GUIDELINES FOR RSB’s SUPPORTED EMPLOYMENT

SERVICE DELIVERY SYSTEM

Background:

The 1986 Amendments to the Rehabilitation Act authorized a formula grant for supported employment services programs. The intent was to assist States in developing and implementing collaborative programs with appropriate public agencies and private non-profit organizations for training leading to supported employment for individuals with the most severe disabilities.

The underlying philosophy of the supported employment program is that all individuals regardless of the severity of their disability are generally presumed to be capable of engaging in gainful employment and should be afforded the opportunity to engage in meaningful and remunerative work in a competitive employment setting where they have the opportunity to interact with individuals who are not disabled. This philosophy is based on the demonstrated ability of individuals with the most severe disabilities to achieve gainful employment in integrated settings if appropriate services and supports are provided.

The supported employment approach to VR service delivery was originally conceived to serve individuals who were mentally-retarded/developmentally delayed. It was quickly expanded to include individuals with chronic mental illness and from there expanded to be available to all individuals with the most severe functional limitations irrespective of the type of disability. Most recently, individuals with traumatic brain injury, attention deficit disorder, and attention deficit-hyperactivity disorder are increasingly choosing supported employment services as a means to become successfully employed.

The Rehabilitation Act Amendments require that all individuals regardless of the severity of their disability be provided a comprehensive assessment that must include consideration of supported employment as an appropriate rehabilitation objective. It is also required that all individuals regardless of the severity of their disability be provided vocational rehabilitation services, including supported employment services, unless there is clear and convincing evidence documented through an extended evaluation of rehabilitation potential that the individual cannot benefit from the provision of VR services, including supported employment services, in terms of an employment outcome.

A supported employment service delivery system involves highly structured job development and placement, individualized job site training after placement, and systematic methods for assuring job retention. Supported employment services are unique in the use of systematic job coaching services for long term assessment of

job performance, training, advocacy, job retention, and follow-up.

Traditional job placement approaches to competitive employment require that the individual be "job ready" before placement occurs. Train the individual in a training environment to a specific level of job skill mastery prior to the final placement. This is referred to as the train-place model of employment.

Supported employment takes the opposite approach and places the individual on the job site and then provides the training at the job site. This makes it possible for individuals who are more likely to become competitively employed by learning the necessary work and/or social skills at the actual job site to succeed. This approach is referred to as the place-train model of employment.

Consumer Centered Placement, On-The-Job-Training, Short-Term Community Employment Services, Supported Employment, and Sheltered Employment are placement strategies that differ in numerous ways. However, they do have in common the variables of the intensity of training needed to perform job tasks at the worksite and consumer ability or capability of working independently in a community based business. Careful consideration of a consumer’s strengths, resources, priorities, concerns, capabilities, interests, and informed choice obtained from the comprehensive diagnostic study will provide the information needed to make an appropriate best match between the consumer and the placement strategies that will most likely lead to successful employment. The following continuum of employment options/placement strategies along the variables of intensity of training needed and consumer ability to work independently in a community based business demonstrate the relationships of these employment options to each other.

CHART GOES HERE

Definitions:

Supported Employment

Competitive work in an integrated work setting with ongoing support services for individuals with the most significant disabilitiesB

a. For whom competitive employment has traditionally not occurred or has been interrupted or intermittent as a result of significant disabilities; and

b. Who, because of the nature and severity of their disabilities, need intensive supported employment services from the designated State Unit and extended services after transition in order to perform this work; or

c. Transitional employment for individuals with most significant disabilities due to mental illness.

Supported Employment Consumer

Is an individual

a. Who is eligible for vocational rehabilitation services;

AND

b. Who has been determined to be a person with the most severe disability(ies), and for whom competitive employment has not traditionally occurred or has been interrupted or intermittent as a result of the disability. RSB defines most severely disabled as an individual who has functional limitations to the extent that they have been unable to perform or maintain work or work related tasks with or without accommodations. For these consumers, traditional VR methods have been ineffective or are viewed as being ineffective to achieving competitive employment;

AND

c. Whose comprehensive assessment identifies supported employment as the appropriate rehabilitation objective, i.e. there is:

1) A need for intensive time-limited supported employment services as well as extended ongoing support services in order to perform competitive work;

AND

2) The ability and desire to work in a supported employment setting.

In considering whether supported employment is appropriate for a consumer there are a number of tools which can be used to provide information which can be used in making this decision. They include the following:

a. It may be particularly helpful to obtain the information requested on the Vocational Assessment Worksheet and screenings of functional vision and O & M skills.

b. Complete RT and OM evaluations would assist in determining skill levels and need for ongoing support to perform those activities of daily living and mobility essential to supported employment.

c. A psychological evaluation can provide information on personal/interpersonal skill levels, learning style, ability to generalize information learned in training to the job site, ability to retain learned material, and need for structure and/or supervision in order to function successfully.

d. Use of the D.O.T. to match consumer abilities and capabilities to potential job requirements and demands as well as assessing transferrable skills.

It order for the SESP to provide assessment information that will be helpful and which builds on evaluations previously completed, it is important that all diagnostic information on the consumer be provided to the SESP prior to initiation of a supported employment assessment.

Along with the diagnostic information, it is important that the counselor request that the SESP address specific questions regarding the consumer’s supported employment rehabilitation needs that have arisen during the counselor’s comprehensive assessment.

Competitive Employment

Employment in the competitive labor market that at the time of transition to extended services is performed weekly on a full-time or part-time basis in an integrated setting.

a. Hourly goals for employment are for the maximum number of hours possible based on the unique strengths, resources, interests, concerns, abilities, and capabilities of the individual and are included as part of the individualized written rehabilitation program.

b. Wage compensation must be in accordance with the Fair Labor Standards Act.

1) Wages must be paid on a basis consistent with those wages paid to workers who are non-disabled with similar job functions within the host business (prevailing wage).

2) Supported employment does not require the payment of minimum wage.

Integrated Work Setting

Job sites where either

a. Most employees are not disabled; and

b. An individual with a severe disability interacts on a regular basis in the performance of job duties, with employees who are not disabled; and

c. If an individual with a severe disability is part of a distinct work group of only individuals with disabilities, the work group consists of no more than eight individuals;

d. If there are no other employees or the only other employees are individuals who are part of a work group as described in item "c" above, an individual with a severe disability interacts on a regular basis, in the performance of job duties, with individuals who are not disabled including members of the general public.

NOTE: The interaction required in the definition of "integrated work setting" may not be satisfied by contact between an individual with a severe disability and individuals who provide on-going support services at the job site.

Supported Employment Models

There are numerous models of Supported Employment described in the literature. The various models can be divided into two major categories: Individual models and Group models.

The distinguishing characteristics of each are indicated in the chart on the following page. Given an individual’s strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice, an appropriate best match can often be made with one or a combination of the models in succession that will most likely lead to successful employment.

An example of how combining models could provide the services needed for a consumer to become employed when use of a single model might not, would be: when assessment data indicated and the supported employment team agreed that a group model of supported employment was required to achieve a successful employment outcome, but due to other vocational issues job coaching more intensive than what can be provided within the traditional group model’s work-crew supervisor/job coach was required, individual job coach services could be authorized. In this situation, the IWRP must specify that when the specific work and/or work related goals are achieved which allow the individual to successfully function under the reduced supervision of the group model supervisor, transition from the individual job coaching model to a lower cost group model will be made. At this point the IWRP would be amended to include work related goals that will provide the basis for determining when job stabilization has been achieved and the transition from time-limited to extended services should be made.

SUPPORTED EMPLOYMENT MODELS CHART GOES ON THIS PAGE - PAGE #7

Job Carving

The systematic process performed through a comprehensive job analysis of piecing components from one or more jobs at a workplace that when combined creates one new job position that a person with the most severe disability has the capability to perform. (See Vocational Evaluation and Placement Manual for further information on job analysis).

Job Coaching

May be provided by skilled job coaches, employment specialists as well as co-workers through natural supports.

Includes:

a. Ongoing assessment at the work site of the individual’s ability to successfully perform job tasks.

b. Job development and placement.

c. Job modification

d. The provision of intensive on-the-job training that is necessary to teach the consumer job skills/duties and job-related responsibilities.

e. Social and/or behavioral training.

f. Assistance in adjusting to the work environment.

g. The facilitation of natural supports at the worksite.

h. Training in use of transportation to/from the worksite with assistance from RSB Orientation and Mobility Specialist as appropriate.

i. Assistance in achieving family support.

j. Assistance with wage subsidies as requested by RSB counselor.

k. The provision of advocacy services for the consumer with employer, supervisor, and co-workers to assure integration of the consumer as an employee.

l. The provision during extended services, of services to include regular contact with employers regarding consumer performance and employer satisfaction, training on new job duties, and other responsibilities that assure job retention.

m. Other services needed for the individual to achieve and maintain job stability.

Natural Supports

The process of using existing community supports to enhance successful employment and integration into the employment site, and reduce the need for job coaching and other extended services.

a. Community supports include employer, residential, family, social, recreational, and transportation resources.

b. At the job site, emphasis is placed on teaching co-workers to provide the support needed by the consumer.

c. May include support from supervisors and coworkers, providing or facilitating such things as mentoring, friendships, socializing at breaks and/or after work, providing feedback on job performance, or learning a new skill together at the invitation of the supervisor or co-worker.

d. Used as appropriate as time-limited and/or extended services.

Are seen to greatly facilitate long-term job retention and to enhance the social integration between the individual, their coworkers and supervisor.

Ongoing Support Services

Means services that are:

a. Needed to support and maintain an individual with a most significant disability in supported employment;

b. Identified based on a determination by RSB of the individual’s needs as specified in an IPE; and

c. Either:

1) Time-Limited Services

Provided singly or in combination and are organized and made available in such a way to assist an eligible individual in entering or maintaining integrated, competitive employment;

a) On-going support services provided by RSB through a supported employment service provider, or as natural supports from the time of job placement until transition to extended services.

b) Provided for a period not to exceed 9 months, unless an exception is made by the RSB State Office.

c) Post-employment services following transition to extended services that are unavailable from an extended services provider and that are necessary to maintain the job placement. (e.g. job station redesign, repair and maintenance of assistive technology, and replacement of prosthetic and orthotic devices).

d) May be provided as natural supports.

2) Extended Services

a) Provided by one or more extended services providers such as a State agency, a private non-profit organization, or any other appropriate resource including natural supports, after an individual has made the transition from RSB financial support.

b) Provided throughout the individual’s term of employment in a particular job placement or multiple placements if those placements are being provided under a program of transitional employment.

Must include:

a. At a minimum, twice-monthly monitoring at the work site of each individual in supported employment to assess employment stability, unless the IWRP provides for off-site monitoring, and based upon that assessment, the coordination or provision of

specific services at or away from the work site, that are needed to maintain employment stability.

b. If off-site monitoring is determined to be appropriate, a minimum of two meetings with the individual and one contact with the employer each month.

Job Stabilization

A condition which is individually determined for each consumer and includes the following specific indicators:

a. Employer satisfaction

1) Productivity level is satisfactory.

2) Social and work behaviors are acceptable.

b. Integration has been achieved.

c. Training, adjustment, and fading activities of the job coach are completed.

d. IWRP objectives have been met.

In group models in particular it is recommended that specific work related objectives be identified and included in the IWRP to provide the basis for determining when job stabilization has been achieved and the transition from time-limited to extended services should be made.

e. The individual is suitably employed and satisfied.

Once job stabilization has been achieved, the case is put in "22" and consumer performance is monitored. If job stabilization is maintained for 60 days the case may be closed.

Wage Subsidy

When an employer pays a worker a greater amount than the person actually earns, due to the employer receiving another form of subsidy in the provision of job coaching to assure that the necessary work is complete. The difference in the amount paid to the employee and amount that the employee’s work is actually worth is the amount of the subsidy.

A job coach may assist an employer in determination of the actual value of the worker’s service and submit a statement which documents the actual value to SSA. The subsidized amount of wages paid can be excluded in determining whether SGA has been reached.

Transitional Employment

Employment in a series of temporary community based competitive jobs in integrated work settings for individuals with serious mental illness.

a. The typical transitional employment client may be employed part-time for different employers over the same amount of time that the typical supported employment client is employed during the time-

limited ongoing support phase of supported employment.

b. Multiple placements may also be provided after the individual has made the transition to extended services.

Includes on-the-job and around-the-job supports.

Designed to circumvent barriers that prevent psychiatric patients from working in commerce and industry. The primary purpose is to strengthen basic work habits, motivation, and attitudes necessary to all jobs. It is critical to coordinate transitional employment services with mental health experts.

Phases of transitional employment

a. Choosing phase

(1) Special emphasis is placed on the process of choosing the job.

(2) The assessment is critical in the choosing phase to gain consumer participation. It is recommended that assessment of the individual’s physical, intellectual and emotional capacities, their personal strengths across potential working, social, and living environments, as well as their style of learning be made.

b. Job getting phase

(1) Involves training in areas of resume' writing, interviewing skills, filling out applications, and addressing difficult questions.

c. Keeping phase

(1) Involves instructional activities focusing on the application of newly found skills and generalizing those skills to different settings and then maintaining those skills.

A transitional employment case may be moved from time-limited support services to extended services while the individual is in one of the temporary transitional job placement only if the service agency providing the extended on-going support will be providing the services required to obtain the final job placement and job permanency.

To be served under transition employment, the individual must have a medical diagnosis of mental illness from a qualified mental health professional.

IWRP for Goal of Supported Employment

Includes:

a. The supported employment services to be provided.

b. Specific work and/or work related objectives including anticipated number of hours of work per week which should be to be reached and which will provide the basis for determining when job stabilization has been achieved and the transition from time-limited to extended services should be made.

c. The expected extended services needed and that

1) Extended services will be provided at a minimum of twice a month at the worksite, or if off-site monitoring is deemed appropriate, that there be a minimum of two meetings with the individual and one contact with the employer each month; and

2) For transitional cases, extended services will include sequential job placement within similar job categories until job permanency is achieved.

d. Identification of the funding source for extended services, which may include natural supports.

e. To the extent that it is not possible to identify the source of extended services at the time the individualized written rehabilitation program is developed, a statement describing that basis for concluding that there is a reasonable expectation that such sources will become available.

Service Provision

The SESP will provide the following services:

a. Functional assessment;

b. Survey of businesses and assurance of potential community based assessment and work sites suited to the needs of consumers;

c. Analysis of all relevant job related variables, (i.e. transportation, job restructuring/carving, tax credit for employers, etc.);

d. Direct training at employment sites until employment standards have been achieved;

e. Advocacy services for the consumer with an employer, supervisor, co-workers to assure integration of the supported employee;

f. Decreased job coach assistance within the first 320 hours or three months;

g. Extended services at a minimum of twice a month at the worksite of each individual, OR, if off-site monitoring is determined to be appropriate, it must, at a minimum, consist of two meetings with the individual and one contact with the employer each month;

h. An internal advocacy system which provides all consumers with an opportunity to participate in identification and resolution of day to day needs that directly affect that consumer.

The SESP may agree to provide maintenance and/or transportation expenses in accordance with an authorization issued by RSB for these services while an individual is receiving assessment or training services.

The SESP may agree to provide Short-Term Community Employment Services.

The SESP assessment will:

a. Address those medical, psychological, social, and vocational aspects in the consumers background which effect the consumers ability to participate in a program of supported employment, and/or the type of job they could potentially perform, and identify the supports the individual needs. In addition, the assessment must address the following criteria necessary to determine a consumer’s appropriateness for supported employment services:

1) Job interests

2) Strength and endurance

3) Learning style and implications for job placement

4) Challenging behaviors

5) Mobility

6) Transportation needs

7) Residential setting and implications

8) Family/care giver support

9) Incentives (Need to work {availability of SS work incentives})

10) Disincentives (SSI, Medicaid etc.)

11) Functional application of academic skills (reading, handling of money, time telling, et cetera)

12) Expressive and receptive communication skills

13) Effects of medications on functioning

14) Relationship of the person’s skills to the local labor market

15) Need for assistive technology services/devices

16) Need for psycho-social support to promote integration and job retention

17) Availability of potential long-term extended services

b. Include work experience at a minimum of three community based work sites for a minimum of four hours at each site or the maximum number of sites or hours that the individual’s disability will permit.

c. Be completed within six weeks for all consumers.

The SESP assessment report shall:

a. State the dates of service.

b. Support a determination that the consumer has/does not have the ability or potential to engage in the evaluating SESP’s program leading to supported employment.

c. If the individual does have this ability/potential to enter supported employment, the suggested number of hours per week the individual might be expected to work should be included.

d. Include the name and description of the community work sites and the number of hours the individual worked at each site.

e. Include a natural supports implementation plan. (See

Appendix B).

f. Name the long term extended service funding source and the anticipated types of supports necessary.

g. Be submitted to the consumer’s VR counselor as soon as possible but no later than 30 days after completion of assessment.

An assessment staffing will be held upon completion of the supported employment assessment and will include the following individuals shall be conducted to review results and as appropriate develop the IWRP.

a. Consumer

b. VR Counselor

c. Parents or Guardian (as appropriate)

d. Supported Employment Service Provider Representative (must be one who is knowledgeable of consumer strengths, weaknesses, potential, etc.)

e. DMH Case Manager (as appropriate)

f. Individuals or representatives from community agencies working with the consumer (as appropriate)

g. Extended Service Provider Representative (as appropriate)

h. RSB job development specialist (as appropriate)

Job Development

a. Authorized after a supported employment assessment has been done, a report submitted, and the staffing completed with a determination that supported employment services appear appropriate.

b. RSB job development specialists will assist and be a resource to the counselor for the SESP supported employment placement in the same ways they are for traditional placement.

c. As deemed appropriate and as recommended by the counselor, RSB job development specialists will work with the SESP in their efforts to place the consumer.

d. The SESP will submit a monthly job development report to include:

1) The amount of time spent on job development.

2) The names of businesses contacted on behalf of the consumer.

3) How the business contacts were made, i.e. by phone, in person, with or without the consumer and whether the consumer was interviewed.

e. A final report of job development activities and a completed second half of the natural supports plan will be submitted with the final job development billing.

Job Coaching

a. Authorized when consumer obtains employment for 320 hours or three months whichever comes first.

b. SESP will submit a monthly report of consumer progress. (See Appendix C).

Upon completion of the initial job coaching authorization, consumer progress will be reviewed in a formal staffing.

a. The staffing should include:

1) Consumer

2) VR Counselor

3) Parents or Guardian (as appropriate)

4) Supported Employment Service Provider Staff

5) DMH case manager (as appropriate)

6) Individuals or representative from community agencies working with the consumer (as appropriate)

7) Extended Service Provider

8) Employer (If unavailable there should be documentation of his/her input including as applicable the reasons that additional services are necessary)

9) Job development specialist (as appropriate).

b. Factors to be reviewed:

1) Fading of job coaching, i.e. # of hours job coach has spent at the work site.

2) Production quantity and quality.

3) Number of hours worked per week.

4) Natural supports.

5) Employer satisfaction.

6) Appropriateness of job placement.

7) Date when consumer can be expected to move to extended services.

8) Continued availability of extended services provider.

c. This progress report shall:

1) State the dates of service.

2) Address the same factors as were addressed in the assessment staffing (see item "2)" above and any IWRP objectives not covered by these factors.

3) Be submitted to the consumer’s VR counselor within 30 days after completion of the three month authorization.

Continuation of services is authorized only when the staffing results and progress report:

a. Document that maximum efforts have been made to fade job coaching to the point the consumer could transition to extended services and the reasons the strategies used were not successful.

b. Substantiate that it is still anticipated the consumer can achieve job stabilization.

c. State the alternative strategies which will be used to reduce job coaching time and the amount of additional job coaching time needed for the consumer to be able to transition to extended services.

Consumer progress for job coaching services beyond the initial authorization will be reported monthly by the SESP and reviewed in a formal staffing in the end of the authorization in accordance with the same procedures specified for the end of the initial authorization.

Extended Services

Extended services support must be provided a minimum of twice a month at the worksite of each individual, OR if off-site monitoring is determined to be appropriate, it must, at a minimum, consist of two meetings with the individual and one contact with the employer each month. RSB cannot fund extended services.

Case Closure

Shall occur when:

a. The consumer after reaching job stabilization and making the transition to extended services has satisfactorily performed all job duties for a period of 60 days; and

b. There is a reasonable expectation that the consumer will continue to satisfactorily perform those job duties.

c. For transitional cases who have not achieved job permanency only:

1) Must have achieved the criteria in "a" and "b" above;

AND

2) There must be IWRP provisions for extended support services to include sequential job placement within similar job categories until job permanency is achieved.

Post-Employment Services

Provided when:

Needed services are unavailable from the extended services provider.

They are necessary to maintain the job placement.

Include services such as job station redesign, repair and maintenance of assistive technology, and replacement of prosthetic and orthotic devices.

Authorization for Service

Will state starting and ending dates for service provision.

Will state for each type of service the number of units to be provided by the SESP, the billable cost per unit, and the total billable cost of that service.

Payment by RSB

Cost of services provided by the SESP without authorization from RSB issued prior to or simultaneously with the initiation of those services is the responsibility of the SESP.

The SESP shall be paid only for those specific services for a specific consumer which have been authorized in writing by RSB.

RSB will not be responsible for any charges for services provided prior to the starting date or after the ending date shown on the official authorization.

RSB will not be responsible for any charges for units of service in excess of the number of units specified on the authorization even though provided prior to the ending date.

The SESP shall be paid only when a report of the services provided for the time period invoiced has been received by RSB.

Any third party funds which are not deducted by the SESP from the cost of services charged to RSB may be withheld and not paid from any payments due under the contract.

RSB is not required to make payment for services billed in invoices not submitted within the required time limits.

Any invoice lacking the required information as specified below will not be processed for payment until the required information is received.

Invoices

Must be submitted at the end of each month during which services were provided.

Must contain the following:

a. Name of the person receiving services.

b. Dates for which services are being invoiced.

c. Price per unit invoiced for each type of service as designated on the authorization.

d. Total number supported employment units being invoiced specified for each type of service as designated on the authorization.

e. Total number of maintenance units paid and cost per unit;

f. Total number of transportation units paid and cost per unit;

e. Gross total cost of services invoiced;

f. Amount, if any, of third-party collections; and

g. Net cost invoiced.

Must be submitted with:

a. Consumer progress report for the same period of time for which the invoice is written.

b. Consumer attendance report for the same period of time for which the invoice is written. This report must indicate whether absence was consumer choice or SESP decision.

Must have consumer’s signature on invoices which include maintenance and/or transportation costs. If the SESP is unable to obtain the consumer’s signature, this must be indicated on the invoice.

Supplemental or Corrected Invoices

a. Payment will be made for supplemental or corrected invoices only if such invoices are received by RSB within 60 calendar days of the end of the billing period in which services were provided.

b. EXCEPTION: All invoices for services rendered during the contract year must be received within 30 calendar days after the June 30th expiration date of the contract.

Consumer Termination/Cancellation

The SESP may terminate or cancel a consumer’s supported employment services prior to completion if further services are deemed by the SESP to be inappropriate or non-beneficial to the consumer.

a. The SESP must notify the consumer’s VR counselor by telephone immediately upon making such a decision.

b. Written notice must be given to the consumer’s VR counselor no more than 3 working days after the decision is made.

RSB may cancel or terminate a consumer’s supported employment services at its own discretion.

a. RSB shall notify the SESP immediately upon making such decision.

b. Unless such action by the RSB is to protect the health and safety of the consumer or other consumers, RSB must give written notice of its intent to cancel or terminate a consumer’s supported employment or evaluation at least three (3) working days in advance of the effective date of its decision.

c. If the consumer is present in the facility during the 3 days prior to the effective date of the notice, the SESP is entitled to payment for those days.

SHORT-TERM COMMUNITY EMPLOYMENT SERVICES

Is time limited, community based, vocational training in which the consumer is placed on an actual job site in an individual setting with the services of a job coach.

Services of the job coach are the same as those which may be provided for an individual in supported employment during the time-limited phase of on-going support except job development and placement (see definition of job coach).

Individuals for whom Short-Term Community Employment Services may be appropriate are distinguished from those whom would receive supported employment services in that although they need the intensive job coaching services in order to get to the point where they can perform competitive work, they do not require on-going extended services, in order to maintain their employment. Once job coaching services are completed, the individual is able to successfully perform their job duties with just the supervision provided by

the employer. The individual is placed, trained, and remains employed on the same job.

An IWRP for Short-Term Community Employment Services needs to include the specific objectives the job coach is to target in working with the consumer and would emphasize job related work skills.