Supported Risk Taking Promoting Dignity Of Risk Through Innovative Practices

APSE 2015Presented by Community Integrated Services

Angelina Bush Marcos Rios

Estelle Gilliams

Mission

Community Integrated Services’ mission is to empower people with disabilities through individualized employment

opportunities that foster self-sustainability, equality, and community.

Through partnerships with area businesses and organizations, CIS works to find jobs that fulfill the employment goals and desires for the people they

serve.

Vision

We believe that all people have the right and responsibility to be an active part of their community, regardless of

their disability, and Community Integrated Services helps people with

disabilities Live an Everyday Life through employment.

Community Integrated Services• Non-Profit organization 501(c)3 • Established in 1991 in Philadelphia, PA

– 25 individuals/ $250,000 budget• Supported Employment Agency in

Philadelphia, PA, surrounding counties, and the state of Delaware

• Employment First Agency• 25 staff who have obtained CESP• 47 staff who are ACRE Certified

Community Integrated Services

• Currently serve 756 individuals • 248 Job Placements in 2014• Employment for Everyone!• 6.2 m (F.Y. 2013) vs. 7.8 m (F.Y. 2014)

Community Integrated Services• Diversified Funding Sources

– Medicaid Waivers (Intellectual Disability, Autism, and Office of Long Term Living)– Vocational Rehabilitation– School Districts – Ticket to Work– Settlements and Trust Agreements– Private Pay– SSA Work Incentives– Grants

• Braided funding approach

Risks People Take in their Lives

We all Take Risks

• Crossing Street• Teaching our sons and daughters to drive• Sending our children to school• Driving • Going out on that big date involving a ring

• Attempting to get that prom date• Are all these risks any different from the

people we work with?

Dignity of Risk

The Dignity of Risk is the right to take risks when engaging in life

experiences, and the right to fail in taking these.

Financial RisksWorking vs. Not Working

Financial RisksNot Working

• Expectation to stay on benefits• No financial gain

– Not able to purchase goods/services

• Not paying taxes, not building for retirement

• Non-complacent in general• Mental health deterioration• Isolation• Lack of daily routine

Financial Risks Working

• What makes sense financially?• Will there be a loss in benefits?

– If so, by how much?

• What happens if I stop working?

Elevating Practice & Supporting People

• Realizing individuals have unanswered questions about working and SSA benefits.o Misinformationo Confusing informationo Lack of guidance on application process

• Work Incentive Counseling at CISo Currently have 3 Fully Certified Staff, 1

Provisionally Certified (CWIC)o Assist individuals across agency (756 people)

Proactive Case Management• Work Incentive Counseling since 2011• Upfront and ongoing process• 100% of individuals offered Benefits

Counseling Services• 97% of individuals receive Benefits

Counseling Services• 3% of individuals refuse Benefits

Counseling Services

Proactive Case ManagementIndividuals receive assistance with• Applying for benefits (eligibility and appeals)• Verifying benefits• Understanding how work impacts benefits

– SSA, Medicaid, Medicare, SNAP, HUD, Childcare• Help with reporting work to SSA• Developing and implementing work incentives to

SSA (IRWE, PASS, Subsidy & Special Conditions, BWE, and SEIE)

• Understanding overpayments• Rectifying issues on SSA records

Meet Andy• Receives SSDI & Medicare based on his work

history• Receives the Medicaid Adult Autism Waiver• Benefits Counseling while in job development• Started working full time as a Machinist at an

Engineering company

• Benefits Frustration and Nightmare!!!

Current Nationally Supported Model:Work Incentive Planning and Assistance (WIPA)

• SSA funded program to help individuals receiving SSA Disability Benefits who are working or thinking about going to work.

• Individuals are prioritized to get services.• Promote the Ticket to Work Program and Self

Sufficiency.• Conduct WISE (Work Incentive Seminars) for

Beneficiaries• 93 WIPA programs across the United States (in

2014)• 11.3 m adults ages 18-64 on SSDI or SSI based on

disability in United States as of 04/2015. Not including children.

– http://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/index.html?qs

Local Level WIPA- Philadelphia Region

• Philadelphia area WIPA o Disability Rights Network of PAo Covers Philadelphia County and 3 surrounding Counties.o 3 Staff memberso 184,782 of individuals ages 18-64 on SSA disability based

benefits (SSDI and SSI) o 61,594 individuals per WIPA Staff

• http://www.ssa.gov/policy/docs/statcomps/ssi_sc/2012/ssi_sc12.pdf• http://

www.ssa.gov/policy/docs/statcomps/oasdi_sc/2012/oasdi_sc12.pdf

Limitations of WIPA

• Sheer Volume• Knowledge of WIPA/ Find WIPA/ Initiate

Contact• Not Proactive• Locations of WIPA• Employment team not included• Timeliness of Services• No help with application for benefits

Communication Barriers & Risks

Perceived Risks of Hiring Those With A Language Barrier

• Unable to train• Take too much time

to train• Miscommunication• Perceived

comprehension difficulties

Perceived Risk of Working Where No One Speaks Your Language

• Not fitting in• Not

understanding

People 1ST Language Vs The Deaf Community

PEOPLE 1ST POLICY

• Emphasis on the person 1st and the disability 2nd

THE DEAF COMMUNITY

• Emphasis on “deaf” or “hard of hearing” first before the persono A person who has an

intellectual disAbilityo A person who has

autism

o Deaf persono Hard of hearing person

DEAF CULTURE

• Straight forward • Conversational storytelling • Home signs• Strong community• Some differences within the community

o Deafo Hard of Hearingo Hearing Aideso Cochlear Implant

Number Of Deaf Consumers And Staff Fluent In ASL At CIS

• 33 currently active hearing impaired consumers

• 7 staff fluent in ASL but not certified interpreters

Advantages Of Using A Job Coach Fluent In ASL Rather Than Interpreters

• Relationship w/ the consumer• Understands what the consumer means

and can explain that rather than doing a straight interpretation which might not be what is the intended point

• Understanding supported employment service

• Cost efficient

Other Communication Barriers And Associated Risks

Consumers who: • Have limited speech• Use assistive technology• Speak another language• Use augmentative and alternative

communication

23 CIS Staff Who Speak Another Languages

• 13 Spanish• 7 Staff Fluent in

ASL• 6 others (Croatian,

Laotion, Slovakian Czech, Brazilian Portuguese, Norwegian, and French)

Bilingual Consumers

• 23 individuals CIS supports are bilingual or speak another language .

• PA Department of Education Grant for 5 students this past school yearoNeeded to be bilingualoNeeded to be at risk for dropping out of

school.oNeeded to have an IEP

Meet Eric

• Student from PA Dept of Ed Grant• Interested in working with his hands• Working as a Carpenter’s Apprentice

Accommodations and Assistive Technology

• Used to assist individuals to be as independent at work as possible

• Make things easier on the individualo Can be something simple or complex

• What do we use in our lives to be more efficient and makes things easier?o Reminders and calendars in cell phoneo Alarm clocks/watcheso Automatic bill pay

Meet Chris

• Is deaf with a cochlear implant, is legally blind, and is on the spectrum.

• Is currently in Job Development and had some recent interviews.

• Uses ASL and an iPad to communicate• Benefits counseling

Meet Esther• Extensive stroke history

from a young age• Became a nurse• Suffered a traumatic

brain injury during surgery

• Caused a speech disability

• Uses voice-over machine on MacBook

• Currently is a Nurse Researcher Associate

Accommodations and Assistive Technology

• Task list checker• Text alerts for breaks• Tip counter (to help report earnings)• Voice over on Apple phone• Point of service • Picture book• Zoom text

Transportation Risks• Safety Concerns

o Getting lost, following street signals, safeness of route

o Being lured by a stranger

• Skill level with travel trainingo Transfers with public transportation,

walking distance

• Modes of transportationo Public transportation,

CCT/Paratransit, Rideshare, walking, taxi, biking, family or community members

• Reasonable commuteo Travel time, transfers, and cost

• Paying for travelo Individual, Medicaid waiver, SSA

work incentives, reduced public transportation fare

Transportation Risks con’t

• Looking for employment based on reasonable commute for particular person

• Travel training consumers to ensure knowledge and competence of route.

• Staying safe and teaching safeness while traveling

• Stakeouts • Financial assistance with

travel costs initially

Different Models of Employment

• Traditional wage job• Resource ownership• Independent Contractor • Entrepreneurship• Artists and Artisans

Each model has it’s own risks

Risks of Employment Models

• Going through HR

• Interview process• Fitting in with co-workers• Being singled out based on disability• Negotiating with employer

Reducing Risks Of Non-traditional Employment Models

• Customized employmento Discovery and determining what makes sense for the

individual

• Development of small business advisory councilo Taxes Implications (accounting assistance)o Business Legality (licenses, business structure)o Banking and finances (acquiring loans, profitability)o Benefits Specialist (SSA benefits guidance)o Research and Marketing (business feasibility and

guidance)

Meet Christian

Comic Man Comics on CBS news

Connecting With The Community

• To become fully successful at work, other things in life also need to be addressed:o Interview and work clotheso Coordination and help with other services and

benefits receivedo Daycare helpo Financial counselingo Budgetingo Housing

Community Supportive Partners

• Community Behavioral Health• Client Assistance Program• Social Security Administration• Department of Human Services• Career Wardrobe, Dress for Success, MenzFit, WAY• Child Care Information Services & Emergency

Daycare• The Benefits Bank• PA Health Law Project• Financial Empowerment, Clarifi, LIFT, Benephilly• PHASE group, Project HOME, PHA• Broad Street Ministries (food pantry)

Wrapping up

• The individuals that we support have the same desires in life that we do!

• Dignity of Risk

• We take the same risks!

Any questions or comments?

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