Building Partnerships to Expand Employment: Massachusetts DMR

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Building Partnerships to Expand
EmploymentMassachusetts DMR the MICEO

• John Butterworth
• June 2007

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MICEO

• Collaboration between EOHHS, the University of
  Massachusetts Medical School and UMass Boston.
• Focus on Medicaid infrastructure the
  infrastructure needed to support employment
• Goal is to improve employment services and
  outcomes for individuals with disabilities in
  Massachusetts who want to work.

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MICEO Major Components

• Medicaid Infrastructure Development
• Comprehensive Employment Opportunities
  Infrastructure Development

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Comprehensive Employment Opportunities (CEO)

• Develop consistent state-wide strategies and
  policies that communicate a clear message of work
  as a valued outcome result in seamless
  coordination of supports across state agencies on
  an individual level
• Enhanced choice and self-direction of services
  and supports by providing ready access to
  information that helps identify and choose
  supports that make it possible to work

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CEO. (continued)

• Enhanced capacity of the service system at the
  direct support level to provide a coordinated
  array of employment-related supports
• Access to health care services and information
  for individuals with disabilities and support
  providers at all levels of the service system to
  ensure integration between health-related and
  employment supports

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Major Project Areas

• EOHHS Policy Analysis and Development
• Consumer Advocacy, Outreach and Training
• Employer Outreach and Training
• Employment Provider Outreach and Training
• Clinical Provider Outreach and Training

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Grant Leadership Team

• 7 representatives from disability community
• State agencies
• VR
• Department of Transitional Assistance
• Massachusetts Commission for the Blind
• Department of Workforce Development
• Department of Mental Retardation
• Department of Mental Health
• Office of Medicaid

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Sample Projects

• Snapshot Report
• Employment Disability Summit
• Mission Employment
• MassWorks.org
• ForEmployers.com
• MassCHEC.org

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• SEE-Technical Assistance Project
• DMR Technical Assistance Project
• Peer Employment Benefits Network
• EOHHS Task Force on Employment
• Employment Standards Subcommittee
• Employer Subcommittee

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Research

• Analysis of MassHealth administrative data
• Surveys of MassHealth members
• Evaluations of specific EOHHS agencies to enhance
  service delivery
• Outcome data reporting by state agencies
  providing employment services
• Focus groups with MassHealth members
• Interviews with key informants for policy
  analysis

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DMR Employment Services Strategic Task Force
Initiative

• DMR Goal to Improve Employment Opportunities
  Outcomes
• Commissioner Priority
• Identified by Statewide Regional Quality
  Councils as Priority
• Develop a Strategic Plan to Re-Design
  Employment/Day Services
• Create Framework for Re-Procurement of Services
  in Fall for FY 2009

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US Employment Day Supports
ICI CRP Survey2003
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MA Employment Day Supports
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State success in integrated employment varies
widely
Percent supported in integrated employment by
state MRDD Agencies 2004
Source ICI MR/DD Agency Survey
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Charge Statewide Employment Solutions Team

• Develop an Employment Strategic Plan to improve
  employment outcomes
• Develop recommendations to re-design
  employment/day services build capacity
• Inform planning and framework for re-procurement
  of services (RFR) for FY 2008

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Who Is Involved?

• Statewide Employment Task Force
• Regional Employment Solutions Teams
• SELN

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Capacity Building Activities

• TA to community providers
• Build capacity
• Modify practices
• TA to individuals
• Address policy and practice barriers
• Direct service staff training
• 5-day curriculum for direct support professionals

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Key Activities of Statewide Team

• Current Picture Employment day services
• National Trends Features of HP States
• ID Strengths Barriers in existing system
• Discussed services supports needed in ideal
  system for all adults
• Created four Working Groups
• Consulted with other states

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Statewide Employment Solutions Team

• Work groups on key issues
• Work First
• Contracts and Rate Structures
• Day Supervision
• Building Capacity

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Regional Employment Solutions Teams

• Focus varies by region
• Training for providers (Southeast)
• Career assessment strategy (Metro)
• Transportation (Central/West)
• North Shore Pilot Project (Northeast)
• Interface between regional teams and statewide
  team informs the work of both
• Selected individuals agencies to receive TA

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System-Wide Influences

• Re-design of DMRs Medicaid Waiver Program
• Service definitions Provider Choice
  Portability Participant- Direction
• Transition Planning/Turning 22
• Implementation of MASSCAP
• Identify needs priority for services
• EOHHS Joint Employment Procurement

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Baseline Number Participating by Activity
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Individuals began work in a new individual
jobMay 2005 through April 2006
363
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Mean Hours Worked per Month
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Mean Monthly Wage
DMR 2005
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Percent Earning Minimum Wage
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DMR Percent in Individual Jobs by Provider
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How We Are Using The Data

• Statewide Regional Summaries Trends
• Provider Reports Summaries Trends
• Comparison to State Regional averages
• Trends by Specific Variables
• Website Multiple Reports Data Displays
• Education Staff Providers Consumers

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Provider Name
Provider
Provider
Provider
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Provider 1
Provider 2
Provider 3
Provider 4
Provider 5
Provider 6
Provider 7
Provider 8
Provider 9
Provider 10
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Proposed MajorRecommendations

• Develop Adopt an Employment First Policy
• Re-design Re-Structure Employment Services
  Contracts
• Development of standardized rates for services
• Transportation Planning Funding
• Strategic Focus on Transition-Age Youth

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• Separation of work and day supports
• Education Promotion about Values Benefits of
  Employment
• Capacity Development of Employment Provider
  Network
• Collaboration with EOHHS Agencies Workforce
  System
• Comprehensive Approach to Training Professional
  Development within DMR

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• John Butterworth
• john.butterworth_at_umb.edu
• [phone]
• www.mi-ceo.org
• www.MassWorks.org
• www.ForEmployers.com
• www.masschec.org
• www.statedata.info

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Develop Adopt an Employment First Policy

• Starts with a presumption of employability for
  working age adults
• Will require
• Cultural shift in expectations
• Consistent communication of pro-work message
• Integrated into all aspects of service planning
  and delivery

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Re-design Re-Structure Employment Services
Contracts

• Unbundle integrated employment from
  facility/center-based work
• Review clarify service definitions with
  specific quality standards
• Use of community-based day service options to
  supplement job if needed
• Promote participant-directed options
• Flexible allocation of resources to support
  choice in services providers

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Development of standardized rates for services

• Individual integrated employment as separate
  funding category
• Rates based on adequate pay scales for staff
• Flexibility to enable movement from sheltered or
  group to indiv. employment
• Availability of risk pool to respond to job loss
  or change in support needs

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Transportation Planning Funding

• Different approaches based on type of employment
  service
• Transportation to a job needs to be integral part
  of job development process
• Prioritize use of public personal
  transportation alternatives
• Development of cost allocation standards
• Collaboration with HST and RTAs

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Strategic Focus on Transition-Age Youth

• Facilitate and support direct movement into
  employment
• Transition planning needs to be more
  career-focused
• Education training for families youth
• Partnerships with schools
• Partnership with workforce system
• Expand job experiences during high school years

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Separation of work and day supports

• Consistent approach to assessment of support
  needs requirement of structured day program-
  day supervision
• Increase number of hours individuals are working
• Access to more flexible alternative day
  supports
• Collaboration with residential staff

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Education Promotion about Values Benefits of
Employment

• For all stakeholders
• Consumer friendly information resource
  materials with pro-work message
• Develop Guide to Employment Services
• Information on service options costs
• Resources for benefit planning
• Share employment outcome data

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Capacity Development of Employment Provider
Network

• Comprehensive training offered/required for all
  front-line staff
• Professional development opportunities
• Provision of technical assistance
• Address the diverse needs of the work force
• Develop career pathways
• Community colleges Continuing education

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Comprehensive Approach to Training Professional
Development

• DMR Service Coordinators and AO staff
• Quality employment services customized
  employment impact on benefits..
• Integration collaboration with residential
  other non-employment service providers
• Integrate into orientation values role in
  supporting work problem-solving

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Collaboration with EOHHS Agencies Workforce
System

• Partnership with MRC
• Access collaboration with Career Centers
• Expanded use of other training resources
  supports for example- Benefits planners

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