NYSED / ACCES / VR / Adult Vocational Rehabilitation Service Delivery and Coordination / Policies and Procedures / 1310.00P Supported Employment Procedure

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1310.00P Supported Employment Procedure

(February 1998)

See corresponding policy: 1310.00 Supported Employment Policy

Note: Vocational Rehabilitation procedures provide internal guidance for ACCES-VR staff only and create no procedural or substantive rights for any individual or group.

Table of Contents

• Introduction
• Process
  • Referral
  • Eligibility for Supported Employment Services
  • IPE Development
  • Items Requiring Waivers
  • Elements that Must be Addressed on the IPE
  • Periodic Review and Reporting Specific to the Consumer
  • Situational Assessment Reports
  • Job Development and Placement Reports
  • Intensive Training Progress Reports
  • Extended Services Reports
  • Monthly Supported Employment Status Report Specific to Contract
  • Case Status Recording Requirements
  • Addressing Service Needs Following Rehabilitated - Status 26 Closure
  • Provision of Contracted Services
  • Coding for Non-Contracted Services
    • Case Service Codes
    • Program Codes
    • Case Closure Codes
• Definitions
  • Competitive Work
  • Integrated Work Setting
  • Program Intake and Assessment
  • Supported Employment Models
    • Individual Placement Models
    • Enclave Models
    • Mobile Crew Models
    • Affirmatvie Business Models
    • Transitional Employment Models
  • Intensive Supported Employment Services
    • Situational Assessment
    • Job Development Activities
    • On-Site Training/Job Coaching
  • Natural Support System
  • Stabilization
  • Extended Supported Employment Services
  • Reintervention
• Reference

Introduction

1. Supported employment is paid competitive work that offers ongoing support services in integrated settings for individuals who meet the Most Severe Disabilities definition as defined in Section 205.00 of ACCES-VR Policy on Individuals with Severe Disabilities. Supported Employment can include program intake and assessment, situational assessment, job development, placement, training, stabilization and extended services. Supported employment is intended for individuals for whom competitive employment has not traditionally occurred or has been interrupted or intermittent as a result of a most severe disability.
2. Individuals in Supported Employment must have the same opportunity to interact with persons who do not have disabilities and who are not service providers as nondisabled individuals in the same job. This employment outcome is obtained by providing intensive services and is sustained through the provision of extended services. The level of employment participation may be on a full or part time basis dependent upon the strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice of the individual.
3. Models of supported employment include individual placements, enclaves, mobile crews, affirmative business, and Transitional Employment Programs (TEP) for individuals with the most severe psychiatric disabilities.
4. ACCES-VR has developed contracts with community rehabilitation programs to provide Supported Employment services. Each contract identifies goals, populations and numbers to be served. Specific contract information is available in each District Office.

Process

Referral

Any individual with a Most Severe Disability may be referred to ACCES-VR for consideration of Supported Employment. ACCES-VR staff should review the referral information and the consumer's interests and capabilities to determine whether inclusion in the Supported Employment contract is appropriate for the consumer or whether any less intensive service would be possible.

In working with consumers, ACCES-VR staff may also make referrals to appropriate Supported Employment Programs. When making a referral to a Supported Employment Program or receiving a referral from a Supported Employment Program, the following information should be provided via the ACCES-VR Referral Supported Employment Program form, VES-415(See Attachment A):

1. Consumer's Social Security Number
2. ACCES-VR ID Number
3. Consumer's Date of Birth
4. Consumer's Name, Address and Telephone Number
5. ACCES-VR District Office
6. ACCES-VR Counselor's Name and Telephone Number
7. Provider's Name and Contract Number
8. Consumer's Disability
9. Functional Limitations
10. Educational/Vocational History
11. Current Vocational Interests
12. Suggested Vocational Goal
13. Health Information
14. Attitudinal/Behavioral/Environmental Factors
15. Assistive Devices/Transportation/ADL Needs
16. Other Concurrent Services or Treatment
17. Reports Attached to Referral Form

Eligibility for Supported Employment Services

Supported employment services may be provided to any individual who is determined eligible for vocational rehabilitation services and who meets the criteria stated below as documented in the case record:

IPE Development

After an individual has been made eligible, any supported employment services that are provided by ACCES-VR must be written under an Individualized Plan for Employment (IPE). Once the consumer is placed at a job site intended to be the permanent placement, additional intensive services may be provided up to a maximum of 18 months. The 18 month maximum is the cumulative total for the life of the current case regardless of the number of job placements. The 18 month time frame may only be extended, via a waiver, if the individual and the counselor jointly agree. (See C.1, Items Requiring Waivers)

The source of extended services funding (OMRDD, OMH, NYSED Extended Service Funding, NYCDMHMRAS - New York City only, community rehabilitation programs, local assistance, natural supports as provided by employers) and the extended services provider should be identified at the time intensive supported employment services are being planned. If a provider cannot be identified at that time, but there is a reasonable expectation that such a provider will become available, then a statement to this effect must be documented in the Case Record: IPE Development of the Original IPE. The Case Record: Development of the Original IPE should also include a description of the intensive vocational services that will be provided to help the consumer achieve and maintain employment; a description of ongoing support services (see extended services definition) that will be needed; and identification of the source of extended service funding.

Items Requiring Waivers

The provider must request a waiver from the counselor and the counselor must document the waiver approval decision in the Case Record if the consumer is expected to experience any of the following circumstances:

1. fewer than 20 hours of employment per week by the time of transition to extended services;
2. off-site intervention;
3. more than 18 months of intensive services.

All service exceptions are based on consumer need not program need. The counselor must notify the provider of the decision. Note: Based on Counselor's Supervisory Plan, supervisory approval for all exceptions may be necessary.

Elements that Must be Addressed on the IPE

Periodic Review and Reporting Specific to the Consumer

ACCES-VR counselors must review provider services related to the individual consumer on a periodic basis and take necessary action to assure progress towards a satisfactory completion of the IPE. The counselor must maintain ongoing contact with the consumer, provider agency staff, and the employer, as appropriate and document reviews in the consumer's case folder. Documentation may include correspondence received from provider agency staff and/or the employer or an entry in the Important Events/Chronological Case History section of the Case Record. Providers are required to furnish ACCES-VR counselors with timely monthly reports during situational assessments, job development, intensive services and at least three months of extended services via VES-416, Supported Employment Consumer Monthly Progress Report. (See Attachment C)

Situational Assessment Reports

During the situational assessment, monthly reports should include:

1. feasibility of the goal through Supported Employment (ability to relate to the expectations of a work environment, including but not limited to ability to learn specific job duties, relationship with co-workers, response to supervision, etc.);
2. recommendations regarding suitable vocational goal (taking into account the individual's strengths, interests, likes, dislikes);
3. identification of ongoing support service needs for individual to maintain employment (type, intensity, frequency)
4. potential to benefit from job coaching intervention;
5. possible training strategies (method, duration); and
6. job and task analyses (if a particular work site is already identified) including possible accommodations.

Job Development and Placement Reports

These reports should summarize job development efforts and their results. If placement has not occurred, the report should list employer contacts made on behalf of the consumer. Once placement has occurred, the ACCES-VR counselor must be provided with a description of the specific job developed for the consumer as well as the name of the employer, location, hours, and wages. An indication of integration opportunities must also be included.

Intensive Training Progress Reports

These reports should address the skills the consumer is learning, additional tasks that must be mastered, training strategies to be utilized, and level of job site support. To assist in determining stabilization, Intensive Training Progress Reports should also indicate the number of job coaching hours provided, hours worked by the consumer and percentage of hours which the job coach was with the consumer, as well as hourly wage earned by consumer.

Extended Services Reports

Extended services reports should be provided for at least the first three months that the consumer has been transitioned to the extended services contract.

Monthly Supported Employment Status Report Specific to Contract

In addition to furnishing monthly reports to ACCES-VR counselors regarding specific consumers, Supported Employment providers must submit Monthly Supported Employment Status Reports to their ACCES-VR District Office. The report lists all new referrals received during the month, all consumers who remain on a waiting list, all consumers who remain active, and all consumers who left intensive services in the previous month. This information enables District Offices to track movement of consumers through the Supported Employment process and to assure that there are open cases and IPE's in place for consumers being serviced by these providers. This report is in addition to the New York State Supported Employment Program Quarterly Narrative and Individual Quarterly Progress Report which are submitted to ACCES-VR Central Office.

Case Status Recording Requirements

A case is entered into Status 18, Training, after the IPE is completed but no later than the beginning of on-site training. Consumers should remain in Status 18 until stabilization has occurred. When it is anticipated that intensive on-site instruction is needed beyond 18 months, a service exception waiver must be requested by the provider. (See II.C.1, Items Requiring Waivers)

Once a consumer has reached stabilization and has been transferred to an extended services support system, the individual's case must be entered into Status 22 - In Employment. The status effective date should be the same as the date of transition to extended services.

The case is moved into Status 26 - Rehabilitated when an individual has successfully maintained employment at the stabilization level (see Definitions, Stabilization) for a period of at least 90 days and for whom long-term supports are in place. The consumer should be in an integrated work setting, earning minimum wage, but not less than the customary wage and level of benefits the employer pays other workers who are not disabled and who perform the same or similar work.

Addressing Service Needs Following Rehabilitated - Status 26 Closure

After the case is closed Rehabilitated - Status 26, services may become necessary in order for the consumer to maintain or obtain new employment. These services may be provided by utilizing the extended services contract, case reopening, or Post Employment Services (PES), Status 32.

1. The extended services contract should be utilized when it is anticipated that the intensive services required for restabilization will not exceed 60 hours and can be provided during a 12 week period. Under these circumstances, no ACCES-VR counselor action is required. However, if it is determined that the provision of these services is not going to be sufficient for re-stabilization, the ACCES-VR counselor in conjunction with the consumer and Supported Employment provider, should determine if case reopening is appropriate.
2. If the service needed for restabilization is a short term discrete service (i.e. hearing aid, assistive device), that is not available through the extended services contract, post employment services should be utilized. (See policy on Post Employment Services) Additionally, if the extended services contractor documents that they are unable to provide intensive services required for restabilizaiton through the extended services contract, the counselor should consider the provision of these services through Post Employment Services.
3. Case reopening may also be considered if the individual is determined by the ACCES-VR counselor, in consultation with the consumer, to be substantially underemployed because of his/her disability and requires ACCES-VR's assistance to achieve appropriate employment. Such individuals must meet eligibility requirements for ACCES-VR services as well as for Supported Employment. Case reopening is inappropriate for those individuals who are functioning well on the job but desire a job change for reasons unrelated to their disability.

Provision of Contracted Services

Generally, payment for Supported Employment services is through a Supported Employment contract. When services are provided through the Supported Employment contract, job coach hours related to screening, assessment, job development, on-site and/or off-site interventions, advocacy, travel and report writing are all reportable under this method.

Coding for Non-Contracted Services

Before authorizing a service off contract, staff should consult the District Office resource for Supported Employment.

Case Service Codes

Case service codes have been established to identify Supported Employment services that are provided off contract. These codes will allow tracking capabilities and other benefits. When providing Supported Employment services off-contract, the appropriate case service code should be identified from the following list and entered on the authorization worksheet:

Case Service Code	Description
182	Situational assessment using a job coach. Maximum of 50 hours at the current hourly rate for job coaching.
562	Intensive training at competitive work site for individuals using a job coach. Maximum of 250 hours or the current case expenditure limit of $3,500 for this service, whichever is less.
642	Transitional Employment Program placements for persons with severe persistent mental illness.

Job development services should be coded as either Situational Assessment (181.X) or Intensive Training (561.X), whichever is appropriate.

Program Codes

Program Code 025 is used for all Supported Employment consumers.

Case Closure Codes

An entry for Supported Employment Outcome is required in Closure Data on the VES-200, Statistical Data Sheet.

Definitions

Competitive Work

Competitive work means work that is performed on a full or part time basis in an integrated setting, with the expectation of a full work week or the minimum expectation of averaging at least twenty hours per week, based on the individual's capacity, and 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 who are not disabled. For those individuals who cannot work 20 hours because of the severity of their disability, Supported Employment may still be a goal. Unpaid work and summer employment do not qualify as supported employment. Seasonal employment may be allowable only if it is typical of the local labor market. (See Seasonal employment)

Integrated Work Setting

An integrated work setting means a setting typically found in the community in which consumers interact with non-disabled individuals, other than non-disabled individuals who are providing services to those applicants or eligible individuals, to the same extent that non disabled individuals in comparable positions interact with other persons.

Program Intake and Assessment

Program intake and assessment includes obtaining information about the individual's unique strengths, resources, priorities, interests, and needs, including the need for Supported Employment. (See policy on Assessment, Section 204)

Supported Employment Models

Models of supported employment include:

Individual Placement Models

Individual Placement models establish employment opportunities for individuals with Most Severe Disabilities in local employment settings on a one-person/one-job basis. Typically, a trained job coach develops the job in business, matches an individual to the job, trains the individual on the job until he or she meets employer criteria and has developed social integration skills. The job coach then provides extended services to the individual and the employer.

Enclave Models

Enclave models consist of a small group (generally five to eight) of individuals with Most Severe Disabilities who work in a community based local industry with training, supervision and ongoing support provided by a job coach from a provider agency/agent. Supported Employment enclaves are distinguished by the continuous, individualized job and integrative social skills training provided to consumers.

Mobile Crew Models

Mobile Crew models are set up as small, single purpose service businesses whose employees move from site to site in the community. A general manager is responsible for small crews and there is one supervisor/job coach per crew. Companies using the Mobile Crew model are often organized as not-for-profit corporations, performing such services as cleaning or landscaping. Mobile crew members should be provided the same opportunities for integration with customers and the general public, to the same extent as nondisabled workers in comparable positions interact with others in performing these work activities.

Affirmative Business Models

Affirmative business models are based in small private subcontractors, retail or manufacturing businesses, which are established to provide employment. An Affirmative Business may be a restaurant or a bakery, for example, providing products or services for public consumption. This model employs a small group of individuals with Most Severe Disabilities as well as individuals who do not have disabilities. This provides integration opportunities with co-workers without disabilities, as well as intensive training and supervision at the work site.

Transitional Employment Programs

Transitional Employment Programs are for individuals with most severe psychiatric disabilities. TEP provides a series of time limited positions in integrated settings as an integral part of the consumer's rehabilitation program. ongoing support services, including sequential job placement, continue until stabilization is achieved. ACCES-VR's focus is to link individuals to TEP services and to maintain their participation in TEP until transition to long term support is achieved.

Participants in TEP Programs are guaranteed access to the TE jobs and typically hold a series of such placements before obtaining the confidence, interpersonal skills, and job references needed to secure and maintain independent employment - a job of choice relevant to one's educational background and job skills. Failure on transitional Employment is considered part of the restoration process and individuals are actively encouraged to try again as soon as they are ready. Support services are ongoing in nature and are maintained even after independent employment is achieved. Maintaining such supports provides the individual with immediate access to the rehabilitation program and other TE assignments, should there be a recurrence of severe psychiatric smyptomatology.

Intensive Supported Employment Services

Intensive Supported Employment services are ongoing support services and other appropriate services provided by ACCES-VR. Initially, Supported Employment services are more intense, based on the consumer's need and gradually fade as the consumer demonstrates his/her ability to independently function in the work environment. These services are based on a determination of the specific needs of an individual to enter and maintain a Supported Employment placement. These services are provided through the term of employment, including multiple placements in a program of Transitional Employment. Intensive services must include minimally 2 monitoring sessions per month at the work site of each individual to assess his/her employment stability. If off-site monitoring is determined appropriate, it must at a minimum consist of two meetings with the individual; and one contact with the employer each month unless the consumer requests that there be no contact with the employer or an alternative contact schedule. This action requires a waiver from the vocational rehabilitation counselor. Examples of intensive services are:

Situational Assessment

A situational assessment is a comprehensive community-based evaluation of the individual's overall functioning in relation to the specific environment of the supported job, including the job site, the community through which the person must travel to and from the job and the people at the job site such as the job coach, coworkers, and supervisor. Situational assessment is primarily used to identify appropriate areas for employment, to develop the strategies necessary for such employment, and to assess support needs, environmental preferences and possible accommodations.

Job Development Activities

Job development activities are based on individual need and include contacts with employers in the geographic area so that a job compatible with an individual's abilities can be selected. During this process, elements for consideration include the degree of integration the individual will have with employees who do not have disabilities; the employer's receptivity to the presence of a job coach at the work site; and the responsiveness of the individual and the individual's family to the employment situation.

1. Job Site Assessment determines the suitability of a proposed placement. Basic information about the prospective job site is assessed; i.e., accessibility, working conditions, specific task requirements, job related skills required, attitude of employers and co-workers toward individuals with disabilities and the job coach, transportation options, wages/benefits/promotional opportunities, and turnover rate.
2. Job Site/Worker Compatibility Analysis is a comparative evaluation of job-site assessment with individual assessment data to determine a match on key factors consistent with an employment objective. An analysis is also used to develop alternative strategies for such factors as job availability, transportation, motivation, physical skills, orientation and mobility, production rate, social skills, communications, work behavior skills, need for reinforcement, family supports, and financial considerations.
3. Job Placement Services provide the final steps in the arrangements for the individual to start at a specific job. Activities performed by an employment and training specialist (job coach) include: arranging the job interview or job site visit; negotiating with the employer regarding the terms of the placement and training program; identifying key performance criteria and training standards; ensuring that the individual reports to work on the start date; arranging any necessary employment related accommodations at the individual's residence; and arranging travel to and from the work site.

On-Site Training/Job Coaching

Job coaches may also provide other direct employment related interventions related to advocacy or case management (i.e. represent consumers interest with the Social Security Administration, landlords, etc. or may coordinate referral to other sources to provide these services.)

Job coaches should first assist, to the extent possible, with the development of a "natural support" system, on and off the work site, that reinforces the consumer's sense of belonging to the work force. The second level of supports a job coach should utilize/assist in developing is the network of disability specific services available to the consumer.

Job coaches need to determine and implement strategies appropriate to the needs of the consumer, from basic on-site work skills development to off-site counseling to assist in relating to coworkers, supervisors, dealing with the issue of stigma. Off-site intervention is often more appropriate with consumers with severe and persistent mental illness.

Natural Support System

This model utilizes community and/or workplace supports such as family, neighbors, co-workers to supplement the employment supports provided by the job coach. Examples of natural supports include: co-worker as trainer, mentor; supervisor providing job duty checklist, prompting and monitoring as necessary; transportation needs through family, co-workers; job site development through family, friends, neighbors; recreation and social integration through co-worker "buddy" at company sponsored activities, and after work activities.

Stabilization

Stabilization occurs when the individual's work performance plateaus and the job coaching and related interventions have faded to the lowest level necessary to maintain the individual in employment. Stabilization generally occurs when intervention level fades to less than 20% of the work week for a period of at least 3 consecutive weeks. However in some cases, interventions at greater than 20% may be required in order to sustain an individual on the job. Such decisions regarding stabilization should be made jointly by the consumer, the employer, supported employment provider, and the ACCES-VR counselor. Documentation of this decision must be included in the case record.

Extended Supported Employment Services

Extended supported employment services are the ongoing support services furnished by the provider to assist the individual in maintaining Supported Employment once the intensive training has satisfactorily lead to stabilization of the individual on the job. Extended service providers are usually funded through the Office of Mental Retardation and Developmental Disabilities (OMRDD), Office of Mental Health, ACCES-VR State Funds, or NYCMRMHAS.

Extended services provide continuation of ongoing support, as needed, including at least twice monthly contact at the work site or as appropriate, off-site contact. Off-site monitoring must include a minimum of two meetings with the consumer; and one employer contact per month unless the consumer requests otherwise. Examples of extended services are:

1. periodic observation of work performance in relation to training standards and employer goals to determine the needs for continuing or different intervention;
2. assurance to the supported employee that help is available if a problem arises; and
3. responses to changes in the employment situation or in the consumer's community living arrangements as they may interfere with continued successful employment; and
4. placement in another employment situation if minimal intervention is required.

Reintervention/Reopening a Case

Reintervention occurs after the individual's case has been transferred to extended services contract and the individual shows a need for increased interventions in order to maintain or regain employment. Changes in job duties or work sites, supervisory requirements, medical problems, or the nature of an individual's disability are factors which may jeopardize the individual's ability to maintain employment and may cause an individual to need additional intensive services. Reintervention can be addressed through the extended service contract, Post-Employment Services or a reopening of the consumer's case. (See II.G. Addressing Service Needs following Rehabilitated - Status 26 Closure)

Reference

Other:

• Supported Employment Questions and Answers issued June 14, 2004

Last Updated: February 8, 2012