Supported Employment and Long Term Follow-Along
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Supported Employment and Long Term Follow-Along for the Counselor and Job Coach December, 2008. Introductions:. Judy Hill - EES/LTESS Coordinator. OFFICE OF EMPLOYMENT SERVICES AND SPECIAL PROGRAMS. JUDY HILL 804-662-7108 -email [email protected]

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Supported Employment and Long Term Follow-Along for the Counselor and Job Coach December, 2008

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Supported employment and long term follow along for the counselor and job coach december 2008

Supported Employment and Long Term Follow-Along

for the

Counselor and Job Coach

December, 2008


Introductions

Introductions:

  • Judy Hill - EES/LTESS Coordinator


Office of employment services and special programs

OFFICE OF EMPLOYMENT SERVICES AND SPECIAL PROGRAMS

  • JUDY HILL 804-662-7108

  • -email [email protected]

  • FAX NUMBER FOR ESSP: 1-804-662-9140

    DRS TOLL FREE VOICE 1-800-552-5019

    WEBSITE: http://www.vadrs.org

    then click on Employment and Vocational Services

    The Supported Employment Guide can be found at:

    http://vadrs.org/essp/downloads/seguide/pdf


What s in your resource packet

What’s in your resource packet?

  • Understanding Order of Selection Brochure

  • Power point Presentation

  • Enclave/Mobile Crew 101, Stability for Individual SE

    Other SE Issues, Revised SE Forms

  • OESSP Information Sheet

  • Appendices B & C - WAT, SA and Provisions for Extended Employment Services (EES)

  • Appendix D - Guidelines for SE and JCTS

  • Appendix E - Provision of Long Term Employment Support

  • LTESS Guidelines

  • LTESS forms - application, requisition, closure

  • Policy on Integrated Settings-Employment Outcomes and Extended Employment

  • Successful Closure

  • Definition of Most Significant Disability (MSD)

  • Post Employment

  • List of Acronyms

  • List of DRS Statuses

  • EES/LTESS Forms


Topics to cover

Topics to Cover:

  • Insights into SE/Long Term Practices

  • Brief Historical Background – EES and LTESS

  • Key Service Requirements for Long Term Follow-Along


Drs impact on eso programs

DRS IMPACT ON ESO PROGRAMS

  • *DRS Field Spends almost 10 Million

  • **DRS OESSP EES and LTESS Spends over 7.2 Million

    * State Fiscal Year 2008

    **This includes the 15% reduction in both programs


Why are we here

Why are we here?

  • To stress the importance of communication and collaboration among all parties

  • Supported employment specifics

  • Long Term Follow-along – LTESS specifics


The keys to success r elationships

THE KEYS TO SUCCESSRELATIONSHIPS

  • Frequent Contacts between VR and JC

  • Getting info between VR and JC quickly

  • VR and JC view themselves as part of a team

  • Access to VR counselor or job coach


The keys to success trust

THE KEYS TO SUCCESSTRUST

  • VR and JC trust in each other to:

    • Give sufficient hours to do job

    • Use hours given efficiently and effectively

  • Consumer Characteristics/Needs:

    • Difficult vs. less difficult consumers

    • Full use of authorized hours vs request cancellations


  • Supported employment

    SUPPORTED EMPLOYMENT

    • Collaboration and Communication

    • Roles of each of us from referral to follow along

    • Clarification of services

      • Individual SE

      • Group – Enclave, Mobile Work Crew, Entrepreneurial

      • JCTS


    What model to use

    What model to use?

    • Does the consumer require ongoing extended support services in order to maintain competitive employment?

    • Is it required that a job coach work individually with a consumer?

    • Does the consumer require employment in a mobile work crew or enclave?

    • Is employment integrated?


    Se individual placement

    SE - Individual Placement

    • Single supported employee placed in an integrated work setting in the community

    • employed by employer

    • ongoing follow-along required

    • most widely used SE model

    • Advantages: flexibility, max. integration, ease in differentiating between training and LTFA


    Enclave model

    Enclave Model

    • small group of supported employees placed in community-based employment

    • may work together or be dispersed with integrated setting

    • may be employed by employer or ESO

    • ongoing follow-along required

    • advantage: higher level of supervision and support


    Mobile work crew model

    Mobile Work Crew Model

    • group of supported employees who travel together to one or more integrated work settings in the community to perform contract work

    • employed by the ESO

    • ongoing support required

    • advantage: higher level of supervision and support


    Entrepreneurial model

    Entrepreneurial Model

    • supported employees producing a service or product either on a sub-contract basis or as a prime manufacturer

    • SE employees, along with managers and others, comprise the business

    • advantages: integrated, public contact, PR


    Supported employment and long term follow along for the counselor and job coach december 2008

    JCTS

    • Consumer receives initial situational assessment, job development, job skills training, transportation training, or other support services provided by an ESO; however long term follow-along is not necessary after DRS case closure.

    • This is a separate service and requires applicable service category on vendor’s rate sheet.

    • Service Item Codes are not the same as those for SE.

    • When service categories are open, cases can be coded as either MSD or SD.

    • If a consumer receives JCTS services, no follow along is required so therefore, a LTESS application should not be completed. If the consumer demonstrates that LTFA is needed then the ESO can submit a LTESS application after they have DRS counselor approval. The counselor needs to document the change in the case notes and change the SI codes on any authorizations if necessary.


    Drs counselor roles and responsibilities

    DRS Counselor Roles and Responsibilities

    • Once eligibility is established SE planning begins.

    • Are long term supports needed? If yes, then SE case. If no, consider JCTS.

    • Identify long term support.

    • SE cases must be coded as MSD.

    • Share sufficient diagnostic information.


    Drs counselor role

    DRS COUNSELOR ROLE

    • Establish benchmarks regarding progress.

    • Stop the process if needed and discuss issues – Interrupt Failure if needed.

    • Clarify expectations.

    • Maintain a separate role with consumer from vendor.

    • Determine what services can be provided by DRS before asking a job coach to do them.

    • Continue to communicate with consumer after referral to job coach.

    • Case statuses must be properly updated.

    • Communicate and collaborate!!!!!!!!!!!!!!!!


    Hippa issue

    HIPPA ISSUE

    • ESOs will not be able to reference SS #s in the new internet EES/LTESS system. As a result you must use the consumer's participant ID # rather than a case or Social Security # in all communication regarding the consumer.

    • The Certificate of Eligibility has the participant #, therefore we recommend that a copy be sent to the ESO as a part of the referral package.

    • The participant ID # should be reflected on all of the SE forms. It is not on the authorizations generated by AWARE.


    Job coach role

    Assist consumer with locating suitable job matches.

    Assist in job search efforts.

    Provide timely written reports and phone contacts with updates as needed.

    Provide job skills training as needed.

    Ensure consumer stability and job satisfaction on both consumer and employer side.

    Provide extended support services, where appropriate.

    Job Coach Role:


    Job coach responsibilities

    Communicate and collaborate with DRS Counselor and consumers.

    Providing information as to fading plans, need for follow-along, funding options.

    Work as a team with DRS, case managers, consumers, families, etc. to improve likelihood of success.

    Job Coach Responsibilities


    Topics coming up communication issues

    Topics coming up:Communication Issues

    • Initial Planning

    • Authorizing Services

    • Service Provision

    • Report Writing

    • Invoicing


    Opportunities for communication and collaboration

    Opportunities for Communication and Collaboration

    • Initial Planning Expectations

      • Situational Assessment

      • SE vs. JCTS

      • Job Goal/Development

      • Placement and Training

      • Stability/Fading

      • Long Term Follow Along


    Who pays for services

    WHO PAYS FOR SERVICES?

    • Initial Planning for Services:

      • DRS pays for situational assessment, job development and placement and training through stabilization

      • Long term support funds pay for extended services including post stabilization while the case is still open. Examples-LTESS,CSB

      • DRS pays for post employment, not LTESS


    Opportunities for communication and collaboration1

    Opportunities for Communication and Collaboration

    • Authorizing Services:

      • All authorizations need to consider individual consumer need.

      • Need to be in place prior to provision of service.

      • Justification needed for requested hours and a timely response from counselors including emergencies like post employment.

      • DRS Counselor should keep in mind that there are no caps/no maximums.


    Opportunities for communication and collaboration2

    Opportunities for Communication and Collaboration

    • Service Provision:

      • Job Development

        • Agreement of goals for consumer.

        • Provide sufficient service hours - No maximums or minimums, individually considered.

        • Monthly progress reports should contain information as to name, numbers and types of contacts made, strategies applied, job development hours used, potential placement possibilities or outcomes expected and request for next month.


    Opportunities for communication and collaboration3

    Opportunities for Communication and Collaboration

    • Service Provision:

      • Job Placement/Training

        • No maximum or minimum hours allowed for Placement/Training - has to be individually considered (18 month duration limitation).

        • Training time is not standardized .

        • Monthly reports, including intervention percentage and fading schedule along with progress made to date.

        • Last monthly SE P&T Report (SE Form 3) should indicate consumer is stable in employment before LTFA begins.


    Invoicing billable services under se

    INVOICING:Billable Services under SE

    Expectation of Counselor – Complete, Timely, Individualized, and Accurate Billing

    • Work Site Activities:

      • Includes travel, training and intervention with consumer, employer, and employees at work site

    • Job Development Activities:

      • Includes consumer specific job development with employers, supervisors, and other personnel for purposes directly relating to employment

    • Off-Site Activities:

      • Includes training in transportation, money handling, and advocacy for persons not directly affiliated with the work site

        Remember, if a DRS employee can provide the service, that should be the priority!


    Invoicing billable services under se1

    INVOICING:Billable Services under SE

    • Assessment/Report Writing:

      • Includes provision of situational assessment services and all task analysis, training and progress report writing

      • Billing for report writing and telephone calls should reflect actual and reasonable time spent, not standardized times


    Fading

    Fading:

    • Intervention percentage time is the time the Job Coach spends supporting the consumer on the job site divided by the total number of hours worked.

    • Intervention declines over time as a measure of progress.


    Employment stability and the movement from time limited to ltess funding

    EMPLOYMENT STABILITY AND THE MOVEMENT FROM TIME LIMITED TO LTESS FUNDING


    What is stability

    WHAT IS STABILITY?

    • Traditional guideline: job coaching support is 20% or less. This may not always be the case.

    • Consumer is emotionally, behaviorally stable.

    • Consumer will demonstrate stability for at least 30 days in “service” status before case is moved to “employed” status.

    • Last placement and training form (SE Form 3) submitted to DRS must note stability has been reached and when the case will begin long term follow along.

    • Communication between the ESO and DRS is imperative for this action to be successful.


    How to calculate stability

    How to calculate STABILITY?

    • “Stability” is the direct/indirect intervention hours by the employment specialist divided by the number of consumer work hours for that time period (usually calculated weekly and/or monthly).

      • Example: 10 intervention hours divided by 20 consumer work hours is 50%. While DRS case service and LTESS funds pay for employment specialist transportation and documentation, the hours spent providing these services do not enter into the calculation of “stability”.


    Drs individual se case movement

    DRS Individual SE Case Movement

    • The DRS Counselor keeps the consumer in “service” status until stability for 30 days or more is achieved.

    • The DRS counselor will then move the consumer to “employed” status for at least 90 days.

    • Once the consumer has worked in “employed” status for a minimum of 90 days or more and remains stable on the job, the case is successfully closed “Closed - Rehab”.

    • LTESS funds begin supporting LTFA at the beginning of “employed” status.


    Stability in group models

    Stability in Group Models

    • For persons in group models, “stability” is defined as the completion of a 60 day period in which intervention is directed at maintaining a level of production and not at major barriers to successful integration into the job site. In other words, the job coach/trainer is devoting the majority of time addressing training issues rather than behavioral issues. The consumer is meeting a level of production that is acceptable to the employer (either the business or ESO itself).

    • The case remains in “service” status until the stability period ends. The case then goes to “employed” status at the end of a minimum 60 day period. At this point the case is considered to be in LTFA. Funding could be from a number of sources.


    Ongoing services form se form 4

    Ongoing Services Form (SE Form 4)

    • The Code of Federal Regulations requires twice a month monitoring of the consumer until DRS closes the case. The ESOs are required to complete the Ongoing Services Form each month from the time the case begins follow along until DRS case closure. The job coach is required to send a copy to the DRS counselor each month until the case is closed.


    Eso action to access ltess

    ESO Action to Access LTESS

    • Before the 30 day stability period ends, a LTESS application must be received no later than the 20thof the month preceding the start of follow along services. This ensures that LTESS funds will support LTFA after time limited services by the DRS counselor ends.

    • All LTESS applications must be approved by a DRS counselor. The ESO must document the approval in the case record.


    Individual ltfa definition

    Individual LTFA Definition

    • With the approval of the DRS counselor and ESO job coach either bimonthly or quarterly contacts with the consumer would be acceptable to DRS provided that:           * the consumer and family understand the frequency,           * the consumer is given access to follow along supports if needed sooner than the next scheduled contact, and            * the ongoing supports being provided are adequate to meet the client’s needs with respect to maintaining employment.


    Ltfa vs post employment services

    LTFA VS POST EMPLOYMENT SERVICES

    • LTFA is the maintenance of a person in employment.

    • LTFA does not mean case management.

    • LTESS does not fund training, retraining or job placement.

    • If retraining, job placement or other services are needed, the DRS counselor should be contacted immediately. The consumer probably will need services other than LTFA.


    One last reminder

    ONE LAST REMINDER

    • LTESS funds vocational support services that are necessary and sufficient for consumers to maintain employment. Case management, independent living or other services that are not vocational in nature should not be billed to LTESS funds. Per the Code of Virginia, LTESS funds are not appropriated by the General Assembly to fund those services.


    Questions

    QUESTIONS?????


    Ees ltess budgets fiscal years 08 09

    EES/LTESS BUDGETSFISCAL YEARS 08-09

    • No new LTESS dollars in FY 08 or 09

    • Total LTESS dollars after 3% reductions in FY 2008 -- $5,184,044

    • Total LTESS dollars after 15% reductions in FY 2009 -- $4,406,437


    Ees ltess budgets fiscal years 08 091

    EES/LTESS BUDGETSFISCAL YEARS 08-09

    • Total EES dollars after reductions in FY 2008 -- $3,200,104 -3%

    • Total EES dollars after reductions in FY 2009 -- $2,720,088 -15%


    Long term employment support services funding 95 08

    Long Term Employment Support Services Funding 95-08


    Extended employment services funding 95 08

    Extended Employment Services Funding 95-08


    Ltess history

    LTESS HISTORY

    • Grassroots effort by ESOs with General Assembly in FY 94

    • Success for FY 95 - $375,000 in State funds with primary target of Supported Employment Follow Along for persons with severe disabilities

    • Incremental increases in past years

    • Funds have been reduced each year for the last two years.


    Ees ltess what s the difference

    EES/LTESS – What’s the difference?

    EES Funding:

    • Services provided are onsite employment, enclave and mobile crews – No individual SE

    • No counselor approval

    • Limited number of ESOs involved

    • No additional allocations – program not growing

      LTESS Funding:

    • Full array of services provided including individualsupported employment, onsite employment, enclave and mobile crew

    • Counselor must be involved in the approval of consumers

    • Double the number of ESOs involved in LTESS funding

    • Concentrated efforts to “grow” the LTESS pot


    Extended employment services ees history

    Extended Employment Services (EES) - History

    • First allocated from General Assembly for FY 84 and 100% state funds.

    • Current allocation is now over $2.7M distributed across the original 41 vendors providing Extended Employment Services to fund long term support to severely disabled consumers.

    • No additional funds allocated from the General Assembly since 1989.

    • Numbers of consumers served have declined over the years because of no increase in funds.


    Supported employment and long term follow along for the counselor and job coach december 2008

    EES

    • Half of ESOs provide community placement – enclaves and/or mobile crews.

    • Individuals served primarily have disabilities of MR (66%) or SMI (14%).

    • EES is not restricted to DRS consumers.

    • Must be one of the original vendors to receive an EES allocation.

    • Most recently funding has been lost to reductions.


    Supported employment and long term follow along for the counselor and job coach december 2008

    EES

    • Any consumer is eligible for EES funds as long as they are documented as having a severely disability.

    • Counselors do not have to be contacted prior to an EES application.

    • ESO must provide an integrated setting for a DRS/DBVI counselor to receive a closure. The counselor may still refer a consumer to an ESO that is not integrated if that is the best placement.

    • Bottom line is to do what is best for the consumer.

    • Due to limitations in the EES program, ESO community lobbied for additional follow along dollars which would be available to all approved vendors….


    Ltess what is it

    LTESS - WHAT IS IT?

    • Long Term Employment Support Services

      • 100% State dollars appropriated by the General Assembly for FY1995

      • Intended as long term funding to support individuals with severe disabilities in accessing and maintaining employment

      • Not intended to supplant other funds used for the same purpose.


    Ltess background

    LTESS BACKGROUND

    • 1994 General Assembly appropriated $375,000 for FY 95 and 201 consumers were served.

    • The LTESS program is currently serving over 2,800 consumers a month in 77 ESOs around the state.

    • Individuals served primarily have disabilities of MR (44%) or SMI (25%).


    Ltess guidelines

    LTESS GUIDELINES

    • LTESS funds CANNOT be used to supplant planned or current funding for long term supports.

      • If a consumer is being sponsored by a public source, it should continue

      • Generally, no split funding for employment

    • Vendors cannot charge DRS more than any other purchasers of the same services as specified on the vendor rate sheet.

    • Exception: individual, private pay

    • Medicaid rates changed to be the same as DRS rates.


    Ltess guidelines continued

    LTESS GUIDELINES (continued)

    • Individuals who have been sponsored for employment services by public funds must wait 12 months to become eligible for LTESS

      • A mechanism is established by DRS for exceptions in the case of hardship.

    • LTESS funding is not disability specific!

    • Organizations accepting LTESS funding must work with all DRS consumers and not discriminate on the basis of disability.


    Ltess guidelines continued1

    LTESS GUIDELINES (continued)

    • Services billed through LTESS must be employment related follow-along services

      • Job development, retraining, referral to DRS tp reopen the case and general case management services are NOT considered follow-along

      • Provide the services needed to maintain employment – not “nice to do” or “always have done it that way” or “the employer likes me to come every week”

      • Spikes are expected-over 20% of hours worked-send in documentation

      • Email notification is sent to counselors upon submission of LTESS application


    Ltess guidelines continued2

    LTESS GUIDELINES (continued)

    • As LTESS is the funding of last resort for long term supports, vendors must document attempts to secure sponsorship and the absence of alternative funding sources.

    • Each consumer is required to have an individualized service plan that is clear, complete, and current following CARF guidelines.


    Ltess guidelines continued3

    LTESS GUIDELINES (continued)

    • Monthly reports (including intervention sheets) should be maintained in the individual consumer file except:

      • if an individual is billed 20% or more of the total hours worked, the vendor must submit justification in the form of a monthly progress report


    General information

    GENERAL INFORMATION

    • Any consumer with a goal of receiving Supported Employment or Extended Employment is a possible candidate for LTESS funding

      • Does NOT have to be an open DRS case or a DRS case at all

    • DRS or DBVI counselor approval is required for use of all LTESS dollars

      • Includes unfunded, on-site extended employment

      • Includes closed DRS SE that may require additional follow along to maintain employment

      • Includes JCTS if discovered consumer needs support to maintain employment

    • Collaboration and Communication!!


    Major ltess issues

    MAJOR LTESS ISSUES

    • Counselor approval must be obtained and documented before applications submitted.

    • Applications must be thoroughly completed.

    • Applications must be submitted by the 20th.

    • Applications cannot be submitted for consumers receiving JCTS.

    • Applications for consumers in wrong DRS status.


    Allocation methodology

    ALLOCATION METHODOLOGY

    • Allocations are based on a 3-year rolling average of expenditures utilizing a 125% rule.

    • One bad year will not “hurt” as much if averaged with two good years.


    Reallocations

    REALLOCATIONS

    • DRS reviews expenditure patterns throughout the fiscal year and completes reallocations as needed.

    • Reallocations are based on an individual organization’s statistics-average hours billed, average attendance, individual rates, months/days remaining in fiscal year.


    Reallocations continued

    REALLOCATIONS (continued)

    • Vendors need to monitor themselves on a monthly basis.

    • If a vendor chooses to maintain more individuals than their allocation can support with hopes of receiving additional dollars, that vendor is committing to be responsible for those individuals at the same level of service regardless of future allocations.


    General information for ees ltess

    General Information for EES/LTESS

    • Vendor discretion as to how to apply their EES/LTESS funds

      • MAY choose to support individuals in SE, individual or group models, extended employment or a combination

      • counselors may request certain consumers be supported with EES/LTESS, but vendors have final say following their own policies

      • overextending EES/LTESS funds is risky

        • vendor discretion

    • EES/LTESS allocations are public information.


    The future

    THE FUTURE

    • Recommendations were made to update the 15+ year old computer system

    • Web based

      • No paper

      • Forms partially filled in

      • Errors minimized with edits and drop down help boxes


    The future1

    THE FUTURE

    • Financial data available on demand

    • Production data available on demand

    • Savings of paper, postage, phone bills (faxes)

    • Secured web site, password protected

    • Hipaa compliant

      Timeframe – FY 08 Initiated System

      Training for All in March 2009


    Forms

    FORMS

    • Applications

    • Closures

    • Requisition/Invoices


    Questions1

    Questions?


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