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Transition Policy changes on Steroids
“Suit the Actions to the Words”
Texas Transition Conference
Dallas, Texas
February 20, 2015
Allan I. Bergman
What’s Driving all of these Changes?
2015: Happy Anniversary 25th ADA 40th IDEA 45th DD Act 50th Medicare and Medicaid 80th Social Security
The tough question is:What has been achieved???
Employment participation 2011
PercentWorking
American Community Survey
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 25.0% 27.9%
Total U.S. Population 14.3% 15.1%
5
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.
It is expected that SSDI/SSI annual payments will reach over $1 trillion by 2023.
American Community Survey
Lives Below Poverty Threshold 2011
2008 Government Expenditures for Working-Age Adults with DisabilitiesWhat’s wrong with this picture???
$357 Billion, Federal (12% of federal spending)
$ 71 Billion, State spending Healthcare; 55% Income Maintenance; 41% Housing & Food Assistance; 3% Education, Employment & Training; 1%
Livermore, Stapleton and O’Toole, 2011
Medicaid Overview: 2012 data fromCongressional Budget Office; 5-2013
67 million beneficiaries:
47 % children ; 21% of expenditures 28% adults; 15% of expenditures 9% seniors; 15% of expenditures 16% PWD; 44% of expenditures
Total expenditures for state and federal governments, FY'11: $432 Billion…
Employment and Day SupportsIDD Agencies: Nation
ICI National Survey of State IDD Agencies
Choice
No paid job 85%
Paid job 15%
Does not want job
53%
Wants job 47%
No job goal in
ISP70%
Job goal 30%
National Core Indicators Project 2012-2013
605,680 243,339 170,337
Data on SSI Beneficiaries, 2010 4.6 million between ages 18 and 64 years (25% of these beneficiaries also received
some type of Social Security payment) Only 5% of the SSI beneficiaries of working
age reported earned income The average earned income is $286/year (for
individuals who are blind, $460/year) Less than 1% leave the rolls per year and only
½ of those for employmentSource: SSA
Annual Expenditures for Federal Cash and Health Benefits for Persons With Severe Disabilities
FY 2008 – FY 2020
$1,100
$861
$543
$426
0
200
400
600
800
1000
1200
1400
2008 2012 2016 2020
Bil
lio
ns
of
Do
lla
rs
©2008. Institute for Economic Empowerment
$1 Trillion
Source: CBPP projections based on CBO data.
Current Policies Are Not Fiscally Sustainable
Heading for a crash!
14
Budget Shortfalls
Weighty Legacy Services & Structures
Workforce Shortages
Quality Problems
Rising Unmet Demand
Antiquated Technologies
Fragmentation
The Employment First Imperative
Why do People Work?
Why should People with Disabilities seek competitive, integrated employment?
Why should People with Disabilities not work and not be expected to work?
Why Pursue Employment & The
Employment First Imperative? Get out of poverty; pay taxes
Increased independence & economic self-sufficiency
Opportunities to make friends and expand relationships
Make a contribution to the community
Positive image and valued role within the family and community
Opportunities for learning
Perception is Reality
What we believe to be true is the basis of our
personal reality and the key to how we experience
the world around us.
DISABILITY CONSTRUCT IN MULTIPLE FEDERAL LAWS
“Disability is a natural part of the human experience and in no way diminishes the right of individuals to: Live independently Enjoy self determination Make choices Contribute to society Pursue meaningful careers Enjoy full inclusion and integration in the
economic, political, social, cultural, and educational mainstream of American society.
2020
What To Do???What To Do???
We can’t stay on We can’t stay on
this spotthis spot
We need to rethink what we do – affirm our values and resolutely search for “valued outcomes”
Arc of the United Statesmission statement
“The Arc of the United States promotes and protects the human rights of
persons with intellectual and developmental disabilities and
actively supports their full inclusion and participation in the community
throughout their lifetime.”
United Cerebral Palsy
The mission of UCP is to advance the independence, productivity and full
citizenship of people with a spectrum of disabilities.
Life without limits for people with disabilities
Autism Society of America
Vision: …meaningful participation and self-determination in all aspects of life for individuals on the autism spectrum and their families;
Advocating for inclusion, participation & self-determination in all aspects of life for individuals on the autism spectrum and their families.
Defining Recovery
A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
– SAMHSA, 2011
Recovery Support Strategic Initiative
Values, Outcomes and
Guiding Principles
within Federal Legislation,Guidance &
the Court
PUBLIC POLICY IS
VALUE-BASED
Purpose of DD Act (mission)“to assure that individuals with DD & their families
participate in the design & have access to needed community services, individualized supports… that promote self-determination, independence, productivity, and integration and inclusion in all facets of community life, through culturally competent programs authorized…unique strengths, resources, priorities, concerns, abilities and capabilities of such individuals."
Assistive Technology Defined:“…any item, piece of equipment, or product system,
whether acquired commercially, modified, or customized that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.”
Includes accessibility adaptations to the workplace and special equipment to help people work;
Identical definition in 4 federal laws: Assistive Technology Act; DD Act; IDEA; and Rehabilitation Act
Individuals with Disabilities Education Act: Purpose
“to ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare
them for further education, employment, and independent living.”
20 U.S.C. 1400(d)(1)(A)
LRE National Data, FFY 2011; April 2013Students with Intellectual Disability
Ages 6-21 years
> 80% of day included 17.0% 40-79% of day included 26.6% < 40% of day included 48.8% Separate school orResidential facility 6.5%
IDEA Transition Amendments of 2004
“The term ‘transition services’ means a coordinated set of activities for a child with
a disability that:• Is designed to be within a results-oriented
process, that is focused on improving the academic and functional achievement of the child with a disability to facilitate the child’s movement from school to post-school activities, including…..
IDEA Transition amends. of 2004, cont.
postsecondary education, vocational education, integrated employment (including supported employment) continuing and adult education, adult services, independent living, or community participation;
• Is based on the individual child’s needs, taking into account the child’s strengths, preferences and interests; and,
IDEA Transition amends of 2004, cont.
• Includes instruction, related services, community experiences, the development of employment and other post-school adult living objectives, and, if appropriate, acquisition of daily living and functional vocational evaluation.”
Dept. of Ed. to Disability Rights WI.
January 2012 informal guidance on the application of LRE to transition IEPs
Melody Musgrove, Ed.D, Dir, OSEP Work placement can be an appropriate
transition service and, if determined appropriate by team, it must be in the IEP
Placement decisions, including those related to transition services (including work placement) must be based on LRE principles and made by the IEP team
IDEA 2004 says that transition is…
“A Coordinated Set of Activities” Planning must begin no later than age 16
37
Who is Involved in Transition Planning? Does the student
feel ‘invited’ or engaged in the
process?
What does youth engagement look like in transition?
I do not feel engaged in transition when…
I feel like I shouldn’t even be
there if they are not going to ask
me questions or acknowledge
me.
Youth Employment Data, August 2011, Bureau of Labor Statistics
Youth Without Disabilities 29.2% for youth between
the ages of 16 to 19
62.9% for youth between the ages of 20 to 24
Youth With Disabilities 13.2% for youth between
the ages of 16 to 19
31.2% for youth between the ages of 20 to 24
Ohio Federal Court Case on Transition Services – February 11, 2014
Southern District of Ohio, W. District Joe & Laurie Gibson, as next friends of Chloe
Gibson v. Forest Hills School District Board of Education
Chloe’s DOB is 12-16-1990 Began with administrative due process
complaint on 12-14-2009; mixed decision from state level review officer (SLRO)
Filed for Judicial review of SLRO on 6-6-2011; Chief Judge Susan J. Dlott
Gibson v. Forest Hills, cont. Court concluded that Forest Hills violated
IDEA by not providing Chloe with adequate transition services on 6-11-2013
Settlement conference with Court held on 8-20-2013 did not reach agreement
Plaintiffs then filed Motion for Transition Remedy with the Court.
Findings of the Court Chloe was not invited to the IEP The informal approach to determining Chloe’s
postsecondary preferences and interests was not sufficient (“based upon teacher’s knowledge of what she likes to do and her interests at school.”)
“focus away from job-training is consistent with Forest Hill’s belief that Chloe would participate in a recreational/leisure environment after leaving h.s., not a supported work environment.”
Findings of the Court, cont. Goodwill evaluation in summer and fall of 2010
“not able to meet competitive standards for quality and pace…did show a willingness to learn and to try new things.” Recommended if Chloe was interested in supported employment, she “participate in site specific-extended Community Based Assessments that would allow Chloe to fully identify interests assess stamina over time, & … see if repetition would improve pace & quality.”
Findings of the Court, cont. “ The Court concludes that Forest Hills
failed to invite Chloe to meetings to discuss postsecondary goals and failed to otherwise fully consider her interests and preferences. This resulted in substantive harm and a denial of FAPE.”
“The Court based its decision upon a preponderance of the evidence.”
Findings of the Court, cont. Plaintiff’s expert: Margaretha Vreeburg Izzo,
Ph.D., professor of Psychiatry at the Ohio State University and transition services consultant
Recommended major set of services as compensatory education with a focus on customized employment and community-based Discovery experiences, assistive technology assessment, job coaching, transportation and a trust fund for compensatory educational needs.
Findings of the Court, cont. Forest Hills: questions whether Chloe, given the
extent of her cognitive disabilities would receive a meaningful benefit from the employment-related skills instruction & other services proposed… contends that remedy more appropriate for children who qualified for the Turpin High School life skills classroom…she will work best in a familiar environment, with familiar individuals, and with appropriate supports.
Findings of the Court, cont. Forest Hills’ expert: Thomas Sullivan, Ph.D.
clinical neuropsychologist, certified by American Board of Prof. Psychology
Never met or observed Chloe Concluded Chloe “suffers from functional
degradation” due to seizures that have never been fully controlled by her earlier surgery or medication
…moderate to severe intellectual impairment & her ability to acquire & use new information & skills appears to be degraded.
Wisdom from President John F. Kennedy
“ The great enemy of the truth is very often not the lie – deliberate, contrived and
dishonest – but the myth – persistent, persuasive, and
unrealistic.”
Findings of the Court, cont. Dr. Sullivan recommended: for Chloe to
obtain vocational services from the Hamilton County DD Services, also stating that Chloe could not go into the community without one-to-one assistance (which was not Dr. Izzo’s recommendation
After evaluating all of the evidence and recommendations from all parties, the Judge issued her orders:
The Court Orders 120 hours of community-based employment
discovery services at a rate of no more than $70 per hour
190 hours with a job coach at a rate of no more than $56 per hour
165 hours of instruction on employment-related skills at a cost of no more than $26 per hour
115 hours of services from a customized employment consultant or approved by Dr. Izzo at a rate of $70 per hour
The Court Orders, cont.
Forest Hills reimburse the Gibsons for transportation costs up to 100 round trips into the community at a cost not to exceed $40.18 per trip
Forest Hills reimburse the Gibsons for the reasonable costs of Dr. Izzo’s services for providing the transition services remedy assessment.
State V.R. Program Policy…
“(3) It is the policy of the United States that such a program shall be carried out in a manner consistent with the following principles:
“(A) Individuals with disabilities, including individuals with the most severe disabilities, are generally presumed to be capable of engaging in gainful employment and the provision of individualized vocational rehabilitation services can improve their ability to become gainfully employed.
“(B) Individuals with disabilities must be provided the opportunities to obtain gainful employment in integrated settings. Rehabilitation Act, 1992
Rehab Act’s Presumption of Benefit“(2) Presumption of benefit(A) Demonstration: For purposes of this section, an individual shall be presumed to be an individual that can benefit in terms of an employment outcome from V.R. services, …unless the designated State unit involved can demonstrate by clear and convincing evidence that such individual is incapable of benefiting in terms of an employment outcome from V.R. service due to the severity of the disability of the individual.
Rehab Act’s Presumption of Benefit..(B) Methods: In making the demonstration required above, …shall explore the individual’s abilities, capabilities, and capacity to perform in work situations, through the use of trial work experiences…with appropriate supports provided, except when an individual cannot take advantage of such experiences. Such experiences shall be of sufficient variety and over a sufficient period of time to determine eligibility of the individual or to determine the existence of clear and compelling evidence..
V.R. Employment Outcome, 2001“Employment outcome means, with respect to an individual, entering or retaining full-time or, if appropriate, part –time competitive employment as defined in 361.5(b) (11), in the integrated labor market, supported employment, or any other type of employment in an integrated setting, including self-employment, telecommuting or business ownership, that is consistent with an individual’s strengths, resources, priorities, concerns, abilities, capabilities, interests &informed choice 34CFR361.5(b)1
Additional Federal V.R. Policy January 22, 2001: RSA implemented the
principle of integrated employment in a regulation that:
Prohibits placement in sheltered workshops or other segregated settings for “extended employment” from being counted as an employment outcome for the V.R. program.
Transforming the Front Door to Adult Supports and Services
Transition from school to adult life in the community requires:
a system of seamless supports, from Education to Rehabilitation to LTSS
in order to prevent regression, and loss of a significant investment in human
capital.WAITING LISTS ARE UNACCEPTABLE!
Rehabilitation Services AdministrationTechnical Assistance Circular 14-03
May 6 2014
Carol Dobak, Chief, VR Program Unit
Transition Planning & Services Provided Through the State VR Services Program
Rehabilitation Services AdministrationTechnical Assistance Circular 14-03
“…all students with disabilities, including those with significant and the most significant disabilities, are presumed to be eligible for VR services, unless the VR agency concludes, based on clear and convincing evidence……an employment outcome (integrated employment)”
R.S.A. TAC 14-03, cont.
“ ‘Clear and convincing evidence’ is defined, in part, as the highest standard in our civil system of law whereby VR agencies must have a high degree of certainty before concluding that an individual is incapable of benefiting from services in terms of an employment outcome. The term ‘clear’ means unequivocal.”
Results-Driven Accountability (RDA) in Special Education, Summary 4/2012
Educational outcomes of children & youth with disabilities have not improved as much as expected, despite significant federal efforts to close achievement gaps through federal IDEA and NCLB
Children with disabilities are part of, not separate from, the general education population. Special education accountability should strengthen & complement other ED reforms
R.D.A. in Special Education, 2 An emphasis on compliance over results in
special education fails to acknowledge those States where children with disabilities are achieving and being prepared for a range of college and career options appropriate to their individual needs and preferences
The accountability system under IDEA should provide meaningful information to the public on the effectiveness of State & LEAs in educating children with disabilities
RDA in Special Education, 3 The current system places heavy
emphasis on procedural compliance without consideration of how the requirements impact student learning outcomes. In order to fulfill the IDEA’s requirements, a more balanced approach to determining program effectiveness in special education is necessary.
IDEA Selected Indicators Indicator 13: the percentage of youth
aged 15 and above with an IEP that includes coordinated, measurable IEP goals and transition services that will reasonably enable the student to meet the post secondary goals (in the law)
Indicator 14: Secondary Transition/Post School Outcomes – Competitive Employment.
Dept. of Ed. Letter to States, 5/21/14 Deborah S. Delisle, Asst. Sect. for Elementary &
Secondary Education Michael Yudin, Acting Asst. Secretary for
OSERS “…Rather, we know that when students with
disabilities are held to high expectations, have access to the general curriculum alongside their same-age peers, and receive effective instruction and support, they can achieve to high academic standards.”
Dept. of Ed. Letter, 2 “Students with disabilities make up
approximately 13 percent of the school age population, and the majority of these students spend a significant amount of their day in the general education classroom. In fact, 60 percent of students with disabilities spend 80 percent or more of their day in general education, and 80 percent of students with disabilities spend 40 percent or more of their day in the general education environment.
Dept. of Ed. Letter, 3Given these numbers, it is clear that a comprehensive, integrated strategy which leverages all available resources , strongly supported by your agency is essential if we are to fulfill the ideals of IDEA: equality of opportunity, full participation, independent living, and economic self-sufficiency for students with disabilities.”
New Accountability Framework Raises the Bar for State Special Education
Programs; June 24, 2014 “To improve the educational outcomes of
America’s 6.5 million children and youth with disabilities, the U.S. DOE today announced a major shift in the way it oversees the effectiveness of states’ special education programs.
Until now, the Department’s primary focus was to determine whether states were meeting procedural requirements such as timelines for evaluations, due process
New Accountability Framework, 2
hearings and transitioning children into pre- school services. While these compliance indicators remain important to children and families, under the new framework known as Results-Driven Accountability, the Dept. will also include educational results and outcomes for students with disabilities in making each state’s annual determination under the IDEA.
New Accountability Framework, 3 ‘Every child, regardless of income, race, background, or disability can succeed if provided the opportunity to learn,’ U.S. Sect.of Education Arne Duncan said. ‘We know that when students with disabilities are held to high expectations and have access to the general curriculum in the regular classroom, they excel. We must be honest about student performance, so that we can give all students the supports and services they need to succeed.’ “
National Center for Systemic Improvement
Launched on October 1, 2014 $50 million technical assistance center “Less than 10 percent of our nation’s eighth
graders with IEPs are scoring proficient in reading…We can and must do better. RDA is about using the accountability framework to provide the states with incentives and support to implement evidence-based strategies to improve results and outcomes for students with disabilities.” Michael Yudin
The Role of Appropriate Data
Every successful enterprise uses
outcome data and information to improve
results
National Center for Systemic Improvement (NCSI)
Co-Directors: Rorie Fitzpatrick (CA.) and Kristin Reedy (VT.) of WestEd
Partners: American Institutes for Research; National Association of State Directors of Special Education; Council of Chief State School Officers; SRI International; National Parent Technical Assistance Centers Network;
Evaluator: Meadows Center for Preventing Educational Risk at UT-Austin
RDA State Data for 2012-2013 Meets Requirements: FL, GA, IN, KS, MA, MN,
MO, NE, NH, NJ, PA, VT, VA, WI, WY, Federated States of Micronesia, Marshall Islands, Palau
Needs Assistance: AL, AK, AZ, AR, CO, CT, HI, ID, IL, IA, KY, LA, ME, MD, MI, MS, MT, NM, NY, NC, ND, OH, OK, OR, RI, SC, SD, TN, UT, WA, WV, American Samoa, N. Marianas, Guam, Puerto Rico
Needs Intervention: CA, DE, DC, TX, Bureau of Indian Ed, Virgin Islands
Workforce Innovation & Opportunity Act
Bipartisan-bicameral negotiated bill passed by Congress, July 9, 2014; signed into law, July 22, 2014: P.L. 113-128
Reauthorizes Workforce Investment Act and Rehabilitation Act (V.R.)
15% of V.R. funds must be spent on students with disabilities transitioning from school to work/postsecondary education
Workforce Innovation & Opportunity Act V.R. may maintain an open case file for up to 24
months while in supported employment
Section 511 prohibits PWD under the age of 24 from working for less than minimum wage unless they first try V.R. services among other requirements.
Sen. Tom Harkin & Rep. Pete Sessions ++
Marc Gold & Associates© 78
Customized Employment
According to the 2014 Amendments to the Rehab Act (H.R. 803 Section 7 (7) (29 U.S.C. 705)
Customized Employment means competitive integrated employment, for an individual with a significant disability, that is based on an individualized determination of the strengths, needs, and interests of the individual with a significant disability, is designed to meet the specific abilities of the individual with a significant disability and the business needs of the employer, and is carried out through flexible strategies, such as:
The “flexible strategies” of Customized
Employment in WIOA
(A) job exploration by the individual;
(B) working with an employer to facilitate placement,including — (i) customizing a job description based on currentemployer needs or on previously unidentified andunmet employer needs; (ii) developing a set of job duties, a work schedule and job arrangement, and specifics of supervision (including performance evaluation and review), anddetermining a job location; (iii) representation by a professional chosen by the individual, or self-representation of the individual, in working with an employer to facilitate placement; and (iv) providing services and supports at the job location.
Marc Gold & Associates© 79
The Difference between Customizing a Position and “Job Carving”
Carving Focus on what the person
CAN’T do
Highlights that its not a “full” of “real” job
Difficult sell to employer
Sends a bad message
Customizing Focuses on what the
person CAN do
Presents as a full job that fills all needs
Makes sell easy
Sends a message of competence
Customized Employment Requires Building a “Positive Personal
Profile”
Believe in your job seeker Focus on skills – not deficits Positive; strengths based No prerequisites Everyone is “job ready” What will employer value about the job
seeker?
Free resources at marcgold.com
Activity log for Discovery and CE Profile forms, samples and guides Worksheets and sample for Customized
Plan for Employment Sample Visual Resume Employer Needs/Benefits Analysis forms
and sample Numerous articles on the CE Process
Marc Gold & Associates© 82
Competitive Integrated Employment “…means work that is performed on a full-time
or part-time basis, including self employment, (A) for which an individual is compensated at a rate that shall be not less than the higher of FLSA or the rate specified in the applicable State or local minimum wage law; and, it not less than the customary rate paid by the employer for the same of similar work performed by other employees who are not individuals with disabilities and who are similarly
Competitive Integrated Employmentsituated in similar occupations by the same employer and who have similar training, experience and skills, or in the case of an individual who is self-employed, yields an income that is comparable to the income received by other individuals who are not individuals with disabilities, and who are self-employed in similar operations or similar tasks and who have similar training, experience & skills; & is eligible for the level of benefits provided to other employees;
Competitive Integrated Employment
(B) that is at a location where the employee interacts with other persons who are not individuals with disabilities – not including supervisory personnel or individuals who are providing services to such employee – to the same extent that individuals who are not individuals with disabilities who are in comparable positions interact with other persons;
Competitive Integrated Employment
And ( C ), that as appropriate, presents opportunities for advancement that are similar to those for other employees who are not individuals with disabilities and who have similar positions.” (Section 7, U.S.C. 705 as amended in WIOA, July 2014)
Findings of Congress in the Americans with Disabilities Act
“physical or mental disabilities in no way diminish a person’s right to fully participate in all aspects of society, yet many people with physical or mental disabilities have been precluded from doing so because of discrimination others who have a record of a disability or are regarded as having a disability also have been subjected to discrimination.”
Signed into law July 26, 1990 (24 yrs. ago)
ADA Findings, cont.
“Historically, society has tended to isolate and segregate individuals with disabilities, and, despite some improvements, such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem.
ADA Findings, cont.
“Individuals with disabilities continually encounter various forms of discrimination, including outright intentional exclusion... overprotective rules and policies, failure to make modifications to existing facilities and practices, exclusionary qualification standards and criteria, segregation, and relegation to lesser services, programs, activities, jobs….
ADA Findings
The continuing existence of unfair and unnecessary discrimination and prejudice denies people with disabilities the opportunity to compete on an equal basis and to pursue those opportunities for which our free society is justifiably famous, and costs the United States billions of dollars in unnecessary expenses resulting from dependency and nonproductivity.
Goals of the Americans with Disabilities Act of 1990
The nation’s proper goals regarding individuals with disabilities are to assure: Equality of Opportunity Full Participation Independent Living Economic Self Sufficiency
ADA INTEGRATION MANDATE
“A public entity shall administer services, programs and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.”
28CFR section 35.130(D)
The Role of the ADA and Olmstead
Cannot be ignored June 22, 2011 was 12th anniversary of the
Olmstead Supreme Court Decision DOJ issued:Statement of the Department of Justice on Enforcement of the Integration Mandate of
Title II of the Americans with Disabilities Act and the Olmstead v. L.C.
DOJ on the ADA, June 22, 2011
Integrated settings are located in mainstream society; offer access to community activities and opportunities at times, frequencies, and with person’s of an individual’s choosing; afford individuals choice in their daily life and activities; and, provide individuals the opportunities…..
DOJ on the ADA, June 22, 2011
The “most integrated setting” is defined as “a setting that enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible.”
DOJ, June 22, 2011, cont.
Segregated settings include, but are not limited to:
(1) congregate settings populated exclusively or primarily with individuals with disabilities;
DOJ, June 22, 2011, cont.
Segregated settings include, but are not limited to:
(2) congregate settings characterized by regimentation in daily activities, lack of privacy or autonomy, policies limiting visitors, or limits on individuals ability to engage freely in community activities and to manage their own activities of daily living
DOJ, June 22, 2011, cont.
Segregated settings include, but are not limited to:
(3) settings that provide for daytime activities primarily with other individuals with disabilities
DOJ, June 22, 2011, cont.
A public entity may violate the ADA if it promotes or relies upon the segregation of individuals with disabilities through its: Planning Service system design Funding choices, or Service implementation practices
DOJ, June 22, 2011, cont.
Public entities are required to have:
“a comprehensive, effectively working Olmstead plan…that must contain concrete and reliable commitments to expand integrated opportunities.
DOJ, June 22, 2011, cont.
The plan must have specific and reasonable timeframes and measurable goals… the public entity may be held accountable, and there must be funding to support the plan, which may come from reallocating existing service dollars
DOJ, June 22, 2011, cont. The plan should include commitments for each group unnecessarily segregated such as individuals with developmental disabilities spending their days in sheltered workshops and segregated day programs.
The plan must demonstrate success by moving individuals to integrated settings in accordance with the plan.”
Statement of Eve Hill, Sr. Counsel to Asst. Attorney General for Civil Rights
“ The Supreme Court made clear over a decade ago that unnecessary segregation of PWD is discriminatory. Such segregation is impermissible in any state or local government program whether it be residential services, employment services or other programs. Unfortunately the type of segregation and exploitation we found [in Rhode Island] is all too common when states allow low expectations to shape their disability programs.”
U.S. v. State of Rhode Island Consent Decree
April 2014 to resolve complaint filed January 2013
Does not impact interim settlement of June 2013 re: Providence
Ten year plan to transform entire system from segregated day and sheltered work
Annual targets and benchmarks Many service definitions including
Customized Employment and Discovery
US DOJ-Rhode Island Consent Decree
Central theme is increasing integration; ensuring that PWD have same access to community (employment, leisure and daily life) as peers without disabilities
People in R.I. in supported employment are also entitled to community-based integrated day services and supports as a “wrap around” for up to 40 hours per week.
US DOJ-Rhode Island Consent Decree
Individuals can seek a variance to remain in a segregated setting only if they try integrated employment first, including a community-based supported employment assessment, work incentives benefits counseling and a trial work experience in the community.
This constitutes “informed choice”.
US DOJ-Rhode Island Consent Decree
Transition finding: about 5% of youth with ID/DD leaving school between 2010-2012 transitioned into integrated employment
R.I. Dept. of Ed. will adopt an Employment First policy, making integrated employment a priority service for youth
State agencies will promote the implementation of school to work transition planning process with specific timelines and benchmarks for all youth 14 - 21
U.S. v. Rhode Island, cont.
Youth in transition will receive Integrated vocational and situational
assessments, including Discovery Trial work experiences An array of other services to ensure that
they have meaningful opportunities to work in the community after exit school
Work will average 20 hours/week Integrated work & non-work hours will total
40 hours/week.
Maryland Works State Use Program
Board issued decision July 7, 2014
“In light of the changing nature of what constitutes appropriate and acceptable employment services for people with disabilities, Maryland Works is phasing out assignment of Employment Works Program (EWP) contracts for completion in sheltered workshops.”
Maryland Works State Use Program
Any new EWP contract which will be completed in a sheltered workshop will have an end-date of June 30, 2015
All current EWP contracts tied to sheltered workshops will be discontinued on June 30, 2015.
Maryland Works State Use Program
“As you know, there has been a flurry of activity undertaken, by a wide range of private and public entities, aimed at ending sheltered workshop services. Chief among these activities has been the Department of Justice…”
Maryland Works State Use Program
“Actions by the DOJ have resulted in greater clarity as to what is and is not acceptable in services provided for people with disabilities. It is abundantly clear that, when it comes to employment related services, sheltered workshop services are no longer acceptable as anything other than a last resort; and, even that use of sheltered workshop services is highly questionable and out of favor.”
U. S. Senate Committee on Health, Education, Labor & Pensions (HELP)
Unfinished Business: Making Employment of People with Disabilities a National Priority
Senator Tom Harkin, Chair
July 2012
Statement of Senator Harkin“ Specifically, I call for public & private sector
employers to set goals for boosting disability employment, … opportunities for entrepreneurs with disabilities, improved services to young people with disabilities that can lead to better employment outcomes after graduation, and bipartisan reforms to the largest disability entitlement programs so that they consistently support the efforts of people with disabilities to achieve success in the labor market and become part of the middle class.”
National Governors AssociationA Better Bottom Line: Employing People with Disabilities
July 2012
Governor Jack Markell (DE.), NGA Chair, 2012- 2013
Focus on the employment challenges that affect individuals with intellectual and other significant disabilities
Partnerships “Government, business, the general public, individuals with disabilities, and their
families…all stand to benefit from increased
employment of people with disabilities; all have a role and shared responsibility in reaching this goal.”
A Better Bottom Line: Why? The Right Thing to Do – Individuals with
disabilities have demonstrated ability and are an untapped resource.
The Smart Thing for Government to Do - Individuals with disabilities are heavily reliant on government benefits. When people with disabilities are employed and living more independently, they are less reliant on government payments and contribute to the economy
A Better Bottom Line, cont. Makes Good Business Sense – Individuals
with disabilities are a valuable asset for business. There are business models throughout the United States with proven results.
Community – Providing employment opportunities for individuals with disabilities is an important factor in promoting their integration into the community
Dept. of Education: PROMISE GrantsPromoting Readiness in S.S.I.
Competitive aps., Aug. 19, 2013 Funding for 3-6 states for up to 5 years State to develop & implement Model
Demonstration Projects (MDPs) to promote positive outcomes for children who receive SSI & their families
To improve provision & coordination of services/supports for this population to achieve improved results with Outcome-based Payment Models (OBP).
Promise Grants Awarded; Sept. 2013
Arkansas $32,427.44 California $50,000.00 Maryland $31,190.76 New York $32,500.00 Wisconsin $32,497.81 ASPIRE- 6 state $32,500.00Collaboration of Utah, S. Dakota, N. Dakota,Montana, Colorado and Arizona
CMS Issues Updates to Medicaid Waiver Technical Guide on Employment
Services; September 16, 2011“We hope that by emphasizing the importance
of employment in the lives of people with disabilities, updating some of our core
service definitions, and adding several new core service definitions to better reflect best and promising practices that it will support States’ efforts to increase employment
opportunities and meaningful community integration for waiver participants.”
Major Changes in Waiver, cont. Adds a new core service definition by splitting
supported employment into individual and small group
Adds new service, career planning Emphasizes critical role of person centered
planning Acknowledges self-determination, peer support &
other best practices Clarifies that Ticket to Work Outcome and Milestone
payments are not in conflict with Medicaid services rendered payments
Major Changes in Waiver, cont. Modifies both the prevocational and supported
employment definitions to clarify that volunteer work and other activities that are not paid, integrated community employment are appropriately described in pre-voc, not supported employment services.
Explains that pre-voc services are not an end point, but a time limited (no limit is given) service for the purposes of helping someone obtain competitive employment.
CMS Imposes Special Terms & Conditions on New York State’s OPWDD
“The receipt of expenditure authority for transformation for 4/1/13 – 3/31/14, is contingent on state’s compliance and CMS’ receipt of the following deliverables:”
Baseline # of people receiving supported employment services & in competitive employment for 5/1/12 – 4/30/13
Increase that number by 700 people with no exception for attrition, and
Increase by 250 persons by 10/1/13
CMS & N.Y. OPWDD, cont. Effective July 1, 2013, New York will no longer
permit new admissions to sheltered workshops and must report quarterly enrollment in sheltered workshops
On 10/1/13, submit a draft plan for review and final plan by 1,1/2014 on transformation to competitive employment
To include detailed work plan (sic) for number of students exiting educational system moving directly into competitive employment
CMS & N.Y. OPWDD, cont.
Plan must include a timeline for closing sheltered workshops, and a description of the collaborative work with the New York educational system for training/education to key stakeholders on the availability and importance of competitive employment.
Social Security’s Mixed Social Security’s Mixed Message to People with Message to People with
DisabilitiesDisabilities
CMS Issues Final Rules on HCBS and the Definition of Community: Jan. 16, 2014
Applies to 1915 ( c ) HCBS waivers; 1915 ( I ) SPA for HCBS; and, 1915 ( k ) Community First Choice SPA
Extensive criteria for the development of a “person centered plan”
“Informed choice” “Providers of HCBS for the individual, or those who
have an interest in or are employed by a provider of HCBS for the individual must not provide case management or develop the PCP……
CMS Final Rules, 1-16-2014, cont.…except when the State demonstrates that the only willing and qualified entity to provide case management and/or develop person-centered service plans in a geographic area also provides HCBS.”Home & Community-Based Settings – “must have all of the following qualities, and such other qualities that the Secretary determines to be appropriate, based on the needs of the individual as indicated in their person-centered service plan:…..
CMS Final Rule, 1-16-2014, cont. “ (i) The setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.(ii) The setting is selected by the individual from among setting options including….
CMS Final Rules on HCBScontinued
#3. “Optimizes, but does not regiment individual initiative, autonomy, and independence in making life choices, including, but not limited to, daily activities, physical environment, & with whom to interact.”
“Supports full access to the greater community – opportunities to engage in community life – choice of
daily activities and with whom to interact” How do people engage in community life? What are daily activities? What is an everyday life? Planned activities in the home community within all of life’s activity domains:
Work Volunteering - at soup kitchen, community clean up, or other neighborhood service Learning experiences and activities; books on tape; book clubs and art classes; self-
help classes; Joining community organizations Recreation – swimming, bowling, dancing, movies Social Life – getting together with family and friends; Peer support groups Shopping Maintain health and wellness – walking; gym membership; diet groups; going to
medical appt. Personal care – hairstyling, having nails done, Maintaining home; maintenance and improvement; cleaning; laundry Caring for others; relatives or friends Spirituality: worship; meditation; yoga classes; Hobbies: Pet care – walking the dog; gardening, painting; photography Going on vacation
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Metrics and measurement; accountabilityAll costs must produce clear measurable
outcomes; cost effectivenessEquity in resource allocation & incentivesPockets of excellence must be scalableDisparities in outcomes must translate
statewideSustainable value that can be quantifiedTransformational policy across state agencies,
infrastructure changes and capacity building are essential
Adapting to the “New Normal”
Where Do We Go?What Do We Do?
Presumption of Employability
“ Everybody is a genius. But if you judge a fish by
its ability to climb a tree, it will live its whole life
believing that it is stupid.”Albert Einstein
Employment First is the ImperativeEmployment First is the Imperative General theme:
Employment in the community is the first/primary service option for individuals with disabilities
APSE Statement on Employment First
Employment in the general workforce is the first and preferred outcome in the provision of publicly funded
services for all working age citizens with disabilities, regardless of level of disability.
Employment First is Employment First is not just aboutnot just about
“best practice”.“best practice”.
It is aboutIt is aboutclear public policiesclear public policiesthat employment is that employment is
the prioritythe priority
Employment First is Employment First is not just aboutnot just about
“best practice”.“best practice”.
It is aboutIt is aboutclear public policiesclear public policiesthat employment is that employment is
the prioritythe priority
A critical focus of Employment First must be on shifting public resources to be in alignment with our values…
Texas Employment First Legislation:SB 1226, 83rd Session; 2013
Employment established as the first and preferred option for working age Texans with disabilities
Established the Interagency Task Force to promote competitive employment of indivdiuals with disabilities & the expectation that indivdiduals with disabilities are able to meet the same employment standards, responsibilities & expectations as other working age adults.
Employment First in Texas “Integrated and competitive employment is
the primary goal and priority for citizens using publicly funded services regardless of disability or level of disability”
Guiding Principles for E.F. in Texas: PWD become as self-sufficient as possible Youth with disabilities have integrated
work experiences for transition into the workforce and self-sufficiency
E. F. Guiding Principles, 2 Presumed that PWD can earn competitive wages in
integrated employment & have the right to pursue range of opportunities
Work key to QOL for all; benefits include: Earning & keeping wages to spend Developing & expanding relationships Seen as contributing member of society Full inclusion in all aspects community Increased health & safety; more visibility Increased self-esteem Development of a career path…….. Power & choice of life beyond services
E.F. Guiding Principles, 3 Anyone who wants to be employed should
receive education, training & employment services & support as long as needed to obtain & maintain integrated, competitive employment, regardless of disability or level of disability
Individual preferences & informed choice drive the process
All relevant state agencies have a shared responsibility to implement E.F. principles; partnerships, vision & creativity
Is Texas Alone?
32 states haveformal EmploymentFirst policies
44 states have Employment Firstinitiatives underway
Costs and Outcomes of Supported and Sheltered Employment
Robert Evert Cimera, Ph.D.Kent State University
What are the Costs of Supported and Sheltered Employment?
Cumulative Costs SE: $18,813SW: $46,855
Cost per Hr. Worked SE: $11.88
SW: $17.12
Cost per Dollar Earned SE: $2.02SW: $9.39
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Individuals in both SE and SW at the same time. Source: Cimera (2011)
What is the Return on Investment?
• Is SE more cost-efficient to workers? SE: $4.20 SW: $0.24
Is SE more cost-efficient to taxpayers? SE: $1.21 SW: $0.83
• Regardless of disability or its severity, SE has a better ROI than SW
Cimera, 2010
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Are SWs “Value Added”?(ID)
No Sheltered Settings
Earnings $137
Cost $4,543
Sheltered Settings
Earnings $119
Cost $7,895
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9,808 Supported Employees with Intellectual Disabilities
42.5% decrease in cost; 15.1% increase in earnings (Source: Cimera, 2011)
Do Transition Services Matter?(Rates of Employment—ID)
By Age 14
2006 74.3%*
2007 61.7%*
2008 69.7%*
2009 42.8%*
By Age 16
57.8%
57.0%
53.8%
28.2%
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7,520 Transition-Age Students with ID (Source: Cimera et al., in prep)
Be Passionate about the Mission
“Cowardice asks the question: is it safe?Expediency asks the question: is it politic?Vanity asks the question: is it popular? ButConscience asks the question: is it right?
And there comes a time when one must take a position that is neither safe, nor politic, nor
popular – but one must take it simply because it is right.”
Dr. Martin Luther King, Jr.
Wisdom from Jim Collins
“Great performance is about 1% vision and
99% alignment”(It all starts with a vision and then a
specific plan and process to execute that vision.)
Built to Last
Aligning Federal Agency Policy & Financing1988-2013
WORK
PLAY
FRIENDS
EMPLOYMENT FIRST IMPERATIVE
“All people, regardless of severity of their disabilities,
are entitled to integrated employment with the correct job match and appropriate
supports.” June 23, 2013
Helen Keller
“Alone we can do so little; together
we can do so much.”
“Equal Justice Under the Law”
For Additional Information, contact
Allan I. BergmanPresident & CEOHIGH IMPACT
Mission-based Consulting & Training757 Sarah Lane
Northbrook, IL. 60062(773) 332-0871
