Professional Documents
Culture Documents
Abstract.
BACKGROUND: The United States Department of Labors (DOL) Office of Disability Employment Policy (ODEP) initiated
the Employment First State Leadership Mentoring Project (EFSLMP) to assist states to align policies, regulations and funding
priorities to encourage integrated employment as the primary outcome for individuals with significant disabilities.
OBJECTIVE: This paper describes the activities undertaken by two states designated as Protege States of the Employment First
State Leadership Mentoring Project of the United States Department of Labors (DOL) Office of Disability Employment Policy
(ODEP).
CONCLUSION: Protege states received mentoring from the identified mentor state as well as training and technical assistance
by Subject Matter Experts (SMEs). While five aspects of system change were shared by the states, the efforts undertaken to effect
change were individual to each state. Lessons learned are also noted.
Keywords: Employment First State Leadership Mentoring Project (EFSLMP), Department of Labors (DOL), Office of Disability
Employment Policy (ODEP), systems change
1. Introduction
For decades the employment status of individuals with disabilities has been regarded as dismal. In
an effort to change this long-standing dilemma there
has been a resurgence of effort to increase integrated
employment outcomes for all individuals with disabilities regardless of the severity of the disability. Recent
Department of Justice settlements i.e., Rhode Island
(Samuels, 2014) and Oregon (Lane v. Kitzhaber, 2012)
and the recognition that the Americans with Disabilities
Act, thus the Olmstead Decision, relates to employment
settings and services in addition to residential settings
and services (Lane v. Kitzhaber, 2012) has brought
Address for correspondence: SueAnn Morrow, Ph.D., University
of Iowa, Money Follows the Person Program, 2927 Old Highway 218,
Mount Pleasant, IA 52641, USA. Tel.: +1 319 430 8710; Fax: +1 319
385 1365; E-mail: Sue-morrow@uiowa.edu.
1052-2263/15/$35.00 2015 IOS Press and the authors. All rights reserved
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S.A. Morrow et al. / Working with ODEP to create systems change: The story of two protege states
a Parent and Family Coalition, a grassroots effort inclusive to all parents and families who desired employment
for their family member. Both EFSLMP and our
AIDD grant have led these efforts. The goals of the
Coalition include generating legislative priorities; providing leadership; and serving as a liaison for parents
with community groups, policy makers and stakeholders. It also provides another avenue to distribute
relevant information from federal, state, and local
policymakers.
2.3. Business model transformation
For years Iowa has relied heavily on segregated
employment services and spent approximately 80%
of its Medicaid employment service dollars on segregated employment services (Morrow, Amsbaugh,
Moskowitz, Westhoff, & Walker, 2011). To help show
providers a different way of doing business, EFSLMP,
along with the AIDD grant, worked with six agencies
to implement Customized Employment.
The six pilot projects worked with a total of 30
individuals specifically targeted for EFSLMP. The
individuals were to have been previously considered
unemployable. At the end of the Project, 14 of those
individuals were employed, working an average of
13-14 hours a week with an average wage of $7.65
per hour. One individual employed through the Project
noted, This is my first minimum wage job in my entire
wheel-chair life (Idactionia, 2013). And that timespan
had been over 40 years.
Another SME was brought in to provide information
and technical assistance to administrators of agencies
interested in transforming their services. While we
originally targeted the six administrators from the Pilot
Projects, it has grown as administrators from other
agencies are asking to be part of the movement. Multiple on-site training and technical assistance have been
provided either through EFSLMP, Iowa Association of
Community Providers (IACP) or the AIDD grant. With
the new focus on integrated employment, the 14 agencies involved in the transformation activities helped 427
individuals with disabilities secure integrated employment with an average wage of $7.81 per hour and
average number of hours worked at 17 per week.
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3. Tennessees story
While Tennessee worked on the same five aspects of
systems change, our approach was slightly different.
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easier for a family member to access employment services. All of the respective coalition members have the
vision of their family member employed in the community. Members also learn how to advocate for services
that lead to enhanced employment outcomes.
3.3. Business model transformation
Our state decided early on that we wanted to meet
providers where they are and then work collaboratively to assist them in transforming from facility based
services to integrated services. We also heavily publicized the lawsuits in Oregon and Rhode Island and
shared that some of the concerns noted in these states
mirrored some of the services being provided in Tennessee. We strategically asked three providers in each
of our Regions (East, Middle, and West) to gauge their
interest in participating in the Initiative. The majority of
them said no including SRVS, who eventually agreed
to be involved.
SVRS is one of the oldest, largest nonprofit
providers of services for individuals with disabilities
in Tennessee. It provides a range of services including
residential support, integrated employment services,
adult day services, and a sheltered workshop. While
they initially declined, they looked at actions in Oregon and Rhode Island and realized that at some point
there might be litigation and they would be forced to
close their workshop. They wanted to be pro-active
and make changes in a systematic and planful manner. They anticipated resistance by a number of entities
including the people with disabilities themselves, their
family members, other team members, and likely some
board members. They also realized that lack of funding
would be a potential obstacle.
They addressed these obstacles through meeting with
the different concerned groups as well as conducting
meetings with individuals. They formed a steering committee of board members who wanted to move forward.
They re-worked their employment process to make it a
much more dynamic system with a full time job developer, an on-site rehabilitation counselor and separate
employment consultants.
They did a major marketing campaign to raise awareness of the community including employers. They used
TV spots, billboards, You-Tube, a newsletter, and word
of mouth.
3.4. Rate restructuring
Our rate restructuring work is not complete. Tennessee uses a tier system with the highest reimbursement
S.A. Morrow et al. / Working with ODEP to create systems change: The story of two protege states
rate occurring for more hours and more pay for the
individual. We are collaborating with TennCare, our
Medicaid agency, to study rates to best determine
the most appropriate way to move forward. We have
released a concept paper and held community and stakeholder forums to receive input and feedback needed to
develop rates. We are researching other states funding
structures and we have also worked with SMEs for specific guidance on how to successfully restructure rates to
fully incentivize community integrated employment.
3.5. Capacity building
Requiring trained staff is a critical component for
Tennessee to continue to build a system that promotes
integrated employment. To that end, we have held
topical monthly webinars, much like Iowa, featuring
different SMEs. We also provided training around Customized Employment and Discovery through webinars
and in-person sessions.
We also expressed a desire to grow the capacity of
our providers. We have worked with them to become
Employment Networks and to increase the use of the
Ticket to Work program through the Social Security
Administration. Training has also been offered on Plans
to Achieve Self Sufficiency (PASS) and other work
incentives through Social Securitys PASS Cadre.
4. Reections
Our experiences with the EFSLMP demonstrate the
value of technical assistance and support being provided
by a federal agency such as ODEP. Through this assistance both states were able to make progress toward
the adoption of Employment First policies and practice.
While our efforts were similar, the unique environments
of our individual states dictated our specific activities. In
Iowa, stakeholder involvement was particularly needed.
Lisa Mills, the SME who worked closely with us in Iowa
regarding the rate restructuring, noted: The benefits of
stakeholder engagement was clearly evident in the Iowa
process of revising Medicaid service definitions and
developing new rates to incentivize integrated, competitive employment outcomes. Rather than limiting stakeholder engagement to community conversations reviewing SME recommendations, or seeking input from
stakeholders on final change proposals, Iowas state
agencies engaged a Work Group of key stakeholders and
undertook the often arduous work of redesigning service
definitions, provider qualifications, and reimbursement
rates and methodologies in partnership with the Work
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Mentoring Program (EFSLMP) by Federal Contractor Economic Systems, Inc. (under Blanket Purchase
Agreement DOLQ089427777). Under the first year
of EFSLMP (DOLU119432412; Contract #GS-10F0042M), the states of Iowa and Tennessee were two of
four original states that received funding and technical
support. The lead state government agencies involved
in the receipt of support from EFSLMP on behalf of
these two states were the Iowa Vocational Rehabilitation Services Division and the Tennessee Department
of Intellectual and Disabilities Services, respectively.
The opinions expressed herein are those of the authors
and not necessarily those of U.S. Department of Labor
or the Office of Disability Employment Policy.
References
CMS. (2014a). Medicaid Program: State Plan Home and Community
Based Services, 5-Year Period for Waivers, Providers Payment
Reassignment, and Home and Community-Based Setting Requirements for Community First Choice (Section 1915(k) of the Act)
and Home and Community-Based Services (HCB) Waivers. (Section 191(c) of the Act, 79 Fed. Reg. 2947-3039.
CMS. (2014b). Home and Community Based Services Toolkit.
Retrieved from: http://www.medicaid.gov/Medicaid-CHIPProgram-Information/By-Topics/Long-Term-Services-andSupports/Home-and-Community-Based-Services/Home-andCommunity-Based-Services.html.