Employment

1
Division of Mental Health, Developmental
Disabilities, and Substance Abuse Services

• Employment
• Services Updates

2
Employment Works!

• Why encourage people with disabilities to work?
• Sense of identity other than a diagnosis
• Using skills and talents
• Personal satisfaction
• Community inclusion
• Social Integration
• Reduces double stigma disability and lack of
  occupation
• Employment should be the expectation not the
  exception
• Education and awareness is key

3
NC DMH/DD/SAS Statistics

• Served in 2010 332,796
• 232,397 Mental Health
• 20,127 Developmental Disabilities
• 80,272 Substance Abuse
• Working in competitive employment
• 4,500 (MH)
• 7,400 (SA)
• Of those working
• Employed F/T 7
• P/T 12
• Unemployed but seeking work 81
• NC individuals on Social Security benefits
  198,684

NCTOPPS self reports from LMEs
4
NC Department of Health Human Services

• Division of Mental Health, Developmental
  Disabilities, and Substance Abuse Services
  (DMH/DD/SA)
• Vocational programs and Supported Employment
  transition through Long Term Vocational Supports
• IPRS state dollars contracted to Local Managing
  Entities/Managed Care Organizations (LME/MCOs)
• Community collaboration and awareness
• In partnership with
• Division of Vocational Rehabilitation (DVR)
• Supported Employment (SE), Transitional
  Employment, support services, On the Job Training
  (OJT), school formal education, work adjustment
  training,
• Rehab Counselors are getting more MH training and
  focus
• Community Rehabilitation Programs (CRPs)

5
Community Rehab Programs (CRPs)

• CRPs provide vocational rehabilitation services
  to individuals with disabilities to enable those
  individuals to maximize their opportunities for
  employment, including career advancement.
• There are over 100 CRPs in North Carolina VR
  oversight
• LMEs contract with them to provide ADVP, LTVS,
  and SE services.

http//www.ncdhhs.gov/dvrs/employ/rehab.htm
6
Services Definitions

• Adult Developmental Vocational Program (ADVP)
• Day/night service which provides organized
  activities for individuals with IDD, or to
  individuals with physical disabilities, to
  prepare the individual to live and work as
  independently as possible.
• ADVP principles are designed to adhere to the
  principles of normalization and community
  integration.
• Activities may include
• personal and community living skill development,
  compensatory or adult basic education, training
  in cognitive, communication and motor skills, use
  of leisure time, vocational evaluation and
  adjustment, work skills training, and paid
  employment
• Community Activity Employment Transitions
  (CAET) is an alternative service definition that
  offers more community integration and is
  cross-disability focused some LMEs offer this
  (i.e., Durham, Mecklenburg, ECBH, Smoky)
• Eligibility Criteria
• There is an Axis I or II diagnosis present or the
  person has a condition that may be defined as a
  developmental disability
• Level of Care Criteria, NCSNAP/ASAM
• The recipient is experiencing difficulties in at
  least one of the following areas
• functional impairment
• crisis intervention/diversion/aftercare needs,
  and/or
• at risk of placement outside the natural home
  setting.
• The recipients level of functioning has not been
  restored or improved and may indicate a need for
  clinical interventions in a natural setting if
  any of the following apply
• At risk for out of home placement,
  hospitalization, and/or institutionalization due
  to symptoms.
• Presents with intensive verbal, and limited
  physical aggression due to symptoms associated
  with diagnosis, which are sufficient to create
  functional problems in a community setting.
• At risk of exclusion from services, placement or
  significant community support systems.
• Requires a structured setting to foster
  successful integration into the community

7
Services Definitions

• Supported Employment (SE)
• Involves arranging for and supporting paid work
  for an individual, age 16 or older, in a job
  which would otherwise be done by a nondisabled
  worker.
• Includes intensive involvement of staff working
  with the individual in the work setting or in
  support of the individual so that the
  individual's employment can be maintained in a
  normal community environment.
• Services may be either temporary or permanent.
  Specific versions of this model include
• Individual or Group Transitional Employment
  Program services commonly associated with
  Psychosocial Rehab Programs or
• Job Coach services.
• Activities may include
• vocational evaluation, job development, intensive
  training, job placement and long-term support.
• Eligibility Criteria
• There is an Axis I or II diagnosis present or the
  person has a condition that may be defined as a
  developmental disability
• Level of Care Criteria, NCSNAP/ASAM
• Individual verbalizes desire to work and
  currently expresses a preference for a group
  employment setting
• Individual has an established pattern of
  unemployment or sporadic employment
• Individual requires assistance to obtain
  employment and/or requires assistance in addition
  to what is typically available from the employer
  to maintain competitive employment because of
  functional deficits and behaviors associated with
  diagnosis.

8
Services Definitions

• Long-Term Vocational Support Services (LTVS-
  Extended Services)
• Begins after the intensive phase of job coaching
  funded through the Division of Vocational
  Rehabilitation ends.
• The individual participates in choosing the type
  of LTVS, the manner of its delivery, and the
  people who will provide it, both on and off the
  job site. .
• The individual has the right to decline this
  service at any time
• Activities must include,
• Services both on and off the job site to ensure
  ongoing employment success and career growth.
• Assisting the individual in acquiring and
  maintaining the necessary generic work skills
  that leads to a satisfactory employment
  relationship, such as communication and social
  skills, time management, benefits management, and
  other issues that may impact long term career
  success
• At a minimum, twice-monthly monitoring at the
  work site of each individual in supported
  employment to assess employment stability under
  special circumstances, off-site monitoring and/or
  a reduced amount of monitoring. Must include at
  least two meetings with the individual and one
  contact with the employer each month.
• Eligibility Criteria
• There is an Axis I or II diagnosis present or the
  person has a condition that may be defined as a
  developmental disability
• Level of Care Criteria, NCSNAP/ASAM
• Individual verbalizes desire to work
• Individual has an established pattern of
  unemployment or sporadic employment
• Individual requires assistance to obtain
  employment and/or requires assistance in addition
  to what is typically available from the employer
  to maintain competitive employment because of
  functional deficits and behaviors associated with
  diagnosis.

9
New Program Project Search

• The Project SEARCH High School Transition Program
  started at Cincinnati Children's Hospital Medical
  Center in 1996. It is dedicated to providing
  education and training to young adults with
  intellectual and developmental disabilities
  through an innovative workforce and career
  development model. The primary goal is to secure
  competitive employment outcomes for each of our
  student graduates
• NC Projects
• Mecklenburg LME
• Employer host is Mecklenburg County Human
  Resources Department.
• Jobs include backroom office support, copy,
  printing, document scanning, inventory control,
  small typing jobs.
• Education Partner is Central Piedmont Community
  College- Compensatory Education Program
• Community Rehab Program is InReach Inc,
• LME Contact is Dennis Knasel
• Durham LME
• Employer host is Durham Regional Hospital and
  affiliate of Duke University Health System
• Education Partner is Durham Public Schools
• Community Rehab Program is OE ( Orange
  Enterprises)
• LME contact is Terry Ames
• A third program is in planning stage at Guilford
  LME, Greensboro, with Educational Partner being
  Greensboro Public Schools and the CRP Partner
  being The ARC of Greensboro and TEEACH.

10
Updates for SFY2011-2012

• Employment Points of Contact in each of the 23
  LMEs
• Contract language for Employment Services is in
  the LME contract revisions for SFY 2011-2012 we
  will ensure it remains in the Waiver LME/MCO
  contracts (in development).
• Long Term Vocational Support allocated into a
  CASP (Cross-Area Service Program) that protects
  this funding to be used for what it was meant
  for, we will begin monitoring SFY 2011-2012
• Long Term Supports (YM645) allocated by the
  General Assembly (4 Million)
• SFY 06 SB 622 Conference Report Item 19
  1,500,000 (Recurring) SFY 08 HB 1473
  Conference Report Item 104 2,500,000
  (Recurring)
• Employment First Steering Committee workgroup
  started in August 2011
• To discuss the future of employment services in
  this state
• To promote a cross-disability employment
  initiative
• To strengthen the broad-based collaborative
  effort between the state divisions, advocates,
  organizations, stakeholders 
• To be a launching point for ideas, issues,
  initiatives

11
NC Business Leadership Network

• NCBLN is a new chapter and affiliate of the USBLN
  
• USBLN is the national disability organization
  that serves as the collective voice of over 60
  Business Leadership Network affiliates across
  North America, representing over 5,000 employers.
• Embraces the full inclusion of people with
  disabilities in the labor force and marketplace
• assists in career preparation for and employment
  of people with disabilities,
• improves customer experiences for people with
  disabilities,
• promotes the certification and growth of
  disability-owned business

12
State Employment Leadership Network

• North Carolina joined the State Employment
  Leadership Network (SELN) on October 1, 2011.
• Activities include
• Monthly Conference Calls
• State Strategic Employment Self-Assessment (to be
  completed by mid-November)
• Identify the specific policy and service areas
  that the state would like to address through the
  project
• Assess the strengths and weaknesses of each
  states existing employment support
  infrastructure
• Community Supplemental Survey open to all
• SELN Project Team Staff Visit (early January
  2012)
• Review the information gathered through the
  self-assessment process
• Discuss program strengths/barriers and identify
  desired project outcomes
• Pinpoint the objectives for technical assistance
  needs
• Develop linkages with participating states
• Identify issues of common concern that should be
  the focus of national attention

13
Employment First

• Purpose
• This position paper represents a statewide
  initiative sponsored by the North Carolina
  Alliance on Full Participation to promote the
  values and principles of Employment First.
• Vision
• The State of North Carolina will have an
  Employment First Policy. Employment in the
  general workforce is the first and preferred
  outcome in the provision of publicly funded
  services for all citizens with disabilities, aged
  18-62, regardless of level of disability, in a
  job of their choosing with supports and
  accommodations provided as necessary to achieve
  and maintain employment.
• Next Steps
• Awareness Campaign This paper should be
  disseminated to DHHS Agencies, NC School Systems,
  Councils for Independent Living, Legislators,
  Advocacy Groups, Committees, Families/Self-Advocat
  es, Local Managing Entities, Community
  Rehabilitation Programs/Employment Providers,
  DD/MH/SA Service Providers, Business
  Networks/Employers, and any other group that has
  a stake in the employment services continuum.
• Endorsement If your organization supports the
  values and principles of Employment First and
  wishes to endorse this document, contact us and
  your organizations name will be added to our
  list at the end of this paper. As we move
  forward, we will also be seeking assistance for
  the Implementation Process.
• employmentfirstNC_at_gmail.com

14
LME/MCO Waiver Sites
15
Waivers Support Employment

• Ability to change and improve services in real
  time
• Flexible funding
• Access for the indigent population, not just
  Medicaid clients
• Closed networks for better quality of care
• Ability to choose providers- open network
• Choice is promoted
• New waiver sites supported by Implementation
  Management Teams (IMTs) with DMH/DMA staff

16
LMEs, Managed Care Employment Array
LME
MCO
State Dollars (IPRS Y codes)
Medicaid Dollars (H, T codes, CAP)
LTVS
LTVS
ADVP
CAET
SE
SE
Day Support Day Activity
Day Support Day Activity
Home Comm. Supports
Home Comm. Supports
17
Supported Employment at PBH

• The waiver can allow for additional services
  through B-3 to address service gaps. For example,
  the addition of B-3 Respite and Supported
  Employment have reduced the waiting list for
  Innovations (i.e., CAP).
• B-3 services are extra Medicaid services that
  come from PBH Medicaid savings (Specific to the
  Waiver, approved by CMS in 2007).
• are available to individuals who are Medicaid
  eligible.
• are optional and as such not an entitlement- have
  to be provided within the capitation.
• B-3 services include
• Community Transition
• Peer Support
• Individual Support
• Respite
• Crisis Respite
• Supported Employment
• Psychiatric Consultation
• New waiver sites may implement the same services

18
State Divisions

• NC Department of Health and Human Services
  http//www.ncdhhs.gov/disabilities/index.htm
• NC Division of Mental Health, Developmental
  Disabilities, and Substance Abuse
• Services Locator http//www.ncdhhs.gov/mhddsas/ser
  vices.htm
• Advocacy and Customer Service http//www.ncdhhs.go
  v/mhddsas/consumeradvocacy/index.htm
• NC Division of Vocational Rehabilitation
• Directory of Employment Programs
  http//www.ncdhhs.gov/dvrs/pwd/crs.htm

19
Employment Resources

• Think Beyond the Label Making the business case
  for employing people with disabilities
  http//www.thinkbeyondthelabel.com/Default.aspx
• NC Dept. of Commerce Workforce Job Link centers
  http//www.nccommerce.com/workforce
• Economic Empowerment Center- Charlotte
  http//www.innervisionnc.org/node/38
• Social Security Work Incentives
• Ticket to Work Employment Networks-
  https//yourtickettowork.com
• Over 15 other types of work incentives
  http//www.ssa.gov/disabilityresearch/wi/generalin
  fo.htm
• Americans with Disabilities Act EEOC- QA
  http//www.ada.gov/qandaeng.htm
• US Business Leadership Network http//www.usbln.or
  g/
• NC Commission on Volunteerism and Community
  Service www.VolunteerNC.org
• State Employment Leadership Network
  http//www.seln.org/
• Southeast TACE Emp. Initiatives
  http//tacesoutheast.org/

20
Reasonable Job Accommodations

• What is JAN?
• The Job Accommodation Network (JAN) is the
  leading source of free, expert, and confidential
  guidance on workplace accommodations and
  disability employment issues. 
• Helps people with disabilities enhance their
  employability,
• Shows employers how to capitalize on the value
  and talent that people with disabilities add to
  the workplace.
• What services does JAN provide?
• One-on-one guidance on workplace accommodations
  the Americans with Disabilities Act (ADA)
• self-employment and entrepreneurship options for
  people with disabilities
• Help for all disabilities (IDD, MH, physical, etc)

http//askjan.org/ JAN Accommodations for MH
http//askjan.org/media/psyc.htm
21
PBH Waiver Resources

• Facts Myths about Waiver http//www.pbhcare.org
  /docs/Myths20and20Facts20Booklet20-20Innovati
  ons.pdf
• Supported Employment UM Criteria
  http//www.pbhsolutions.org/PubDocs/Upload/Documen
  ts/Supported20Employment20Innovations20-20Comm
  unication20Bulletin20FY-0809-AA-08.pdf
• Supported Employment QA http//www.pbhcare.org/p
  ubdocs/upload/documents/PBH_UM_QandA_Document_2_SE
  _043009_20090513140024.pdf

22
Contact Info

• Emery Cowan, MS, LPC, LMHC, NCC
• Program Manager
• NC DHHS Division of MH/DD/SAS
• Best Practice Community Innovations Team
• Phone [phone], ext. 263 Fax [phone]
• emery.cowan_at_dhhs.nc.gov