Supported Employment and Long Term Follow-Along

1

• Supported Employment and Long Term Follow-Along
• for the
• Counselor and Job Coach
• December, 2008

2
Introductions

• Judy Hill - EES/LTESS Coordinator

3
OFFICE OF EMPLOYMENT SERVICES AND SPECIAL
PROGRAMS

• JUDY HILL 804-662-7108
• - email JUDY.HILL_at_DRS.VIRGINIA.GOV
• FAX NUMBER FOR ESSP 1-804-662-9140
• DRS TOLL FREE VOICE 1-800-552-5019
• WEBSITE http//www.vadrs.org
• then click on Employment and Vocational
  Services
• The Supported Employment Guide can be found at
• http//vadrs.org/essp/downloads/seguide/pdf

4
Whats in your resource packet?

• Understanding Order of Selection Brochure
• Power point Presentation
• Enclave/Mobile Crew 101, Stability for Individual
  SE
• Other SE Issues, Revised SE Forms
• OESSP Information Sheet
• Appendices B C - WAT, SA and Provisions for
  Extended Employment Services (EES)
• Appendix D - Guidelines for SE and JCTS
• Appendix E - Provision of Long Term Employment
  Support
• LTESS Guidelines
• LTESS forms - application, requisition, closure
• Policy on Integrated Settings-Employment Outcomes
  and Extended Employment
• Successful Closure
• Definition of Most Significant Disability (MSD)
• Post Employment
• List of Acronyms
• List of DRS Statuses
• EES/LTESS Forms

5
Topics to Cover

• Insights into SE/Long Term Practices
• Brief Historical Background EES and LTESS
• Key Service Requirements for Long Term
  Follow-Along

6
DRS IMPACT ON ESO PROGRAMS

• DRS Field Spends almost 10 Million
• DRS OESSP EES and LTESS Spends over 7.2
  Million
• State Fiscal Year 2008
• This includes the 15 reduction in both
  programs

7
Why are we here?

• To stress the importance of communication and
  collaboration among all parties
• Supported employment specifics
• Long Term Follow-along LTESS specifics

8
THE KEYS TO SUCCESSRELATIONSHIPS

• Frequent Contacts between VR and JC
• Getting info between VR and JC quickly
• VR and JC view themselves as part of a team
• Access to VR counselor or job coach

9
THE KEYS TO SUCCESSTRUST

• VR and JC trust in each other to
• Give sufficient hours to do job
• Use hours given efficiently and effectively
• Consumer Characteristics/Needs
• Difficult vs. less difficult consumers
• Full use of authorized hours vs request
  cancellations

10
SUPPORTED EMPLOYMENT

• Collaboration and Communication
• Roles of each of us from referral to follow along
• Clarification of services
• Individual SE
• Group Enclave, Mobile Work Crew,
  Entrepreneurial
• JCTS

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What model to use?

• Does the consumer require ongoing extended
  support services in order to maintain competitive
  employment?
• Is it required that a job coach work individually
  with a consumer?
• Does the consumer require employment in a mobile
  work crew or enclave?
• Is employment integrated?

12
SE - Individual Placement

• Single supported employee placed in an integrated
  work setting in the community
• employed by employer
• ongoing follow-along required
• most widely used SE model
• Advantages flexibility, max. integration, ease
  in differentiating between training and LTFA

13
Enclave Model

• small group of supported employees placed in
  community-based employment
• may work together or be dispersed with integrated
  setting
• may be employed by employer or ESO
• ongoing follow-along required
• advantage higher level of supervision and
  support

14
Mobile Work Crew Model

• group of supported employees who travel together
  to one or more integrated work settings in the
  community to perform contract work
• employed by the ESO
• ongoing support required
• advantage higher level of supervision and
  support

15
Entrepreneurial Model

• supported employees producing a service or
  product either on a sub-contract basis or as a
  prime manufacturer
• SE employees, along with managers and others,
  comprise the business
• advantages integrated, public contact, PR

16
JCTS

• Consumer receives initial situational assessment,
  job development, job skills training,
  transportation training, or other support
  services provided by an ESO however long term
  follow-along is not necessary after DRS case
  closure.
• This is a separate service and requires
  applicable service category on vendors rate
  sheet.
• Service Item Codes are not the same as those for
  SE.
• When service categories are open, cases can be
  coded as either MSD or SD.
• If a consumer receives JCTS services, no follow
  along is required so therefore, a LTESS
  application should not be completed. If the
  consumer demonstrates that LTFA is needed then
  the ESO can submit a LTESS application after they
  have DRS counselor approval. The counselor needs
  to document the change in the case notes and
  change the SI codes on any authorizations if
  necessary.

17
DRS Counselor Roles and Responsibilities

• Once eligibility is established SE planning
  begins.
• Are long term supports needed? If yes, then SE
  case. If no, consider JCTS.
• Identify long term support.
• SE cases must be coded as MSD.
• Share sufficient diagnostic information.

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DRS COUNSELOR ROLE

• Establish benchmarks regarding progress.
• Stop the process if needed and discuss issues
  Interrupt Failure if needed.
• Clarify expectations.
• Maintain a separate role with consumer from
  vendor.
• Determine what services can be provided by DRS
  before asking a job coach to do them.
• Continue to communicate with consumer after
  referral to job coach.
• Case statuses must be properly updated.
• Communicate and collaborate!!!!!!!!!!!!!!!!

19
HIPPA ISSUE

• ESOs will not be able to reference SS s in the
  new internet EES/LTESS system. As a result you
  must use the consumer's participant ID rather
  than a case or Social Security in all
  communication regarding the consumer.
• The Certificate of Eligibility has the
  participant , therefore we recommend that a copy
  be sent to the ESO as a part of the referral
  package.
• The participant ID should be reflected on all
  of the SE forms. It is not on the authorizations
  generated by AWARE.

20
Job Coach Role

• Provide job skills training as needed.
• Ensure consumer stability and job satisfaction on
  both consumer and employer side.
• Provide extended support services, where
  appropriate.

• Assist consumer with locating suitable job
  matches.
• Assist in job search efforts.
• Provide timely written reports and phone contacts
  with updates as needed.

21
Job Coach Responsibilities

• Communicate and collaborate with DRS Counselor
  and consumers.
• Providing information as to fading plans, need
  for follow-along, funding options.

• Work as a team with DRS, case managers,
  consumers, families, etc. to improve likelihood
  of success.

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Topics coming upCommunication Issues

• Initial Planning
• Authorizing Services
• Service Provision
• Report Writing
• Invoicing

23
Opportunities for Communication and Collaboration

• Initial Planning Expectations
• Situational Assessment
• SE vs. JCTS
• Job Goal/Development
• Placement and Training
• Stability/Fading
• Long Term Follow Along

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WHO PAYS FOR SERVICES?

• Initial Planning for Services
• DRS pays for situational assessment, job
  development and placement and training through
  stabilization
• Long term support funds pay for extended services
  including post stabilization while the case is
  still open. Examples-LTESS,CSB
• DRS pays for post employment, not LTESS

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Opportunities for Communication and Collaboration

• Authorizing Services
• All authorizations need to consider individual
  consumer need.
• Need to be in place prior to provision of
  service.
• Justification needed for requested hours and a
  timely response from counselors including
  emergencies like post employment.
• DRS Counselor should keep in mind that there are
  no caps/no maximums.

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Opportunities for Communication and
Collaboration

• Service Provision
• Job Development
• Agreement of goals for consumer.
• Provide sufficient service hours - No maximums or
  minimums, individually considered.
• Monthly progress reports should contain
  information as to name, numbers and types of
  contacts made, strategies applied, job
  development hours used, potential placement
  possibilities or outcomes expected and request
  for next month.

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Opportunities for Communication and Collaboration

• Service Provision
• Job Placement/Training
• No maximum or minimum hours allowed for
  Placement/Training - has to be individually
  considered (18 month duration limitation).
• Training time is not standardized .
• Monthly reports, including intervention
  percentage and fading schedule along with
  progress made to date.
• Last monthly SE PT Report (SE Form 3) should
  indicate consumer is stable in employment before
  LTFA begins.

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INVOICINGBillable Services under SE

• Expectation of Counselor Complete, Timely,
  Individualized, and Accurate Billing
• Work Site Activities
• Includes travel, training and intervention with
  consumer, employer, and employees at work site
• Job Development Activities
• Includes consumer specific job development with
  employers, supervisors, and other personnel for
  purposes directly relating to employment
• Off-Site Activities
• Includes training in transportation, money
  handling, and advocacy for persons not directly
  affiliated with the work site
• Remember, if a DRS employee can provide the
  service, that should be the priority!

29
INVOICINGBillable Services under SE

• Assessment/Report Writing
• Includes provision of situational assessment
  services and all task analysis, training and
  progress report writing
• Billing for report writing and telephone calls
  should reflect actual and reasonable time spent,
  not standardized times

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Fading

• Intervention percentage time is the time the Job
  Coach spends supporting the consumer on the job
  site divided by the total number of hours worked.
• Intervention declines over time as a measure of
  progress.

31
EMPLOYMENT STABILITY AND THE MOVEMENT FROM TIME
LIMITED TO LTESS FUNDING
32
WHAT IS STABILITY?

• Traditional guideline job coaching support is
  20 or less. This may not always be the case.
• Consumer is emotionally, behaviorally stable.
• Consumer will demonstrate stability for at least
  30 days in service status before case is moved
  to employed status.
• Last placement and training form (SE Form 3)
  submitted to DRS must note stability has been
  reached and when the case will begin long term
  follow along.
• Communication between the ESO and DRS is
  imperative for this action to be successful.

33
How to calculate STABILITY?

• Stability is the direct/indirect intervention
  hours by the employment specialist divided by the
  number of consumer work hours for that time
  period (usually calculated weekly and/or
  monthly).
• Example 10 intervention hours divided by 20
  consumer work hours is 50. While DRS case
  service and LTESS funds pay for employment
  specialist transportation and documentation, the
  hours spent providing these services do not enter
  into the calculation of stability.

34
DRS Individual SE Case Movement

• The DRS Counselor keeps the consumer in service
  status until stability for 30 days or more is
  achieved.
• The DRS counselor will then move the consumer to
  employed status for at least 90 days.
• Once the consumer has worked in employed status
  for a minimum of 90 days or more and remains
  stable on the job, the case is successfully
  closed Closed - Rehab.
• LTESS funds begin supporting LTFA at the
  beginning of employed status.

35
Stability in Group Models

• For persons in group models, stability is
  defined as the completion of a 60 day period in
  which intervention is directed at maintaining a
  level of production and not at major barriers to
  successful integration into the job site. In
  other words, the job coach/trainer is devoting
  the majority of time addressing training issues
  rather than behavioral issues. The consumer is
  meeting a level of production that is acceptable
  to the employer (either the business or ESO
  itself).
• The case remains in service status until the
  stability period ends. The case then goes to
  employed status at the end of a minimum 60 day
  period. At this point the case is considered to
  be in LTFA. Funding could be from a number of
  sources.

36
Ongoing Services Form (SE Form 4)

• The Code of Federal Regulations requires twice a
  month monitoring of the consumer until DRS closes
  the case. The ESOs are required to complete the
  Ongoing Services Form each month from the time
  the case begins follow along until DRS case
  closure. The job coach is required to send a
  copy to the DRS counselor each month until the
  case is closed.

37
ESO Action to Access LTESS

• Before the 30 day stability period ends, a LTESS
  application must be received no later than the
  20th of the month preceding the start of follow
  along services. This ensures that LTESS funds
  will support LTFA after time limited services by
  the DRS counselor ends.
• All LTESS applications must be approved by a DRS
  counselor. The ESO must document the approval in
  the case record.

38
Individual LTFA Definition

• With the approval of the DRS counselor and ESO
  job coach either bimonthly or quarterly contacts
  with the consumer would be acceptable to DRS
  provided that           the consumer and
  family understand the frequency,        
     the consumer is given access to follow along
  supports if needed sooner than the next scheduled
  contact, and            the ongoing supports
  being provided are adequate to meet the clients
  needs with respect to maintaining employment. 

39
LTFA VS POST EMPLOYMENT SERVICES

• LTFA is the maintenance of a person in
  employment.
• LTFA does not mean case management.
• LTESS does not fund training, retraining or job
  placement.
• If retraining, job placement or other services
  are needed, the DRS counselor should be contacted
  immediately. The consumer probably will need
  services other than LTFA.

40
ONE LAST REMINDER

• LTESS funds vocational support services that are
  necessary and sufficient for consumers to
  maintain employment. Case management,
  independent living or other services that are not
  vocational in nature should not be billed to
  LTESS funds. Per the Code of Virginia, LTESS
  funds are not appropriated by the General
  Assembly to fund those services.

41
QUESTIONS?????
42
EES/LTESS BUDGETSFISCAL YEARS 08-09

• No new LTESS dollars in FY 08 or 09
• Total LTESS dollars after 3 reductions in FY
  2008 -- 5,184,044
• Total LTESS dollars after 15 reductions in FY
  2009 -- 4,406,437

43
EES/LTESS BUDGETSFISCAL YEARS 08-09

• Total EES dollars after reductions in FY 2008 --
  3,200,104 -3
• Total EES dollars after reductions in FY 2009 --
  2,720,088 -15

44
Long Term Employment Support Services Funding
95-08
45
Extended Employment Services Funding 95-08
46
LTESS HISTORY

• Grassroots effort by ESOs with General Assembly
  in FY 94
• Success for FY 95 - 375,000 in State funds with
  primary target of Supported Employment Follow
  Along for persons with severe disabilities
• Incremental increases in past years
• Funds have been reduced each year for the last
  two years.

47
EES/LTESS Whats the difference?

• EES Funding
• Services provided are onsite employment, enclave
  and mobile crews No individual SE
• No counselor approval
• Limited number of ESOs involved
• No additional allocations program not growing
• LTESS Funding
• Full array of services provided including
  individual supported employment, onsite
  employment, enclave and mobile crew
• Counselor must be involved in the approval of
  consumers
• Double the number of ESOs involved in LTESS
  funding
• Concentrated efforts to grow the LTESS pot

48
Extended Employment Services (EES) - History

• First allocated from General Assembly for FY 84
  and 100 state funds.
• Current allocation is now over 2.7M distributed
  across the original 41 vendors providing Extended
  Employment Services to fund long term support to
  severely disabled consumers.
• No additional funds allocated from the General
  Assembly since 1989.
• Numbers of consumers served have declined over
  the years because of no increase in funds.

49
EES

• Half of ESOs provide community placement
  enclaves and/or mobile crews.
• Individuals served primarily have disabilities of
  MR (66) or SMI (14).
• EES is not restricted to DRS consumers.
• Must be one of the original vendors to receive an
  EES allocation.
• Most recently funding has been lost to reductions.

50
EES

• Any consumer is eligible for EES funds as long as
  they are documented as having a severely
  disability.
• Counselors do not have to be contacted prior to
  an EES application.
• ESO must provide an integrated setting for a
  DRS/DBVI counselor to receive a closure. The
  counselor may still refer a consumer to an ESO
  that is not integrated if that is the best
  placement.
• Bottom line is to do what is best for the
  consumer.
• Due to limitations in the EES program, ESO
  community lobbied for additional follow along
  dollars which would be available to all approved
  vendors.

51
LTESS - WHAT IS IT?

• Long Term Employment Support Services
• 100 State dollars appropriated by the General
  Assembly for FY1995
• Intended as long term funding to support
  individuals with severe disabilities in accessing
  and maintaining employment
• Not intended to supplant other funds used for the
  same purpose.

52
LTESS BACKGROUND

• 1994 General Assembly appropriated 375,000 for
  FY 95 and 201 consumers were served.
• The LTESS program is currently serving over
  2,800 consumers a month in 77 ESOs around the
  state.
• Individuals served primarily have disabilities of
  MR (44) or SMI (25).

53
LTESS GUIDELINES

• LTESS funds CANNOT be used to supplant planned or
  current funding for long term supports.
• If a consumer is being sponsored by a public
  source, it should continue
• Generally, no split funding for employment
• Vendors cannot charge DRS more than any other
  purchasers of the same services as specified on
  the vendor rate sheet.
• Exception individual, private pay
• Medicaid rates changed to be the same as DRS
  rates.

54
LTESS GUIDELINES (continued)

• Individuals who have been sponsored for
  employment services by public funds must wait 12
  months to become eligible for LTESS
• A mechanism is established by DRS for exceptions
  in the case of hardship.
• LTESS funding is not disability specific!
• Organizations accepting LTESS funding must work
  with all DRS consumers and not discriminate on
  the basis of disability.

55
LTESS GUIDELINES (continued)

• Services billed through LTESS must be employment
  related follow-along services
• Job development, retraining, referral to DRS tp
  reopen the case and general case management
  services are NOT considered follow-along
• Provide the services needed to maintain
  employment not nice to do or always have
  done it that way or the employer likes me to
  come every week
• Spikes are expected-over 20 of hours worked-send
  in documentation
• Email notification is sent to counselors upon
  submission of LTESS application

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LTESS GUIDELINES (continued)

• As LTESS is the funding of last resort for long
  term supports, vendors must document attempts to
  secure sponsorship and the absence of alternative
  funding sources.
• Each consumer is required to have an
  individualized service plan that is clear,
  complete, and current following CARF guidelines.
  

57
LTESS GUIDELINES (continued)

• Monthly reports (including intervention sheets)
  should be maintained in the individual consumer
  file except
• if an individual is billed 20 or more of the
  total hours worked, the vendor must submit
  justification in the form of a monthly progress
  report

58
GENERAL INFORMATION

• Any consumer with a goal of receiving Supported
  Employment or Extended Employment is a possible
  candidate for LTESS funding
• Does NOT have to be an open DRS case or a DRS
  case at all
• DRS or DBVI counselor approval is required for
  use of all LTESS dollars
• Includes unfunded, on-site extended employment
• Includes closed DRS SE that may require
  additional follow along to maintain employment
• Includes JCTS if discovered consumer needs
  support to maintain employment
• Collaboration and Communication!!

59
MAJOR LTESS ISSUES

• Counselor approval must be obtained and
  documented before applications submitted.
• Applications must be thoroughly completed.
• Applications must be submitted by the 20th.
• Applications cannot be submitted for consumers
  receiving JCTS.
• Applications for consumers in wrong DRS status.

60
ALLOCATION METHODOLOGY

• Allocations are based on a 3-year rolling average
  of expenditures utilizing a 125 rule.
• One bad year will not hurt as much if averaged
  with two good years.

61
REALLOCATIONS

• DRS reviews expenditure patterns throughout the
  fiscal year and completes reallocations as
  needed.
• Reallocations are based on an individual
  organizations statistics-average hours billed,
  average attendance, individual rates, months/days
  remaining in fiscal year.

62
REALLOCATIONS (continued)

• Vendors need to monitor themselves on a monthly
  basis.
• If a vendor chooses to maintain more individuals
  than their allocation can support with hopes of
  receiving additional dollars, that vendor is
  committing to be responsible for those
  individuals at the same level of service
  regardless of future allocations.

63
General Information for EES/LTESS

• Vendor discretion as to how to apply their
  EES/LTESS funds
• MAY choose to support individuals in SE,
  individual or group models, extended employment
  or a combination
• counselors may request certain consumers be
  supported with EES/LTESS, but vendors have final
  say following their own policies
• overextending EES/LTESS funds is risky
• vendor discretion
• EES/LTESS allocations are public information.

64
THE FUTURE

• Recommendations were made to update the 15 year
  old computer system
• Web based
• No paper
• Forms partially filled in
• Errors minimized with edits and drop down help
  boxes

65
THE FUTURE

• Financial data available on demand
• Production data available on demand
• Savings of paper, postage, phone bills (faxes)
• Secured web site, password protected
• Hipaa compliant
• Timeframe FY 08 Initiated System
• Training for All in March 2009

66
FORMS

• Applications
• Closures
• Requisition/Invoices

67
Questions?
68