Supported Employment and Long Term Follow-Along for the Counselor and Job CoachDecember, 2008

Introductions:

Judy Hill - EES/LTESS Coordinator

OFFICE OF EMPLOYMENT SERVICES AND SPECIAL PROGRAMS

JUDY HILL 804-662-7108-email JUDY.HILL@DRS.VIRGINIA.GOVFAX NUMBER FOR ESSP: 1-804-662-9140 DRS TOLL FREE VOICE 1-800-552-5019WEBSITE: http://www.vadrs.org then click on Employment and Vocational Services

The Supported Employment Guide can be found at:http://vadrs.org/essp/downloads/seguide/pdf

Whats in your resource packet?Understanding Order of Selection BrochurePower point PresentationEnclave/Mobile Crew 101, Stability for Individual SEOther SE Issues, Revised SE FormsOESSP Information SheetAppendices B & C - WAT, SA and Provisions for Extended Employment Services (EES)Appendix D - Guidelines for SE and JCTSAppendix E - Provision of Long Term Employment SupportLTESS GuidelinesLTESS forms - application, requisition, closurePolicy on Integrated Settings-Employment Outcomes and Extended EmploymentSuccessful ClosureDefinition of Most Significant Disability (MSD)Post EmploymentList of AcronymsList of DRS StatusesEES/LTESS Forms

Topics to Cover:Insights into SE/Long Term Practices

Brief Historical Background EES and LTESS

Key Service Requirements for Long Term Follow-Along

DRS IMPACT ON ESO PROGRAMS

*DRS Field Spends almost 10 Million

**DRS OESSP EES and LTESS Spends over 7.2 Million* State Fiscal Year 2008**This includes the 15% reduction in both programs

Why are we here?To stress the importance of communication and collaboration among all parties

Supported employment specifics

Long Term Follow-along LTESS specifics

THE KEYS TO SUCCESSRELATIONSHIPS

Frequent Contacts between VR and JC

Getting info between VR and JC quickly

VR and JC view themselves as part of a team

Access to VR counselor or job coach

THE KEYS TO SUCCESSTRUSTVR and JC trust in each other to:

Give sufficient hours to do jobUse hours given efficiently and effectively

Consumer Characteristics/Needs:

Difficult vs. less difficult consumersFull use of authorized hours vs request cancellations

SUPPORTED EMPLOYMENTCollaboration and Communication

Roles of each of us from referral to follow along

Clarification of servicesIndividual SEGroup Enclave, Mobile Work Crew, EntrepreneurialJCTS

What model to use?Does the consumer require ongoing extended support services in order to maintain competitive employment?

Is it required that a job coach work individually with a consumer?

Does the consumer require employment in a mobile work crew or enclave?

Is employment integrated?

SE - Individual PlacementSingle supported employee placed in an integrated work setting in the community

employed by employer

ongoing follow-along required

most widely used SE model

Advantages: flexibility, max. integration, ease in differentiating between training and LTFA

Enclave Modelsmall group of supported employees placed in community-based employment

may work together or be dispersed with integrated setting

may be employed by employer or ESO

ongoing follow-along required

advantage: higher level of supervision and support

Mobile Work Crew Modelgroup of supported employees who travel together to one or more integrated work settings in the community to perform contract work

employed by the ESO

ongoing support required

advantage: higher level of supervision and support

Entrepreneurial Modelsupported employees producing a service or product either on a sub-contract basis or as a prime manufacturer

SE employees, along with managers and others, comprise the business

advantages: integrated, public contact, PR

JCTSConsumer receives initial situational assessment, job development, job skills training, transportation training, or other support services provided by an ESO; however long term follow-along is not necessary after DRS case closure.

This is a separate service and requires applicable service category on vendors rate sheet.

Service Item Codes are not the same as those for SE.

When service categories are open, cases can be coded as either MSD or SD.

If a consumer receives JCTS services, no follow along is required so therefore, a LTESS application should not be completed. If the consumer demonstrates that LTFA is needed then the ESO can submit a LTESS application after they have DRS counselor approval. The counselor needs to document the change in the case notes and change the SI codes on any authorizations if necessary.

DRS Counselor Roles and ResponsibilitiesOnce eligibility is established SE planning begins.Are long term supports needed? If yes, then SE case. If no, consider JCTS.Identify long term support.SE cases must be coded as MSD.Share sufficient diagnostic information.

DRS COUNSELOR ROLEEstablish benchmarks regarding progress.Stop the process if needed and discuss issues Interrupt Failure if needed.Clarify expectations.Maintain a separate role with consumer from vendor.Determine what services can be provided by DRS before asking a job coach to do them.Continue to communicate with consumer after referral to job coach.Case statuses must be properly updated.Communicate and collaborate!!!!!!!!!!!!!!!!

HIPPA ISSUEESOs will not be able to reference SS #s in the new internet EES/LTESS system. As a result you must use the consumer's participant ID # rather than a case or Social Security # in all communication regarding the consumer.The Certificate of Eligibility has the participant #, therefore we recommend that a copy be sent to the ESO as a part of the referral package. The participant ID # should be reflected on all of the SE forms. It is not on the authorizations generated by AWARE.

Job Coach Role:Assist consumer with locating suitable job matches.Assist in job search efforts.Provide timely written reports and phone contacts with updates as needed.Provide job skills training as needed.Ensure consumer stability and job satisfaction on both consumer and employer side.Provide extended support services, where appropriate.

Job Coach ResponsibilitiesCommunicate and collaborate with DRS Counselor and consumers.Providing information as to fading plans, need for follow-along, funding options.Work as a team with DRS, case managers, consumers, families, etc. to improve likelihood of success.

Topics coming up:Communication IssuesInitial PlanningAuthorizing ServicesService ProvisionReport WritingInvoicing

Opportunities for Communication and CollaborationInitial Planning ExpectationsSituational AssessmentSE vs. JCTSJob Goal/DevelopmentPlacement and TrainingStability/FadingLong Term Follow Along

WHO PAYS FOR SERVICES?

Initial Planning for Services:

DRS pays for situational assessment, job development and placement and training through stabilization

Long term support funds pay for extended services including post stabilization while the case is still open. Examples-LTESS,CSB

DRS pays for post employment, not LTESS

Opportunities for Communication and CollaborationAuthorizing Services:All authorizations need to consider individual consumer need.Need to be in place prior to provision of service.Justification needed for requested hours and a timely response from counselors including emergencies like post employment.DRS Counselor should keep in mind that there are no caps/no maximums.

Opportunities for Communication and Collaboration

Service Provision:Job DevelopmentAgreement of goals for consumer.Provide sufficient service hours - No maximums or minimums, individually considered.Monthly progress reports should contain information as to name, numbers and types of contacts made, strategies applied, job development hours used, potential placement possibilities or outcomes expected and request for next month.

Opportunities for Communication and CollaborationService Provision:Job Placement/Training

No maximum or minimum hours allowed for Placement/Training - has to be individually considered (18 month duration limitation).

Training time is not standardized .

Monthly reports, including intervention percentage and fading schedule along with progress made to date.

Last monthly SE P&T Report (SE Form 3) should indicate consumer is stable in employment before LTFA begins.

INVOICING:Billable Services under SEExpectation of Counselor Complete, Timely, Individualized, and Accurate Billing

Work Site Activities:Includes travel, training and intervention with consumer, employer, and employees at work site

Job Development Activities: Includes consumer specific job development with employers, supervisors, and other personnel for purposes directly relating to employment

Off-Site Activities:Includes training in transportation, money handling, and advocacy for persons not directly affiliated with the work site

Remember, if a DRS employee can provide the service, that should be the priority!

INVOICING:Billable Services under SEAssessment/Report Writing:

Includes provision of situational assessment services and all task analysis, training and progress report writing

Billing for report writing and telephone calls should reflect actual and reasonable time spent, not standardized times

Fading:Intervention percentage time is the time the Job Coach spends supporting the consumer on the job site divided by the total number of hours worked.

Intervention declines over time as a measure of progress.

EMPLOYMENT STABILITY AND THE MOVEMENT FROM TIME LIMITED TO LTESS FUNDING

WHAT IS STABILITY?Traditional guideline: job coaching support is 20% or less. This may not always be the case.

Consumer is emotionally, behaviorally stable.

Consumer will demonstrate stability for at least 30 days in service status before case is moved to employed status.

Last placement and training form (SE Form 3) submitted to DRS must note stability has been reached and when the case will begin long term follow along.

Communication between the ESO and DRS is imperative for this action to be successful.

How to calculate STABILITY?Stability is the direct/indirect intervention hours by the employment specialist divided by the number of consumer work hours for that time period (usually calculated weekly and/or monthly).

Example: 10 intervention hours divided by 20 consumer work hours is 50%. While DRS case service and LTESS funds pay for employment specialist transportation and documentation, the hours spent providing these services do not enter into the calculation of stability.

DRS Individual SE Case MovementThe DRS Counselor keeps the consumer in service status until stability for 30 days or more is achieved.The DRS counselor will then move the consumer to employed status for at least 90 days.Once the consumer has worked in employed status for a minimum of 90 days or more and remains stable on the job, the case is successfully closed Closed - Rehab. LTESS funds begin supporting LTFA at the beginning of employed status.

Stability in Group ModelsFor persons in group models, stability is defined as the completion of a 60 day period in which intervention is directed at maintaining a level of production and not at major barriers to successful integration into the job site. In other words, the job coach/trainer is devoting the majority of time addressing training issues rather than behavioral issues. The consumer is meeting a level of production that is acceptable to the employer (either the business or ESO itself). The case remains in service status until the stability period ends. The case then goes to employed status at the end of a minimum 60 day period. At this point the case is considered to be in LTFA. Funding could be from a number of sources.

Ongoing Services Form (SE Form 4)The Code of Federal Regulations requires twice a month monitoring of the consumer until DRS closes the case. The ESOs are required to complete the Ongoing Services Form each month from the time the case begins follow along until DRS case closure. The job coach is required to send a copy to the DRS counselor each month until the case is closed.

ESO Action to Access LTESS Before the 30 day stability period ends, a LTESS application must be received no later than the 20th of the month preceding the start of follow along services. This ensures that LTESS funds will support LTFA after time limited services by the DRS counselor ends.All LTESS applications must be approved by a DRS counselor. The ESO must document the approval in the case record.

Individual LTFA Definition With the approval of the DRS counselor and ESO job coach either bimonthly or quarterly contacts with the consumer would be acceptable to DRS provided that: * the consumer and family understand the frequency, * the consumer is given access to follow along supports if needed sooner than the next scheduled contact, and * the ongoing supports being provided are adequate to meet the clients needs with respect to maintaining employment.

LTFA VS POST EMPLOYMENT SERVICESLTFA is the maintenance of a person in employment.

LTFA does not mean case management.

LTESS does not fund training, retraining or job placement. If retraining, job placement or other services are needed, the DRS counselor should be contacted immediately. The consumer probably will need services other than LTFA.

ONE LAST REMINDERLTESS funds vocational support services that are necessary and sufficient for consumers to maintain employment. Case management, independent living or other services that are not vocational in nature should not be billed to LTESS funds. Per the Code of Virginia, LTESS funds are not appropriated by the General Assembly to fund those services.

QUESTIONS?????

EES/LTESS BUDGETSFISCAL YEARS 08-09No new LTESS dollars in FY 08 or 09 Total LTESS dollars after 3% reductions in FY 2008 -- $5,184,044Total LTESS dollars after 15% reductions in FY 2009 -- $4,406,437

EES/LTESS BUDGETSFISCAL YEARS 08-09Total EES dollars after reductions in FY 2008 -- $3,200,104 -3%Total EES dollars after reductions in FY 2009 -- $2,720,088 -15%

Long Term Employment Support Services Funding 95-08

Extended Employment Services Funding 95-08

LTESS HISTORYGrassroots effort by ESOs with General Assembly in FY 94

Success for FY 95 - $375,000 in State funds with primary target of Supported Employment Follow Along for persons with severe disabilities

Incremental increases in past years

Funds have been reduced each year for the last two years.

EES/LTESS Whats the difference?EES Funding:Services provided are onsite employment, enclave and mobile crews No individual SENo counselor approvalLimited number of ESOs involvedNo additional allocations program not growingLTESS Funding:Full array of services provided including individual supported employment, onsite employment, enclave and mobile crewCounselor must be involved in the approval of consumersDouble the number of ESOs involved in LTESS fundingConcentrated efforts to grow the LTESS pot

Extended Employment Services (EES) - HistoryFirst allocated from General Assembly for FY 84 and 100% state funds.

Current allocation is now over $2.7M distributed across the original 41 vendors providing Extended Employment Services to fund long term support to severely disabled consumers.

No additional funds allocated from the General Assembly since 1989.

Numbers of consumers served have declined over the years because of no increase in funds.

EES

Half of ESOs provide community placement enclaves and/or mobile crews.

Individuals served primarily have disabilities of MR (66%) or SMI (14%).

EES is not restricted to DRS consumers.

Must be one of the original vendors to receive an EES allocation.

Most recently funding has been lost to reductions.

EESAny consumer is eligible for EES funds as long as they are documented as having a severely disability.

Counselors do not have to be contacted prior to an EES application.

ESO must provide an integrated setting for a DRS/DBVI counselor to receive a closure. The counselor may still refer a consumer to an ESO that is not integrated if that is the best placement.

Bottom line is to do what is best for the consumer.

Due to limitations in the EES program, ESO community lobbied for additional follow along dollars which would be available to all approved vendors.

LTESS - WHAT IS IT?Long Term Employment Support Services100% State dollars appropriated by the General Assembly for FY1995

Intended as long term funding to support individuals with severe disabilities in accessing and maintaining employment

Not intended to supplant other funds used for the same purpose.

LTESS BACKGROUND1994 General Assembly appropriated $375,000 for FY 95 and 201 consumers were served.The LTESS program is currently serving over 2,800 consumers a month in 77 ESOs around the state.Individuals served primarily have disabilities of MR (44%) or SMI (25%).

LTESS GUIDELINESLTESS funds CANNOT be used to supplant planned or current funding for long term supports.

If a consumer is being sponsored by a public source, it should continueGenerally, no split funding for employment

Vendors cannot charge DRS more than any other purchasers of the same services as specified on the vendor rate sheet.

Exception: individual, private pay

Medicaid rates changed to be the same as DRS rates.

LTESS GUIDELINES (continued)Individuals who have been sponsored for employment services by public funds must wait 12 months to become eligible for LTESSA mechanism is established by DRS for exceptions in the case of hardship.

LTESS funding is not disability specific!

Organizations accepting LTESS funding must work with all DRS consumers and not discriminate on the basis of disability.

LTESS GUIDELINES (continued) Services billed through LTESS must be employment related follow-along services

Job development, retraining, referral to DRS tp reopen the case and general case management services are NOT considered follow-alongProvide the services needed to maintain employment not nice to do or always have done it that way or the employer likes me to come every weekSpikes are expected-over 20% of hours worked-send in documentationEmail notification is sent to counselors upon submission of LTESS application

LTESS GUIDELINES (continued)As LTESS is the funding of last resort for long term supports, vendors must document attempts to secure sponsorship and the absence of alternative funding sources.

Each consumer is required to have an individualized service plan that is clear, complete, and current following CARF guidelines.

LTESS GUIDELINES (continued)Monthly reports (including intervention sheets) should be maintained in the individual consumer file except:

if an individual is billed 20% or more of the total hours worked, the vendor must submit justification in the form of a monthly progress report

GENERAL INFORMATIONAny consumer with a goal of receiving Supported Employment or Extended Employment is a possible candidate for LTESS fundingDoes NOT have to be an open DRS case or a DRS case at all

DRS or DBVI counselor approval is required for use of all LTESS dollarsIncludes unfunded, on-site extended employmentIncludes closed DRS SE that may require additional follow along to maintain employmentIncludes JCTS if discovered consumer needs support to maintain employmentCollaboration and Communication!!

MAJOR LTESS ISSUES Counselor approval must be obtained and documented before applications submitted.

Applications must be thoroughly completed.

Applications must be submitted by the 20th.

Applications cannot be submitted for consumers receiving JCTS.

Applications for consumers in wrong DRS status.

ALLOCATION METHODOLOGY

Allocations are based on a 3-year rolling average of expenditures utilizing a 125% rule.

One bad year will not hurt as much if averaged with two good years.

REALLOCATIONSDRS reviews expenditure patterns throughout the fiscal year and completes reallocations as needed.

Reallocations are based on an individual organizations statistics-average hours billed, average attendance, individual rates, months/days remaining in fiscal year.

REALLOCATIONS (continued)Vendors need to monitor themselves on a monthly basis.

If a vendor chooses to maintain more individuals than their allocation can support with hopes of receiving additional dollars, that vendor is committing to be responsible for those individuals at the same level of service regardless of future allocations.

General Information for EES/LTESSVendor discretion as to how to apply their EES/LTESS funds MAY choose to support individuals in SE, individual or group models, extended employment or a combination

counselors may request certain consumers be supported with EES/LTESS, but vendors have final say following their own policies

overextending EES/LTESS funds is riskyvendor discretionEES/LTESS allocations are public information.

THE FUTURERecommendations were made to update the 15+ year old computer systemWeb basedNo paperForms partially filled inErrors minimized with edits and drop down help boxes

THE FUTUREFinancial data available on demandProduction data available on demandSavings of paper, postage, phone bills (faxes)Secured web site, password protectedHipaa compliantTimeframe FY 08 Initiated SystemTraining for All in March 2009

FORMSApplications

Closures

Requisition/Invoices

Questions?

Over time, progress in medical and assistive technology has challenged vocational rehabilitation professionals to redefine existing boundaries in determining eligibility for services. Rehabilitation practitioners continually seek innovative resources and programs that offer the possibility of increasing consumer productivity, earnings, integration, and independence.