Everyone Works!

Outline of Presentation

• Introduction of Panel• Aging and Disability Resources (ADRC)• Children’s Long Term Support (CLTS)• Managed Care/Family Care (MCO)• IRIS (Include Respect I Self-Direct)• Employment Data• Questions• Contact Information• Resources

Aging and Disability Resources

Neal Minogue

By 2013 every county in Wisconsin will

have an ADRC.

The Office for Resource Center Development is housed within the State of Wisconsin’s Department of Health Services, Division of Long Term Care/ Bureau for Aging And Disability Resources.

The Office for Resource Center Development supports ADRC staffs throughout our state.

Office of Resource Center Development

In 2010 ADRCs had 300,000 contacts with customers throughout the year and we expect that number to reach 500,000 by the end of 2013.

We expect to have 70 counties and 9 tribes operating ADRCs by the end of this year. (Oneida & Menominee Tribal start dates are unknown at present) The ADRC of Dane County is expected to open before the end of this year. (Both Door and Rock counties are expected to open ADRCs in 2013).

There are currently more than 600 Information and Assistance staff employed by ADRCs both full and part-time and more than 70 Disability Benefit Specialists. 

ADRC Statistics

 

Each ADRC has an assigned Disability Benefit Specialists (DBS). DBS are able to give basic information about work incentive benefits to ADRC customers. In addition DBS will as needed connect people to local Work Incentive Benefits Counselors and to DVR for the funding of the counseling service. Examples of providers benefits counseling: Riverfront, ERI, and Independence First. DBS and ADRC Information and assistance staff will help people work through the process of applying and if found eligible enrollment into the LTC program of their choice. One of the benefits of LTC is employment services and support. I addition DBS are tasked helping people apply for Social Security.

Disability Benefits Specialists

If you are interesting in finding an ADRC in Wisconsin please look at or office website:

http://www.dhs.wisconsin.gov/ltcare/adrc/

Or simply type in “ADRC Wisconsin” in your favorite web search engine

ARDC Resources

Children’s Long-Term Support (CLTS) Waivers Overview

Jessica Thompson

Quick CLTS Waivers Overview

Eligibility

Eligible for Special Education

Eligible for CLTS Waivers

Role in TransitionCounty CLTS Waivers “Support and Service Coordinators” can:

•Facilitate conversations with youth and families • Explore hopes and dreams for adult life

•Encourage youth to practice self-determination by participating in their ISP development

•Connect families with information and resources

•Communicate across systems

•Explore services to help youth develop and practice skills that are valuable as employees and adults

• Daily Living Skills Training, Mentoring, Supported Employment…

Eligibility for Adult Long-Term Care• Children enrolled in CLTS Waivers may not be eligible for

Adult Long-Term Care Waivers

• Especially youth who qualify for CLTS Waivers with an “SED Level of Care”• Youth with mental health disorders (EBD students) but no other

developmental or physical disabilitiesBUT

Aging and Disability Resource Centers (ADRCs) can still provide valuable information for these youth

AND• Community mental health programs are available in each

county

Managed Care/Family CareIntegrated Employment

Tammy Hofmeister

Types of Supported Employment

•Integrated Employment

•Group Supported Employment

Integrated

Employment•Working for competitive wage•Working in the community•No more than two individuals placed and supported to work together

• Includes working from home• Includes self-employment

Group Supported Employment•Working for competitive wage•Working in the community•Three or more individuals supported and working together which is considered a work crew or enclave

Vocational Futures Planning Services (VFPS)

• (VFPS) is a person-centered, team based comprehensive employment planning and support service that

provides assistance for waiver program participants to obtain,

maintain or advance in employment or self-employment.

Service Strategies VFPS

1) Development of an employment plan based on an individualized determination of strengths, needs and interests of the individual with a disability, the barriers to work, including an assistive technology prescreen or in-depth assessment, and identification of the assets a member brings to employment;2) benefits analysis and support;3) resource team coordination;4) career exploration and employment goal validation;5) job seeking support; and,6) job follow-up and long-term support

Prevocational Services• Prevocational services involve the provision of learning and

work experiences where a member can develop general, non-job-task-specific strengths and skills that contribute to employability in paid employment in integrated, community settings.

• Services are expected to occur over a defined period of time as determined by the member and his/her care planning team in the ongoing member-centered planning process.

• Services are expected to specifically involve strategies that enhance a participant's employability in integrated, community settings.

• Competitive employment or supported employment are considered successful outcomes of prevocational services.

Intent of Prevocational Services

• Prevocational Services are intended to lead to participation in integrated employment

• The integrated employment does not have to be fulltime

• A member is not required to leave prevocational services completely

• Prevocational services, if authorized, are intended to help Family Care members make reasonable and continued progress toward voluntary participation in at least part-time integrated employment

Intent of Prevocational Services cont.

• Voluntary participation• Good faith effort over sufficient period of

time by IDT and prevocational provider is expected

• Good faith effort includes identifying and addressing any concerns the member or guardian may have about the member participating in integrated employment

New entrant to Prevocational Services

• All members enrolled as of September 1, 2010 who did not participate in prevocational services prior to that date.

• Any member who enrolls after September 1, 2010 and did not participate in prevocational services funded by the CIP waiver, the IRIS waiver or a county human service agency prior to that date.

New Entrant Guidelines

• Prevocational services in any setting can be authorized if the purpose is to:

(1) Help the member achieve an integrated employment outcome identified in the member’s plan;

(2) Provide additional “wrap-around” supports to a member who is participating in part-time integrated employment;

(3) Provide a temporary safety net to a member who may lose an integrated job at some point and may need time to find a new integrated job.

Family Care Employment

Resourceshttp://www.dhs.wisconsin.gov/ltcare/programops/prevoc/index.htm

IRISParticipant Employment

John O’Keefe

IRIS Basics• Serves as CMS required choice to Family Care

• Participant self directs their IRIS plan• Individual Budget based on acuity & cost neutral to FC

• IRIS Consultant for each participant• IRIS Financial Services Agency pays invoices & worker wages• 80% of participants hire their own workers

IRIS Choosers• 7,048 participants exceeds original

estimates (10/31/12) • 44% Developmental Disability• 40% Physical Disability• 16% Frail Elders 

Younger people choose IRIS• Age 18-22 = 17%• Age 23-29 = 13% 

Family Care transfers = 18%

IRIS Employment Data (4/2012)

• IRIS Participant Employment (April, 2012 data)

• Integrated Employment (103)• 11 hrs/week $7.51/hr• Work Crew/Enclave (21)

• 9 hrs/week $3.87/hr• Facility Based Employment (149)

• 13 hrs/week $2.09/hrWe can and must do much better!

Employment Services in IRIS

• Supported Employment • Vocational Futures Planning Services

• Prevocational Services• Customized Goods & Services

Customized Goods and Services• IRIS Service Category definition approved by Federal Government:• Help achieve outcome related to living arrangement OR

relationship OR community inclusion OR work, OR medical or functional status.

• Listed on plan, allowable per Fed/State rule, no other fund obligation, not experimental

• AND also either • Safety in home or community maintained or increased ;OR• Reduce Medicaid service dependence or prevents increase,

OR• Skill improves or loss prevented, OR• Community access or involvement increased or

maintained.

Examples• Andrew

• Small business related to anything worms• Mother recruits, trains & supports 1:1 job

coaches  • Martha

• IRIS Self Directed Personal Care• Hired Personal Care worker while at work

 • Alexis

• AJ Special Services • Video Support costs $5/hour

IRIS Resources

http://www.dhs.wisconsin.gov/bdds/IRIS/index.htm

1-866-515-4747

Employment Outcomes Data and Services in Adult Long Term Care

Programs

Ellie Hartman

Wisconsin: Developmental DisabilitiesWorking Age (18 to 64)Integrated Employment Rates

• Adult Long Term Care Functional Screen Federal Fiscal Year (FFY) 2011• Dane County Supported Employment Summary (March 2011)

Individuals with Developmental Disabilities (18 to 64) and Enrolled in Long Term Services based on Most Recent Functional Screen Distinct Count Percent

Any Employment 8948 51%

Community Employment 2431 14%

Home Employment 75 <1%

Work Center Employment 5378 31%

Group Employment 1955 11%

Total Individuals with Functional Screen 17,469 100% 35

Wisconsin: Physical Disabilities Working Age (18 to 64)Integrated Employment Rates

• Adult Long Term Care Functional Screen

Count of Individuals with Physical Disabilities (18 to 64 and no co-occurring DD, MI, or TBI) and Enrolled in Long Term Services based on Most Recent Functional Screen (FFY2011) Distinct Count PercentAny Employment 463 6%Community Employment 165 2%Home Employment 109 1%Work Center Employment 101 1%Group Employment 103 1%

Total Individuals with Functional Screen 7813 100%36

Employment Status of Transition Age Youth (18 to 24)

• Number of individuals in a mental health programs with their employment status reported on the Mental Health Status Report and number of these individuals with integrated employment (competitive, supported, and temporary employment)

• Number of individuals with an adult long term care functional screen and number of these individuals with integrated employment (employed in community or home)

• Total (any disability)

• Developmental disabilities (DD)

• Physical Disabilities (PD)

• Co-occurring Mental Health (MH) Disability

37

DEVELOPMENTAL DISABILITIES (18 TO 64):LONG TERM CARE FUNDED EMPLOYMENT SERVICES

• Source Long Term Care Encounter Reporting (FFY2011), HSRS (FFY 2011), and Dane County Supported Employment Report (March 2011)

Individuals with Developmental Disabilities and Long Term Services (18 to 64) Count PercentPre-Vocational Services 6013 31%Supported Employment Services 3061 16%Total with Long Term Care Services 19,182 100%

38

PHYSICAL DISABILITIES (18 TO 64): LONG TERM CARE FUNDED EMPLOYMENT SERVICES

• Source Long Term Care Encounter Reporting and HSRS (FFY 2011)

Employment Assistance Description as Reported on the Functional Screen for Individuals with Physical Disabilities (no DD, MI, or TBI and 18 to 64) Count Percent

Pre-Vocational Services 122 1%

Supported Employment Services 29 <1%

Vocational Futures Planning and Support (VFPS) Services 11 <1%

Total with Long Term Care Services 8420 100%

39

Employment Services of Transition Age Youth (18 to 24)

• Different reporting systems (Encounter and Human Services and Reporting System aka HSRS) track the different services people receive through these long term care and mental health service systems, including pre-vocational and supported employment services.

• The number of transition aged youth (18 to 24) receiving any services and employment specific services through these programs in state fiscal year 2011 are reported in the following graph.

40

PRELIMINARY PPS EMPLOYMENT OUTCOMES DATA FOR THOSE EMPLOYED (18 TO 64)

• First Time Data Collected• Family Care Members and IRIS Participants• Employed according to most recent Adult Long Term Care

Functional Screen• Employment Outcomes for April 2012• 95% Response Rate • 6,602 reported whether or not individual had integrated

employment goal• 3,001 (45%) “yes” • 2,235 (34%) “no”• 1,366 (21%) “unknown”

• 5,879 of 6,572 (89%) Worked for at least one paid hour in April 2012

• Some were paid for activities they completed during day or residential services. (These individuals will not be included next reporting month.)

41

PRELIMINARY PPS EMPLOYMENT OUTCOMES DATA FOR EMPLOYED LONG TERM CARE PARTICIPANTS (18 TO 64)1,510 (26%) Worked in Integrated Employment

Average 43 Hours in April 2012Average Earnings of $351.48Average Hourly Wage of $8.01

277 (5%) Worked in Work Crew/Enclave EmploymentAverage 40 Hours in April 2012Average Earnings of $252.93Average Hourly Wage of $6.39

4,542 (77%) Worked in Facility Based EmploymentAverage 67 Hours in April 2012Average Earnings of $149.55Average Hourly Wage of $2.33 42

A Summary of the Vocational Service Costs in Wisconsin’s Medicaid Funded Long-TermCare System for Individuals with Developmental Disabilities (Robert Cimera, Ph.D.)• http://www.dhs.wisconsin.gov/WIpathways/pdf/

ASummaryVocationalServiceCostsWisconsin.pdf

43

An Evaluation of the Costs and Outcomes Obtained by Agency and Individual-Provided Follow Along Services (Robert Cimera, Ph.D.)• This study investigated outcomes achieved by two different methods of

providing follow along services to supported employees: • (a) services provided by 31 agency-based personnel and • (b) services provided by 19 individual-provided service providers (not

affiliated with adult service agencies) • Comparable demographics across six variables.

• Individual-provided supported employees were more than twice as likely to have autism and multiple disabilities than agency-provided supported employees (26.3% versus 13.0% and 31.6% versus 14.4%, respectively).

• Agency-provided supported employees were more likely to have offensive and self-injurious behaviors (32.2% and 18.3%) than individual-provided supported employees (26.3% and 10.5%).

44

Work Incentive Benefits Counseling (WIBC)• http://www.percthinkwork.org/resources/item/

workincentivesoverview

45

Questions???

Contact InformationSarah Lincoln – General ContactDHS/DLTC/BADR/OIESarah.Lincoln@wisconsin.gov608-266-7974

Jessica Thompson – Children’s Long Term SupportDHS/DLTC/BLTS/CSSJessicaL.Thompson@wisconsin.gov 608 267-3377

Tammy Hofmeister – Managed Care OrganizationsDHS/DLTC/OFCETammy.Hofmeister@wisconsin.gov 608 266-7251

47

Contact Information Cont. John O’Keefe– IRISDHS/DLTC/BLTSJohn.OKeefe@wisconsin.gov 608 261-6749

Neal Minogue– Aging and Disability Resource CentersDHS/DLTC/BADRNeal.Minogue@wisconsin.gov 608 266-2036

Ellie Hartman– Employment Data ResearchDHS/DLTC/BADR/OIEEllie.hartman@wisconsin.gov 608 266-2756