Establishing Effective Partnerships with State Vocational Rehabilitation Agencies

Establishing Effective Partnerships with

State Vocational Rehabilitation Agencies

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Agenda• Welcome and Introductions• Overview of learning objectives and agenda• WIPA/VR Relationship survey• Overview of the VR process• Linking VR service delivery to the WIPA

employment continuum• Benefits counseling along the employment

continuum: Negotiating expectations

Agenda - Continued

• Guest Speaker: Angie Howell, WIPA Program Manager, Easter Seals Nebraska. Dennis King, VR Liaison, Department of Education, Vocational Rehabilitation, Nebraska.

• Questions• Partnership Plus program overview• Guest Speakers: Joyce Armstrong, Nora Bishop,

Bureau of Rehabilitation Services, Connecticut• Questions• Closing remarks

Learning Objectives• To examine the various ways in which WIPA programs

across the country are working with Vocational Rehabilitation and discuss strategies for establishing effective policies and practices for appropriate referrals between agencies.

• To incorporate the employment continuum while working with VR consumers and counselors.

• To understand Partnership Plus, and how to counsel beneficiaries so that they are empowered to use this service delivery option to their advantage to obtain necessary employment supports, and access the protections afforded by the Ticket to Work program.

WIPA/VR Relationship Survey

Vocational Rehabilitation BasicsPurpose

Vocational Rehabilitation (VR) assists individuals with disabilities to obtain, regain, or maintain and

advance in employment. Goal: To maximize employment, independence and integration into the workplace and the community

Eligibility– Individuals must have a physical or mental

impairment that results in a substantial impediment to employment;

– Be able to benefit from VR services; – Need VR services to gain and maintain employment.

Individuals receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) are presumptively eligible for VR services.

Understanding VR Performance Measures

• Measured by the Federal Evaluation Standards and Performance Indicators

• Evaluation Standard State agencies must assist any eligible individual, including an individual with a significant disability, to obtain, maintain, or regain high quality employment.

• Performance IndicatorsThe seven indicators are listed on the

handout titled – VR Performance Indicators

VR Agency must pass 4 out of 7 of the indicators

http://www.ed.gov/rschstat/eval/rehab/standards-archive.html

Stages of VR Case Progression

• Application• Eligibility Determination - 60 days

• Assessment- May include vocational evaluation, referrals for testing, gather information for the development of the IPE

• Individualized Plan for Employment (IPE)- Defines job goal and services necessary to achieve the goal (informed choice)

• Case Closure

• Post-employment Services

Assessment

• Prior to developing the IPE there must be a comprehensive assessment, to the extent necessary, to determine the employment outcome, objectives, and nature and scope of VR services.

• The assessment evaluates the unique strengths, resources, priorities, abilities and interests of the individual.

• Assessments can include educational, psychological, psychiatric, vocational, personal, social and medical factors which affect the needs of the individual.

• May also include a referral for the provision of rehabilitation technology services to assess and develop the capacities of the individual to perform in a work environment.

The IPE

The IPE must include: • The specific employment outcome, chosen by the

individual, consistent with the individual’s unique strengths, concerns, abilities and interests.

• The specific VR services to be provided, in the most integrated setting appropriate to achieve the employment outcome.

• The timeline for starting services and achieving the employment outcome.

• The specific entity, chosen by the individual, to provide the VR services and the method chosen to procure those services.

The IPE(continued)• The criteria for evaluating progress• The responsibilities of the VR agency, the individual

(to obtain comparable benefits) and any other agencies (with regard to obtaining comparable benefits)

• In states that have a financial needs test , any costs for which the individual will be responsible

• For individuals with the most significant disabilities who are expected to need supported employment, the extended services to be provided

• The projected need for post-employment services, if necessary

Examples of Services that VR can Fund

• Counseling, guidance and job placement services

• Vocational and other training, including higher education and the purchase of tools, materials and books

• Diagnosis and treatment of physical or mental impairments to reduce or eliminate impediments to employment, to the extent financial support is not available from other sources, including health insurance or other comparable benefits

• Maintenance for additional costs incurred during rehabilitation

VR Service Examples (continued)

• Transportation, including adequate training in the use of public transportation, vehicles, and systems needed by the individual to achieve an employment outcome

• Personal assistance services while receiving VR services

• Interpreter services for individuals who are deaf, and readers, rehabilitation teaching and orientation and mobility services for individuals who are blind

• Occupational licenses, tools, equipment, initial stocks and supplies

More VR Service Examples

• Technical assistance for those who are pursuing telecommuting, self employment or small business operation

• Supported employment

• Rehabilitation technology (i.e., AT), including vehicle modification, telecommunications, sensory, other aids and devices

• Transition services for students with disabilities to facilitate the achievement of the employment outcome identified in the IPE.

Closing the Record of Service

In order for VR to Close a record of services as a successful employment outcome, the following conditions must be met:

• the individual must be employed at a competitive wage for no less than 90 days

• the individual and VR counselor must agree that the employment outcome is satisfactory

• The VR agency must also notify the individual that post-employment services may be available even after the record is closed.

Post Employment Services are discrete services

• Necessary for the individual to maintain, regain or advance in employment.

• Example - maintain employment: the individual’s employment is jeopardized because of conflicts with supervisors or co-workers and the individual needs mental health services and counseling

• Example - regain employment: the individual’s job is eliminated through reorganization and new placement services are needed

• Example - advance employment: the employment is no longer consistent with the individual’s strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice

What VR Counselors Want• Consumers who want to work – VRCs are

evaluated by the number of their consumers that go to work.

• Case movement - cases that move forward to employment. Every state has cases that have been with them for over ten years with no hope of employment.

• A manageable caseload with an adequate budget.

• Successful closures – clients employed at competitive wages for over 90 days.

• Limited Post-Employment Cases - clients who return for services within three years after being successfully closed.

WIPA Basics

Purpose• To promote employment and enhance self

sufficiency for individuals receiving a benefit from Social Security based on disability. (including 1619(B) and EMPC)

Eligibility• Be at least age of 14, but not yet full retirement

age,• Be disabled per Social Security’s definition, and• Already receiving a benefit from Social Security

based on disability (SSI, SSDI, CDB or DWB).

The Employment Continuum

• Contemplative Stage: deciding whether to work, few to no steps taken toward employment.

• Preparatory Stage: decision made to pursue work, some steps taken in refining job goal

• Job Search Stage: actively looking for employment/ business ownership, clear vocational goal, using employment services

• Employment Stage: working, begun self-employment, changing jobs, promotion

Beneficiaries at each stage have unique requirements for work incentives counseling , information and support

The Employment Continuum and VR Services

• Pre-eligibility and Eligibility Determination- Beneficiaries are likely to be at the Contemplative or Preparatory Stage- may not have a career goal, uncertainty about services available.

• Assessment- Beneficiaries are likely to be in the Preparatory Stage-decision has been made to go to work, beginning to decide on a job goal, taking steps to begin job search

The Employment Continuum and VR Services

• IPE- Beneficiaries are in the Preparatory or Job Search Stage- may be acquiring training or education, supported employment, actively looking for work. At the completion of the IPE, they will be in the Employment Stage.

• Case Closure- Beneficiaries are in the Employment Stage- have begun working for pay/self-employment. May be considering promotion, change in hours, etc.

Benefits Counseling along the Employment Continuum/ VR

Services Timeline• Contemplative Stage- (Pre eligibility,

eligibility) Beneficiary concerns- impact of work on benefits/health insurance, family. Unsure about employment options. WIPA Services- Information and referral, fact sheets, SSA publications, general information. Follow up contacts as needed. BSA/WIP development would be rare, but may be appropriate in isolated cases.

Benefits Counseling along the Employment Continuum/ VR

Services Timeline

• Preparatory Stage- (Assessment, IPE) Beneficiary concerns- How potential job goal might affect benefits, what services do they need. WIPA Services- Referrals, screen for work incentives, including PASS. Explain advantages/requirements of Ticket to Work. BSA/WIP development as appropriate- as job goal is defined. Follow up to ensure progress is being made, problem resolution.

Benefits Counseling along the Employment Continuum/ VR

Services Timeline• Job Search Stage (IPE) - Beneficiary

concerns- how the particular job will affect benefits, choices/protections for health insurance, benefits for other family member. Other benefits, such as food stamps, HUD. WIPA Services- Probe for potential future use of work incentives, provide more detailed explanations that are individualized. Examine the cost/benefit of job offers. Provide more detailed counseling on health insurance options. Information about recordkeeping/reporting requirements. BSA/WIP development or updated.

Benefits Counseling along the Employment Continuum/ VR

Services Timeline

• Employment Stage- (IPE, Case Closure) -Beneficiary concerns- changes in employment status, benefit cessation, health insurance, overpayments. WIPA services- Encourage focus on financial outcome- maximize employment when feasible. Provide detailed , individualized written information. BSA/WIP updates. Follow-up at critical touchpoints

WIPA/VR PartnershipsWIPA collaboration requirements include:• Communicating directly with agencies to build

understanding of their missions, eligibility rules, policies and procedures, and services provided.  

• Educating employment service community on role of WIPA in directly supporting employment efforts of beneficiaries.  

• Identifying, developing, and implementing formalized processes for joint employment and work incentive/support planning for beneficiaries. 

• Implementing strategies to build knowledge of use of work incentives to provide access to employment services and supports and how use of these incentives can be incorporated into vocational planning, job development, and employment support efforts.

Why Should VR Want to Partner With WIPA?

• It is generally agreed that job seekers are much more likely to achieve and sustain a work goal when fully informed about work incentives.

• Benefits systems are complex-beneficiaries need ongoing benefits resources to support their transition to work.

• Through collaboration, VR can focus on employment, while WIPA can support benefits issues.

• WIPA and VR could be substantially stronger by using each other’s expertise to help beneficiaries to achieve their employment goals.

How VR Helps WIPA

• By providing quality referrals to ensure that beneficiaries get work incentives information. They are working with a beneficiary on an employment goal, so can “prescreen” referrals to WIPA. This can help limit the initial screening process to determine eligibility, which in turn saves valuable time.

• The Work Incentive Plan (WIP) is largely directed by the beneficiary with the assistance of the CWIC. Some tasks on the WIP can be delegated to VR counselor. Conversely, some WIP steps may be taken from the IPE

How VR Helps WIPA

(continued)

• Other partners also have access to information and services that may be outside the CWIC’s area of expertise. VR counselors are advisors in the employment process and can help to connect beneficiaries to other necessary services.

How WIPAs Help VR

• CWICs have direct access to SSA, and can assist in development of previous work that may impact future work and benefits.

• CWICs help VR to meet their agency goals in relation to placements via the information they provide to both beneficiaries and providers. Addressing fears of work impact on benefits increases the likelihood that VR consumers will work, as well as set higher targets for work effort and earnings.

• CWICs can provide technical information on Ticket options.

• CWICs can help identify an EN for ongoing support services

How WIPAs Help VR

(continued)• CWICs identify, develop, and support management

of work incentives to assist with costs of employment.

• Long term planning for benefit transitions throughout the employment process to reduce benefit bumps in the road and increase the likelihood that beneficiaries stay employed

Communicating Clear ExpectationsParameters of Expectations• Level/Intensity of Work incentives Counseling• Type of documentation provided to VR staff and when

provided• WIPA programs obligation to provisions of SSA

cooperative agreements• Differences between role of CWICS who work in WIPA

programs vs. Community PartnersStrategies for Success• Development of agreements at the agency level• Provide clear, written guidelines for referral and

services provided• Have a clear understanding of VR services and

regulations

Establishing effective policies / practices for appropriate referrals

between agencies • Best to establish an interagency agreement between

VR (state level) and all WIPAs in the state, if possible. – How referrals will be made by each party – What documentation will be shared and process

for this– Addresses confidentiality and conflict of interest

issues (e.g. release of information)– Addresses data sharing and QA issues

• Follow up interagency agreement development with negotiation of protocol/procedure discussions with each local office

Best Practices / Strategies • Provide VR with written referral guidelines that:

– Address eligibility for WIPA services– Indicates the prioritization set by SSA and the

implications for beneficiaries referred before IPE/goal development is completed

– Provides examples of each of the above– Identifies paperwork that will be shared by VR with

WIPA and vice-versa related to shared customers– Identifies who to contact if there is an issue that is

not resolved at the counselor/CWIC level• Meet at least twice yearly with field office supervisor

to modify procedures based on lessons learned

Guest Speaker

Angie Howell, WIPA Program Manager

Easter Seals, Nebraska

Dennis King, Department of Education, Vocational Rehabilitation, Nebraska

Questions?

• We will now take some time for the audience to ask questions about any of the topics that have been presented so far.

• How to ask a question:– Follow operator instructions to ask your

question verbally, OR– Type your question in the text chat box.

Partnership Plus - Overview

• In 2008, the Social Security Administration (SSA) issued revised regulations that significantly improved the Ticket to Work (Ticket) program. This included the advent of Partnership Plus

• SSA hopes to encourage more organizations to become Employment Networks (ENs) and increase the types and number of ENs available to serve Ticket Holders

• Promote partnering between organizations and expand the range of services available to Ticket Holders

• Improve the coordination of Vocational Rehabilitation (VR) and EN services and the various SSA Work Incentives.

Partnership Plus- In-Use SVRA• In most states, VR has chosen the Cost Reimbursement

(CR) system for almost all beneficiaries served. The CR system reimburses State VR agencies for money that is spent rehabilitating beneficiaries.

• A VR agency may submit for CR when a beneficiary has completed a continuous period of Substantial Gainful Activity (SGA) for 9 out of 12 months.

• The new regulations create a new status, “in-use SVRA,” for those situations where VR is serving a beneficiary under the traditional CR program.

• Affords beneficiaries the same protections against Medical Continuing Disability Reviews (CDRs) as associated with Ticket assignment. When a Ticket is in this status, it is not otherwise available for assignment to another EN.

Partnership Plus – Sequential Services

• Under the Partnership Plus option, the beneficiary may initially receive VR services to meet his/her intensive up-front service needs under the CR system (in-use SVRA).

• After the VR case is closed, the Ticket Holder may assign his/her Ticket to an EN and receive job retention services or ongoing support services.

• The EN has the potential to earn Phase 2 Milestone and Outcome payments.

Milestone Payments to EN when VR is Involved

• Ticket payments are based on work-related milestones and outcomes occurring after Ticket assignment and after job placement

• VR provided services leading to job placement and initial efforts at self-supporting employment

• When a beneficiary’s VR CR case is closed successfully (person is employed), the Phase 1 milestones are not available to the EN that subsequently gets the Ticket assignment

• Level of employment at case closure (hours, earnings) does not matter

• Even with the loss of the Phase 1 Milestone payments, each Ticket still has a value of $16,000 to $17,000

Facilitating Informed Choice

• SVRAs are mandated to provide information to facilitate informed choice by their consumers. Options include:

• Refer beneficiaries to the MAXIMUS web site for a list of approved ENs: www.yourtickettowork.com

• Provide beneficiaries with a list of approved ENs serving the area

• Provide beneficiaries with a list of ENs that offer the specific services the beneficiary needs

• Refer a beneficiary back to an EN that provided services to him/her under a VR vendor agreement while the VR case was open

VR-EN Agreements

State VR agencies and ENs should enter into written agreements when:

• An EN is referring Ticket Holders to VR and keeping the Ticket assignments: Only time an agreement is “required” in Ticket regulations

• Creating a coordinated system of services that includes structured referrals

• Information on beneficiary service needs, earnings, etc. will be shared

• Revenue obtained through EN payments will be shared• VR is purchasing post-employment or job retention

services from an EN as identified in IPE

Partnership Plus Models

A variety of Partnership Plus models are emerging• A few VR agencies have pilot projects where VR

functions as an EN for certain populations (e.g., SE, MH) –Some are sharing Phase 1 Milestones with ENs

• A few VR agencies are partnering with CRPs to function as a single EN

• To address the loss of Phase 1 Milestone payments, a few VR agencies are purchasing needed post-employment services from ENs that are VR vendors (services added to IPE based on discussion of post-employment needs)

Partnership Plus Models

A variety of Partnership Plus models are emerging

(continued)

• A few VR agencies are providing short-term job retention payments to VR vendor/ENs that assist beneficiaries to retain or advance in employment (e.g., case closed below SGA and EN helped beneficiary achieve nine months of SGA level earnings)

Advantages of Partnership Plus

• Strengthening partnerships between VR agencies and ENs to expand the scope of services and supports available to assist beneficiaries in entering and re-entering the workforce.

• Improving the coordination of services provided by VR agencies and ENs.

• Proving a longer period of employment support to increase the beneficiary's successful sustained employment.

Advantages of Partnership Plus• Providing funding to support ongoing services and

supports for beneficiaries in Supported Employment programs.

• Maintaining and expanding best practices, ethical standards, and support for consumer rights and choices.

• Maximizing CR payments for VR agencies and Ticket payments for ENs.

• Minimizing the administrative tasks associated with CR and Ticket payments.

• Ensuring that beneficiaries understand their options and choices under the TTW program and how work can affect their benefits.

The Future of Partnership Plus• New approaches to service delivery are evolving . There

are many opportunities for meaningful cooperation under the Ticket to Work (TTW) program.

• Exciting new prospects for VR-EN partnerships mean a better mix of services for beneficiaries and improved coordination of services.

• The Partnership Plus option represents the first influx of new monies in many years into the service delivery system.

• Partnership Plus represents an opportunity for service providers and beneficiaries to exercise increased control over employment services.

• Success depends on beneficiaries understanding options under Ticket program after VR case closure

• This could represent a win-win situation for all involved.

WIPA and VR- Ticket to Work

• CWICs counsel beneficiaries on the TTW program, including defining good Ticket candidates, explaining the benefits of using a Ticket, timely progress reviews, and Ticket assignment issues

• CWICs help beneficiaries understand the implications of ticket assignment or “in use SVR” when working with VR, especially timely progress reviews and CDR protections

• VR counselors can defer to CWICs to explain the implications of ticket assignment or “in use SVR” to the Beneficiary

• CWICS can provide ongoing follow up services to encourage beneficiaries to utilize ticket assignment under Partnership Plus to maintain employment

Guest Speakers

Joyce Armstrong and Nora BishopBureau of Rehabilitation Services - CT

Questions/Closing Remarks

• We will now take questions on the Partnership Plus program, and any other concerns from the audience

• Closing remarks