2012 Guidelines for Supported Employment

(June 2012)

TABLE OF CONTENTS

• Introduction
• Eligibility for Supported Employment Service
• Required Features for Supported Employment Programs
• Waivers
• Service Expectations
• Referral Process
• Authorization for Supported Employment Services
• Service Delivery and Reporting
• Extended Supported Employment Services
• Continuation of Ongoing Support Service
• Seasonal Employment
• On-the-Job-Training/Work Try Out
• ACCES Funding of Extended Services
• Addenda: Summary of Reporting Requirements
• Reference Material

Introduction

The Office of Adult Career and Continuing Education Services-Vocational Rehabilitation (ACCES-VR), in cooperation with the Office for People with Developmental Disabilities (OPWDD), the Office of Mental Health (OMH) and the Commission for the Blind and Visually Handicapped (CBVH), and with the involvement of service providers, advocacy organizations and consumers, developed the 2008 Guidelines for Supported Employment that established a common base of accepted practice and procedures for supported employment. The 2012 Guidelines for Supported Employment update this information in order to facilitate quality service delivery and cooperation among supported employment service providers and the New York State agencies that serve individuals with disabilities.

Through the authority of Chapter 515, of the Laws of 1992, ACCES-VR has been assigned the responsibility for administering, establishing standards, and monitoring the intensive service component of supported employment programs. ACCES-VR also has responsibility for the provision of extended services to individuals who are not eligible for such service through other sources.

COMMENT: Supported Employment (SE) is competitive work that offers ongoing support services in integrated settings for individuals with the most significant disabilities. It is intended for individuals for whom competitive employment has not traditionally occurred, or has been interrupted or intermittent as a result of a most significant disability, and who need ongoing supports to maintain their employment. The employment outcome is attained by providing intensive supported employment services and is maintained through the provision of extended services. The level of employment participation may be full- or part-time based on the individual’s employment factors (strengths, resources, priorities, concerns, abilities, capabilities, career interests and informed choice).

Eligibility Requirements for Supported Employment Service

Supported employment services are the ongoing support services and other appropriate services that are necessary to obtain and maintain an individual with a most significant disability in employment. Supported employment services may be provided to any individual who is determined by ACCES-VR or CBVH to be eligible for vocational rehabilitation service, and who meets all of the criteria stated below.

1. Has a Most Significant Disability. This means that the individual:
   1. Has one or more physical or mental disabilities that cause substantial functional limitations;
   2. Has a severe physical or mental impairment which seriously limits three or more functional capacities (such as mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of an employment outcome; and,
   3. Whose vocational rehabilitation will require multiple vocational rehabilitation services over an extended period of time; and
   4. For whom, as a result of a most significant disability, competitive employment has not occurred or has been interrupted or intermittent.
2. Has had a comprehensive assessment of rehabilitation needs by ACCES-VR/CBVH which identifies supported employment as the appropriate vocational objective, and:
   1. Meets all the criteria for an individual with a most significant disability and is eligible for vocational rehabilitation services;
   2. Has a need for ongoing support services in order to obtain and maintain competitive work; and
   3. For whom extended service funding is available, or there is a reasonable expectation that such funding will be available.

COMMENT: The comprehensive assessment is an activity of the Vocational Rehabilitation (VR) Counselor by which the vocational rehabilitation needs of the individual are determined. The ACCES-VR/CBVH VR counselor is required to make a determination of eligibility for each individual who applies for vocational rehabilitation services. Before referring an individual for supported employment services, the VR counselor must determine, through a comprehensive assessment, the individual’s employment factors (i.e. unique strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice) as well as the need for supported employment services.

During the comprehensive assessment the VR counselor makes a professional judgment that supported employment is appropriate for the individual. The basis for determining that supported employment is the appropriate service and a description of the need for ongoing supports should be communicated to the provider in writing as part of the referral. The provider should be informed by ACCES-VR/CBVH as to why supported employment was chosen rather than other services.

Information to be used in performing the comprehensive assessment:

• Limited to information that is necessary to identify the rehabilitation needs of the individual in order to develop the individualized plan of employment;
• Uses, as a primary source of information, to the maximum extent possible, in accordance with confidentiality requirements:
  • Existing information obtained for the purpose of determining the individual’s eligibility; and
  • Information that can be provided by the individual and, if appropriate, by the family of the individual.
• The comprehensive assessment may also include, to the degree needed to make such a determination:
  • an assessment of the personality, interests, interpersonal skills, intelligence and related functional capacities, educational achievements, work experience, vocational aptitudes, personal and social adjustments, and employment opportunities of the individual, and the medical, psychiatric, psychological, and other pertinent vocational, educational, cultural, social, recreational, and environmental factors that affect the employment and rehabilitation needs of the individual;
  • An appraisal of the patterns of work behavior of the individual and services needed for the individual to acquire occupational skills and to develop work attitudes, work habits, work tolerance, and social and behavior patterns necessary for successful job performance, including the use of work in real job situations to assess and develop the capacities of the individual to perform adequately in a work environment.

Required Features for Supported Employment Programs

All supported employment programs funded by ACCES-VR/CBVH resources are required to comply with applicable regulations, and to have the following characteristics:

1. Programs must be designed to serve those people with the most significant disabilities who require supported employment services, including ongoing support services, in order to obtain and maintain employment in an integrated work environment.

COMMENT: The resources for supported employment services are reserved for the employment of people having the most significant disabilities who cannot work in the competitive labor market without ongoing support services.

2. The program must include the provision of assistance necessary to maintain the person in employment, (for as long as this assistance is required in order for the individual to maintain employment).

3. Programs must emphasize the integration of persons with the most significant disabilities into the general work force. An integrated setting is one in which the person has the opportunity for regular interaction with people who do not have disabilities (and who are not caregivers) to the same extent that individuals without disabilities in comparable positions would have this opportunity. Natural supports, such as car pooling, and job training provided by co-workers, should be used whenever possible to facilitate integration.

4. Programs should develop and utilize natural supports. Natural supports are supports from supervisors and co-workers, such as mentoring, friendships, socializing at breaks and/or after work, providing feedback on job performance, or learning a new skill. These natural supports are particularly effective because they enhance the communication and social integration between the employee with a disability and his/her co-workers and supervisor. In addition, natural supports may be more permanent, consistent and readily available; thereby facilitating long-term job-retention. Friends and family members may also provide significant supports, such as assistance with transportation and problem solving issues pertaining to work.

5. The supported employment program provides ongoing support services both in the intensive and extended services phase. Ongoing support services, include, but are not limited to:

• necessary additional assessments at the work site;
• the provision of skilled job trainers (job coaches) who accompany the individual for intensive job skill training at the work site;
• job development and training;
• social skills training;
• regular observation or supervision of the individual;
• follow up services including regular contact with the employers, the individual, the parents, family members, guardians, advocates, other authorized persons in order to reinforce and stabilize the job placement;
• facilitation of natural supports at the work site; and
• facilitation of any other services identified in the scope of vocational rehabilitation services at or away from the work site, such as transportation and personal assistance services.

Supported employment services are provided both in the intensive services phase:

• Intensive supported employment services are provided both on and off the job site as frequently as necessary. Once the individual is placed in a job, at least two monthly face-to-face monitoring meetings with the consumer should occur on the job site unless these on-site monitoring meetings are waived by ACCES-VR/CBVH. (Note: If on-site monitoring visits are waived, two face-to-face meetings with the individual each month are still required; however these meetings occur away from the work site). Training should be directly related to the employer’s specific requirements and services should be customized to meet the individual needs of the consumer. Intensive training, at one or more work sites, may be provided for up to 18 months unless the CBVH or ACCES-VR counselor, consumer and provider agree that it is necessary to waive this time frame in order to meet the goal of the IPE.

The intent of supported employment services is to provide ongoing support services necessary to assist the person with:

• learning specific work duties and performance standards;
• learning formal and informal site-related expectations;
• acquiring site-appropriate work-related behaviors;
• understanding and using the benefits of employment (e.g., spending pay, using leave, participating in employee programs, employer benefits, working under direction from the supervisor, and socializing with co-workers); and
• developing a community support system that accommodates and positively reinforces the employee's role as a worker.

COMMENT: To the extent job skills training is provided, the training will be provided on the job site.

• Extended services are those ongoing support services that are needed to support and maintain the individual in supported employment. Extended services are provided after an individual has made the transition from intensive support services funded by ACCES-VR or CBVH to stabilization. Extended services are provided both on and off the job site, as frequently as necessary, to assess and maintain employment stability.
  • At least two monthly face-to-face meetings with the consumer must occur on the job site unless the on-site monitoring is waived by ACCES-VR/CBVH. (Note: If on-site monitoring meetings are waived, two face-to-face meetings, away from the job site are still required).
  • In addition, at least one contact with the employer must take place each month. (Note: The employer contact does not have to be face-to-face). The monthly contact with the employer is required unless the individual does not want the employer contacted. If the individual has not disclosed their disability or involvement in a supported employment program to the employer, then contact with the employer should not occur.

6. Providers must establish a written Extended Support Service Policy, which describes how extended services will be provided and identifies the funding source(s) being used for the provision of such services.

7. Compensation must be in accordance with the Federal Fair Labor Standards Act (FLSA) and the New York State Department of Labor Minimum Wage Order Guidelines for Rehabilitation Programs. Federal regulations require competitive wages for an employment outcome. Individuals in supported employment who are earning below the competitive wage must be working towards a competitive wage.

8. Establishment of an hourly minimum employment goal as cooperatively determined with each person and agreed upon with ACCES-VR/CBVH.

COMMENT: Job placement is expected to be in the type of job and level of integration most appropriate to the individual's employment factors. The consumer should be earning a competitive wage at time of transition from intensive services to extended services, i.e. not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals who do not have a disability. Providers should monitor those individuals making less than minimum wage to ensure the individual is given maximum opportunity to make minimum wage. The placement is expected to be for the maximum number of hours possible based on the individual’s employment factors, (i.e. unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individual).

Waivers

The provider must request and receive a written waiver from the ACCES-VR/CBVH VR counselor under either of the two circumstances described below. Each waiver request must include an appropriate justification.

1. Off-site monitoring visits – If the mandated minimum of two monthly face-to-face meetings is not provided at the worksite, a waiver is required. The two visits are still required. A waiver will enable this requirement to be met by off-site face-to-face meetings. The record must demonstrate the provider's plan to provide the necessary services and supports to assist the individual to maintain employment without the on-site monitoring visits. Justification for the request for an off-site waiver must be based on specific circumstances such as the non-disclosure to the employer or the consumer's explicit request for off-site monitoring visits. (If the individual has not disclosed the disability, then employer contact is prohibited by law.)
2. More than 18 months of Intensive Services – If the consumer will require more than 18 months of intensive training services while in a job placement, a waiver is required. The 18 months timeframe is a cumulative total including all job placements and the timeframe begins only after the initial job placement. Justification for the provision of intensive training services that exceed the 18 months must be based on the consumer's informed choice and the feasibility of achieving the employment outcome.

Service Expectations

The following expectations are established as provider responsibilities:

• Actively involve consumers and their families in assessment, planning, and decision-making throughout the service delivery process. With the consumer's consent, and where appropriate, families will be included in providing reinforcement of the worker's role and in being consulted regarding their observations of the suitability of services.
• Consider both the individual's and employer's satisfaction with the nature and frequency of the provider's services and with the job placement itself.
• Pursue the employment goals detailed in the ACCES-VR/CBVH Individualized Plan for Employment (IPE) by using supported employment resources to the best advantage of the individual, through a consumer-centered decision making process.
• Report in a timely fashion as required to ACCES-VR/CBVH on programmatic and fiscal details.
• Deliver supported employment services in accordance with federal/state standards and any additional contractual obligations.
• Administer programs in ways that promote the continued availability of existing supported employment services, which operate at a reasonable and necessary cost.

The service provider has the primary responsibility to ensure the quality and expertise of direct service staff assigned to deliver such services. Providers are encouraged to send staff to formal supported employment training and/or design an appropriate structured in-house curriculum.

Supervisors should have or seek expertise in supported employment service delivery in order to provide appropriate guidance to staff that require ongoing supervision and support. Arrangements for supervision must take into account the fact that the majority of duties are performed away from the provider's central offices and in isolation from the informal collegial support of other staff.

Referral Process

Referrals for supported employment services must address the reasons why the individual needs the service, based on the ACCES-VR/CBVH VR counselor’s comprehensive assessment that shows the need for supported employment. When the referral originates from ACCES-VR/CBVH this would be addressed in the comprehensive assessment of the consumer's rehabilitation needs.

The determination that a person is eligible for vocational rehabilitation is made by ACCES-VR/CBVH alone. The decision as to which program is most appropriate for that person is made by the ACCES-VR/CBVH VR counselor along with the consumer. The ACCES-VR counselor uses the CaMS Supported Employment Referral Case Form when referring an individual to a Supported Employment program. A supported employment provider or other source may also refer a potential candidate for supported employment to ACCES-VR/CBVH. For all referrals from ACCES-VR/CBVH to a supported employment provider, the information below must be included; for referrals by a provider to ACCES-VR/CBVH, this information should also be included to the extent possible.

• the consumer's name
• the ACCES-VR/CBVH identification number
• date of referral
• the Provider's information including name and contract number
• ACCES-VR/CBVH contact information that includes the District Office along with the ACCES-VR/CBVH VR counselor's name and telephone number
• the consumer's information including address, telephone number, Social Security number and date of birth
• the basis for the referral (i.e. why ongoing supports are required to obtain and maintain employment)
• issues other than disability that may affect an individual’s opportunity for employment
• anticipated extended services provider
• consumer's disability/impairment
• functional limitations
• educational/vocational history
• current vocational interests
• suggested vocational goal
• medical information
• attitudinal/behavioral/environmental factors
• assistive devices/transportation/ADL needs
• other concurrent services or treatment
• list reports attached to the SE Referral form

COMMENT: It is encouraged that the providers use the VR-415 referral form to refer to ACCES-VR/CBVH - a form specific for this action; however, the referral may be submitted using another format. Providers should be aware that the referral is for vocational rehabilitation services with the recommendation of supported employment as the appropriate service.

Upon receipt of an ACCES-VR/CBVH referral to the supported employment program, the provider should review the referral and accompanying documentation and ensure that the referral is appropriate and complete. To do so, the provider will need to:

• confirm that the individual has a most significant disability;
• determine whether the consumer qualifies for extended funding and under which funding source; and
• determine whether there is capacity remaining in their contract to serve that consumer.

If the provider has any questions regarding the referral, the provider should contact the ACCES-VR/CBVH VR counselor. The provider must have a fiscal authorization and the employment goal from ACCES-VR/CBVH before initiating any service. (Refer to Authorization for Supported Employment section below).

COMMENT: The referral documentation must demonstrate that the individual has a most significant disability and meets the eligibility requirements for supported employment services. It should include an explanation of why competitive employment has not occurred, or will not occur; the need for ongoing supports and the basis on which it has been determined that the individual will need ongoing supports to maintain a job. These are essential elements to eligibility for supported employment and service delivery considerations. When a provider receives a referral, the provider must first determine that they have the necessary information for an individual’s entrance into supported employment services. It should also be noted that the provider retains the decision for acceptance of an individual into their program.

Authorization for Supported Employment Services

In order to initiate supported employment services the provider must have received:

(1) the ACCES-VR/CBVH financial authorization that includes the number of hours that are approved and the time period in which they may be provided; and

(2) the IPE with the employment goal or the CaMS Supported Employment Letter to Provider.

The provider record must contain documentation from ACCES-VR/CBVH for both of these requirements before providing services to the individual.

Service Delivery and Reporting

Assessment

• The ACCES-VR/CBVH VR counselor, through a comprehensive needs assessment, makes the initial determination that an individual is appropriate for supported employment. Once this has been done, the individual is referred to a supported employment program. Any further observational assessments that may be necessary are considered part of supported employment services and must be community-based (situational) rather than facility-based (simulated).
• In a community-based situational assessment, the person's skills in relation to specific job duties and work behaviors are assessed in conjunction with the person's ability to function in the community. The assessment should take into account the individual's employment factors, i.e., strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice. Situational assessments should consider the following:
  • feasibility of the employment goal through supported employment;
  • ability to relate to the expectations of a work environment;
  • ability to learn specific job duties;
  • relationship with co-workers;
  • response to supervision;
  • suitability of the vocational goal;
  • identification of ongoing support services (type, intensity, frequency) needed for the individual to maintain employment, including assistive technology;
  • potential to benefit from job coaching ongoing support services;
  • possible training strategies (method, duration); and,
  • job and task analysis including possible accommodations.

The Intensive Service Plan

• Once sufficient information has been obtained, the provider should prepare a written individual Intensive Service Plan (ISP), which summarizes the relevant information, outlines the consumer's goals, and describes what intensive services will be provided to accomplish the goals. The defined goals and services provided must be consistent with the VR referral information and the service plan must be consistent with the ACCES-VR/CBVH documented goal. Any changes to that goal must be discussed with and approved by the ACCES-VR/CBVH VR counselor and the record must document approval of the change in goal.
• The ISP should provide the framework for how the job coach or other staff will assist this individual in achieving his/her employment goals. The employment goal must always be provided in an integrated setting. Individual placement in the community is preferred. ACCES-VR/CBVH considers individual placement in competitive employment with ongoing supports as the primary goal for supported employment. Individual placement focuses on locating community jobs for specific individuals. Other supported employment models such as enclaves, mobile work crews, and affirmative business models offer a wide range of experiences, and must be evaluated based on each individual’s needs and employment experience. When an individual is not working in an individual job placement, the ISP needs to provide justification for placement in an enclave, mobile work crew or affirmative business model. Regardless of which supported employment model is used, the work setting must meet the definition of an integrated setting.
• A copy of the Intensive Service Plan is sent to ACCES-VR/CBVH.

Job Development / Placement

Job Development activities are based on a comprehensive, person-centered assessment of the individual’s strengths, capabilities, needs, skills and experiences prior to initiating the job search. It considers individual preferences and goals, transportation, desire to work including the number of hours and expected wages, physical skills, orientation and mobility, appearance, communication and social skills, work behavior skills, reinforcement needs, family supports, required natural supports, needed accommodations, financial considerations and other factors.

This allows the job developer and the job seeker to contact employers with a clearer focus of potential job options. Contacts are made with employers within the geographic region, including businesses known to the person and their support network, previous employers, and networking committees. It requires building partnerships with businesses that have potential employment opportunities for the targeted job candidate. Initial contacts, follow up and on-going relationship development with businesses relevant to the specific job candidates’ goals within a reasonable time period are necessary activities.

Worker and Job Site Compatibility Analysis is a comparative analysis of the person’s capabilities with the job possibilities of a potential employer or business. The analysis may also serve to develop alternative strategies that might facilitate matches on important factors, including job creation and job carving where the job developer and job seeker work with an employer to restructure or create a job uniquely suited for both the needs of the employer and the skills of the job seeker. This requires determining if the employer has certain unmet work needs or demands that could be performed by the job seeker, creating efficiencies and value for the employer.

Job placement refers to completing arrangements to start a worker at a particular job, including:

• arrangement of a job interview or job site visit;
• negotiation with the employer regarding the terms of the placement and training program;
• identification of key performance criteria and training standards;
• arrangement of necessary travel, benefits, and accommodations to enable the trainee to report to work on the start date.

The record should document the potential for job advancement, and integration opportunities available. All job development efforts and worksite information is to be reported on the VR-416 report form.

Intensive Training and Reports

• Each consumer is to receive services in a continuous process leading to obtaining and maintaining community placement. Multiple services are provided during intensive training that may include:
  • job orientation and assessment;
  • transportation or travel training;
  • job skill training at the work site;
  • development and maintenance of production levels as expected by employer;
  • advocacy with co-workers and/or employer to promote acceptance of the worker and his/her integration with the work force;
  • advocacy with consumer's residence, treatment services, and benefits programs to promote support in relation to the employment;
  • provision of reasonable accommodations; and
  • periodic reassessment and alteration of strategies, as appropriate.
• This process must be reported in both the New York Employment Services System (NYESS), and on the Intensive Training Progress Report Form (VR-416). The VR-416 must indicate what services were delivered in the areas of assessment, job development/placement, intensive training, stabilization, and retention of employment. The VR-416 report form must be submitted monthly until at least 90 days of satisfactory employment following stabilization has been reported, or until it is reported that the individual has exited the supported employment program.
• The VR-416 form should include, as appropriate:
  • A summary of progress as it relates to the supported employment Intensive Service Plan and/or notes about any significant changes to the plan.
  • A list of job site contacts and results or list the employer contacts and result of contacts;
  • Information regarding the job, including average hours worked per week and hourly wage earned.
  • A job description/task analysis at placement.
  • A summary of the individual's performance and progress and continuing support needs.
  • The basis for determining that the placement is satisfactory, including that the job placement is compatible with the approved IPE goal, is consistent with the individual's employment factors taking into account the individual’s functional limitations, and that both the individual and the employer are satisfied with the placement and with the level of support provided.

COMMENT: It is important that this information is current especially at the time of reporting transition to extended service and 90-day post stabilization retention of employment.

• The report must state what direct services were provided and the number of hours of service provision. The specific services should be described in the context of the barriers or issues being addressed, and outcome when known. A VR-416 report that states “no service provided” is not a billable 416 activity.
• The narrative report should also address the need for additional assistance from ACCES-VR/CBVH (e.g., adaptive equipment, training, or services from sources other than the primary service provider).
• The report must indicate when stabilization has been achieved, as soon as it occurs, and the basis for this recommendation, as documented in the case record.

COMMENT: Providers should be aware that payment may only be made for direct services which have been provided. While report writing and travel to deliver service are allowed, it is important that they also be identified on the narrative as a service provided.

Direct services are defined in the RFP for Supported Employment as the following:

• Assessing the individual’s ability to participate in supported employment;
• Advocating for the individual prior to employment;
• Developing jobs and placing the individual with an employer (a key indicator);
• Identifying necessary on-site supports to maintain employment through the individual's involvement in situational assessment and employment;
• Staff travel to provide services at a variety of community-based employment locations;
• Assessing the individual's involvement in volunteer or unpaid work to help determine his/her skills;
• Hours of on-site ongoing support services with an individual with a disability, employer and employees, to ensure both the ability to function at work tasks and to interact successfully in the workplace;
• Hours of off-site ongoing support services needed for the individual to remain employed, including supports or service linkages needed to address other life areas that may be affecting successful job retention.

The individual should be transitioned from intensive vocational services to extended services when stabilization on the job has been achieved.

• Stabilization occurs when the individual's work performance reaches a performance level acceptable to the employer, and the job coaching and related ongoing support services have diminished to the level necessary to maintain the individual in employment. At this point stabilization is agreed upon by the VR counselor, the supported employment provider/job coach, the employer and the consumer. When stabilization occurs, the worker is ready to transition from ACCES-VR/CBVH funded intensive supported employment services to the appropriate source of ongoing support services known as extended services. The determination that stability has been achieved must be clearly explained in the case documentation.

COMMENT:
Factors to be considered and addressed for stabilization:

• the individual’s knowledge of the essential tasks of the job;
• the individual’s attendance and punctuality within acceptable standards;
• the individual’s social adjustment in the work place; and
• any other factors as identified during assessment and/or noted in the Intensive Service Plan.

All parties must agree that ongoing supports will be provided in order for the individual to maintain the job.

Employer satisfaction with the employee's job performance as well as consumer's satisfaction with the job and the ongoing support services should be assessed through a structured format as part of the process of determining that the job is secure and stability has been achieved.

Case documentation must show the consideration of each of these factors and the agreement by all parties.

The consumer is regarded as in training until stability is achieved. Employment begins with the transition to extended service. It is from this point that the count towards 90 days in employment begins.

Monthly Supported Employment Status Report

Supported employment providers must also submit Monthly Supported Employment Status Reports to the ACCES-VR District Office. These reports should list new referrals received during the month, consumers on a waiting list, active consumers, and consumers who left intensive service in the previous month, stabilization and transition date, provider and funding source for extended service, and date of achievement of satisfactory employment for 90 days following transition, as applicable.

Provider Documented Responsibilities

Providers must maintain internal documentation which should include:

• copies of all reports (summarized in the Addenda chart at end of Guidelines) within the case records as well as pertinent information including:
  • documentation of mandated ongoing support services, what was being done, where, why, with what outcome;
  • how long each service took;
  • any required travel and report writing that will be billed; and
  • current wage and hour information.
• copies of ACCES-VR/CBVH correspondence (including electronic correspondence), and documentation of ACCES-VR/CBVH contacts, as appropriate.
• documentation of major changes in consumers' status (changing jobs, leaving or reentering program, treatment, etc.).

Extended Supported Employment Services

For all individuals receiving supported employment services, there is an expectation that the individual will need ongoing support services to maintain employment, with funding through extended services. The intensity, frequency, and duration of ongoing support services should be continually adjusted to meet the individual's needs.

Definition of Extended Supported Employment Services

Extended services are the ongoing support services furnished by the provider that are needed to support and maintain the individual in supported employment. Extended services are provided after an individual has made the transition from intensive support services funded by the VR Program (ACCES-VR/CBVH) to stabilization. Extended services assist the individual to maintain, or in some cases, regain employment. This often consists of regular monitoring of the consumer and contact with the employer regarding the consumer's job performance in order to determine the individual’s ability to retain the job. It is the expectation that needed ongoing support services to resolve difficulties and maintain employment - or in some instances to regain employment - will be provided as a part of the extended services. No time limits are permitted for extended services.

Extended Services Plan

Each individual receiving extended supported employment services, regardless of the extended funding source, must be provided with an individual Extended Services Plan. It is developed at the time the individual transitions to extended services. It is to be signed and dated by the program representative and by the individual being served. A copy is to be sent to ACCES-VR/CBVH.

The Extended Services Plan should include the following basic information:

• name of individual who will be receiving services;
• type of job placement (individual placement, work crew, enclave);
• employer;
• job title;
• wages and hours;
• date of transition to extended service;
• service needs of the individual both on/off the job site;
• a description of what services are planned, who will be providing them, how they are funded, whom to contact if problems arise, and how to make direct contact to obtain help with those problems.

The record should document that the individual received a copy of the plan. Both the employer and the employee should be assured that ongoing support services are available as needed to maintain employment.

COMMENT: Funding for extended services is most often provided through the resources of other state agencies or, as appropriate, through the ACCES-VR Extended Services Fund. Providers must work directly with the source of extended service funding to obtain such resources. Any provider having an intensive supported employment contract must also be an extended service provider or have made provisions with another agency as described in the RFP and/or contract to provide extended services to their consumers.

The ACCES-VR extended services fund is intended to provide for ongoing support services only for individuals who meet the criteria to be eligible for supported employment but who are not eligible for extended service from any other existing extended service funding source.

Following transition to extended services funding the extended services will continue to include:

• regular observations of work performance in relation to employment expectations. A minimum of two face-to-face meetings each month at the work site is mandatory. If on-site meetings are waived, a minimum of two face-to-face meetings each month with the consumer is still mandatory.
• on going assessment of employee's job satisfaction and whether there is a need for ongoing support services.
• minimum of one contact each month with the employer to monitor the consumer's job performance. If the consumer has not disclosed the disability to the employer, then employer contact would be prohibited.
• interactions with the employer, family members, residence staff, and coworkers as appropriate to determine need for continuing or choosing a different support service.
• ongoing support services through the provider’s monitoring visits as needed on or off the job site to reinforce job-related skills.
• placement in another employment situation, If requested by the consumer and is appropriate.

Continuation of Ongoing Support Services under Extended Services

The purpose of extended services is to provide those ongoing support services that are necessary to maintain the individual in the job, to restore stability as necessary, and to place the individual in a new job when a job is lost or when appropriate to career development. Ongoing meetings with the individual and monthly contact with the employer are required for routine support, to monitor the individual’s work performance and adjustment, and to determine at the earliest time when destabilization appears to be occurring.

When job stability has been lost, services that are necessary to restore stability in the current job should be provided under extended services. This might include placement and stabilization in a new job. A return to intensive services through ACCES-VR/CBVH should not be requested unless there is expectation that substantial intensive vocational rehabilitation services will be required to restore stability in the current job placement or the individual requires a new employment goal. The provider case record should document the basis for either of these situations. If either of these situations occurs, services should continue to be provided under extended services and ACCES-VR/CBVH should be contacted immediately.

If the consumer is referred back to ACCES-VR/CBVH the VR counselor will need to determine whether the individual is eligible for vocational rehabilitation services and whether supported employment services are still needed.

If the services needed to reestablish stabilization is a short term discrete service (i.e. hearing aid, assistive device), that is not available through the extended services contract, post employment services (PES) may be utilized.

Supported employment providers should place individuals in employment situations suitable to the individual’s employment factors and that offer upward mobility or a career ladder, or provide services or other resources to individuals that will enable them to achieve full opportunity for personal growth and advancement in employment. Case reopening by ACCES-VR/CBVH may be considered if the individual is determined by the ACCES-VR/CBVH VR counselor, in consultation with the consumer and provider, to be substantially underemployed because of his/her disability, and will require ACCES-VR/CBVH assistance to achieve an appropriate employment outcome. Such individuals must meet eligibility requirements for ACCES-VR/CBVH and a new employment goal would be established.

Case reopening may not be appropriate for those individuals who are functioning well on the job but desire a job change for reasons unrelated to their disability. Consideration should be given as to whether this is appropriate career development and if significant barriers due to the most significant disability are preventing such changes.

Seasonal Employment

Seasonal employment may be considered as a supported employment outcome if it is based on the informed choice of the consumer as to employment alternatives, the reasonable expectation that the individual will be offered a similar position during the next employment season, and the expectation that the individual will work long enough (90 days minimum after transition) to be considered rehabilitated during the work season. These considerations must be clearly documented and the seasonal nature of the employment goal must have approval from ACCES-VR/CBVH. The supported employment provider will use extended service for the readjustment period in subsequent seasons.

If the consumer is placed into another job during the off-season, then extended funding may be used to maintain them in that job. Otherwise, if supported employment services are not being provided to maintain the individual in a job, then the consumer must be removed from extended funding until he/she resumes the seasonal job.

On-the-Job-Training/Work Try Out

On-the-Job training (OJT) or Work Try-Out (WTO) may be combined with supported employment when it is deemed by the ACCES-VR/CBVH VR counselor to be necessary for the individual to achieve the employment outcome. When an OJT or WTO is authorized in conjunction with supported employment, it must be clearly documented by the provider that it is necessary to meet the rehabilitation needs of the individual and is not a duplication of services. Approval by the ACCES-VR/CBVH management is required and must meet the requirements of ACCES-VR/CBVH policies and procedures.

ACCES Funding of Extended Services

Ongoing support services funded through the ACCES-VR extended services contract must meet the minimum requirement for twice monthly monitoring at the worksite. This requirement can be met through the use of ACCES-VR extended services or through the facilitation of natural supports at the worksite. If an individual has sufficient natural supports to maintain employment, then intermittent funding of the ongoing support services may occur.

This permits the ACCES-VR extended services to be gradually phased out if adequate natural supports exist to maintain the individual on the job. Intermittent funding may be considered if:

• the individual no longer requires the funded ongoing support services;
• paid support needs decrease; or
• natural supports are observed to meet some or all of the individuals ongoing support needs.

It is only appropriate when:

• natural supports are identified on the Extended Services Plan at stabilization or after rehabilitation;
• supports required to maintain employment are documented;
• the individual, family, service provider, employer, provider agency and ACCES-VR are in agreement.

The appropriate frequency is determined based on the individual’s need. As appropriate, the individual may be considered for funded ongoing support services which may occur every other month or less.

The individual may return to twice monthly monitoring visits under the ACCES-VR extended services contract or remain on an intermittent schedule where the ongoing support services are provided by the employer or other resource. In some situations, an individual may graduate from extended services using natural supports to maintain employment. Intermittent funding of extended services and “graduation” (where paid extended services end and the individual is maintained with natural supports only) are initiated by the provider agency and must be documented in the Extended Services Plan and approved by the ACCES-VR district office.

Addenda: Summary of Reporting Requirements

Documentation	Purpose
Referral	Explains why the individual with a most significant disability needs supported employment. Should be in both provider and ACCES-VR/CBVH record. These are the findings of the comprehensive assessment.
Significance of Disability	Statement of determination of most significant disability by ACCES-VR/CBVH. Should be in both provider and ACCES-VR/CBVH record. May be in referral document.
Authorization for Supported Employment	Authorizes entry into contract with identification of employment goal on IPE - could be a letter such as the CaMS generated Supported Employment Letter to Provider - or a copy of the fully signed and date IPE - AND fiscal authorization to utilize contract funds. Note: A referral is NOT an authorization and takes place prior to the IPE which designates the employment goal.
Intensive Service	Developed by provider and consumer, a copy is sent to ACCES-VR/CBVH. Identifies pertinent issues and the IPE employment goal.
Extended services plan	Must be developed by provider with consumer at time of transition to extended service. It is to be signed and dated by provider and consumer, and record must document that the consumer has received a copy. Copy must also be sent to ACCES-VR/CBVH. Job title, type of placement (individual or group), date of transition, hours and wages, service needs, services planned, who will provide them, funding source, whom to contact if problems arise, and how to make direct contact to obtain help with those problems should be clearly noted.
Provider Case Notes	Providers must maintain full and complete records. All services billed must contain documentation indicating what service was provided, for what purpose, where it was provided (e.g. at the work site), whether it was face-to-face or otherwise, and the duration of the particular service. If billing is to be done for travel or case recording, then the time required for this should be included in the service note.
VR-416	Must be submitted by provider to ACCES-VR/CBVH every month until it is reported that the individual has maintained satisfactory employment for 90 days following transition to extended service, or it is reported the individual has exited Supported Employment. Submission of the VR-416 is required even if no billing is done for that month. Services provided: Work site information Consumer progress Issues that need to be addressed Consumer and employer satisfaction Basis for determining that stabilization has occurred Transition to extended funding Whether the employment continues to be satisfactory following transition until 90 days after transition, or any factors that destabilize Services provided should include both category of service and what was done.
Monthly Supported Employment Status Report	Provider reports to ACCES-VR district office manager for individuals who have entered, consumers on a waiting list, are currently in, or exited the program during the month. Additional information may be reported as requested by a district office.
Waivers	Written waiver from ACCES-VR/CBVH must be in provider record if any of the waiver conditions occur.

Reference Material

Information on supported employment including contracts, forms, notices, and the Rehabilitation Act are available on ACCES-VR's Supported Employment website at: http://www.acces.nysed.gov/vr/supportedemployment/home.html