Pre-Vocational Services In

1. Pre-Vocational ServicesIn

2. Credits: Who We Are: Byron White, Employment Coordinator ADMH Central Office Byron.white@mh.alabama.gov Karen Coffey, Director of Systems Management, AMDH Central Office Karen.coffey@mh.alabama.gov Derek Greer, Employment Resource Specialist, Region I Derek.greer@mh.alabama.gov Margaret “Virginia” Mattox, Employment Resource Specialist, Region V Margaret.mattox@mh.alabama.gov Jennifer Carpenter, Employment Resource Specialist, Region III Jennifer.carpenter@mh.alabama.gov

3. Who We Aren’t: WAIVER

5. Settings Rule Path to Employment Pre-Vocational Services Defined Alabama Other States Wavier Services and Pre-Voc Time Limited Setting Discovery Vocational Rehabilitation Pre-Vocational on the Big Screen Questions & Answers

6. HCBS Settings Rule Background • The final Home and Home and Community-based services (HCBS) regulations known as the “Final Rule” were published in the Federal Register on January 16,2014; they became effective March 17, 2014 • Designed to enhance the quality of HCBS, provide additional protections, to ensure full access to benefits of community living • Establishes requirements for the qualities of settings where individuals live and/or receive Medicaid-reimbursable HCBS provided under 1915 (c), 1915 (i), 1915 (k), 1915 (b)(3), and 1115 of the Social Security Act) • Focus on the quality of the individual’s experiences • The intent is that individuals receiving Medicaid-funded HCBS have the opportunity to receive these services in a manner that protects individual choice and promotes community integration

7. Any residential or non-residential setting where individuals live and/or receive HCBS must have the following five qualities: • Integrated and supports full access of individuals to the greater community • Provides opportunities to seek employment, work in competitive integrated settings, engage in community life, control personal resources and • Ensures that individuals receive services in the community, to the same degree of access as individuals not receiving HCBS. • Is selected by the individual from among setting options including non-disability specific settings and options for private unit in a residential setting • Person-centered service plans document the options based on the individual’s needs, preferences, and for residential settings, resources available for room and board. • Ensures an individual’s rights of privacy, dignity and respect, and freedom from coercion and restraint. • Optimizes individual initiative, autonomy, and independence in making life choices, including, but not limited to, daily activities, physical environment, and with whom to interact. • Facilitates individual choice regarding services and supports, and who provides them.

8. States use two types of assessment processes to evaluate whether their standards and settings are in compliance with the federal home and community-based setting regulations Systemic: The state’s assessment of the extent to which its regulations, standards, policies, licensing requirements, and other provider requirements ensure settings are in compliance Site-Specific: The process by which a state assesses specific settings in which home and community-based services are provided to determine whether the settings are in compliance

9. At a minimum, states are expected to conduct site-specific assessments of a representative and statistically significant sample of settings to determine the number of providers that are or are not in compliance with the federal setting requirements • States use a variety of methods to conduct site-specific assessments, including: • provider self-assessments • licensure surveys • site visits • policy and record reviews • reviews by case managers affiliated with the state and managed care organization staff

10. Pre-Vocational Self-Assessment • Agency:___________________________ Person Completing Assessment:_________________________ • Contact for Person Completing Assessment:_________________________________________________ • Are Pre-Vocational Services facility based ____ Yes ____No • 2. Are Pre-Vocational Services Community based? ____ Yes ____ No • Are Pre-Vocational Services both Community and Facility based? ___ Yes ____ No • What percentage of pre-vocational services are Facility Based? _____ % • What percentage of pre-vocational services are Community Based? _____ % • Should Total 100 % • 6. Do individuals participating in pre-vocational services have employment related goals? • ____ Yes ____ No • 7. Do Individuals participating in pre-vocational service earn wages? ____ Yes ____ No • Are Wages at or above minimum wage? ____ Yes ____ No • 8. Please list pre-vocational services you provide that address work related skills: • 9. List factors used to determine an individual’s preference for pre-vocational services: • 10. List benchmarks used to determine individual’s progress in pre-vocational services: • 11. When is a referral to VR made for individuals participating in pre-vocational services?

11. PRE-VOCATIONAL SERVICES • Services that provide learning and work experiences, including volunteer work, where the individual can develop general, non-job-task-specific strengths and skills that contribute to employability in paid employment in integrated community settings. • Services are expected to occur over a defined period of time and with specific outcomes to be achieved, as determined by the individual and his/her service and supports planning team through an ongoing person-centered planning process, to be reviewed not less than annually or more frequently as requested by the individual. • Individuals receiving prevocational services must have employment-related goals in their person-centered service plan. • The general habilitation activities must be designed to support such employment goals. • Competitive, integrated employment in the community for which an individual is compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities is considered to be the successful outcome of prevocational services”

12. Pre-Vocational Services Outside Alabama

13. Administered by the Developmental Disabilities Division of the Hawaii State Department of Health • Prevocational Services are Community Based • Services are limited to a maximum Two-Year Period • Individuals may also receive educational, supported employment, and day health services concurrently Prevocational Services Include: Career Assessment Person-Focused Career Planning Benefits Counseling Work Trials Apprenticeships Job Readiness Skills (compliance, attendance, task completion, safety and transportation) Personal Care/Assistance

14. L OUISIANA • Administered through the Developmental Disabilities Division of the Louisiana Department of Health • Career planning is a major component of prevocational services (includes vocational assessments, discovery process, ongoing career counseling, and job shadowing) • All career planning activities focus on creating a path to community employment at the highest level for each participant • Additional services covered under the prevocational services include: personal care, transportation, and volunteer activities • Services are limited to a 4-year duration

15. Administered through the Tennessee Department of Intellectual and Developmental Disabilities • Services are time limited and offered in a community-based setting. Services can be provided in a variety of ways and locations which could include: • Volunteering at non-profit agencies • Touring Businesses • Health & Fitness Education Classes • College Courses • Adult Education Classes • Conducting Assessments • Financial Literacy and benefits planning

16. Administered through the Alabama Department of Mental Health, Division of Developmental Disabilities • For Individuals being referred for Pre-Vocational Services as a new service: • Up to 20% of time in community for the first 499 units, and then as follows: • 40% (500-999 units) • 60% (1000- 1,499 units) • 80% (1,500- 1,999 units) • 100% (2,000- 2,470 units)

17. Coming Soon to a Facility Near You! • Ratios • Pre-Vocational Services can be provided in group setting when appropriate, i.e. Individuals may be taken on a company tour to learn the types of job available within the company. • The Ratio for group activities is One Staff with up to 8 Participants • Other situations may require lower ratio or even a one of one service • One staff member can support up to 8 individuals in a variety of pre-vocational settings concurrently, making sure the participants are comfortable with a natural support, typically an individual identified as a mentor. To bill pre-vocational services (group), staff must support and monitor the individuals throughout their day as they participate in the community-based pre-vocational service.

18. Employment Starting Line

19. Let’s Go to Work!!! • Prevocational Services • Designed to create a pathway to employment • Teach Concepts: Attendance, Task Completion, Problem Solving, Interpersonal Relations and Safety • Does not include teaching specific job task • Employment Related goal must be on the Individual’s Person Centered Plan • Should match job with the individual’s interests, strengths, priorities, abilities, and capabilities

20. Are delivered for the purpose of furthering habilitation goals leading to • employment • Prepare the participant for integrated employment • Should enable attainment of the highest possible level of work • Prepare the participant to earn wages at or above minimum wage • Must address transportation needs • Must be delivered in the community • Not available through VR or LEA • Requires supporting documentation of services delivered • Time Limited - 2470 Units Unit defined as one hour • Referral to VR is expected Pre-Voc Continued

21. CMS also says:“Participation in prevocational services is not a required pre-requisite for individual or small group supported employment services provided under the waiver. Many individuals, particularly those transitioning from school to adult activities, are likely to choose to go directly into supported employment. Similarly, the evidence-based Individual Placement and Support (IPS) model of supported employment for individuals with behavioral health conditions emphasizes rapid job placement in lieu of prevocational services.“

22. Individual Scenario William is a 35 year old individual served on the waiver for the last 9 years. For the past 4 years he has been working in the workshop operated by the agency. He spends 3 hours of his day in the workshop and the other 2 hours he spends in day habilitation. William experiences difficulty understanding time and is unsure when he should take a break. As a result he will often walk away from his work station when he thinks it’s break time. Staff are also concerned with William’s social behaviors. He doesn’t seem comfortable around people and fails to maintain eye contact. However during Williams annual PCP, he states that he wants to go to work in a hospital laundry division. How Are Services Arranged for William?

23. Employment Goals of working in the laundry is placed on William’s Plan of Care The team will create the plan for employment and place William in prevocational services where the focus is to improve his attention span. He will be placed in Pre-Vocational Services for 4 hours 5 days to address attention span deficits. He will also volunteer in the laundry at the local homeless shelter so he can be practice separating laundry, folding laundry, etc. To improve his social skills, William will attend class for 1 hour 5 days each week focused on socialization skills. Once William is ready, he will be referred for VR services

24. A Recap of Pre-Vocational Services • Available to individuals that choose to work and want to be on a path to employment. • Not a pre-requisite for work or supported employment participation • Time limited • 2470 Units (Pre-Vocational Service a 1 Hour Unit) • Wages are allowable • Should not be used as a “filler” service, i.e. person returns to workshop each afternoon after working morning just to fulfill his 5 hour day • Justification needed when a person would require additional pre-vocational services while employed • Returning to day services from pre-vocational services not necessarily a step back when a person decides they are no longer interested in employment or able to participate in employment. Services should reflect what person has chosen in their Person Centered Plan! • Not designed to teach specific job related tasks • Wages are allowable under pre-voc but not necessarily a best practice. Code of Federal Regulations (CFR) states anyone earning more than 50% of minimum wage shouldn’t be receiving prevocational services • Services should be provided in a community setting as much as possible!

26. Post-Test Questions & Answers www.al-apse.org