What Was I Thinking?

Assistive Technology for Executive Function

Continuing with our assistive technology (AT) theme for Shared Solutions, this month we suggest helpful AT for those who have difficulty with executive function. What is executive function? Every day our brain goes back and forth between different thoughts, actions, and to-do’s in order to complete a job. The brain’s ability to juggle multiple thoughts and actions is referred to as its executive function.

Nearly every workplace requires executive function skills and activities such as memory, attention, self-control, time management and decision-making. The ability to start and finish tasks and many other skills are necessary to accomplish work assignments. 

Three types of brain function that executive function and self-regulation skills depend on are working memory, mental flexibility and self-control. In order to achieve the successful application of executive function skills, the three brain functions must operate in coordination with each other. The diagram below shows the importance of executive function and the difficulties caused when the areas don’t work properly. 

Let’s break it down a little more and look at some of the most common effects on employment when executive function is not working properly.

• Difficulties with initiating, organizing, and carrying out activities or the “loss of get up and go”--Oftentimes, we may mistake this behavior as a lack of motivation or energy, or worse, as a person being just plain lazy.

• Rigidity in thoughts and actions--This inflexibility causes an individual to have difficulty evaluating the result of actions, to change behavior, or switch between tasks if needed. One example might look like this: John is working on his regular task of scanning insurance claims when the supervisor asks him to do another task, out of his normal routine. John struggles with this request and does not follow his boss’s direction. When the boss speaks to him again, John begins throwing things.

The employment specialist can be pro-active in the scenario above by planning with the supervisor to build in a solution for John’s day-to-day routine. They could explore the use of certain apps and technologies to help John transition from one task to another. 

Smartphones or a tablet can be invaluable on the job for people who might need a little extra support with executive function. In John’s case we recommend a free app called Wunderlist. (Note that this app will change to Microsoft To-Do in May 2020.) Wunderlist is a task management app that can be used for daily planning, for work or personal life activities. 

This is just one example. An abundance of free apps are available to assist anyone on the job!

Websites and Lists with Helpful Tools

And with that in mind, we introduce you to a very cool website, Bridgingapps, designed for individuals with disabilities. You can search for apps by age, skill, category, cost, and more! Bridgingapps provides a detailed description of each app and offers many of them at no cost.

The Arc's TechToolbox is a website to find, share, rate and/or review technology for people with intellectual or developmental disabilities (I/DD). This site offers job-related apps and provides a description and price for each app.

We've also created a list of apps you may find helpful to support workers who struggle with executive function at work and life in general. Download "Apps and Ideas to Support Executive Function at Work."

How to 'See' When You Can’t

Assistive Technology for People Who are Blind or Have a Vision Impairment

Let’s 'See' What AT Can Do

Assistive technology plays an important part in the life of people with disabilities, but  universal design benefits all of us.  This is the first of a miniseries on assistive technology to assist you with the individuals you support.  

Essentially, two types of assistive technology (AT) are available for people with vision impairment: those that magnify and those that allow interaction with visual material through speech.  Magnification works for someone who still has some usable vision by allowing them to read and interact with their environment by making everything bigger. Screen readers and/or optical character recognition systems are examples of tools needed for people whose vision loss has reached a point that magnification will not work or is no longer practical. In other words, the magnification would have to be so big that it would be cumbersome to read a word or paragraph.

Thanks to recent technological advances, both of these types of AT are more streamlined and less cumbersome, as well as less costly than ever before.

Let’s take a look at some examples of magnification and other AT that you can talk to or that talks to you.

Magnification

A number of different items fall into this category, both stand-alone and hand-held such as: hand-held magnifiers, closed circuit televisions (CCTV’s), handheld CCTV’s, large-print keyboards, large monitors, and magnification software (such as ZoomText).

Because a number of people with vision impairments react strongly to light or glare and may have problems with contrast vision or the ability to see contrast between different shades of color, some of these magnifiers allow for different color contrast than normal. For example, you’re most likely reading this blogpost comprised of black letters on a white background. A person with magnification software with color contrast capability (such as ZoomText), may be reading yellow letters on a black background or any of a variety of other color schemes that work best for them. CCTV’s and handheld CCTV’s also have the ability to change color contrast as well as to magnify.

Magnification devices are used for more than just reading; they can also be used to assist people with low vision to do self-care tasks such as trimming their nails or putting on make-up. Some magnification aids can also act as screen readers or text-to-speech when a person becomes fatigued from using magnification. These AT devices are also helpful to a person in the transition from magnification to screen readers and text-to-speech in the case of progressive vision loss.

Screen Readers, Optical Character Recognition, and 'Talking' Devices

Screen readers are software or built-in systems for a computer that enable a person who has no functional vision to access information on their computer screen. Examples of screen readers are JAWS and WindowEyes for a PC, which are separate software programs, and VoiceOver for Mac, which is built into Mac computers.

Optical Character Recognition Systems involve taking a picture of, scanning, and reading (or converting to Braille) material that is not on a computer or is not in a readable format for the screen reader. Examples are KNFB Reader for smartphones, Seeing AI for I-Phone, and OrCam MyEye.

In addition, talking devices, such as talking watches, talking thermometers, and talking thermostats allow those who cannot see to keep track of time and temperature. Another talking device is a glucometer, which makes it possible for a person be able to test their blood sugar; this is particularly critical for someone whose vision has been affected by diabetes.

Refreshable Braille Displays

Another category preferred by those who use Braille as their primary form of reading and writing are the Refreshable Braille Displays. With this portable device, a person can access information on their computer, phone, or tablet through a Braille display (controlled with pins) and a Braille keyboard. This allows them to read and write without hearing or speaking, and can be a critical piece of AT for someone who is both hearing impaired and visually impaired. The Braille Display receives information through a screen reader and converts to Braille rather than to a synthetic voice.

Smartphones and Tablets

If you are working with a person who has a vision impairment, and they have a smartphone, they already own a sophisticated piece of assistive technology that performs in ways that decades ago would never have seemed possible or affordable.

Smartphones have both built-in magnifiers (similar to a handheld CCTV) and screen readers (IPhone’s VoiceOver and Android’s TalkBack). Of the applications for persons who are blind, IPhone’s Seeing AI, which is free of charge, contains an optical character reader that reads print and handwriting, a money identifier, a color identifier, facial recognition capability, a light indicator, and product identification (through barcode recognition). Note that Seeing AI is only available for IPhones at the time of this writing, but an Android version is expected to be on the market.

Another feature IPhones have that Androids do not at this time is Voice Control – the ability for the person with a vision impairment to control the functions of their phone with their voice. A unique application available for both Android phones and IPhones is Be My Eyes. In this application, a sighted volunteer receives a video call from the person with a vision impairment and is able to literally be their eyes—to see an expiration date on a milk carton, help navigate in new surroundings, or see whatever the person needs to see.

On the topic of smartphones, BrailleWorks.com suggests the top five mobile apps for people who are blind or visually impaired.

Smart Speakers and Smart Home Assistants

Another piece of universal design technology, smart speakers, allow a person who is blind to obtain information that once required reading or viewing something. For example, the person can ask their smart speaker (which is connected to the internet) what time it is, what the weather is like outside, for a recipe, or to make a grocery list. Everyone benefits from universal design technology. Examples of smart speakers are Amazon Echo and Google Home.

You Can 'See' for Yourself 

Whether it is built-in accessibility on a smartphone, a free application, or built-in magnification on a computer, you may be able to assist someone on your caseload with accessing their world in a new way. While this is a great first step, don’t hesitate to talk with the person and their vocational rehabilitation counselor about an assistive technology evaluation. Identifying necessary assistive technology could help a job seeker meet their vocational goal.

While we’ve mentioned a number of different types of AT in this article, these are only a very small sampling and some suggestions of what is available. For more information, check out the resources below.

Resources

American Foundation for the Blind: Technology Resources for Persons with Vision Loss

INDATA Project at Easter Seals Crossroads

Job Accommodations Network on Blindness

Job Accommodations Network on Low Vision

Mobility International USA: Assistive Technology for Blind or Low Vision Participants

National Federation for the Blind: Center of Excellence in Non-Visual Access

Talking Book and Braille Library

Making Expenses Count: Two Ways to Offset Costs

Impairment-Related Work Expenses (IRWEs) and Subsidy or Special Conditions 

In this final post in our Social Security Benefits Information Series, we offer an overview of two work incentive programs: Impairment-Related Work Expenses (IRWEs) and Subsidy or Special Conditions. Both programs help offset the costs that some workers with disabilities need to spend every month just so that they can go to work.  
 
Life is just more expensive for people with a disability, and associated costs can accumulate. We all know that meaningful work plays a vital role in an adult’s life. Unfortunately, a person saddled with all sorts of expenses just to be able to have a job may decide working costs them more than it is worth. However, thanks to IRWEs, it does not have to be that way. With an IRWE, a worker does not have to experience the feeling that he or she is working “for nothing.”       
 

Consider costs that can abound for a person who may have out-of-pocket expenses related to their disability for items they need in order to work--things like medicine, medical supplies, medical devices, service animals, and disposable items such as bandages and syringes. Additionally, they may accumulate out-of-pocket expenses for medical services such as doctor’s visits and/or some attendant care services charged for preparing for work, attending to them while at work, or getting them to and from work. Any of these and other unreimbursed expenses, such as transportation and modifications to their home, car, or van that allow them to work, may be eligible as an IRWE. Both Social Security Disability (SSDI) and Supplemental Security Income (SSI) beneficiaries may apply for IRWEs.

The treatment for any impairment/condition (and not just the impairment that allowed an individual to be approved for benefits) may also be eligible for an IRWE. Consequently, eliminating the expenses that are necessary for a person to maintain employment from their monthly gross wages could mean that worker receives a boost in take-home earnings.
 
Lightening the Load and Increasing the Take Home
 
In the example below, you can see how an IRWE can allow a worker to keep more of their earnings.  A person making $10 an hour and working 25 hours a week would earn $1,075 a month. With receipts to support a $250 Impairment-Related Work Expense, the Social Security Administration (SSA) would adjust the person’s monthly gross wages as shown in the table below. 

As you can see in the example above, SSA only considers $370 as countable earned income of the $1,075 gross wages. That means this worker can now spend (or save) the $250 they were spending on their IRWE on other areas of their life.
 
Subsidy or Special Conditions Incentives                                                    
 
Subsidy or Special Conditions is another work incentive for those who are receiving SSDI benefits or for beneficiaries who are concurrent, meaning they may be receiving both SSDI and SSI. Workers must have completed the Trial Work Period to use this work incentive.
SSA considers the value of subsidies and special conditions against a worker’s monthly gross earnings when making an SGA decision. When determining how much an individual earns, Social Security must consider whether the worker does their job under special conditions, such as the person: 

• Has fewer or simpler tasks to complete than others doing the same job for the same pay.
• Has a job coach or mentor on the job who helps to perform some of the work. 
• Has allowances for extra time to perform duties.
• Has special accommodations.

Social Security has a questionnaire to help employers determine how much they subsidize a person’s work activity. SSA asks the employer to document the value of a person’s work and services. The value of the subsidy is determined by comparing the work time, skills, and responsibilities with that of non-disabled employees doing similar work.
 
The Social Security Administration Office of Employment Support Programs must review the information for accuracy and approve the Subsidy or Special Conditions. We realize this information is quite complicated. Doctor’s notes can help to get an IRWE approved, so it’s important to start the process by notifying the Social Security Administration and providing required documentation of any treatment that is necessary for the worker to be healthy enough to work.
 
A Community Work Incentives Coordinator or an Indiana Benefits Information Network liaison can help complete the required documentation to submit to SSA for an IRWE or a Subsidy.     

Ask your VR counselor who the BIN liaison or CWIC is in your area.                                                                             
 
Additional IRWE Resources:

• SSA: Spotlight on Impairment-Related Work Expenses -- 2019 Edition
• SSA: Impairment-Related Work Expense Request Form – IRWE Request
• SSA: Subsidy and Special Conditions
• SSA: Impairment-Related Work Expense Request Form – Subsidy or Special Condition Request
• Impairment-Related Work Expense for SSDI 2019 Fact Sheet from IIDC
• Impairment-Related Work Expense for SSI 2019 Fact Sheet from IIDC 
• Subsidy and Special Conditions Fact Sheet from IIDC

PASS: Plan for Achieving Self Support

PASS It on for Success!

September may be the official end of summer, but this month brings us the beginning of not only the beautiful fall season but also FOOTBALL! The start of a new season can seem so promising. That anticipation and hope that this will be “the year” is thrilling. 

Okay, here’s the fantasy football hand-off: You’re the quarterback. You have the opportunity to PASS! Using an incredible Social Security work incentive, you send this beautiful spiral to your job seeker who makes a tremendous in-air catch with their vocational goals and gloriously lands in the end zone. And the crowd roars!

That flawless PASS you threw is the Plan for Achieving Self Support (PASS). It’s a self-directed, self-funded Social Security work incentive that allows an individual to write their own playbook toward their personal vision of success!

PASS Without Pain

With a PASS, individuals with disabilities can set aside income and/or resources for a specified period of time. During that time, they can obtain items or services they need to reach their employment goal—whether that’s a new career or self-employment.  (More on those items or services later.)

Here’s how it works: When Social Security determines the amount of a beneficiary’s monthly check, they usually adjust the amount of earnings they count for a variety of different supports that the beneficiary may be relying on. That’s a good thing. It allows the worker or beneficiary to keep more of their benefit. 

If there’s a PASS plan in place, Social Security won’t count the money set aside in the plan as income, which means they’ll allow the beneficiary to keep a higher amount of their Supplemental Security Income (SSI) each month. Essentially, Social Security is helping PASS plan users save money without feeling the financial burden of the loss of expendable cash!

For example, Ava wants to be a hair stylist but doesn’t have the money to save for school, which will cost her $2,000. She works at a beauty supply store and sets up a PASS with Social Security to save $200 a month. The money goes in the bank, but Social Security won’t consider it as income, so she’ll continue to receive the same amount of benefit in her SSI check. After 10 months she will have saved for her goal, and she didn’t even feel the financial pain of having $200 less in her monthly income.

Who’s Eligible to Play?

Although PASS is a work incentive primarily used by SSI recipients, it can also be a viable option for those individuals who receive both SSI and SSDI benefits (also known as ‘concurrent beneficiaries’). PASS may be an option for some people who receive a lower SSDI check and could live on the Federal Benefit Rate for SSI ($771 for an individual in 2019).

To be eligible for PASS, a person must have income or assets other than their SSI check that they can use for savings. They also must have a feasible vocational goal and a need for items or resources to get them to that specific goal.  Participants must also want to decrease or eliminate their dependence on benefits through the completion of a PASS; like the name states, PASS is a Plan for Achieving SELF-SUPPORT!

Using PASS Savings

Money or resources set aside in a PASS are not counted for most benefits! This is a great way to be able to save in order to get ahead without those savings impacting eligibility for essential benefits, such as SSI, Medicaid, and SNAP. Maintaining access to benefits can be critical for those who want to try to work towards being less dependent, but who still need these supports in order to get to their long-term goals!


PASS funds can be used in various ways, such as:

• Saving for education or training
• Starting a business
• Purchasing medical equipment, assistive technology, or adaptive equipment needed for work
• Tools and equipment for a trade
• Funding for more job coaching or employment supports
• Child care or attendant care
• Purchasing a vehicle if needed for a vocational goal

And so many other services or items, as long as the end result is a job that makes the individual more self-sufficient!

If you know of a beneficiary who is willing to work toward a vocational goal, they may be the perfect candidate for a PASS. They can fill out a PASS application online (see the link below). Social Security even provides specially trained PASS specialists or “cadres” to help individuals complete the PASS. (Find a PASS specialist in your area.) 

Just as in football, this game isn’t played alone. A person can obtain assistance through their Social Security office, benefits counselor, employment consultant or even their Vocational Rehabilitation Counselor, if working with VR. 

Once a PASS is approved, participants can save their funds until they reach their goal. Social Security can then PASS it on and…TOUCHDOWN!

PASS Resources

PASS Application
Plan for Achieving Self-Support: 2019 Fact Sheet
Working While Disabled--A Guide to Plan for Achieving Self-Support
PASS Online: Resource for the Plan for Self-Support (Cornell University)
2019 Social Security Red Book (see pages 26 and 27)

It's Cool to Be in School!

No matter where you look these days, the signs are everywhere that the carefree days of summer are dwindling. From department stores to your local grocery store, the seemingly endless back-to-school sales are a constant reminder that a new school year is upon us. As this fact sinks in, students, parents and teachers are scrambling to get ready. Beyond the usual back-to-school routine, one more item should be added to the to-do list. Remind families and students you’re working with to contact their local Social Security office to discuss the Student Earned Income Exclusion.

Unlike sales that promise to put money back into your pocket, this Social Security work incentive can actually do just that! This almost-too-good-to-be-true work incentive allows some students receiving SSI who are under age 22 and regularly attending school to have income excluded when Social Security adjusts their SSI check monthly.

Essentially, the Student Earned Income Exclusion decreases the amount of countable earned income so the student can keep more of their SSI check and also have their earnings from work. 

Oftentimes, this allows students to test their ability to work and keep their whole SSI check. For example, Trevor worked full-time over the summer at his local community pool and earned $1,376 per month and was also able to keep his full SSI check!

Almost Too Good to Be True

If an SSI recipient under 22 is working while pursuing education, the Student Earned Income Exclusion could be an option. The exclusion is applicable to students: 

• in grades 7-12 attending school at least 12 hours a week (this includes those who are being homeschooled, getting homebound instruction, or attending an online school)
• in a college or university for at least eight hours per week
• in training to prepare for a paying job for at least 15 hours per week if the course involves shop practice or hands-on activities, or
• in training to prepare for a paying job for at least 12 hours per week if it does not involve shop practice

Allowances may be made for fewer hours of instruction than indicated above for reasons beyond the student's control, such as attendance, illness, or any circumstances that justify the reduced credit load.

The amount of income a student can exclude monthly and annually is adjusted every year, but these amounts are shockingly high. In 2019, the monthly gross earned income a student can exclude is $1,870 and up to a maximum annual exclusion of $7,550! With limits this high, it’s not surprising that the majority of students who are working are under this monthly limit and able to keep their entire SSI check!

Maintaining Benefits While Learning and Earning

For example, a student working 10 hours a week after school and earning $8.50 per hour would have about $340 in gross income from work. By using the Student Earned Income Exclusion, they could keep their entire SSI check of $771 (if receiving the Full Benefit Rate) + $340 from work = $1,111. Total!! Now that really is an incentive to work! Students often have no problem spending this extra money but saving in an ABLE account, Trust, or Plan for Achieving Self-Support are great options to save without jeopardizing their eligibility for Medicaid. 

As you can see in the example below, a working student receiving the Full Benefit Rate of $771 and earning $340 in one month could keep both the SSI and the paycheck. Every working student should explore this incentive.

Connecting Work to a Better Life

When students are first starting out in the workforce, it’s important for them to make the critical connection between how working and earnings can equate to a better quality of life. This incredible work incentive is a great way for them to have the opportunity to feel the benefits of working and having more money to spend! By allowing transition-age youth to work while keeping more of their benefit, they can experience life above the base SSI rate. Once a student experiences how having more money enriches their lives, they begin to develop a work habit rather than a dependence on benefits. This can have a powerful impact at a critical juncture for these students. For students who work a part-time job during the school year or just over the summer, simply telling Social Security that they are a student can equate to MORE money! Being in school really is cool.

Resources for the Student Earned Income Exclusion

2019 Work Incentive Fact Sheet Student Earned Income Exclusion

Spotlight on Student Earned Income Exclusion -- 2019 Edition

Program Operations Manual System (POMS)

Student Earned Income Exclusion for SSI

The Fine Art of Fading

Last month, we discussed stabilization and promised to give you more insights into fading, a key step to a worker’s independence. During the newly-employed worker’s first weeks on the job, you observed their learning traits, interpersonal skills, and job routines to determine what they required to be successful. Before the employee can be completely successful in their new position, though, your role will evolve to accomplish the ultimate goal: success without you.

So, the big question is how do you go about making that graceful exit?

Fading…I’m Fading…!

Dorothy melts the Wicked Witch of the West, Wizard of Oz,
William W. Denslow, illustrator, 1900.

Think of the Wicked Witch in the Wizard of Oz melting away.  Minus the wickedness part, of course, you want to melt away or gradually fade into the background. Fading is actually important to your employee’s success. Since the ultimate goal has always been for the employee to be employed without your support, your fading efforts will become your new priority soon after your employee learns their basic tasks and gets the lay of the land in the workplace. In other words, you’ll need to create a fading plan soon after your employee is hired. 

Strategizing Your Fade

Eight strategies for fading offered by Teresa Grossi, Ph.D., of the Indiana Institute on Disability and Community, include:

• Supervisor and coworkers should be involved right from the start; 
• Fade systematically;
• Fade toward the natural cues; 
• Fade toward the natural supports;
• Fade your proximity and accessibility to the worker;
• Move to less and less intrusive types of assistance and prompts;
• Increase the amount of time between cues and prompts; and
• Institute self-management strategies and self-reinforcement strategies.

When you’re fading, you will be decreasing your time coaching, mentoring, and/or modeling, while your employee will be increasing their independence and their ability to rely on natural supports and self- management strategies when needed.  

Want to see some examples?  

Though this video mentions creating a fading plan on Day One, we actually recommend putting together a plan for fading even before the employee starts their new job.

Fading, Not Disappearing

The process of fading may sound simple, but it’s really a fine art. Timing is key. Fading too fast results in the worker making more errors and requiring a longer period of training. Fading too slowly fosters the worker’s dependence on you, which also increases the training time. 

Stay alert and watch for the cues. You want the employee to rely less on you and more on the supports they have through family, friendships, associations with fellow employees and supervisors, and associations developed through participation in their community. When you suspect that your employee still needs support, but you also think it’s time to help them test their independence, try something other than side-by-side support. Consider adapting the task, designing a new approach, using graphics, or creating a support other than yourself.

Collecting Data Is Key

Collecting data is key to determining and demonstrating the employee’s success. The job tasks determine the data you will collect. Writing a task analysis, when needed, at the start of the job is the first step to charting progress. For some employees, you may need to record the number of times during a day he/she correctly completes a task, while for others you’ll note the length of time they need to do a task. A job/task analysis will help identify stumbling blocks and allow planning for adaptation to training strategies.  You’ll use the task/job analysis to collect probe data, which is used to find out how the worker is doing without any intervention, prompts, or reinforcement. 

You’ll also collect data when you’re training one-on-one and you need to identify where a worker is having difficulty performing specific steps. (Need more information on collecting data? Enroll in Indiana Employment Specialist Training. Our August/September course begins August 7! Or save the date for November/December training, beginning November 5.)

Data should be meaningful, simple to use, easy to read, and easy to interpret. Data:

• provides a record of the worker’s performance.
• assists with objective evaluation of performance.
• shows areas for fading and from continued training.
• calls attention to areas that may need different training methods, adaptation, and self-management systems.
• can be used as a reinforcement tool for the worker.
• can be shared with the employee and co-workers to ask for assistance, feedback, and new ideas.
• serves as an accountability tool to funders, management, and families.

As an employee achieves their goals and accomplishes their tasks, you should modify the fading plan to further reduce the time you are spending either with the employee or on their behalf. (And don’t forget to update the ESRP!) As your communication with the employee and/or business diminishes, you can check in with the employee or supervisor via phone or a random visit.  

Remember, the Wicked Witch of the West (“Fading…I’m fading!”) as you slip out of the scene! 

Resources and References 

• Stabilization Notification Form
• Transfer to Extended Services Form
• Fading Job Site Supports Video Presentation, Teresa Grossi, Ph.D. 

Stabilization--STAT!!

You may have heard doctors on TV medical shows screaming, “I need something, STAT!” You probably knew from their voice and expression that they wanted something right now. Well, yelling, “STAT” for job stabilization is not exactly best practice and may actually be more harmful to the individuals we support every day.

Stabilization, in layman’s terms, is the point at which an individual has reached their greatest level of independence on the job. Although they may not do every task perfectly every time, they have reached their maximum ability. (Note that stabilization may look different for every employee. Some employees, for instance, may still need some assistance at certain tasks but with that accommodation, they’ve reached stabilization.) 
Stabilization occurs when 1) the coaching and modeling you’ve provided to an employee has helped them learn their tasks and workplace culture, and 2) when natural supports are in place.  

Since there’s a Milestone payment affiliated with stabilization, many employment specialists are often in a rush to move a job seeker along, so they can bill for the work they’ve done and move on to the next step. But challenge yourself to step back and think before screaming, “Stabilization - STAT!”  Trust us: You have plenty of time.

Slow Down! Devote Time to Those First Steps

After the job seeker you’re supporting finds a job that seems to be a good fit, they’re ready to use their skills and talents. Your first steps, as an employment specialist, are to support this new employee with learning new job tasks, performing daily duties, and following policy and procedure. Your next steps include supporting the employer as they train the new employee. You’ll also be helping the employee learn the workplace culture and helping the employer and employee as they build natural supports.

The new employee may need assistance getting to know people in their workplace. They may need to understand different work styles of co-workers and supervisors. There may be unwritten rules of the workplace that you’ll need to spell out. Some off-site skills, such as addressing transportation needs to get to and from work, could be fundamental to successful long-term employment. These essential items can be overwhelming to some, and yet, second nature for others. So, take time to address each need as it surfaces.

During the first four weeks or 30 days of employment, take time to make keen observations and listen to an employee’s needs. Take each hurdle they face as a mere “bump in the road.” Address those needs and challenges as creative goals that will increase the individual’s confidence.

Putting those goals in writing to demonstrate how you will support that person is the thrust of the Employment Support and Retention Plan (ESRP). (See “Helpful Links,” below.) The ESRP is where you will continue to identify those areas of support the employee needs to achieve independence. This is also the time that you will identify and discuss how you plan to support that new employee through the strategies and techniques that you will use. Remember that the focus of these first weeks is always progress and never perfection.

And another reminder: You don’t have to do this all alone. Let workplace co-workers and supervisors help support, teach, and coach the new employee. (See the Shared Solutions post, “Don’t Alienate Your Natural Supports.”) Your presence and expertise can make the difference not only for the new employee, but also for the business. You are the professional consultant to the business, supporting their decision to hire the individual and making this partnership work for them, too. 

The Signs of Stabilization

How do you know when your new employee has achieved stabilization?  Per the VR Manual (p. 29), ask yourself:

1. Has the employee made significant progress in gaining independence on the job during the period of supports?
2. Do you have evidence that supports have faded, even if fading has not been entirely linear (i.e., periods of ebb and flow)?
3. Is there strong potential for the individual to become more independent, resulting in additional fading* of supports?
4. Is the employee meeting the employer’s performance standards with as little support as possible and as is likely for that individual?
5. Why do you believe the employee has achieved their highest level of independence? What other evidence do you have?
6. Are you confident that an employee receiving supported employment will be able to maintain their job with appropriate extended services?

Adapted from the VR Manual of Employment Services, (Version 5.0, February 2019, page 29).

Tah Dah!

Stabilization means that even if the individual doesn’t do every job task perfectly every time, they’ve reached their greatest level of independence on the job. Just remember: DO NOT RUSH THIS! Be certain you are ready for your “tah dah moment.” With supported employment services, you have up to 24 months to provide support to your new employee!

 

When the employee has reached stabilization, you’ll complete the Stabilization Notification Form. On this form, you’ll share what you’ve done; any anticipated changes to the schedule, routine, or needs; and/or any additional needs for accommodations, modifications or assistive technology items. Once all team members and your VR counselor are in agreement and sign off on the form, your new employee has achieved stabilization! That’s when your 90-day clock starts. At the end of those 90 days, you may bill for Milestone 3.

Reaching stabilization is a huge deal! You assisted your newly-employed job seeker in learning their tasks, adjusting to their new role, and finding natural supports in their workplace. Over the next 90 days of their employment, your focus will shift from overseer to observer. 

Celebrate and do a TAH DAH with your new employee, because, together, your work was AMAZING!

*Stay tuned. We will discuss the fine art of fading in a future post.

Helpful Links

Stabilization Notification Form

Employment Support and Retention Plan Form

Employment Services Authorization Request Form 

VR Employment Services Manual 2019

The Guardianship Alternative: Supported Decision-Making

Supported Decision-Making is a new alternative to guardianship for people with disabilities and for seniors. With Supported Decision-Making (SDM), an individual who needs assistance chooses supporters they trust and specifies how they want to receive help. 

They can also decide when they need support and when they don’t. For instance, one person may only want assistance for financial planning; someone else may want assistance with health care, paying bills, choosing personal assistants and providers, and any legal matters. The supporters provide assistance, but the person using SDM retains final decision-making authority. Having and using SDM can help promote an individual’s self-determination and independence.

SDM is really a partnership of support, allowing a person to remain the primary decision maker, and it does not remove the individual’s civil rights. In contrast, guardianship does remove some civil rights. Those rights affected by court-appointed guardianship could include the right to marry, the right to buy a home (or enter into contracts), the right to decide where to live, and more. However, it's important to know that an individual who is living with full guardianship—also known as a ward or “protected person”—still has some rights. They can vote, challenge their guardianship, get a different guardian, and visit family and friends.

New Legislation

Governor Eric Holcomb signed new legislation in April supporting the independence of people with disabilities. Indiana now becomes the eighth state to have a Supported Decision-Making law. One component of the new law requires that less restrictive alternatives, including Supported Decision-Making, be considered before a court will appoint a guardian. 

The author of Senate Bill 380, Sen. Eric Koch (R–Bedford), noted that the new legislation “puts Indiana at the forefront of state policy that supports the independence of those with disabilities. No longer will guardianships be the only alternative. Our courts will now have more options to ensure that only the least restrictive option is used in situations where our fellow Hoosiers need some extra help.”

The EST/VRC Angle

Whether you’re a VRC or an employment consultant, SDM may impact the way you engage with participants. Since individuals and families now have more choices available to them for support--ranging on a spectrum from SDM (affording more autonomy) to full guardianship (providing extensive protections)--you'll want to check with your job seekers and the employees you support to find out how they make their decisions. 

One example of how you could have a role in the issue of rights and decisions is when you're working to provide Pre-Employment Transition Services (Pre-ETS) to students in transition. It’s critical to facilitate a discussion with students about their rights and options as they approach age 18. You can have this discussion in a group setting or one-on-one with a transition-aged student. Supported Decision-Making education could be provided as “instruction of self-advocacy.” In fact, this type of Pre-ETS instruction is categorized as “training on self-awareness, disclosure of disability, and knowing individual rights and responsibilities,” which is one of the five required Pre-ETS activities. Educating yourself about SDM will help you talk with and guide the students, parents, case managers, and other participants you work with each day. 

Good Timing: Mental Health Awareness Month

Indiana’s decision to become a Supported Decision-Making state could not come at a better time. It’s National Mental Health Awareness Month. 

SDM can be a tangible way for people with mental health conditions, like OCD, bipolar disorder, or schizophrenia to regain a sense of control, to increase self-advocacy skills, and to create a more direct path to self-determination. People living with mental health issues often experience a sense of isolation, have difficulty expressing thoughts and emotions, face challenges of choice and decision-making and struggle with feelings of adequacy. Having a supportive circle of people (or even just one key supporter) can go a long way toward increasing quality of life, even if the mental health challenge is short term. 

SDM can be a way for people to join forces with others when facing possible guardianship issues. Losing personal autonomy and choice does not need to be yet another “challenge.” Encouraging a meaningful conversation about supported decision-making and providing education about this option would be an excellent step in the right direction, especially during National Mental Health Awareness Month! 

Resources

• Adult Guardianship in Indiana: The Basics--questions and answers from Indiana Disability Rights
• Supported Decision-Making in Action video--a video series from Indiana Disability Rights
• Supported Decision-Making infographic from AARP--illustrating the processes and differences between guardianship and SDM
• Transitioning from Adolescence: Alternatives to Guardianship--a video from the Indiana Institute on Disability and Community 
• WINGS - Working Interdisciplinary Networks of Guardianship Stakeholders--a fact sheet for families
• Guardianship Resources—additional resources, including those for legal professionals

Our Team is Growing!

The Center on Community Living and Careers would like to welcome three new members to our Employment Technical Assistance team!

• Cecilia Buckley--Most recently a Vocational Rehabilitation Counselor in VR's Bloomington office, Cecilia also worked as a VRC in Wisconsin and has expertise in both traumatic brain injury and blind/visual impairment and is a wealth of information about supporting VR participants.
• Brady Foster Powers--Brady joins us from Help the World Foundation, where he was CEO. He's also held a number of other provider leadership positions in Indiana and with Ohio support services organizations.
• Stephanie Gage--Stephanie worked as a career assessment counselor and Benefits Information Network (BIN) liaison for nine years. As our new BIN coordinator, Stephanie brings expertise in work incentives, Social Security, and the Ticket to Work program. 

Cecilia, Brady, and Stephanie join existing team members Jackie Tijerina and Sandy Block and will be working with and supporting providers and VR personnel around the state. 

Questions?  Contact us at employta@indiana.edu   

Fill In the Blank: Resources for VR Forms and Updates

In case you missed the February VR Forms and Employment Services Updates webinar and trainings, or if you just need a refresher, here is a recap.

New and Revised Employment Services 

Documentation has gotten so much easier!

Changes to Work Experience

Work Experience is now an hourly service (it's no longer tiered A,B,C), and includes:

• an arrangement (planning time and effort) of the work experience,
• on-site observation of the participant,
• discussion with the VR participant of their likes, dislikes, and what was learned,
• discussion with the VR participant about next steps, and
• documentation

VR no longer requires an employment service provider to be on site for 75% of the time during a work experience. The amount of supportive time on the work experience should match the needs of the participant.

Youth Extended Services

VR is introducing a new service for MSD participants 14-24 years of age. Youth extended services:

• can extend up to 4 years or until age 25 once stabilization is achieved. 
• requires that providers investigate and use natural supports or other funding sources if available.
• can only be used if these services are required in order to maintain competitive, integrated employment.

More Employment Services Update Resources

• Employment Services Update Webinar, February 2019 

• Employment Services Update Webinar PowerPoint 

• Updated Employment Services Manual (version 5.0, February 2019) 

Forms (They're Easier; We Promise!)

How-to Videos for the New VR Forms

Need more instruction on how to fill out the new VR forms? Visit this YouTube VR Forms playlist for details on completing each form. And in case you hadn't heard, VR has added two new forms to make your job easier: the Monthly Progress Report and the Authorization Request Form.

Sample New Forms

To get a sense of how the new forms play out in the employment process, you can see examples for VR participants Amy Sample, Don Dolittle, and Angie Chen on VR's  "Sample Employment Services Forms" page. There you can see how employment specialists and VR counselors use each of the forms for various types of participants. Forms included in the examples are: 

• authorization request, 
• monthly progress summary,
• Discovery Profile, 
• job development and placement plan, and 
• stabilization and notification form. 

Note that during the course of any participant’s Discovery and job development process there will be many more monthly summaries than you see included in the examples.

Finding Forms

You'll find the gold mine of forms on VR's website. Using this link, scroll down to "Employment Service Forms."  And don't forget to bookmark the page!