab.alabama.govByron.White@mh.alabama.govCourtney.Tarver@mh.alabama.gov

WWW.APSE.ORGWWW.THEARC.ORG (Employment)WWW.DOL.GOV/ODEP

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