1 Leveraging State Resources to Help People with Disabilities Access Housing and Employment

2 Medicaid Transformation Demonstration (1115 Medicaid Waiver)5 Year Demonstration of new ways to provide Medicaid Services Includes payments for Supportive Housing Services and Supported Employment Still a work in Progress but scheduled to start July 1, 2017

3 1115 - Supported EmploymentDesigned for Individual Placement and Support (IPS) Model (aka EBSE) Target Population Aged, Blind, Disabled(ABD) and Housing & Essential Needs(Hen) Recipients Persons with Severe &Persistent Mental Illness and co-occurring disorders Working aged youth with behavioral health conditions Individuals receiving long term services & support

4 1115 Implementation IssuesAwaiting the details that will be defined by the “Third Party Administrator” Fee structure will be predicated on a 5.5 hour a month average service expectation Supportive Housing will be able to be certified for Supported Employment like MH Programs – enabling them to be a DVR vendor (Community Rehabilitation Program) without costly CARF certification.

5 Supported Employment Initiated in the 1987 Rehab ActMainstream Jobs in the Community Pay at least minimum wage Work setting includes people who are not disabled Long term Support People with Severe disabilities Alternative to Sheltered Work Shops, Enclaves and other segregated work programs

6 Competitive Employment Rates in 23 Randomized Controlled Trials of IPS

7 Overall Findings for 23 RCTsAll 23 studies showed a significant advantage for IPS Mean competitive employment rates for the 23 studies: 55% for IPS 23% for controls

8 King County’s S.E. ExperienceProviding Evidence Based Supported Employment since 2008 at 8 agencies 1000 clients a month All participants from Jan 2010 to March 2014 and their services12 months before and after starting the program.

9 King County’s S. E. King County Jail Bookings – decrease 30.3%Length of Jail Stay – decrease 44.9% - Saving $334,836.00 Psych Hospitalization Episodes –decrease 59.4% Length of Hospital Stay –decrease 67.1% Saving $4,759,500.00 Western State Episodes – decrease 92.1% Length of Western – decrease 93.8% Saving $978,670.00

10 Organizational Factors Differentiating High Performing from Low Performing Supported Employment Programs Administrative Factors- Program leaders emphasize - the value of work in peoples lives - the belief that people can work. - strength based practices (quick to identify clients' strengths. - vocational data to guide programing and practice. Staff did not view Stigma as a barrier to employment. - perceive consumers desire and motivation to work. - share stories about that reflect their belief that consumers can work. - - focus on the positive. Line Staff Factors-- - Employment Specialists meet frequently with Case Managers and Peer Specialists and have a high level of collaboration. - Case Managers and Therapists help prepare clients go to work and support employment goals ( so do the Doctors and Nurses) Goudy, Carlson, Rapp High-performing programs possessed a higher opinion of the abilities, talents, and spirit of their consumers than did the comparison sites. Furthermore, this opinion was widely shared throughout the organization, not just with the supported employment staff. This shared belief seemed to influenced the amount of formal and informal conversation among staff concerning competitive employment.

11 In all of the Studies 60 to 75% of the possible participants indicated that they wanted to work. In the one Housing First Study of SE more than half of the clients chose not to participate and they were the ones with the greatest challenges to employment.

12 Client's Reluctance to Consider EmploymentFear of Loosing Benefits and Housing Lack of Role Models Onset of Symptoms Coincided with First Jobs Long Term Unemployment Leads to Negative Self Image Care Givers’ Warnings Poor Soft Skills Natural Ambivalence with Stages of Change Unrealistic Expectations Experience with Inadequate Employment Programs

13 Critical Numbers for SEFidelity Score Employment Rate Bottom Line

14 Recovery and IPS (From Dartmouth website)

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16 8 Elements of IPS 1) Competitive Employment 2) Eligibility Based on Client Choice 3) Integration of Rehabilitation and Mental Health Services 4) Attention to Worker Preferences 5) Personalized Benefits Counseling 6) Rapid Job Search 7) Systematic Job Development 8) Time Unlimited and Individualized Supports

17 What to Provide to DVR Social Security Card Valid IDDocumentation of Disability Pertinent Medical Records DVR Vocational Information Form Communication and Partnership

18 Community Based Assessment - Gia45 years old Currently housed, previously homeless 5+ years Last job over 10 years ago, Income Source ABD Past physical injury, PTSD Identify Supports and Strengths What are we hoping to learn? What types of supports or accommodations does she need? Where are her strengths?

19 Job Placement Robbie Identified Supports30 years old, recent criminal history, functionally illiterate, $0 Income PTSD, Depression, Psychosis related to Thyroid Disorder Identified Supports Job Development and Advocacy Resume and Application Assistance Interviewing Practice and In Person Support Letter of Explanation for Criminal History

20 Intensive Training Services Paul49 years old, homeless 10+ years 4th job with Supported Employment Developmental Delay/ Brain injury, Major Depression, Suicidal Identified Supports Assistance with shelter moves and bus routes Employment Specialist working with direct supervisor Communication Support, Shift Flexibility, Feedback Anger Management Skills Monitor for Suicidal Ideation Learning New Job Tasks

21 Housing First Employment First Targeted to the most vulnerablePeople are moved into housing directly from the street, without preconditions of treatment acceptance or compliance Full integration of housing and treatment teams. Ongoing support from the agency. Harm Reduction (not harm acceptance) approach. Residents have leases and tenant protection under the law. Mainstream housing in the community, resident choice. Targeted to most serious mental illness. People are supported into jobs with non-exclusion criteria. Full integration at work setting and with treatment teams. Ongoing support from the agency. Model good work behavior, meeting job seekers where they are NOW. Hired as full employees of the company (permanent, not short term or transitional). Mainstream jobs in the community, client choice.

22 Supported Employment and Supportive HousingVocationalizing Housing as a tool Incorporate Peers Housing helps with soft skills and building Meaningful Activities > Scheduled Structured Meaningful Activities Moving from a Reactive Life Style to a Planful Life

23 Make use of Resources/ Ask for supportYour Resources: The broader statewide SE/IPS learning community Everyone in this presentation and at this conference https://www.ssa.gov/redbook/ https://www.dshs.wa.gov/ra/division-vocational-rehabilitation Your feedback is appreciated to identify how best to spread the word about the benefits of Supported Employment.

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25 Staff Competencies Competencies of Employment SpecialistMarketing training or experience, or desire to learn. Have to want to do marketing/job development as well as the “social service” aspect of the job. Need to have networking abilities and a large network Ability to engage individuals/be “engaging”. Computer expertise Ability to complete thorough documentation Organizational skills Ability to work independently Competencies of a supervisor Clinical Supported Employment experience Supervisory experience

26 Data & Tracking for outcomesWhat you measure will be done! Job placements and job retentions Employer outreaches/time in community (tools: job log, others) Follow along supports Others…