The Office of Disability Employment Policy

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The Office of Disability Employment Policy Powered By Docstoc
					   The Employment First State
   Leadership Mentor Program
            Serena Lowe, Senior Policy Advisor
       Office of Disability Employment Policy
              U.S. Department of Labor
202-693-7928 (Office) Lowe.Serena.D@dol.gov
Thus Far, We Have Made the Shift
From This……




                                               To……..               2




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           A Catalyst for Change, Transforming the American Workforce
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    A Catalyst for Change, Transforming the American Workforce
Community Supports Enable Individuals
to….


                               Live in their own home and enjoy
                               the support of family and friends

                               Get a job

                               Enjoy good health

                               Be part of and contribute to their
                               community

                               Achieve their personal potential for
                               independence and self sufficiency



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           A Catalyst for Change, Transforming the American Workforce
Where have we Come? Where are we Going?
MAKING THE CASE FOR
REFORM
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         A Catalyst for Change, Transforming the American Workforce
 Poverty by the Numbers

 SUBPOPULATION           2009 Poverty Rate       2010 Poverty Rate
 Children                20.7%                   22.0%
 African-American        25.8%                   27.4%
 Hispanic                25.3%                   26.6%
 Disability              26.0%                   27.9%
 Total U.S. Population   14.3%                   15.1%
                                                 U.S. Census Bureau (13 September 2011)

46.2 million Americans were living in poverty in 2010.

Persons with Disabilities experienced the highest rates
of poverty of any other subcategory of Americans for
the tenth year in a row.
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                     A Catalyst for Change, Transforming the American Workforce
   There is a Correlation between
   Employment and Poverty
                   U.S. DISABILITY EMPLOYMENT PROFILE


STATISTIC                        WITH DISABILITY            WITHOUT
                                                           DISABILITY
                                August      August      August    August
                                 2011        2012        2011      2012

% of population in the labor     21.0%      20.9%       69.9%       69.4%
force
Employment-Population            17.7%      18.0%       63.8%       63.8%
Ratio
Unemployment Rate                16.1%      13.9%        8.8%       8.0%

  As reported by the U.S. Department of Labor’s Bureau of Labor Statistics,
                                 Table A-6                                    7




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                     A Catalyst for Change, Transforming the American Workforce
Poverty and Disability:
Lack of $$ is the Not Always the Problem
  Figure 1. Percentage of Estimated Federal and State Expenditures
  for Working-Age People with Disabilities by Major Expenditure
  Category, Fiscal Year 2008[1]



                                                                    $357
                                                                    Billion
                                                                    in
                                                                    FY2008

                                                                      Also includes
                                                                      LTSS for PWD
                                                                      via Medicaid &
                                                                      Medicare             8
              [1]   Adapted from Livermore, Stapleton and O’Toole (2011, Health Affairs)




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                         A Catalyst for Change, Transforming the American Workforce
Self-Sufficiency is not only better for PWD,
It also makes Economical Sense:
Supported v. Sheltered Employment
 • Regardless of disability or severity, SE costs
   less than SW
     SE: $6,619
     SW: $19,388
 • SE is more cost-efficient to taxpayers
     SE: 1.21
     SW: 0.83
 • SE is more cost-efficient to workers
     SE: 4.20
     SW: 0.24
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                            Cimera, R. (2007, 2008, 2009, 2010)
              A Catalyst for Change, Transforming the American Workforce
Community Services Make
Financial Sense
                                               People Served
      Type of Service      Cost per Person
                                                 with $5 M


         ICF/DD               $128,275                       39

         HCBS
                               $70,133                       71
       Residential

       Host/Foster
                               $44,122                      113
        Family


       Own Family              $25,072                      200


Data Source: Lakin, K.C. MSIS and NCI data from 4 states (1,240               10




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Individuals), 2009
                     A Catalyst for Change, Transforming the American Workforce
How is Tennessee Faring?
I/DD in Integrated Employment

METRIC                         1996         2004        2010
Total Number of ID/DD          5,803       6,102       7,789
Served

Total ID/DD Served in             0         1457        1272
Integrated
Employment

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            A Catalyst for Change, Transforming the American Workforce
How is Tennessee Faring?
Vocational Rehabilitation Outcomes,
FY2004 and FY2010
 METRIC                                       FY 2004       FY 2010
 Total Number of VR Case Closures             12,223        11,466
 Total Number of Closures for I/DD            1,716         1,758
 Closures into an Employment Setting          3,773         1,651
 Closures into Employment for I/DD            727           372
 Percentage of all Closures into              30.9%         14.4%
 Employment
 Percentage of all closures with IDD into     42.4%         21.2%
 employment
 Mean Weekly Earnings at Closure              $319          $283
 Mean Weekly Earnings for I/DD                $156          $163
 Mean Weekly Hours Worked at Closure          31.8          26.8
 Mean Weekly Hours Worked for I/DD            23.8          20.8                12




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StateData: National Report on Employment Services & Outcomes,
                       A Catalyst for Change, Transforming the American Workforce
2010 (institute for Community Inclusion
Words of Wisdom


                              "If no mistake
                              have you made,
                              yet losing you
                              are....a different
                              game you
                              should play."

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       A Catalyst for Change, Transforming the American Workforce
The Good News: You’ve Done the Early
Work, and You Have all the Right
Ingredients to Succeed Tennessee

• Tennessee Employment Consortium
• Tennessee’s Project Income
• Tennessee’s Benchmarking System
• Mandatory Situational Assessments
• Community Employment Training by and for
  People with Disabilities
• Scaling of National Customized Employment
  Demonstration


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             A Catalyst for Change, Transforming the American Workforce
What if we turned “the system” upside down In
terms of priorities and expectations for citizens with
disabilities?

THESE TIMES ARE A
CHANGIN’
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             A Catalyst for Change, Transforming the American Workforce
                   The Cyclical Dependency Model




 EDUCATION        TRANSITION      EMPLOYMENT           HOUSING           FINANCIAL
• Segregated     • Presumption    • Individual      • Primary            PLANNING
  from class       of lowest        typically         options are       •Asset Limit
  or school.       expectations     placed into       institutions      of $2K has
• Placed on      • Lack of          expensive         and               not been
  non-             access to        segregated        congregate,       revised
  diploma          transition       options           provider          since 1985
  track as         activities                         operated          •Benefits
  early as 3-5   • No pressure    • Subminimum        group home        riddled with
  years old.       on schools       wages often       facilities that   complexities
                                    paid              regiment
                                                      people's lives
           This Model results in Chronic Impoverishment, Cyclical                 16
        Dependency, and Loss of Human Dignity throughout Lifespan.




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                        A Catalyst for Change, Transforming the American Workforce
            The Self-Sufficiency Investment Model




EDUCATION       TRANSITION       EMPLOYMENT            HOUSING        FINANCIAL
• Full          • Transition    • Presumed          •Focus is on      PLANNING
  inclusion       planning        eligibility to    getting person   • Allow
  in home         begins at       supports via      into home in       consumers
  school          14              VR, one-stops     integrated         to control
• Special ed    • Work            and local/state   setting            public
  viewed as       experience      programs          •Ongoing           resources
  service,        required as   • Outcome is        personalized     • Increase
  not a place     part of         integrated        supports to        asset limits
• Exposure        transition      employment in     optimize           to $10K
  to general      activities      general           independence
  ed            • PSE             workforce
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        This Model represents Optimal Self-Sufficiency,




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       Independent Living, Economic Empowerment and
                 A Catalyst for Change, Transforming the American Workforce
      Changed Thinking Leads to
        TRANSFORMATION

From:                        To:
Assuming that PWD            Discovering that PWD
 Need to be                   Can be self
  taken care of                 sufficient
 Can’t work                   Can work and
                                pay taxes
 Need constant
  supervision                  Don’t need
                                constant
 Are a burden to               supervision
  families                     Are valued
                                family members
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        A Catalyst for Change, Transforming the American Workforce
Out with the Old, In with the New


• Old Ways of Thinking          • A New Approach
  – Cyclical Dependency            – Dignity of Risk
  – “Determined ineligible         – Presumption of
    for employment                   Employability for
    supports”                        Everyone
  – “Payer of Last Resort”         – Everyone has a shared
                                     responsibility, and
                                     accountability from Day


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               A Catalyst for Change, Transforming the American Workforce
Infusing the Ideals of Employment First:
Recent Federal Testimonials
• “Work is a fundamental life            • “The success of the
  activity for adults with and             Employment First approach
  without disabilities….it provides a      highlights the need to align
  sense of purpose, shaping who            Federal and state policies,
  we are and how we fit into our           regulations and funding
  community…..All individuals,             priorities to ensure that
  regardless of disability and age,        integrated, community-based
  can work and work optimally with         employment is the primary
  opportunity, training, and support       employment outcome for the
  that builds on each person’s             targeted audiences.” [ADD
  strengths and interests.” [CMS           Projects of National
  Informational Bulletin                   Significance: Partnerships in
  (September 16, 2011)]                    Employment Systems Change
                                           (HHS-2011-ACF-ADD-DN-
                                           0156)]                            20

                    A Catalyst for Change, Transforming the American Workforce
Infusing the Ideals of Employment First:
Recent Federal Testimonials
• “ … critical agencies at each level of government must work
  together to align policies, regulations, planning and funding to
  ensure a consistent approach to systems transformation and
  strategy implementation. The need for such alignment of our
  public system of disability services has been recognized and
  suggested by subject-matter experts, advocates and individual
  Federal agencies as the critical first step in a successful
  employment systems transformation.”
   – [ODEP Employment First State Leadership Mentoring Program Performance
     Work Statement, 20 July 2011]




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                    A Catalyst for Change, Transforming the American Workforce
Using a Carrots and Sticks Approach to
Incentivize & Reward Systems & Providers for
Doing the Right Thing

EMPLOYMENT                      1ST:
THE PATHWAY TO TRANSFORMATION
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            A Catalyst for Change, Transforming the American Workforce
Government Role in Employment First:
Developing a Common Cross-Systems Strategic Framework to
Effectuate Employment First




                 Legal                                            Training &
 Funding                        Incentives      Regulations
              Protections                                             TA




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                  A Catalyst for Change, Transforming the American Workforce
FUNDING:
Money Matters….and Drives Practice




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          Be Bold. Embrace Difference. Change Lives.
            A Catalyst for Change, Transforming the American Workforce
Example: HCBS Waiver funding and impact
on institutionalization
• There is no private insurance product to cover life long supports for
  people with significant disabilities
• No one individual or family can bear the costs of supports for a life time
• Until Medicaid HCBS, institutions were the only alternative for many
  PWD




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                     A Catalyst for Change, Transforming the American Workforce
Government Role in Employment First:
Developing a Common Cross-Systems Strategic Framework to
Effectuate Employment First




                 Legal                                            Training &
 Funding                        Incentives      Regulations
              Protections                                             TA




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                  A Catalyst for Change, Transforming the American Workforce
THE LAWS MATTER TOO!

• Civil rights protection against employment
  discrimination

• Equal access to and effective participation in
  federally funded programs

• Affirmative obligations of federal contractors

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             Be Bold. Embrace Difference. Change Lives.
               A Catalyst for Change, Transforming the American Workforce
Government Role in Employment First:
Developing a Common Cross-Systems Strategic Framework to
Effectuate Employment First




                 Legal                                            Training &
 Funding                        Incentives      Regulations
              Protections                                             TA




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                  A Catalyst for Change, Transforming the American Workforce
 Infusing the Ideals of Employment First:
 Recent Federal Agency Incentives

   Administration on            Promoting Readiness of
     Intellectual and           Minors in Supplemental        Office of Disability
Developmental Disabilities         Security Income         Employment Policy at the
     Partnerships in                                         Department of Labor
                                      (PROMISE)
  Employment Systems                                               EFSLMP
         Change                  SSA, OSEP, HHS, DOL




                                             Federal Improvements to Medicaid
                                              Community First Choice Option
      Office of U.S. Special Education &     Balancing Incentives Program and
            Rehabilitative Services              Money Follows the Person
                                              Centers for Medicare & Medicaid
                                                       Services (CMS)

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                         A Catalyst for Change, Transforming the American Workforce
Government Role in Employment First:
Developing a Common Cross-Systems Strategic Framework to
Effectuate Employment First




                 Legal                                            Training &
 Funding                        Incentives      Regulations
              Protections                                             TA




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                  A Catalyst for Change, Transforming the American Workforce
Federal Directives that Support
Employment First 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 Advocating for
  Repeal of Section 14(c) of FLSA
• Congress:
   – Release of “Unfinished Business Report”
   – Introduction of Fair Wages for Workers with
     Disabilities
                                          OLMSTEAD
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               A Catalyst for Change, Transforming the American Workforce
Government Role in Employment First:
Developing a Common Cross-Systems Strategic Framework to
Effectuate Employment First




                 Legal                                            Training &
 Funding                        Incentives      Regulations
              Protections                                             TA




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                  A Catalyst for Change, Transforming the American Workforce
Employment First State Leadership
Mentor Program (EFSLMP)

Promoting the promise and expansion of integrated
   employment by:
• Matching “protégé” states with a state mentor for
   policy and funding alignment (TN, OR, and IA)
• Providing intensive technical assistance for
   employment first strategic plan development and
   implementation from Subject Matter Experts
• Facilitating an ongoing Community of Practice for
   participating states
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              A Catalyst for Change, Transforming the American Workforce
Employment First State Leadership
Mentor Program (EFSLMP):
Unique Features
• Initiative is contract-based, not competitive grant
• State E1st Teams include I/DD, Medicaid,
  Education, VR, workforce investment, and mental
  health as required partners
• Moving into Year 2, focus will be on:
  –   Availability of Subject Matter Experts, paid for by DOL
  –   Peer-to-peer mentoring via meetings focused on knowledge
      sharing and information dissemination
  –   Some resources for convenings, meetings, and travel
  –   Qualitative evaluative component
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                 A Catalyst for Change, Transforming the American Workforce
Tennessee is 1 of 3 Protégé States

 Aligning departmental policies for coordination of
 integrated employment services. Key areas of
 focus are on capacity building of provider network,
 including increasing the use of customized
 employment strategies by service providers as well
 as to cultivate a better understanding of and use of
 SSA work incentives.



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             A Catalyst for Change, Transforming the American Workforce
EFSLMP Progress to Date
• All Protégé states completed strategic plans
  – Foci centered around transition, reimbursement restructuring, and
    capacity building/conversion models for provider systems


• Community of Practice initiated (23 states)

• Technical Assistance for implementing strategic
  plans of protégé states underway

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                  A Catalyst for Change, Transforming the American Workforce
Community of Practice Focus (Year 1)
• Building Statewide Capacity to Implement EF
• Maximizing Efficiencies through Systems
  Coordination (2-part Series)
• Reimbursement/Rate Restructuring; Funding
  Stream Alignment
• Innovation in Transition School-to-Work Models
• Customized Employment as a Strategy for Securing
  Integrated Employment Outcomes for PWD
• Outcome Development, Data Collection &
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  Performance Measurement
             A Catalyst for Change, Transforming the American Workforce
 Community of Practice Focus (Year 1)
• Participating states include:
   – Core EFLSMP States
   – States that applied to be an EFLSMP core state but were unsuccessful
   – AIDD Partnerships in Employment Systems Change Grantees
• States included in Year 1:
  – AR, CA, DC, DE, IA, ID, IL, KY, ME, MI, MS, MO, MT, NC, ND, NJ, NY,
    OR, RI, TN, VA, WA, WI
• Plans for Expansion of EFLSMP Community of Practice (Years
  2-3)
  – Additional Year 2 AIDD Grantees
  – States that applied to AIDD grant but were unsuccessful
  – DEI States not already captured through another eligibility criteria      38

                     A Catalyst for Change, Transforming the American Workforce
 Additional Community of Practice
 Platform: ePolicy Works

Web-based platform with three tiers:
1. one large umbrella Employment First Group that will include
   all EFLSMP subcontracting states, all AIDD grantees, and
   any interested state who applied to either of these programs
2. individual private state workgroups that allow each state
   who is participating in either the EFLSMP as a contractor or
   who is an AIDD grantee to have their own private state work
   group
3. accessible only to ODEP EFSLMP state subcontracting
    entities and Subject Matter Experts
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                 A Catalyst for Change, Transforming the American Workforce
A New Policy Development Model




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      A Catalyst for Change, Transforming the American Workforce
Comprehensive Resources:
Key Policy Products/Templates

• Draft State Executive Order
• Draft Cross-Systems Regulatory Guidance
• Draft Interagency Agreements on Blending/Braiding of
  Resources
• Definition Alignment
• Policy Audit
• Touchpoints for Sustainability
• Recommended Performance Metrics/Data Collection
  Points

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               A Catalyst for Change, Transforming the American Workforce
EFSLMP Current structure

Mentor State: Washington

Washington implemented its Working Age Adult
 Policy in 2006, the first “Employment First”
 policy in the country. This policy was the
 culmination of over three decades of concerted
 activity to insure that persons with disabilities
 have quality of life through employment.
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             A Catalyst for Change, Transforming the American Workforce
We Have Proof that People Can Work
When Services Focus on Employment

          Success in employment varies widely 2009
                                                Washington State (88 %)
                                                Oklahoma (60%)
                                                Connecticut (54%)
                                                Louisiana (47%)
                                                New Hampshire (46%)




               2009 – UMASS Boston ICI ID/DD Agency Survey                43




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           A Catalyst for Change, Transforming the American Workforce
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A Catalyst for Change, Transforming the American Workforce
    Employment Supports are Cost-Effective:
    Data from Washington State


•    People in individual integrated employment
     were working 7.7 hours, or almost 8 hours
     for each hour of paid support from a
     provider.^
     * Sample from Fiscal Year 2009. Represents approximately 40% of individual employment clients.
     ^ 880,000 hours worked / 115,000 service hours = 7.7 hours worked for each hour of service
     ~ (880,000 hours worked – 115,000 service hours) / 1,200 clients = 640 annual hours worked, for each person, without
     any paid service.


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                                    A Catalyst for Change, Transforming the American Workforce
Employment First




   Rhetoric or Possibility?


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          A Catalyst for Change, Transforming the American Workforce
Government Role in Employment First:
Developing a Common Cross-Systems Strategic Framework to
Effectuate Employment First


 • State Plans
 • Individual Program Planning
 • Results-Oriented Objective Setting
 • Informed Consent/Active Self-Advocate Engagement
   in Decision Making Processes
 • Service and Support Menus
 • Performance Metrics and Measurement
 • Data Collection and Analysis
 • Annual Reporting, Monitoring & Evaluation
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                 A Catalyst for Change, Transforming the American Workforce
Government Role in Employment First:
Essential Tactical Elements in Promoting Employment First




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                 A Catalyst for Change, Transforming the American Workforce
Transformational Leadership:
Reform is Imminent




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          Reform is inevitable…..




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           A Catalyst for Change, Transforming the American Workforce
Transformational Leadership:
What Road will you take?




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   USE OUR CURRENT FINANCIAL CRISIS AS AN




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  OPPORTUNITY FOR SYSTEMS TRANSFORMATION
           A Catalyst for Change, Transforming the American Workforce
Comprehensive Resources

Integrated Employment Toolkit



www.dol.gov/odep/ietoolkit

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          A Catalyst for Change, Transforming the American Workforce
      WWW.DOL.GOV/ODEP
(866) ODEP-DOL              TTY (877) 889-5627                   52

        A Catalyst for Change, Transforming the American Workforce

				
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