Supported Employment 2.0: Let's Talk Turkey!

Most people expect that on Thanksgiving, there will be a nice turkey at the table. Similarly, VR expects that most people with a most significant disability (MSD) will need to use supported employment (SE) services to reach stabilization. When you request SE, you’re not asking for ice cream (or hot dogs or kimchee) at the Thanksgiving table. This service is a part of the employment services process for most people with an MSD. Since we’re in order of selection, we think that’s probably the majority of your caseload. 

That being said, we know that not everyone has turkey on Thanksgiving. There are vegetarians who eat lentils on Thanksgiving, or perhaps a nice pasta dish works for your family. Not everyone needs supported employment services, but we expect that most people with an MSD will need SE services, just like most people will eat turkey this Thanksgiving.

Last month, we talked about what supported employment is, isn't, and should be. Now let’s flesh out that turkey.

Who 

VR participants with an MSD are eligible to receive supported employment (SE) hourly. Refer to last month’s post for more details.

What 

Employment professionals may bill for SE hourly to support any skills the participant needs in order to become as independent as possible on the job and reach stabilization.  

When 

From an Indiana VR perspective, you use this service after 4 weeks on the job (Milestone 2 or M2) and before stabilization, OR during M2 if more than 45 hours of support are already used. Want to learn more? Refer to the supported employment decision graphic. 

Use supported employment hourly when the supported employee needs assistance for skill development, coordination, or other kinds of support to work towards stabilization. It’s important to remember that being successful at work includes much more than the job tasks a person is paid to complete. There is all of this other stuff: fitting in and becoming a part of the team, knowing what to do when you need help, and building those relationships up so that when the employment specialist is gone, they can still get the support they need. 

Each situation is different, and there is no exhaustive list of the ways this service can be used. However, here are a few examples:

• Learning core job tasks and episodic job tasks
• Using a new type of technology, like a software system, copier, or sanitizer
• Communicating effectively with coworkers
• Developing the skills to get to work on time (perhaps setting an alarm, having a uniform ready the night before, calling the Uber)
• Dealing with difficult situations
• Building natural supports
• Coordinating with paid staff and unpaid supports
• Building self-management skills

And almost always, unanticipated challenges arise. Bosses or coworkers change, people have medical events, or perhaps changes in home life. All of these events can impact a person’s success at work and lead to the loss of a job if appropriate supports are not provided. Finally, think back to why the person was referred to VR. If a person has a mental illness and experiences symptoms every 4-6 months, they may be very successful for the first few months but may need additional services several months into work. This is precisely why we shouldn’t be in a rush to declare that an employee has reached stabilization. Stuff (stuffing?) happens!

Where 

You can provide SE hourly at a job site or off a job site, depending on what makes sense.  Consider the most discrete and supportive way to deliver the training or other job support. Be as unobtrusive as possible and provide supports in the most natural environment. For example, if a supported employee is working to develop coping strategies for stressful situations, it may be more appropriate to work on this in a private place, like a person’s house or at your office, rather than at the job site. If you’re helping the supported employee learn how to clock in for the day, then at the job site is probably your best bet. Where you provide support influences how people will perceive the supported employee. 

How 

Providing quality SE services is both a skill and an art. The details are important. The way you provide supported employment can really impact the success of a supported employee. You must identify the areas a supported employee needs help in, figure out what skill to teach, how to teach it, and monitor progress. While doing all of these different things, you need to be building natural supports at work and work yourself out of a job. That is, when providing SE services, you are working to phase yourself out of the mix while you facilitate a relationship between the SE and those who he or she could rely on at work. 

This sounds simple, but it requires a lot of training and skills. Learn from seasoned experts at your organization, seek out training, and use what you already know to be successful. Dust off that Discovery profile to review successful support strategies! Facilitating can be an art, but we know you’re up for the challenge.

Why 

Because it works! You can’t just eat the turkey and walk away from the table. There are dishes to load, pots to wash, leftovers to stash. Similarly, effective SE is often the work you do after you find employment for your job seeker. Establishing the right supports can ensure long-term success for an employee—even after you’ve faded your supports, gobbled the pumpkin pie, and said your goodbyes.

Resources & Training

Thanksgiving leftovers! Yummy! Here again, are some of the resources we referenced in last month’s intro to supported employment.  

“Supported Employment Resources,” VCU Rehabilitation Research and Training Center. 

“Strategies for Effective Supported Employment,” (formerly Advanced Supported Employment). Watch your inbox and the CCLC Employment Training webpage for news about two opportunities to participate in 2019!  

• Winter training begins with online modules, January 14 through March 15, with face-to-face meetings at Easterseals Crossroads in Indianapolis on February 27 & 28.  
• Summer training runs online June 28 through July 26, with face-to-face meetings, at Easterseals Crossroads on July 11-12. 

Supported Employment: What It Is, What It Isn't, What It Should Be

This month’s post returns to supported employment basics. 

Under order of selection, Indiana VR must first serve individuals who are most significantly disabled (MSD). That means that most, if not all, of your job seekers will be individuals designated as MSD and, as such, they will need supported employment. From the Indiana VR Manual of Employment Services: “For individuals with a MSD, it is best practice for VR to routinely provide an authorization for SE upon job placement.”

It’s vital, then, that as an employment specialist or VR counselor you understand what supported employment is and what it isn’t, and that you know how and when to use supported employment for your job seekers.

Tom-ay-to, Tom-ah-to? Nope!

Let’s start here: Supportive employment is NOT the same thing as supported employment. "Supported employment" is actually set forth in federal law, but you won’t find the term "supportive employment" in employment law or a waiver manual of services. Supported employment is a tool of your trade as an employment specialist, so it’s important that you use the right terminology.  (Okay, so glad we got that pet peeve off our chests.)

Need a reminder as to just what supported employment actually is?  According to the Office of Disability Employment Policy, supported employment is “assistance such as job coaching, transportation, assistive technology, and specialized job training that enables individuals with significant disabilities to obtain and retain employment.” Supported employment facilitates competitive work in integrated settings for job seekers with significant disabilities: 1) who aren’t usually selected for competitive employment, and 2) who, because of the nature and severity of their disability, need ongoing support services in order to perform their job.

It bears repeating that integrated and competitive are both key components of the supported employment definition. Supported employment does not take place in segregated, enclave environments or on mobile work crews comprising only workers with disabilities.

For more information on how the Rehabilitation Act Amendments of 1998 and the Workforce Innovation Opportunity Act (WIOA) of 2014 define supported employment, refer to p. 17 of The Hoosier Orientation Handbook on Employment.

Putting Supported Employment to Work

So now that you know what supported employment is, here are a few pointers on how to ensure success.

Point #1:  Talk about supported employment to make it available.

As an employment specialist or consultant, you will be communicating with your VR counselor throughout the Discovery process about the support needs of your job seeker, which will include conversations about appropriate supported employment services.  When you, the VR counselor, and your job seeker meet, you’ll list supported employment as a service on the individual plan for employment (IPE).  Keeping supported employment at the forefront of your discussions paves the way to authorization.

Point #2: Supported employment doesn’t mean someone can’t.

Don’t jump to the conclusion that an individual’s need for ongoing supports means he or she is not suited for or capable of doing that job. Skills acquisition and supportive workplace and offsite supports require time. For an employment specialist, this means developing a strategy for effective instruction, natural supports, and ample staffing. For a VRC, this means providing additional authorized hours based upon training needs established in the Employment Support and Retention Plan. Don’t give up simply because a person needs help. Remember why they knocked on your door in the first place.

Point #3: Give it time.

Skills acquisition and supportive workplace supports take time. Indiana VR advises (Manual, p. 13), “this initial authorization for SE services should generally be, at minimum, 30-60 hours, covering a time period of no less than 3 months.” Supported employment is not a rush to “place-train-and-close.” Remember, Indiana VR’s current employment service model can provide funding for supporting a worker for up to 24 months.

You should provide additional hours of supported employment until the new employee achieves stabilization, and this doesn’t always occur in the first three months. Some new workers, for instance, experience a honeymoon period for several weeks. Everything seems fine until a co-worker becomes annoyed with your client’s constant on-the-job chatter, and suddenly there’s a blow-up. Or, your new hire is having problems picking up skills until, three months after her start date, you find the right combination of supports and your new hire blossoms and becomes a star employee. Be patient.

Point #4: Supported employment also works with other challenges.

Providing supports to employees experiencing mental health issues?  There has been substantial research about models that successfully use supported employment for people with a variety of mental health challenges (schizophrenia, bipolar, depression). Scroll through the IPS Employment Center’s website, which describes the eight principles of the Individual Placement and Support model.  Or, read through the positive stories of real-life people in “Work is Recovery,” from the Center for Evidence-Based Practices from Case Western Reserve University.

Additional Resources, References & Trainings

“Supported Employment Resources,” VCU Rehabilitation Research and Training Center. 

“Supported Employment: What Is It?” (2012). Journal of Vocational Rehabilitation

“Supported Employment: A Conceptual Overview,” (1988). The Center on Human Policy at Syracuse University

Since we’ve only scratched the supported employment surface here, we’ve decided we need to do a “Supported Employment 2.0,” follow-up post. In that one, we’ll explore the nitty-gritty how-tos of providing employment supports both on and off the job. Watch your inbox.

Our Employment Training webpage will also have news about “Strategies for Effective Supported Employment,” (formerly Advanced Supported Employment).  We’re planning to offer two Strategies trainings in 2019!  

• Winter training begins with online modules, January 14 through March 15, with face-to-face meetings at Easterseals Crossroads in Indianapolis on February 27 & 28.  

• Or, if you’d rather wait until Summer, join us online June 28 through July 26, with face-to-face meetings, at Easterseals Crossroads on July 11-12. 

Save the dates, and we’ll keep you posted!

…………………………………………………

It’s National Disability Employment Awareness Month  

On August 11, 1945, President Harry S. Truman approved a Congressional resolution declaring the first week in October “National Employ the Physically Handicapped Week.” In 1962, the word "physically" fell off to acknowledge the employment needs and contributions of individuals with all types of disabilities. Congress expanded “National Employ the Handicapped Week” to “National Disability Employment Awareness Month,” which is recognized now each October. To learn more about the NDEAM’s mission and activities, click this link: https://www.dol.gov/odep/topics/ndeam/

The Golden Ticket

I've got a golden ticket.
I've got a golden chance to make my way.
And with a golden ticket, it's a golden day.

You can offer job seekers the golden ticket by simply providing a service you already do! You may have heard of the Social Security Administration’s Ticket to Work program. However, you may also have more questions than answers or have heard some concerns. Shared Solutions has information and answers!

What is the Ticket to Work?

The Ticket to Work and Self-Sufficiency Program provides choices, opportunities, and support to help people with disabilities obtain and keep a job. The program also supports the financial independence of participants—helping them reduce or even eliminate their reliance on government benefits.

People eligible to use a Ticket may not actually have a paper ticket. Social Security is letting some job seekers know they’re eligible and will mail them an actual ticket, but you can assure your job seekers that as long as they have a disability and are receiving either SSI or SSDI, they’re eligible to participate in Ticket to Work—even if they don’t have a paper ticket. (See more about eligibility later.)

Essentially, Ticket to Work allows any job seeker receiving Social Security benefits to choose certain employment providers, known as Employment Networks (more on Employment Networks later), to help them find successful employment. This is especially important now, since Indiana Vocational Rehabilitation (VR) is operating under an order of selection, which means that some job seekers may not be able to receive services through VR. Ticket to Work gives eligible job seekers the chance to prepare, search for, and work at a job even if they’re on a deferred list for VR services.

Who is eligible to use the Ticket?

People eligible to participate in Ticket to Work have a disability, are between the ages of 18-64, and receive monthly cash benefit payments through Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI).

How does it work?

In this program, ticket holders “assign” their ticket to an approved employment service provider. They can select an Employment Network (EN) or Indiana VR (if they’re an Indiana resident). If either VR or an EN accepts the Ticket assignment, they will provide appropriate services to help the Ticket holder find and maintain employment. Social Security says services can include education and training, resume development, benefits and career counseling, job development, job coaching, and any other ongoing support services necessary to achieve the work goals that the job seeker and EN agree to in the Individual Work Plan.

Ticket holders also agree to maintain a certain level of earnings over a specific period. They will be working toward a goal of self-sufficiency; however, that could be a long-term goal (up to 5 years).

What’s in it for the Ticket holder?

While participating in the program, Ticket holders can safely explore work options and find the right job without immediately losing cash benefits. They can also use various Social Security work incentives to maximize their income until they earn enough to support themselves.

A Ticket holder can:

• go to work without automatically losing benefits,
• return to benefits if he or she has to stop working,
• continue to receive health care benefits, and
• be protected from a medical Continuing Disability Review (CDR) while making expected progress with work or educational goals. (While other job seekers receiving Social Security benefits can also use work incentives, Ticket to Work participants have an advantage because their CDRs are suspended, so they can work without fear of a medical review.)

 What is an Employment Network?

An EN is any qualified private or public entity that enters into an EN agreement with SSA under the Ticket to Work program. ENs and Ticket holders work together to create a written Individual Work Plan (IWP).

Why would a person choose the Ticket to Work program? Why would your agency think about offering this program? Here are a few reasons:

• The job seeker is not able to obtain VR services due to OOS.
• The job seeker chooses not to use Vocational Rehabilitation.
• The job seeker goes through VR but does not qualify for extended services. This could include people with mental health challenges or those with physical disabilities—job seekers you may not currently be serving.
• The EN receives “milestone/outcome payments” linked to the earnings of their now-employed Ticket holder. These payments give ENs a revenue stream so they can continue working with job seekers who are not MSD and who may be deferred for VR services.

Ticket partners

Indiana also offers Partnership Plus to Ticket to Work recipients. With this program, both VR and an EN can receive compensation for the same Ticket holder. The VR agency can accept a Ticket to provide services to the Ticket holder under their employment program until the VR successfully closes the case. Then, the EN accepts the same ticket to offer long-term supports.

The EN helps the beneficiary achieve Substantial Gainful Activity (SGA) level earnings, but Partnership Plus ENs do not usually provide pre-employment or job placement services. Instead, they provide job stabilization, retention, and career advancement supports. To ensure some savings to Social Security, Partnership Plus excludes Phase 1 milestone payments to the EN (see the table below) if the Ticket holder already has a job at the time of VR case closure.

Resources

Watch “Meet Ben!” an easy-to-understand introduction to the Ticket program for potential ticket holders. In addition, employment service providers can use the video to educate beneficiaries.  It explains the key benefits of participation in the Ticket to Work program. 

Considering becoming an Employment Network? Review the “payment-at-a-glance” table and additional resources below. The table outlines the potential revenue an EN can realize based upon certain outcomes OR milestones. (Click on Payments at a Glance to see a larger copy of the table) 

Keep in mind that Social Security selects ENs based on the services they can offer to potential Ticket holders, so you’ll want to answer the EN application questions carefully.

To learn more about Ticket to Work or about how to become an Employment Network, visit these websites:

• https://yourtickettowork.ssa.gov/about/index.html 
• https://www.ssa.gov/work/overview.html 
• https://www.iidc.indiana.edu/pages/ticket-to-work

You can also call the Ticket to Work information line at 866-968-7842.

The Center on Community Living and Careers can provide customized consulting to community employment providers wondering about how becoming an EN might help them reach more job seekers.  For more information, call CCLC at 812-855-0169 or refer to our employment training and consultation webpage and flyer.

The Art of the Ask:

Obtaining Authorizations for Supported Employment and Short-Term Supports

As we visit with employment specialists and community employment providers around Indiana, we’re hearing a common question: “Why aren’t our clients receiving authorizations for supported employment or on-the-job supports short-term hours?”

Sometimes we hear variations on the theme, with varying degrees of desperation, depending on the circumstances. 

• “We have to stabilize people right away because we don’t have an authorization for SE hours!”
• “He’s not stable, he needs more support, but I’ve called the VRC and asked for hours and am not getting them!” 
• “We can’t go on providing services for free!”

After a bit of investigation, we think we have some answers for you. If your supported employee has been on the job for four weeks, you may have to ASK, and not just via phone call or email. Using the Employment Support and Retention Plan (ESRP) is the only way to obtain authorizations for additional supported employment or short-term job support hours. 

Need some help on how to do that? This post covers the intricacies (not really—we’ll walk you through it) of using the ESRP to obtain authorization from your vocational rehabilitation counselor for supported employment or short-term support hours. (If you need a refresher on how to use the ESRP, watch this video: https://youtu.be/iP-EQ9oYqVM)

Requesting supported employment hours

The VR Manual now states that it’s best practice for VR counselors to authorize between 30-60 hours of supported employment at the time of job placement for supported employees who have an MSD (Most Significant Disability) designation. The 30-60 hours is for the first three months of employment. If, however, your supported employee who has an MSD designation is NOT receiving supported employment, use the ESRP to request authorization. 

As an employment specialist or consultant, your best practice should include completing the ESRP to request supported employment hours or on-the-job supports short-term so that there isn’t a gap in services for the employee you’re supporting. In other words, don’t rely on an automatic authorization even if your employee has an MSD designation. Fill out the ESRP! It’s not only your key to authorizations, it’s also required for completion of Milestone 2. 

The following chart illustrates three different supported employment scenarios, each of which requires an ESRP request. It’s important to remember that supported employment is available for ALL job seekers whose severity level is designated as MSD. For job seekers whose severity level is designated as NSD (Non-Significant Disability) or SD (Significant Disability), you will request on-the-job supports short term. Take a look:

Supported Employment Authorization Decision Graphic. Click on the link to see a larger view. 

How do I ask for supported employment hours or on-the-job supports short-term hours?

Simple answer: by completing the Employment Support and Retention Plan! All authorizations for supported employment or short-term support hours must be requested through the ESRP (as stated in the VRS Manual). There is no discretion around this document’s use: It is a formal requirement for access to authorized support services.

*For more information on providing additional supports within the first four weeks on the job, consult pages 13-16 of the VR Manual.

**Short-term job supports typically last for 3-6 months, whereas supported employment supports can remain up to 24 months.  

Print-and-save resources!

• With this post, we’re giving you the handy-dandy little reference graphic above, so you’ll know which of your supported employees need supported employment and which might need short-term supports. Download the Supported Employment Decision Guide here. 
• And beyond the what-to-ask-for-who decision, we know you also want to know how and where to make your requests as well as what to say when you DO make the request. We’ve got you covered there too. Download our quick reference guide, Using the Employment Support and Retention Plan to Request Authorization for Supported Employment, here. 
• We’re also including a sample of a completed ESRP showing how to fill out the Plan of Services, Request for Authorization, and monthly Summary of Plan report section. Download the Sample Employment Support and Retention Plan Form, here.

And one more suggestion: Create a mobile, supported employment resource file, where you can keep copies of each of these guides, so you can capture information and complete your ESRP on the road and as you meet with clients. Avoid a service gap: Fill out the form as you go and don’t wait until that first four weeks has flown by!

Take pity on your VRC; they really do need to have it in writing!