Using Data to Inform Strategic Planning and Systems Change: Voices from Connecticut

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• Using Data to Inform Strategic Planning and
  Systems Change Voices from Connecticut

• University of Connecticut Health Center
• Cynthia Gruman
• Julie Robison
• Connecticut Bureau of Rehabilitation Services
• Amy Porter
• Dawn Lambert

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Introduction
In January of 2006, the Connect to Work Center at
the Bureau of Rehabilitation Services implemented
a Comprehensive Employment Opportunities grant
under the Medicaid Infrastructure Grant (MIG)
program. Shortly after receiving the award, the
state embarked on a comprehensive strategic
planning process. The results of this process
will shape the next five years of policy and
program implementation.
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Purpose

• The purpose of Connecticuts plan is to maximize
  opportunities for self-sufficiency and full
  participation. In simple terms . . .
• A job for everyone
• who wants one!

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Work and Employment

• is a context to which people devote most of
  their waking hours and from which they derive an
  essential measure of their identity.
• Hulin, 2002
• provides a source of autonomy, self-esteem,
  relationship outside of the family, purpose in
  life, income and security.
• (Altschuler, 2004 Philipson, 2002)

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Timeline

• November 2005 Award Notification
• December 2005 to January 2006 Steering Committee
  Formed
• January 2006 First Steering Committee Meeting
• January 2006 to Present Expansion of
  Leadership Opportunities
• February 2006 to May 2006 Needs Assessment
• June 2006 Employment Summit
• June 2006 to August 2006 Plan Development
• September 2006 Plan Submission
• January 2007 Inclusion of MIG Strategic Plan
  into Connecticuts Long Term Care Plan

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Needs Assessment Components February 2006 May
2006

• The needs assessment included seven distinct
  research activities. This approach was used to
  gather information about multiple sources and
  stakeholders.
• Extensive review of relevant literature
• Examination of Connecticut census and Department
  of Labor data
• Assessment of existing state councils, boards and
  other entities
• Needs assessment of individuals with
  disabilities surveys and interviews
• Needs assessment of individuals with
  disabilities key informant interviews and focus
  groups
• Needs assessment of employers mail surveys and
  focus groups
• Examination of employment processes of four key
  State agencies

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Needs assessment

• Goal To quantify and measure employers,
  employees and service providers attitudes,
  experiences and expectations regarding
  employment
• Goal To document challenges related to the
  employment process

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Needs assessment strategies

• Employee survey sample
• Surveys of participants from seven different
  Social Service programs
• DMR, DMHAS, PCA, ABI, S05, BODP, CT Home Care
  Program for Elders
• Participants represented a diverse group of
  individuals with disabilities (intellectual,
  physical, mental) and older adults

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Needs assessment strategies

• Employee survey content areas
• Employment
• Personal support services
• Demographics
• Housing
• Transportation
• Health
• Physical functioning
• Locus of control

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Needs assessment strategies

• Individual interviews and mail surveys with
  current/potential employees
• Mail surveys (n536)
• Telephone interviews (n87)
• In-person interviews (n19)
• RR40 overall low-mail 35 high-phone 86

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Needs assessment strategies

• Qualitative in-depth interviews with key
  informants
• Selected for first-hand knowledge of or
  experience with disabilities, employment, and/or
  employment services
• Separate interviews were conducted with people
  with disabilities and older workers, service
  providers, and employers
• n35

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Needs assessment strategies

• Focus groups
• In-depth, qualitative, small group discussions
• Participants included current and potential
  employees, service providers, employers
• Questions were developed from issues identified
  in the literature and by members of the Steering
  Committee
• n35 focus groups 286 participants highly
  diverse groups

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Needs assessment strategies

• Employer survey
• Partnered with Regional Chambers of Commerce and
  other business networks
• Two page mail survey
• Covered the following content areas description
  of business, accommodations, experience,
  attitudes
• n653

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Unique methodological aspects

• Tested multiple methodologies with various
  groups
• Phone, in-person, mail, focus groups
• Tested a triage method prior to mailing the
  survey (work and PA were the triage variables)
• Tested a color coded triage method
• Tested a vignettes question focused on
  preferences for self-directed care

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Methodological results

• Focus groups were an effective method of
  gathering information, though a lot of work with
  many trials and tribulations.
• In person interviews were great overall, but
  worked best with the DMR population (gate keeper
  issues and allowed question rephrasing). Also
  proved helpful with some individuals with mental
  health issues. Very labor intensive.
• Phone interviews worked very well (ease of
  administration and response rate). We
  encountered some communication issues.
• Mail surveys proved effective, though it was
  difficult to reach individuals in the DMR
  population (gate keeper issues)

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Methodological results

• Tested a triage method prior to mailing the
  survey
• Work categories currently working, worked in
  past, never worked for pay
• Method 1 called the person prior to mailing the
  survey and had a brief discussion about work.
  Based on the response, we mailed the appropriate
  work survey
• Method 2 mailed all 3 versions with a definition
  of work. Based on work status the respondent
  would either complete the blue, yellow, or green
  survey.
• Results Both methods yielded similar results.
  The extra step in Method 1 was not necessary. It
  did however increase response rates slightly as a
  number of people during the call completed a
  telephone survey.

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Methodological results

• Tested a triage method prior to mailing the
  survey
• PA categories currently have, do not currently
  have, had in the past
• Method 1 called the person prior to mailing the
  survey and had a brief discussion about PA.
  Based on the response, we mailed the appropriate
  PA survey
• Method 2 provided a general definition and then
  built in skip questions.
• Results Despite a definition, the concept was
  difficult to grasp--different agencies use
  different language (independent skills trainer,
  support staff, etc). Always came back to the
  favorite provider, which may or may not have been
  a PA or PCA.

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Methodological results

• Tested a vignettes question focused on
  preferences for self-directed care (Sciegaj,
  2004).
• Method Presented respondents with a definition
  followed by 3 approaches (each in paragraph
  format) 1) totally self-directed 2) totally
  agency directed 3) mixed self and agency
  approach. This was followed by a qualitative
  discussion.
• Results Though it took up a lot of survey
  space, the question proved to be highly
  successful for mail and in-person methods. The
  content was a bit long and cumbersome for
  telephone interviews. However, we believe this
  could be modified to fit future phone surveys.

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CONNECTICUTS OUTLOOK

• SOFT REVOLUTION - knowledge replacing
  physical resources as main driver of economic
  growth
• 75 of top 100 fastest growing jobs will be
  derived from fields requiring basic/advanced
  knowledge of math, science, or engineering
• Growth expected to be highest in Management
  and Professional fields, with approximately
  78,000 new positions created during the
  10-year period accounting for more than 55 of
  Connecticuts job growth
• Burgeoning High Tech Industries - Fuel Cell
  Development - Medical Device Industry
  - Nanotechnology

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EDUCATION and the WORKFORCE
In 2012, jobs requiring postsecondary training,
college, or more will make up more than half of
net change in new jobs (growth).
In 2002, jobs requiring postsecondarytraining,
college or more representedabout one-third of
Connecticuts workforce.
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47
53
67
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CONNECTICUTS FASTEST GROWING INDUSTRIES 2002
to 2012
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Overarching challenge

• Lack of system coordination
• Within and between
• State Agencies
• Community Providers
• Employers
• Employees

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Overarching result(People with disabilities
versus people without disabilities)

• People with disabilities
• Desire to contribute something meaningful to
  society
• Improve overall health and functioning
• Feel valued in society
• Feel respected in society
• Experience social inclusion

• People without disabilities
• Desire to contribute something meaningful to
  society
• Improve overall health and functioning
• Feel valued in society
• Feel respected in society
• Experience social inclusion

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Employer challenge

• 1. Lack of skilled qualified people with
  disabilities or older adults applying for jobs
• Limited computer skills
• Lack of job specific training
• Particularly difficult to fill management
  positions
• 2. Lack of financial incentives
• Operating in a global economy where profit is the
  key
• Cut into profit margin due to lower productivity
• Hassle for Human Resource staff to deal with
  benefit issues
• Need to spend extra time for initial job training

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Employer challenge

• 3. Concerns about expensive or difficult
  workplace accommodations
• Remodeling workspace or buildings
• Provision of assistive technology, translators
• Flexible work schedules
• 4. Lack of knowledge about the impact on
  insurance rates
• Health, Disability, Workers Compensation
• 5. Lack of knowledge about the incidence and
  outcomes of lawsuits for employers
• Failure to provide accommodations
• Unable to fire

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Employer challenge

• 6. Employers perceptions about workers with
  disabilities or older workers
• Lower levels of productivity
• Absenteeism
• Lack of job specific training
• Do not want to work

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Weve seen a need to bemore aggressive than we
ever thought wed have to infinding qualified
management level people with disabilities.
There are jobs but the people are not adequately
trained to get these jobs. There are also people
losing jobs because they are older.
Cross-training is also important.
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Employee challenge

• 1. Discrimination because of
• Age
• Disability
• Minority status
• 2. Lack of employers
• Willing to hire
• Willing to make accommodations
• Willing to use part-time, half shift, or job
  sharing options

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Employee challenge

• 3. Difficulties in the hiring process
• Difficulty with application process (limited
  computer/technology skills, literacy skills)
• Difficulty getting interviews (criminal record,
  gaps in employment for mental or physical health
  problem)
• Difficulty with interviewing (disability affects
  communication, lack of experience with interview
  process)
• 4. Complexity of state and federal benefit
  programs
• Misperceptions about the rules among recipients
  and providers
• Catch 22in some instances, an increase in income
  could result in lost Social Security or health
  benefits, food stamps, rental assistance, etc.

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Employee challenge

• 5. Lack of appropriate transportation
• Unavailable
• Expensive
• Inaccessible
• Unreliable
• 6. Low expectations from birth
• Doctors/nurses, parents, teachers, service
  providers, employers, self

One of the first questions asked of me was Are
you sure you really want to work? Expectations
are low. We need better expectations of people.
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Employee challenge

• 7. Lack of school involvement
• Lack of knowledge about disability in general,
  and individual disabilities specifically (applies
  to school staff and parents)
• Lack of preparation for life, development of work
  ethic
• Lack of employment preparation vocational
  training, interviewing skills, job experiences
• Lack of assistive technology (school specific)
• 8. Lack of access to post-high school training
• Expensive
• Unavailable
• Geographically too difficult to access
• Unaware that it exists

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Employee challenge

• 9. Limited availability of transition services
• Job coaches, mentors, someone to pave the way
• 10. Time limited service provision
• The transition coordinator/job coach is there for
  only 1 to 3 months
• Additional coaching may be needed if job duties
  change
• 11. Lack of flexibility in the workplace and/or
  workday
• Flexible work schedules, rest periods
• Accommodations
• 12. Mismatch between skills, interests and job
  positions
• Underemployment

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Benefits control people vs. people control
benefits we want to turn that around.
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Now I have maturity, work experience, and I also
have compassion. But its hard to find a job, so
I have been with Title V for 5 years. It means I
can .. only make minimum wage. But Im 69,
whos going to hire me. Sure, they cant ask my
age. All they have to do is look at me and see
that Im not 30 or 40. Even though Im young at
heart, I do feel handicapped.  
We are not considered to be people like everyone
else. They just dont know how to talk to someone
because Im sitting down. They see the chair
before they see the person.  
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Im wondering now if this is why we get resumes
from people who have all this great experience as
an engineer, but applying for an assembler job.
I just push them aside as overqualified if
applying for assembler position.
I am a person that studied. I know computers and
accounting and marketing I know many things.
These people employer didnt give me a chance
to do anything else but pick up the trash from
the floor.
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Employment Summit June 2006

• Strategy Partner with local community
  organizations and businesses Share decision
  making with stakeholders Assure data driven
  change based on the needs of the people

• Outcome 160 Stakeholders participated in
  determination of priorities for the plan
  including self advocates, business owners,
  Superintendents of public school districts,
  leadership of state agencies and providers.

The Summit was designed to solicit input from 160
key stakeholders, including business leaders,
State Agency Commissioners, individuals with
disabilities, students, teachers,
Superintendents, leaders of Governor-appointed
Commissions with a focus on disability, and
leading advocates. These participants joined
together at the Summit to determine the
priorities for Connecticuts strategic plan.
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Goals

• Goal 1 To improve the transition process for
  young adults moving from school to
  post-secondary education or employment.
• Goal 2 To increase expectations for people
  with disabilities in achieving career
  potential.
• Goal 3 To increase the recruitment, employment
  and retention of individuals with disabilities
  into Connecticut businesses.
• Goal 4 To increase access to transportation for
  individuals with disabilities.
•  Goal 5 Provide technical assistance to support
  the development of effective strategies for
  increasing employment of people with
  disabilities.
•  

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Strategic Plan