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10.04 SUPPORTED EMPLOYMENT
Supported employment is competitive work in integrated work settings, or employment in integrated work settings in which individuals are working toward competitive work. It is intended for individuals for whom competitive employment has not traditionally occurred, or for whom competitive employment has been interrupted or intermittent as a result of a most significant disability, and who, due to the severity of their disability, are expected to require on-going support in order to maintain employment.
Supported employment promotes placement in an integrated setting for the maximum number of hours possible, based on the unique strengths, resources, interests, concerns, abilities, and capabilities of the individual. Supported employment must be explored before a sheltered employment outcome is chosen by an individual who may not be ready for or capable of independent competitive employment.
The following defines the terms used in supported employment:
1. "Competitive Work" is work performed on a full or part time basis, averaging at least 20 hours per week for each pay period and for which the individual is compensated in accordance with the Fair Labor Standards Act and the NYS Wage and Hour Regulations. For other individuals who can not work 20 hours, the employment goal can be determined in his or her Individualized Plan for Employment (IPE). Unpaid and summer employment do not qualify as supported employment. Seasonal employment is only allowable if it is typical of a local labor market.
2. An "Integrated Setting", for the purposes of a job placement, is a setting typically found in the community, in which the individual with a disability interacts with regularly with persons who do not have disabilities and who are not paid-care-givers.
Individual with a "Most Significant Disability" means any individual:
a. who has a severe physical or mental impairment which seriously limits three or more functional capacities in terms of an employment outcome; and
b. whose vocational rehabilitation can be expected to require multiple vocational rehabilitation services over an extended period of time (nine months of more), and need intensive supported employment services over an extended period of time to perform and sustain competitive work.
A "Substantial Functional Limitation" is a limitation resulting from physical, sensory, mental, or cognitive impairments, which restricts the person's ability to function independently in family, community and employment activities. A substantial limitation is pervasive and is not easily overcome by readily available methods or resources, or in a short period of time. A substantial limitation usually cannot be simply "fixed".
5. "Ongoing Support Services" are services that are needed to support and maintain an individual with the most significant disabilities in supported employment. These services are provided at least twice a month, usually at the work site, during both the intensive and extended service phases of the individual's employment. The goal of these services is to develop and/or maintain employment stability. These services can occur at places other than the work site, especially if the individual so requests. If provided away from the work-site, it must be documented in the IPE and consist of at least two meetings with the individual and one contact with the employer each month.
On-going support services may consist of:
a. necessary additional assessments at the work site;
b. job coaches at the work site;
c. job development and placement;
d. social skills training;
e. regular observation or supervision;
follow up services with individual, employers, parents, family members, advocates, other authorized persons;
facilitating natural supports at the work site;
h. other support services at or away from the work site, such as transportation and personal assistance services.
This definition applies to both supported employment services under VR and long term extended support provided through other sources after VR has withdrawn.
"Extended Services" are the ongoing support services and other appropriate services provided by appropriate State agencies, private organizations, employers or any other source, to assist the individual in maintaining supported employment once intensive supported employment services are completed.
6. "Transitional Employment for Individuals with Severe Mental Illness" is competitive work in an integrated work setting for individuals with severe and persistent mental illness who may need support services (but not necessarily job skill training) provided either at or away from the work site to perform the work.
Due to the cyclical nature of severe and persistent mental illness, the job may not necessarily be a permanent employment outcome for the individual.
Models of Supported Employment
Supported Employment is achieved through a number of models, strategies and techniques often developed through joint efforts among state agencies, nonprofit organizations and local and community groups.
In selecting a supported employment program, the counselor should try to obtain placement in the model which provides the least restrictive environment for the individual. The models are described below in descending order of desirability:
The "Individual Competitive Placement" model is the individual placement of an individual with the "most significant disability" in an integrated community based job with support and training at the work site.
The "Enclave" is a small work group which is integrated among the regular work force of a single industrial establishment.
The "Mobile Crew" is a small work crew (no more than 8 individuals) which provides a single purpose service at several places of business in the community (such as a janitorial service) and operates from a vehicle with one supervisor.
The "Affirmative Business Model" is a small private business set up specifically to employ disabled persons to produce products for public consumption. Employees may include a small group of individuals with significant disabilities (no more than 8) as well as individuals who do not have disabilities.
The Role of the Rehabilitation Counselor
The rehabilitation counselor has a primary role in the planning and coordinating of supported employment services. Counselors are responsible for periodically reviewing the progress of individuals to determine if services provided need action to assure satisfactory completion of the IPE. The review should determine whether a program should be continued, modified, or discontinued, as appropriate.
Generally, the counselor's role follows three stages:
1. Pre-employment - In the stage of Pre-employment the counselor:
a. obtains an assessment of the individual, including a history of the individual's medical, psychological, social, work and education experiences; and
b. obtains a situational assessment (see p. 10.04.06) using a job coach in a community setting, either to determine eligibility or to develop a plan for supported employment.
A situational assessment provides the individual with the opportunity to demonstrate the capacity to respond to the job coaching and other supports as related to a specific job.
2. Placement and Intensive OnSite Instruction - during this stage the counselor maintains ongoing contact with the consumer, the job coach, other staff of the provider agency, and the employer to assure that:
a. the goals of the IPE are monitored and met;
b. quality of services are maintained; and
c. transition to extended services does not occur until the individual has substantially met the work goal.
3. Stabilization - during this stage, the counselor:
a. monitors the transition of the consumer to the predetermined source of extended funding;
b. follows the usual process to affect a successful rehabilitation outcome.
Target Population - Individuals with the Most Significant Disabilities
CBVH is directing supported employment services to individuals with the most significant disabilities who, due to the nature and severity of their disability, may need intensive supported employment services or ongoing services in order to perform competitive work. Counselors, with input from consumers and their families, will make determinations about the severity of a person's disability based on the following:
1. Functional capacity - The Vocational Rehabilitation Counselor determines the individual to be eligible and an assessment of rehabilitation needs identifies substantial functional limitations. The individual must have a severe physical or mental impairment which significantly limits three or more areas of functional capacity (cognition, mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of achieving an employment outcome; and
2. Service requirements - the individual will require multiple vocational rehabilitation services over an extended period of time (generally nine months or more).
Limitations on Provision of Supported Employment
The provision of intensive Supported Employment Services is limited in that the services must be:
1. needed to support and maintain an individual with the most significant disabilities in employment;
2. based on an assessment by CBVH of the individual's needs as specified on an IPE; and
3. provided for a period not to exceed 18 months (beginning at the time of placement in the work setting when on-the-job intensive coaching is first provided) before the transition is made to extended services. Under special circumstances, the individual and the counselor can jointly agree to extend the 18 month time to meet objectives identified in the IPE.
Transition of funding is made to extended service when the CBVH counselor and the provider rehabilitation agency deem it appropriate, but no later than the end of the 18month period, unless otherwise indicated on the IPE.
A key component in Supported Employment is the "situational assessment". A situational assessment places a consumer in one or more work situations and enables the job coach to observe, record and interpret the individual's performance on a variety of work tasks in a real work setting.
A situational assessment should provide the following types of information about each individual:
a. the feasibility of the goal of supported employment
b. nature and intensity of support services needed
c. job duty restrictions
d. job modifications needed
e. post employment training needs
f. least restrictive environment for that individual
g. anticipated level of intervention
h. the best job match.
When to Conduct a Situational Assessment
A situational assessment may be conducted:
1. prior to eligibility to determine the individual's functional limitations and the likelihood that the individual may benefit from vocational rehabilitation services (i.e. will be able to participate in supported employment and stabilize to a level where longterm follow along is available);
2. prior to IPE development to ensure an optimal match between the individual and a potential job;
3. during supported employment to determine whether another type of job may be more suitable than the original job in which the individual was placed, or whether additional interventions are needed to maintain the individual's current job.
Job coaching refers to the training of a supported employee by an approved specialist, who uses structured intervention techniques to help the supported employee learn to perform job tasks to the employer's specifications and to learn the interpersonal skills necessary to be accepted as a worker at the job site and in related community contacts. In addition to job-site training, job coaching includes related assessment, job development, counseling, advocacy, travel training, and other services needed to maintain the employment of a supported employee.
The Job Coach works in coordination with the counselor to identify the needs of the individual and jointly determine how these needs will be addressed. The Job Coach assists in providing individuals with the most significant disabilities with planning services and skills training for all aspects of the supported employment process.
Functions of the job coach may include:
1. specialized job placement following a thorough task analysis and matching the employment to the interests and strengths of the individual with a disability;
2. intensive on-site instruction of the worker, co-workers, and supervisor based on situational assessment;
3. continuous evaluations by collecting and recording data and modifying the job site as appropriate;
4. advocating for the supported employee both at and away from the job;
5. onsite intensive skills instruction, e.g.,
a. teaching techniques to improve and maintain job performance skills (e.g. sequence, quality and quantity) and job-related skills (e.g. grooming, socializing with coworkers, managing one's paycheck);
b. transition of the individual from dependence on the job coach to greater independence. The coach will assist the consumer to develop natural supports on the job, through co-workers;
6. extended services which include, as a minimum for all Supported Employment workers: job-skill training at least twice a month at the work site (unless off site monitoring is requested by the consumer) and one employer contact each month.
IPE for Supported Employment
An IPE must be developed outlining the services to be provided to each individual under the Supported Employment program. A copy of the IPE must be provided to the supported employment contractor to maintain in their files.
In addition to the IPE requirements in Chapter 6.00, an IPE for supported employment must also include:
1. a description of the extended services needed;
2. identification of the State, Federal, or private programs that will provide continued support;
3. a description, to be entered in the justification of the IPE, of the basis for determining that continuing support is available;
4. determination of the minimum weekly number of hours the consumer can work at the time of transition to extended services;
5. if services will exceed the time limited 18 months, documentation on the IPE which indicates that longer services are necessary for the individual to achieve job stabilization prior to making the transition to extended services; and
6. a completed copy must be sent to the provider agency for regulatory purposes.
The Vocational Goal section of the IPE should reflect the goal as "Supported Work" followed by the title of the competitive job that the individual will be performing. Example: "Supported Work Janitor".
The DOT code used to describe the job would be the code for the competitive title; in this case "janitor".
Documentation of Continuing Support
The counselor must ensure that ongoing support will be available after VR services have been withdrawn.
The case file must contain documentation supporting the likelihood that ongoing support will be available. Examples of acceptable documentation include:
1. a letter from an Office of Mental Retardation and Developmental Disabilities (OMRDD) service coordinator acknowledging the individual's eligibility for OMRDD services, and documentation from the provider agency that they are a recipient of OMRDD Supported Employment funds.
2. a case contact by the counselor documenting that the individual is not eligible for OMRDD or the Office of Mental Health (OMH) funding, and that the counselor intends to use the special State fund for extended services.
Coordination of Planning Efforts
Services provided under the Supported Employment program must be coordinated with the IPE, education, and other service plans (as provided by an educational facility, agency serving developmentally disabled individuals, or others involved with the individual).
The counselor will conduct periodic reviews of the individuals assisted through Supported Employment services to determine whether supported employment services should be:
2. modified or
Supported employment services must be reassessed by the counselor at least once during every 90 day period. The counselor's decision should be based upon the individual's progress as determined through reports, staffing and regular contact with the employer, job coach and consumer. The periodic review will be documented in the case contact section of the case.
Purchasing Supported Employment Services
CBVH counselors may purchase supported employment services through use of:
1. CBVH supported employment projects with private agencies for the blind
Necessary support services not provided as part of a project may be purchased using regular case service funds (for example, mobility).
2. regular case service funds to access:
a. VESID authorized supported employment programs
b. private agencies for the blind who have contracted to provide job coaching, or
c. job coaching services provided by CBVH approved private vendors,
d. newly developed CBVH supported employment programs.
Referrals for Supported Employment
All referrals for supported employment services should be made using the referral form (pages l0.04.14-10.04.15). The counselor will complete the form and submit it, along with a copy of the individual's IPE, to the contracting agency. A copy of the completed referral form must be forwarded to the CBVH Supported Employment Coordinator. The referral should include, if available:
the referral form;
Individualized Plan for Employment;
2. a recent confidential health form;
3. a recent eye medical report;
4. a psychological report
5. educational information; and
6. vocational information.
Supported Employment Funded Under Title I
When it is not possible to use CBVH contractor agencies, CBVH counselors may purchase supported employment services through private agencies for the blind or generic agencies using regular case service funds.
In such instances, job coaching services during the intensive onsite training phase will be limited to a maximum of $3750/consumer ($5,000/consumer who relies upon sign language). If necessary, the counselor may request a waiver as described on page 8.38.04.
As soon as the intensive training services on the IPE for Supported Employment are initiated, the individual should enter Status 18 and remain in that status until stabilization has occurred or the 18 months have ended, whichever occurs first.
Stabilization, Status 22
Stabilization will occur when the counselor determines that the supported employment placement is expected to remain intact for the indefinite future. This is usually determined when the job coach reduces their time to 20 % of the total time the consumer works per week and is placed into extended services by the provider. It will be additionally determined through the employer's and consumer's satisfaction with the job performed and by the fact that a system of support is in place and will be carried out by a long term provider. At this point, the individual's case should enter Status 22.
If it is found that the individual is unable to maintain employment without continued intensive vocational rehabilitation services, either:
1. alternate job sites should be developed, or
2. the individual's case should return to Status 18 for plan redevelopment, or
3. the individual's case should be closed in Status 28.
Individuals who have successfully maintained their employment at the stabilization level for a period of at least 60 days should be closed in Status 26.
Transition to Extended Services
During the development of the IPE for supported employment, the counselor will have determined funding sources for extended follow along services to be provided after vocational rehabilitation funded services have been terminated. Such funding may be available through OMRDD, OMH, private agencies or a special state fund for extended services. CBVH has worked with VESID, OMRDD and OMH to develop a cooperative agreement (i.e. Memorandum of Understanding (MOU)) which includes provision of extended follow along services. A copy of the MOU, which is revised annually, is available in each district office.
Extended services will provide:
1. regular ongoing assessment of the individual's progress after the job coach is no longer on the job site on a daily basis;
2. assurance to the individual employee and the employer that help is available, if a problem arises;
3. response(s) to changes in the employment situation.
4. a minimum of twice monthly on-site visits, unless waived by the counselor, and reflected in the IPE.
5. one contact per month, minimum, with the employer.
Extended services may consist of telephone calls, periodic onsite visits, or most probably a combination of both types of contact. They are expected to continue as long as necessary to maintain the employment, possibly for the individual's lifetime.
Post Employment Services
Individuals who have successfully completed a supported employment program may be eligible for Post Employment Services (PES) through CBVH in addition to the extended services being provided to maintain the supported placement. PES services should be limited to the provision of time limited specific interventions, which cannot otherwise be provided.
Reapplication for Supported Employment Services
At the time of closure, the individual (and, if appropriate, his or her representative) should be advised that he or she may reapply for services if: the individual can no longer continue in supported employment; the current supported employment placement is no longer appropriate, or additional vocational rehabilitation services may
enable the individual to obtain unsupported competitive employment.
In order to maximize the use of Title I and Title VIC funds for supported employment, CBVH will make maximum use of services from public agencies, private nonprofit organizations, and other appropriate resources in the community to carry out a supported employment program.