Transcript Guide to Supported Employment and JCTS

Supported Employment and
Long Term Follow-Along
for the
Counselor and Job Coach
December, 2008
Introductions:
– Judy Hill - EES/LTESS Coordinator
OFFICE OF EMPLOYMENT SERVICES AND
SPECIAL PROGRAMS
• JUDY HILL 804-662-7108
• email [email protected]
• FAX NUMBER FOR ESSP: 1-804-662-9140
DRS TOLL FREE VOICE
1-800-5525019
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/pd
f
What’s in your resource packet?
• Understanding Order of Selection Brochure
• Power point Presentation
• Enclave/Mobile Crew 101, Stability for Individual SE
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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
Topics to Cover:
• Insights into SE/Long Term
Practices
• Brief Historical Background – EES
and LTESS
• Key Service Requirements for Long
Term Follow-Along
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
Why are we here?
• To stress the importance of
communication and collaboration
among all parties
• Supported employment specifics
• Long Term Follow-along – LTESS
specifics
THE KEYS TO SUCCESS
RELATIONSHIPS
- 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
THE KEYS TO SUCCESS
TRUST
- 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
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
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?
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
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
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
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
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
vendor’s 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.
DRS Counselor Roles and
Responsibilities
• Once eligibility is
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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.
DRS COUNSELOR ROLE
• Establish benchmarks regarding progress.
• Stop the process if needed and discuss issues – Interrupt
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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!!!!!!!!!!!!!!!!
HIPPA ISSUE
• ESOs will not be able to reference SS #s in the
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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.
Job Coach Role:
• Assist consumer
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with locating
suitable job
matches.
Assist in job search
efforts.
Provide timely
written reports and
phone contacts
with updates as
needed.
• Provide job skills
•
•
training as needed.
Ensure consumer
stability and job
satisfaction on both
consumer and
employer side.
Provide extended
support services,
where appropriate.
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.
Topics coming up:
Communication Issues
• Initial Planning
• Authorizing Services
• Service Provision
• Report Writing
• Invoicing
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
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
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.
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.
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 P&T Report (SE Form 3) should indicate
consumer is stable in employment before LTFA begins.
INVOICING:
Billable 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!
INVOICING:
Billable 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
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.
EMPLOYMENT STABILITY AND
THE MOVEMENT FROM TIME
LIMITED TO LTESS FUNDING
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.
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”.
DRS Individual SE Case Movement
• The DRS Counselor keeps the consumer in
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“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.
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.
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.
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.
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 client’s needs with respect
to maintaining employment.
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.
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.
QUESTIONS?????
EES/LTESS BUDGETS
FISCAL 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
EES/LTESS BUDGETS
FISCAL 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%
Long Term Employment Support
Services Funding 95-08
$6,000,000
$5,000,000
$4,000,000
$3,000,000
$2,000,000
$1,000,000
$0
95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09
Extended Employment Services
Funding 95-08
$3,500,000
$3,000,000
$2,500,000
$2,000,000
$1,500,000
$1,000,000
$500,000
$0
95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09
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.
EES/LTESS – What’s 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
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.
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.
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….
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.
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%).
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.
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.
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 workedsend in documentation
– Email notification is sent to counselors upon
submission of LTESS application
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.
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
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!!
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.
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.
REALLOCATIONS
• DRS reviews expenditure patterns
throughout the fiscal year and
completes reallocations as needed.
• Reallocations are based on an individual
organization’s statistics-average hours
billed, average attendance, individual
rates, months/days remaining in fiscal
year.
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.
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.
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
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
FORMS
• Applications
• Closures
• Requisition/Invoices
Questions?