MILESTONE PAYMENT SYSTEM

Initially the Oklahoma Department of Rehabilitation Services reimbursed contractors providing Supported Employment services at an hourly rate for time spent working with consumers. Contracts were billed for process rather than results, creating an incentive to maintain consumer dependence.

To reward quality outcomes (rather than process), a self-regulating, consumer success focused payment system was designed in cooperation with contractors. Contractors bid using individual program costs, factoring in dropouts and high need cases. The contractor is paid in increments (milestones), as progress toward the outcome is achieved and required documentation is submitted and verified.

Monitoring capability is readily available through evaluation of billing documentation that includes employer and consumer satisfaction reports, as well as a narrative summary of activities involved in that milestone. This feedback creates opportunity to improve the probability of consumer success through changes in services and/or provision of technical assistance and training. If promised goals are not met, the contractor’s income suffers; however, if required outcomes are produced, the rewards are costs met and possible program expansion.

Impressive outcomes and cost savings have resulted:

q 25% reduction in outcome cost

q 33% reduction in required documentation

q 52% reduction in time consumer spends waiting to enter program

q 18% reduction in time waiting for job placement

q 47% reduction in time from job start to successful integration into the workplace

The Oklahoma Milestone funding system has received recognition from three national award competitions. It is one of two payment methods included in the new legislation for the Social Security Administrations’ Ticket to Work system. In addition, over fifteen state and local governments have based their payment systems on the incentive principals, or used the collaborative planning component to reorganize their contracting systems. The Virginia Commonwealth University’s Rehabilitation Research and Training System describes it as “the fairest combinations of cost control and individualized cost reimbursement…. to date nationally”.

OKLAHOMA

DEPARTMENT OF REHABILITATION SERVICES

DIVISION OF VOCATIONAL REHABILITATION

Central Office Number (405) 951-3400

Mission: The mission of the Department of Rehabilitation Services is to provide opportunities for individuals with disabilities to provide opportunities for individuals with disabilities to achieve productivity, independence, and an enriched quality of life.

Counselors from the Division of Vocational Rehabilitation (DVR) and the Division of Visual Services (DVS) work with consumers to develop individualized plans for employment with specific vocational goals.

Assistance may include: vocational, medical and psychological evaluations; job counseling and guidance; vocational, academics, on-the-job, and work adjustment training; job coaching; rehabilitation equipment and devices; job placement; physical and mental health services for consumers who are blind, Deaf, hard of hearing or deafblind and those with speech impairments.

In general, a person is eligible for vocational rehabilitation (VR) services is he or she has a physical or mental disability, which results in a substantial barrier to employment and can benefit from VR services. Individuals with the most severe disabilities receive priority in the delivery of services.

The primary funding source for VR and employment services is federal dollars. The state provides some matching dollars to support these programs. Consumers may share the cost of some services, depending on their incomes.

As the employment agency for Oklahomans with disabilities, DVR provides vocational rehabilitation services that help people get jobs in careers of their choice. As a result, thousands whose disabilities were barriers to employment become taxpayers each year, eliminating or reducing their need for disability benefits and social assistance.

The Division of Vocational Rehabilitation helps people with all kinds of disabilities, except those with visual impairments, who are served by the Division of Visual Services within the Department of Rehabilitation Services. The Division of Vocational Rehabilitation has offices located all across the state. Consumers with severe disabilities and multiple needs receive help on a priority basis. Individuals may share the cost of some services, depending on financial status.

· Vocational evaluation, counseling and guidance is provided by counselors to consumers throughout the rehabilitation process.

· Medical and psychological assessments are used to determine eligibility and review consumers’ background abilities, disability-related barriers to employment and rehabilitation needs.

· Physical and mental health services may be provided to enhance consumer’s employment opportunities.

· Training may include vocational, academic, on-the-job, and vocational adjustment training, job search skills development and job coaching.

· Rehabilitation equipment and devices (assistive technology) and rehabilitation engineering services enable consumers to function more effectively in the workplace.

· Job placement helps consumers find suitable employment in their chosen careers.

· Specialized programs assist consumers who are deaf, hard of hearing, deaf-blind, individuals with speech impairments and severe disabilities, and those who need supported employment or independent living services.

The DVR process:

1. A person is interviewed by a VR counselor and fills out an application for services.

2. A preliminary assessment explores the applicant’s background, abilities, disability-related barriers to employment and rehabilitation needs.

3. The applicant is generally determined eligible or ineligible for services within 60 days.

4. An eligible consumer and a VR counselor develop a plan of services needed to reach or maintain suitable employment in a career of the consumer’s choice – based on the consumer’s interests, abilities and other important factors.

5. Services are provided to meet the consumer’s employment goals, according to the plan of services.

6. The consumer obtains suitable employment in a career of his/her choice. The VR counselor closes the case because the consumer is successfully employed.

7. Follow-up and/or post-employment services ensure that employment is stable.

The Oklahoma Department of Rehabilitation Services offers:

· Rehabilitation Plans for Employment

Supported Employment

Transition School-to-Work Program

· Independent Living Services

· Services to the Deaf and Hard of Hearing

· Transitional Living Center

· Visual Services

Instructional Services

Older Blind Independent Living Services

Library Services

Business Enterprise Program

· Oklahoma School for the Blind

Residential Education

Outreach

· Oklahoma School for the Deaf

Residential Education

Outreach

ROLES OF REHABILITATION COUNSELORS & JOB COACHES

REHABILITATION COUNSELOR ROLE

Rehabilitation counselor involvement in supported employment includes case management, coordination, and counseling. In this role, the counselor should work in close cooperation with the supported employment service provider whose services are purchased by the counselor.

Counselor Roles

OCase management

OCoordination of services

OCounseling

OPre-authorizing milestones

OPaying claims

OMonitoring quality of service

The counselor authorizes for the supported employment services and monitors the implementation of services provided to the consumer. The counselor should be attentive to issuing preauthorizations at appropriate times and in paying milestone claims in a timely fashion when the provider submits the required information. Milestones can be billed as they are completed and thus can come in to the counselor=s office more than once per month.

At a minimum, the counselor should monitor the progress of the consumer at the end of each milestone when the provider submits progress reports and required documentation for payment. In this respect, the supported employment service for a consumer requires more than the usual amount of the counselor=s attention to a consumer=s training service.

The counselor should be thoroughly familiar with the provisions of the supported employment provider=s contract and the funding that is available. This information is available at any time through staff of the Community Rehabilitation Services Unit, who negotiate the contracts with providers and monitor their contract compliance.

JOB COACH ROLE

A job coach, also known as an employment training specialist or employment specialist, is a trained professional who provides supported employment services that can be purchased by a rehabilitation counselor. The coach provides individualized job placement, job site training, and on-going assessment and support for persons with the most severe disabilities. Usually operating out of placement programs such as mental health centers, sheltered workshops, vocational technical schools, etc., the coach offers a service for counselors to purchase so that individuals with the most severe disabilities can be placed in employment. A job coach can provide the linkage between the client, employer, rehabilitation counselor, case manager, family or caregiver, school personnel, and provider staff. Competencies include a knowledge of client assessment, job analysis, job placement, behavioral training strategies, counseling, advocacy, interpersonal skills, employer needs, business procedures, parent/caregiver concerns, public and private agency regulations, and staff roles.

There are no set criteria for educational background for coaches. Each agency has its own criteria for hiring. Coaches range in education from having Masters degrees to high school education. In Oklahoma, job coaches must receive training and must be Acertified@ within six months of hire. Through a contract with the University of Oklahoma, job coach training is offered in two forms: training for coaches working with people with developmental disabilities, and training for job coaches working with people with mental illness. Coaches who have received training from sources than OU must be able to pass the certification exam.

COMPLEMENTARY ROLES OF COUNSELOR & JOB COACH

Supported employment services are most effective when insightful collaboration occurs among the counselor, the consumer, friends, family members, service providers and the business community. The job coach and rehabilitation counselor each have unique and vital roles in the supported employment process. However, individual consumer choice and desired outcomes are maximized when these professionals develop and nurture a partnership with the consumer that is built on shared values, trust and a commitment for achieving success.

...Program Development

I believe the roles of rehabilitation counselors and job coaches are complementary. The role interface varies depending on the job specification of either party, their individual skills, and the needs of the partnership with consumers. This involves counseling, coordination, planning, implementing, and overseeing the delivery of supported employment services. For the consumer to gain maximum benefit, the rehabilitation counselor and the job coach must be in regular communication with each other and with the consumer. Further, they must both be committed to services that are maximally under the control of the consumer, least intrusive, most natural and facilitate independence and autonomyBEdna Szymanski, Ph.D., University of Wisconsin-Madison

Program development is the process of identifying jobs within a community while assessing a consumer=s skills, interests, and abilities to determine a job match. The rehabilitation counselor and job coach will likely have different contacts within business and industry. It is important that they collaborate in their efforts to advocate for the consumer when interacting with the employers and the community. This increases job possibilities for the consumer. The coordination of program development activities provides further foundation for promoting a positive working relationship.

...Implementation

Program implementation includes those activities associated with actual job placement of the individual. The job coach=s role involves the orientation of the worker in the work environment, job-site training of required

tasks, stabilization of work performance, and follow-along activities. The rehabilitation counselor can provide counseling, initial case management, support, and trouble-shooting associated with the implementation process. The counselor=s educational background often makes him or her a valuable resource in assisting with job analysis, conducting on-site visits to assure both quality placements, consumer and employer satisfaction, and continued counseling and follow-up activities.

...Management

The employment specialist and rehabilitation counselor have case management responsibilities within the supported employment process. The job coach=s activities typically encompass the collection, interpretation, and reporting of consumer data, utilize problem solving skills, provide follow along support, and schedule new consumer placements. The counselor=s role includes assessing and analyzing services provided to the consumer. For example, the counselor monitors the quality of the placement and training, as well as authorizing milestones and monitoring their completion. The rehabilitation counselor also has the major role in identifying funding and resources for the extended services phase of supported employment

...Evaluation

Responsibilities of the job coach include on-going communication with consumers, their families, and employers. The employment specialist utilizes data collected and feedback received to determine on-going stability of the consumer=s job performance and consumer/employer satisfaction. The counselor must effectively monitor and evaluate each job placement to assure quality outcomes. For this to happen, the consumer needs to be directly involved with each individual case and to promote consumer input in the evaluation process.

AQuality Indicators=@ Volume 2, December 1992, newsletter Supported Employment Technical Assistance Center, Virginia Commonwealth University

DEPARTMENT OF REHABILITATION SERVICES

PARTIAL ORGANIZATION CHART

Technical Assistants

Supervisors

COMMUNITY REHABILITATION CONTRACTS

DECISION TREE

The “Decision Tree” is intended as guidance regarding selection of an appropriate type of service for a consumer, based on level of support needs. If inadequate information exists to answer the question, consider additional assessment.

EMPLOYMENT PREPARATION FOR PERSONS WITH DEVELOPMENTAL DISABILITIES

CONTRASTS BETWEEN TRADITIONAL AND SUPPORTED EMPLOYMENT APPROACHES

Cornerstones of the supported employment approach are behavioral training techniques and emphasis on training in the actual work environment. According to the supported employment approach, it is critical for persons with severe disabilities to receive training and other interventions under the circumstances and in the environment where performance is ultimately required. Individuals with mental retardation often have difficulty transferring the job skills and work-related behaviors learned in one environment to a new job site. Supported employment programs utilize situational assessment and detailed job analyses to determine the most appropriate job/client match. Individualized training by a trained job coach is provided on the job site from the first day of paid employment. Behavioral training strategies are used to teach the job skills and work-related behaviors, such as social skills, in the community where they actually occur. As skills are acquired and job tasks performed to the employer's standards, the trainer's time on the job site is gradually reduced or "faded".

In contrast, the traditional rehabilitation approach emphasized training consumers to be "job ready" before placement in competitive employment. Consumers are evaluated, trained, and then placed into employment. Individuals who are deemed not ready for competitive employment may be placed in prevocational or sheltered workshop programs for extended employment or continued work adjustment training. Unfortunately, in many cases sheltered workshops use subcontracts requiring assembly or other skills not representative of real jobs in the community and therefore are not valid predictors of successful community employment. Consumers who entered sheltered employment often never had an opportunity for competitive employment.

The traditional and supported employment approaches differ in regard to sequencing of services for the consumer. In the traditional approach, an individual who could not sign a time sheet, or who lacked the independent travel skills to take a bus, might not be placed in a competitive job if those skills were considered requisite for employment. With the supported employment approach, however, that same person might be placed in a selected job. Job skills and job-related skills, like signing a time sheet and taking a bus, would then be taught by a job coach at the job site or the bus stop and in the context of the individual's job.

Characteristics of model/approach

Traditional

(train/place)

Supported Employment

(place/train)

Assumptions

Behaviors learned in one setting can transfer to another setting

Behaviors are best taught in settings and under circumstances where they will be performed; is extremely difficult for many individuals with DD to generalize behaviors learned in one setting to another setting.

Types of interventions

Day activities; prevocational training; life skills training; work adjustment

Task analysis; individual job-specific training; training in actual work environment

Level of support, instruction & supervision

Relatively constant; amount determined more by program size and regulation rather than by individual need.

Intensive initially, decreasing over time; flexible, amount determined by individual need; support faded as performance stabilizes and natural supports in the business provide needed assistance.

Evaluation/assessment

Traditional, measured prior to learning and traits, occurs before development of vocational goal and initiating of training

Situational assessment of performance on specific job

Opportunities for integration

Very limited

Required

Wages

Piece rate or commensurate wage

Minimum wage required

Competitive employment outcome

Rare

Required

From: Szymanski, E., Buckley, J., Parent, W., Parker, R. & Westbrook, J. (1988). Rehabilitation Counseling in Supported Employment, A conceptual Model for Service Delivery and Personnel Preparation. In Rubin, S. & Rubin, N. (Eds.), Contemporary Challenges to the Rehabilitation Counseling Profession (pp. 111-133), Baltimore: Paul Brookes Publishing Co.

DEVELOPMENTAL DISABILITIES SERVICES DIVISION

The Developmental Disabilities Services Division is an operating unit of the Department of Human Services.

DEFINITIONS

DEVELOPMENTAL DISABILITY

A severe chronic disability of a person which:

T Is attributable to a mental or physical impairment or combination of mental and physical impairments;

T Is manifested before age 22;

T Is likely to continue indefinitely;

T Resulted in substantial functional limitations in 3 or more major life areas;

T Reflects the person's need for a combination and sequence of special, interdisciplinary or generic care, treatment or other services which are lifelong or extended duration and are individually planned and coordinated.

Seven Major Life Areas:

•Self-care activities are the things people do daily to meet their basic life needs. They include eating, personal hygiene and grooming.

•Receptive and expressive language are the verbal and nonverbal skills a person needs to understand others and to express his/her ideas and feelings.

•Learning is the ability to acquire new behaviors, perceptions and information; the ability to apply past experiences to new situations.

•Mobility is the ability to move from one place to another with or without mechanical aids.

•Self-direction is the ability to take care of oneself; to make sound personal decisions and protect his/her self-interests.

•Capacity for independent living describes a person’s ability to live without extraordinary support in a way that is age appropriate.

•Economic self-sufficiency describes a person’s capacity to maintain adequate employment and financial support.

GENERAL TERMS FROM DHS Manual 340:100-1-2:

ADVOCATE: means a person who speaks for or on behalf of an individual, especially when individual rights or interests are at risk.

CASE MANAGER: a professional who is responsible for assuring that services to an individual are planned and provided in a coordinated fashion. Additional responsibilities include independent advocacy, brokerage, and monitoring activities with, and on behalf of persons receiving services.

GROUP HOME: any establishment or institution...for not more than 12 residents, 18 years of age or older who are developmentally disabled or physically disabled, and which offers or provides supervision, residential accommodations, food services, training and skill development opportunities designed to lead to increased independence of the residents, and supportive assistance to any of its residents requiring supportive assistance. Homes certified by DHS as foster homes, and living arrangements certified under the Adult Companion Home Certification Act, are not considered group homes.

GUARDIAN: means a person(s) appointed by a court as general or limited guardian of the person, general or limited guardian of property, special guardian, or temporary guardian as provided by state statutes. The term does not include a person(s) appointed as guardian ad litem.

GUARDIAN AD LITEM: means a person(s) appointed by the court to represent the interests of an individual in a legal action.

HABILITATION SERVICES: means goal-directed services and therapy activities designed to assist an individual with developmental disabilities to achieve greater mental, physical and social development. Activities are based on the individual's capacity to make progressively independent and responsible decisions about social behavior, quality of life, job satisfaction, and personal relationships. The goal of habilitation services is to strengthen developmental skills and resolve personal deficits which interfere with the individual's capacity to successfully remain in his or her home or other community-based settings.

HCBS or HCBW SERVICES: means services funded through Oklahoma's Title XIX Home and Community-Based Waiver.

ICF-MR: means Intermediate Care Facility for the Mentally Retarded - a residential facility licensed in accordance with state law and certified by the federal government as a provider of Medicaid services to persons who have mental retardation or related conditions.

INDIVIDUAL PLAN: (IP) means a plan of intervention developed by the interdisciplinary team based upon assessment of need. It specifies all the goals and objectives being pursued on behalf of the individual, the steps being taken to achieve them and all of the services provided by each agency. The individual habilitation plan is a single, consistent, and comprehensive plan that encompasses all relevant components of

the individual's life. Various aspects of the plan such as education, rehabilitation, health

care, and others are assigned to those persons or agencies who can best provide, or who are legally required to provide, the necessary services.

INTERDISCIPLINARY TEAM: (IDT or Team) means the decision-making body for service planning, implementation, and monitoring of the individual plan. The Team includes the person receiving services, his or her case manager, the legal guardian, and the person's advocate(s), if there is one, who may be a parent, a family member, a friend, or another who knows the person well. The term "Personal Support Team" replaces the term "Interdisciplinary Team".

MENTAL RETARDATION: means a condition which refers to substantial limitations in present functioning. It is characterized by significantly subaverage intellectual functioning or existing concurrently with related limitations in two or more of the applicable adaptive skill areas of: communication, self care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure and work. Mental retardation manifests before age 18.

PLAN OF CARE: means a summary listing of services prescribed within the IHP, which indicates the frequency, duration and cost of each service recommended for funding through HCBWS. This document is not required in service planning for individuals residing in ICF's-MR or who receive services funding through sources other than the HCBS waiver.

EMPLOYMENT TERMS FROM DHS Manual 340:100-1-2:

COMMENSURATE WAGE: means wages paid to a worker with a disability based on the worker's productivity in proportion to the wages and productivity of workers without a disability performing essentially the same work in the same geographic area. Commensurate wages must be based on the prevailing wage paid to nondisabled experienced workers doing the same job.

COMMUNITY INTEGRATED EMPLOYMENT: (CIE) means a service program which provides placement, job training, and short term or long-term supports to assist individuals who are eligible for developmental disabilities services in achieving and maintaining employment within the community.

INTEGRATED VOCATIONAL SITE: means a site or activity that provides regular interaction with people without disabilities, excluding service providers, to the same extent that a non-disabled worker in a comparable position interacts with others.

VOCATIONAL ASSESSMENT: means the employment service, whether or not standardized procedures are employed, that identifies the unique preferences, strengths, and needs of the consumer, evaluates work skills and work behaviors, is supplemented by personal interviews and behavioral observations, and incorporates information that addresses the consumer's medical, physical, psychological, social, cultural, and educational goals and objectives, as well as present and future employment options. The assessment is updated annually or more frequently as needed.

VOLUNTEER JOB: means a job in which a consumer freely participates, which is not a part of a vocational plan or requirement.

ELIGIBILITY CRITERIA FOR DDSD SERVICES (DHS Manual 340:100-31)

1. Individual is a resident of Oklahoma.

2. Individual has mental retardation and/or related developmental disability.

a. Title XIX (ICR-MR, HCBWS) eligibility criteria.

(i) be age six or above,

(ii) be determined to have a disability, with a diagnosis of mental retardation, by the Social Security Administration or the DHS medical evaluation unit.

(iii) be determined financially eligible through the DHS family support services division; and

(iv) be determined by the DHS long term care/Medical Evaluation to meet the ICF/MR/Waiver Level of care requirements.

b. Eligibility for services funded through the State of Oklahoma (without federal subsidy).

(i) determination of eligibility, with a diagnosed of mental retardation, by the Social Security Administration; or

(ii) a determination of eligibility by the DHS/DDSD area manager upon presentation of evidence (psychological assessment) of a measured intelligence full scale IQ of 75 or less; and has substantial limitations in at least three of the following areas of major life activities.

# self care

# receptive and expressive language

# learning

# mobility

# self direction

# capacity for independence

# economic sufficiency

(iii) the applicant has achieved an age defined within provisions of each

state funded program.

(iv) individuals approved for DHS/DDSD service prior to 1-90 shall maintain their eligibility for services.

c. Eligibility for receipt of habilitation and support through the special needs program (Crippled Children's programs) requires that the applicant

(i) be age five or under and

(ii) meet eligibility requirements (medical and financial defined to the program).

d. Individuals residing in nursing facilities prior to January 1, 1989, who are determined by PASSARR evaluation conducted pursuant to the provisions of P.L. 100-203 to have mental retardation or related condition, are eligible for DDSD services.

DDSD FUNDING

...Community Integrated Employment

Community Integrated Employment or CIE, as it is commonly known, is funded with pure state dollars. CIE dollars are used to fund a variety of types of employment programs in sheltered workshops across the state (i.e. work crews, group placements, individual placements, etc.) and, under agreement with DRS, are also used to fund ongoing support services in supported employment programs. For example, if DRS has a contract with a vocational-technical school to provide supported employment services, DDSD will set up a CIE contract with the same vocational-technical school to provide ongoing support services. CIE funds are used only in situations in which Title XIX Home and Community Based Waiver Services dollars are not available.

...Title XIX Home and Community Based Waiver

DOCUMENTATION OF NON-AVAILABILITY OF FUNDS

TVR has no contract to provide the specific services requested in the county in which services are requested.

TVR has no contract with the provider the consumer has requested.

TThe consumer has met the work goal defined in the IPE.

T The consumer has been determined ineligible for VR services.

TThe service requested is not provided by VR.

TThe potential job placement doesn't meet VR requirements.

The Health Care Finance Administration (HCFA) regulations require that before supported employment services can be funded through the HCB waiver, documentation is needed that funding for these services is not available for the recipient through Section 110 (regular case service dollars) of the Rehabilitation Act. According to HCFA, each state must establish its own specific criteria for what constitutes documentation of non-availability of VR funds. For this

purpose, DRS and DDSD have included these parameters in the Interagency Agreement.

The HCB waiver is approximately 67% federal funding, requiring a state match of 33%. Because there is a significant amount of federal funding available, the waiver is a much more "desirable" dollar to spend than are the pure state dollars in the CIE program.

Effective October 1, 1997, Title XIX of the Social Security Act was amended to remove the prior institutionalization requirement for eligible individuals seeking funding for supported employment services through the waiver. However, states must come up with the state match to access these dollars for additional consumers.

DIFFERENCES IN SUPPORTED EMPLOYMENT DEFINITIONS:

HCB WAIVER:

Supported employment services are "provided to persons for whom competitive employment at or above minimum wage is unlikely, and who, because of their disabilities, need intensive ongoing support to perform in a work setting".

REHABILITATION ACT:

Supported employment is defined as "competitive work in integrated settings for persons with the most significant disabilities for whom competitive work has not traditionally occurred or has been interrupted or intermittent as a result of a significant disability".

It can be confusing for counselors to understand that sometimes what DDSD describes as supported employment does not meet DRS criteria. The counselor should always be sure that a "supported employment" placement meets all criteria in terms of integration, work hours, and wages.

TRANSFER OF FUNDING FROM DRS TO DDSD

Supported Employment funding for DDSD programs is transferred from DRS to DDSD when stabilization has occurred at the job site and the case is moved to status 22. The individual is considered "stabilized" when she or he has been employed a total of 17 weeks and is working the minimum work hours set by the DRS counselor in the IPE. Other indicators of having met the stabilization criteria is the consumer and employer satisfaction, as well as documentation that the individual has worked a minimum of 2 entire shifts (within a week) without job coach support.

As part of the interagency agreement with DRS and DDSD the DDSD transfer form is to be completed and submitted by the DRS counselor to DDSD at least 30 days prior to the targeted date of funding shift from DRS to DDSD ongoing support services. The form should be sent at the end of milestone, 10 Week Job Retention, with a target date showing when 17 weeks of employment will occur. The original is sent to the case manager and a copy is sent to the DDSD employment services/resources development unit in Area II. In Area I and Area III, copies are to be sent to the area offices. DDSD case management services need to complete an application for DDSD services. The consumer should make application for DDSD services when referred for supported employment services.

SUPPORTED EMPLOYMENT TRANSFER FORM

(DRS to DDSD Services)

Individual’s Name ____________________________________________________

Last First Middle

No DDSD*

Classification: Focus Balance Non-Class VR Services

DOB: ___________________ SS # _________________________

Race/Sex ______________________ IQ: ___________________________

Diagnosis: __________________________________________________________

Functional Limitations: _________________________________________________

___________________________________________________________________

Date Vocational Rehabilitation services began: _____________________________

Currently employed? Yes / No

Stabilization date: ___________ or 18-month expiration date: _________________

Project Manager: _____________________________________________________

Primary ETS: ________________________________________________________

Date of Targeted Program Transfer: ______________________________________

Status: (circle) a. Stabilization b. 18-month Discharge (Employed) c. 18-month Discharge (Unemployed) d. Supported Employment Denial

Reason:____________________________________________________________

___________________________________________________________________

Additional Comments: ________________________________________________

___________________________________________________________________

*All individuals who do not receive DDSD Case Management Services need to submit a DDS-1, Application for DDSD Services.

Attachments: All Placement/Discharge Reports and Last 2 Months of ETS Intervention Grid.

__________________________ ______________________________

Casemanager Date

SUPPORTED EMPLOYMENT MILESTONES - DD

NAME OF MILESTONE: Determination of Needs

Outcome: A determination of the client's rehabilitation needs through an assessment of the client's abilities and functional limitations.

Service Description: If assessments are determined to be necessary for an individual, such assessments must be completed in a community setting. The number and length of situational assessments must be negotiated with the DRS counselor. Payment will be made when the counselor has sufficient information to determine eligibility and the level of service the consumer requires. Documentation must be submitted to the DRS counselor within 45 days of the consumer's entry into the supported employment program.

Required Documentation:

(a) Computerized progress report;

(b) Situational assessment reports and/or Vocational assessment forms; and

NAME OF MILESTONE: Vocational Preparation Services

Outcome: A client who is prepared for the demands and stresses of competitive work.

Service Description: A Pre-Vocational Training Group, an individualized Work Hardening Program or other pre-approved vocational preparation service should be completed. The program, or curriculum, and trainers must be approved in advance by the designated DRS staff.

A combination of group and individual services can be used. The proposal must clearly state the number of hours of service the average client will receive. The minimum required contact hours between Pre-Vocational Training and Work Hardening is 30 hours. Groups are limited to a total of 8 individuals.

Required Documentation:

(a) Dates and hours of attendance (attendance sheets submitted);

(b) Consumer has completed program; and

NAME OF MILESTONE: Job Placement

Outcome: A job placement has been made which matches the vocational objective contained in the IPE.

Service Description: Job Analysis and Task Analysis have been performed and forms have been competed. The job in which the individual has been placed meets all supported employment guidelines, and the client has begun work. Job Placement will be determined to be completed when the consume has started his/her third day of work.

Group placements will be allowed only for individuals with developmental disabilities who meet the definition of Highly Challenged. The milestone payment allowed will be 7.5% of the bid rather than 15%. The group placement must meet all supported employment guidelines. Wages of individuals working in the group must meet these two criteria: (1) wages are paid by the employer, and (2) represent minimum wage or better.

Required Documentation:

(a) Computerized progress report

(b) Employment verification form signed by employer;

(d) Job analysis form.

NAME OF MILESTONE: 4 Week Job Retention

Outcome: Individual has worked successfully for 4 weeks and has received the support services defined in the IPE.

Service Description: The purpose of the job retention phase is to provide intensive on and off job site supports which assist the worker in adjusting to the demands of the integrated work environment.

Group placements are permitted only for individuals with developmental disabilities who meet the definition for "Highly Challenged". The milestone payment allowed will be 12.5% of the bid rather than 25%.

Required Documentation:

(a) Employment verification form (verification of continued employment and hours worked per week will be required for payment); and

(b) Computerized progress report.

NAME OF MILESTONE: 10 Week Job Retention

Outcome: Individual has worked successfully for 10 weeks and has received the support services defined in the IPE.

Service Description: The purpose of the job retention phase is to provide intensive on and off site supports which assist the worker in adjusting to the demands of the integrated work environment to lead toward successful stabilization.

Group placements are permitted only for individuals with developmental disabilities who meet the definition for "Highly Challenged". The milestone payment allowed will be 10% of the bid rather than 20%.

Required Documentation:

(a) Employment verification form (verification of continued employment and hours worked per week will be required for payment); and

(b) Computerized progress report.

NAME OF MILESTONE: Stabilization

A. Consumers with Developmental Disabilities:

Outcome: The individual has been employed a total of 17 weeks and is working the minimum work hours set by the DRS counselor in the IPE. Consumer has received support services as defined in the IPE, meets all required criteria, and has been switched to extended services funding.

Service Description: The purpose of the stabilization phase is to ensure the consumer will be able tO retain employment with withdrawal of intensive support.

Group placements will be permitted only for DD consumers meeting the criteria of Highly Challenged. This milestone will be paid at 5% of the bid rather than 10%.

Required Documentation:

Verification of the following:

(a) The individual has been employed for a total of at least 17 weeks;

(b) A written employer evaluation has been submitted which indicates acceptable job performance during the most recent month;

DEFINITION OF AHIGHLY CHALLENGED@

An individual can be considered "highly challenged" for purposes of payment of the higher rate in supported employment milestone contracts if any three of the following apply to the individual:

a) Requires support on the job for personal care such as toileting, eating, hygiene and/or good medication compliance;

b) has exhibited an ongoing, documented pattern of explosive behavior, physical aggression, self abuse or destruction of property which would jeopardize himself or others at a worksite;

c) during the last 2 years, has experienced three or more events (e.g. hospitalization, incarceration or other institutionalization, recurring health or mental health issues) of at least 2 week duration which interrupted work or ability to live independently;

d) there is documentation the individual has been rejected by other programs (e.g. schools, vocational providers, etc.) as being too difficult to serve;

e) has been unemployed 30 or more months of the last 36 months; or has lost 4 or more jobs in the last year;

f) there is documentation of loss of 4 or more supported employment placements for reasons related to the individual's behavior, quitting, etc.;

g) supports required for employment success are absent and will be difficult to obtain (e.g. case management, transportation, residential services, advocacy, and positive family involvement);

h) the individual is a Hissom class member who will require extensive coordination with the case manager, team members, and parents (or guardian) to achieve employment success;

i) has a documented history of alcohol and/or substance abuse which has resulted in loss of employment;

j) requires specialized assistive technology such as sensory aids, telecommuniction devices, adaptive equipment, and/or augmentative communication devices to succeed in employment;

k) the primary or secondary disability is Borderline Personality Disorder or Autism;

l) (mental health consumers only) within the last 6 months, there is documentation of 3 of the following: social withdrawal, poverty of speech, poor hygiene, poor medication compliance, difficulty with initiating tasks, and/or 3 months of inactivity;

m) continues to exhibit serious symptoms of mental illness (e.g. hallucinations, delusions, etc.) despite good medication compliance.

GENERAL FLOW OF SUPPORTED EMPLOYMENT MILESTONES

FOR DEVELOPMENTAL DISABILITIES

Milestones	DRS Status	Outcome	Services	Provider Required Documentation
Determination of needs	02-10	Determination of consumers rehabilitation needs through an assessment of the clients abilities & functional limitations. Upon completion counselor writes IRP including job development and placement services. Authorization for milestone III issued to provider.	Community based assessments – Number and length negotiated with DRS counselor.	Within 45 days of application: •computerized progress report •situational assessment reports &/or vocational assessment forms •summary vocational assessment report or vocational profile
Placement	18	Job placement which matches the vocational objective on the IRP.	Job development ,job analysis and task analysis have been completed. The consumer has begun work.	•computerized progress report •employment verification form •job analysis form •task analysis form
4-Week Job Retention	18	Individual has worked successfully for 4 weeks at or above minimum work hours and has received support services defined in the IRP.	Intensive on and off-site job supports which assist the worker in adjusting to the demands of the integrated work environment.	•computerized progress report •employment verification form (verifying continued employment and weekly work hours)
10-Week Job Retention	20	Individual has worked an additional 6 weeks. A total of 10 successful weeks of employment with supports as defined on the IRP has been completed. The counselor sends the notice of transfer to DDSD for extended services to begin after stabilization.	Intensive on and off-site supports to assist the worker in adjusting to the demands of the integrated work environment leading toward stabilization.	•computerized progress report •employment verification form (verifying continued employment and weekly work hours)
Stabilization	22	The individual has worked an additional 7 weeks. A total of 17 successful weeks of employment with supports as defined on the IRP has been completed.	Retention of employment and gradual withdraw of intensive supports.	•computerized progress report indicating the individual has received support services, including ongoing support services and has met the weekly work goal as defined on the IRP •employment verification form documenting 17 weeks of employment •current employer evaluation indicating acceptable job performance and completion of 2 entire shifts without job coach support •current consumer job satisfaction form indicating client/family satisfaction •transfer of extended services funding begins at completion of stabilization
Status 26 Closure	26	The individual meets all required criteria and can be considered rehabilitated by DRS Counselor.	The individual has worked an additional 90 days beyond stabilization. Adequate training and support has been received as defined on the IRP. Ongoing support services are in place. Extended services funding begins.	•computerized progress report. •current employer evaluation •current client job satisfaction form

DEPARTMENT OF HUMAN SERVICES

DEVELOPMENT DISABILITIES SERVICES DIVISION

MISSION: to assist consumers who have successfully completed the VR-Milestone process with follow-along services.

Monthly Report includes:

1. Enter all DDSD billing and monthly progress reports.

2. Print billing report and progress reports.

3. Check billing report for time errors and general correctness.

4. Check progress reports for accuracy (general consumer income, work information).

5. Make backup disc for progress and billing reports.

6. Make copies of reports for client files and DDSD.

7. ADM-12 Form:

Fill in information, make 3 copies for DDSD and one for agency file. To make work easier for the Project Director, set up a computer file in Excel with the consumer’s name, DDSD case number, social security number, date of birth, hour quantity, unit price and amount claimed. This allows the PD to update the quantities and amounts claimed on the computer. Preparing this form has several advantages:

a. Above information like name, DDSD case number and so on does not have to be retyped every month, where the ADM-12 form would have to be typed with the typewriter.

b. It saves time.

c. PD is able to keep tract of monthly spending more easily.

8. Fill out Vocational Progress Reports on all consumers with DDSD Case Managers and send them to DDSD and the Case Managers.

9. Fill out on an as needed basis a Termination Report for consumers who loose their jobs and/or are terminated from the provider agency.

10. Fill out on an as needed basis a Job Placement Report for consumers who are transferred to DDSD funding after completing the milestone program and send it to DDSD.

Human Rights Committee:

1. Establish a Human Rights Committee.

2. Go through HRC training with your newly elected members.

3. Set up Policy and Procedure Manual.

4. Distribute Policy and Procedure Manual to members.

5. Host quarterly Human Rights Committee Meetings, supply agenda and necessary information about consumers which would be discussed in the meeting.

6. Record minutes for each meeting.

7. Make copies of minutes, distribute to members and keep copy for agency file, send copy to DDSD.

DDSD Performance Survey:

1. Complete all paperwork that is sent by the surveyors.

2. Prepare consumer files for surveyors.

3. Prepare documentation as requested by the surveyors.

4. Have staff training records (40 hours required) on hand and available for surveyors to review.

5. Have staff available if surveyors have questions.

Ensure consumer’s eligibility for DDSD services:

1. Supply consumer with DDSD application at intake meeting.

2. Send completed DDSD application to DDSD with signed release of information.

3. Remind VR-Counselor to send psychological testing to DDSD.

Current acceptable testing is limited to: 10 WAIS-R, 2) WISC-R, 3) Stanford-Benet. (Tests may be no older than 5 years; IQ can not be over 68 unless documentation of a secondary disability is available. IQ can be up to 75 if secondary disability is present and documented.)

1. Meet with consumer and family (if family is involved).

2. Discuss reason for termination of services.

3. Record minutes of meeting.

4. Put minutes into consumer’s file and into DDSD file “Voluntary Termination Reports”.

5. Present minutes and reasons for termination to Human Rights Committee.

DOCUMENTATION OF NON-AVAILABILITY OF FUNDS

SUPPORTED EMPLOYMENT TRANSFER FORM

Individual’s Name ____________________________________________________

Milestones

Outcome

Services

Provider Required Documentation