Guidelines for Supported Employment for the 10/1/09-9/30/10 Contract Period

(January 2010)

• Guidelines for Supported Employment: Word (, 295KB, 22pgs)
• Guidelines for Supported Employment: PDF (, 101KB, 22pgs)

TABLE OF CONTENTS

• Introduction
• Eligibility for Supported Employment Service
• Required Features for Supported Employment Programs
• Waivers
• Service Expectations
• Referral Process
• Service Authorization
• Service Delivery and Reporting
• Extended Supported Employment Services
• Continuity of Interventions
• Seasonal Employment
• On-the-Job-Training (OJT)
• Addenda: Summary of Reporting Requirements
• Reference Material

Introduction

The Office of Vocational and Educational Services for Individuals with Disabilities (VESID), in cooperation with the Office of Mental Retardation and Developmental Disabilities, the Office of Mental Health and the Commission for the Blind and Visually Handicapped (CBVH), and with the involvement of service providers, advocacy organizations and consumers, has developed Guidelines for Supported Employment to establish a common base of accepted practice and procedures for supported employment. These guidelines facilitate quality service delivery and cooperation among supported employment service providers and the New York State agencies that serve individuals with disabilities.

COMMENT: Supported Employment is paid 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 service and is maintained through the provision of extended service. The level of employment participation may be full- or part-time based on the interests and abilities of the individual.

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

Eligibility for Supported Employment Service

Supported Employment service may be provided to any individual who is determined by VESID 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 physical or mental impairment which seriously limits three or more functional capacities in terms of an employment outcome; and,
   3. Whose vocational rehabilitation will require multiple vocational rehabilitation services over an extended period of time.
2. For whom, as a result of a most significant disability, competitive employment has not occurred or has been interrupted or intermittent.
3. Has had a comprehensive assessment of rehabilitation needs by VESID/CBVH which identifies Supported Employment as the appropriate vocational objective, and:
   1. Has the ability to engage in a vocational program leading to supported employment;
   2. Has a need for ongoing support services in order to perform and sustain competitive work;
   3. Has the ability to work in a supported employment setting;
   4. For whom extended service funding is available, and
4. For whom VESID/CBVH has authorized entry into the Supported Employment contract and identified the employment goal as
   1. Documented by an Individualized Plan for Employment (IPE) signed by both the consumer and Vocational Rehabilitation Counselor (VRC) or a “CAMS Supported Employment Letter to Provider” identifying the employment goal or any other signed document containing the goal; and
   2. Fiscal authorization which allows billing for direct Supported Employment services.

COMMENT: Comprehensive assessment is an activity of the Vocational Rehabilitation Counselor by which the vocational rehabilitation needs of the individual are determined. For each individual who applies for Vocational Rehabilitation services, the VESID/CBVH VRC is required to make a determination of eligibility. In order to approve Supported Employment services the VRC must also make a comprehensive assessment of the unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and needs, including the need for supported employment services.

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 as part of the referral. The provider should be informed by VESID/CBVH as to why Supported Employment was chosen rather than other services. (What are the consumer's issues that justify this choice?) This is where the barriers and service needs are discussed. In both of these areas, the VRC gives the service provider the basis for their initial service plan. Based on the "comprehensive assessment" the VRC makes a professional judgment that Supported Employment is appropriate for the individual; the VRC tells the provider the findings that form the basis for this judgment.

Information to be used in performing the comprehensive assessment:

• Limited to information that is necessary to identify the rehabilitation needs of the individual and to develop the individualized plan of employment; and
• Uses, as a primary source of information, to the maximum extent possible and appropriate, in accordance with confidentiality requirements:
  • Existing information obtained for the purposes of determining the eligibility of the individual and assigning priority for an order of selection described in Sec. 361.36 for the individual; 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 VESID/CBVH resources are required to comply with applicable regulations, and to have the following characteristics:

1. Programs must be explicitly designed to serve those people with the most significant disabilities who:
   1. may require intervention and/or advocacy on their behalf with employers, co-workers, and/or families to ease their integration into the workforce, and
   2. will require ongoing support service to maintain their employment
      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.
2. The program must include the provision of assistance necessary to maintain the person in employment, with no end date or time limit placed on this assistance.
3. Integration of persons with most significant disabilities into the general work force must be emphasized. An integrated setting is one in which the person has the opportunity for regular interaction with people not having 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 offering supported employment must provide both intensive and extended service including, but not limited to: community-based assessment, job development and placement, job site training, advocacy, and ongoing and related necessary supports. Services to employers must also be made available as needed, either directly by the program or by the program arranging for such services through other agencies, including VESID or the Commission for the Blind and Visually Handicapped (CBVH).
   1. Intensive 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 meetings with the consumer should occur on the job site unless on-site interventions are waived by VESID/CBVH. (Note: If on-site interventions are waived, two face-to-face meetings with the individual each month are still required). 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 VESID counselor, consumer, and provider agree that it is necessary to waive this in order to meet the goal of the IPE.
      The intent of supported employment intensive intervention is to provide all the services necessary to assist the person with:
      1. learning specific work duties and performance standards;
      2. learning formal and informal site-related expectations;
      3. acquiring site-appropriate work-related behaviors;
      4. acquiring the sense of belonging to the workforce;
      5. 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,
      6. 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 site.
   2. Extended services are provided both on and off the job site, as frequently as necessary, to assess and maintain employment stability.
      1. At least two monthly face-to-face meetings with the consumer must occur on the job site unless on-site interventions are waived by VESID/CBVH. (Note: If on-site interventions are waived, two face-to-face meetings with the individual each month are still required).
      2. 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.
5. Providers must establish a written Extended Support Service Policy, which describes how extended services will be provided and the funding source(s) being used for the provision of such services. The policy must include:
   1. The title and name of the current person who is responsible for coordinating and directing long-term services;
   2. A description of the frequency and method by which periodic assessments will be done to identify the changing intervention needs of individuals receiving extended service;
   3. Contingency action steps for handling crises such as placement termination or failure, the employer going out of business, or the community agency discontinuing operation; and,
   4. A provision that each supported employee be provided with an Individual Extended Service Plan, describing what services are planned, who will be providing them, whom to contact if problems arise, and how to make direct contact to obtain help with those problems.
6. 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.
7. Establishment of an hourly minimum employment goal as cooperatively determined with each person and agreed upon with VESID/CBVH.

COMMENT: Placement is expected to be in the type of work and level of integration most appropriate to the individual's abilities and interests. The consumer should be earning competitive wage at the time of transition from intensive service to extended service - 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. Such competitive wage earnings, however, will not be a requirement for VESID to rehabilitate the individual into supported employment as long as the extended service plan continues to address competitive wage as a goal. The placement is expected to be for the maximum number of hours possible based on the unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individual. If the individual is not averaging at least 20 hours per week the providers should request a waiver from VESID stating the justification for fewer hours. This justification may be based only on the consumer's needs and issues. A waiver can be issued provided that their service outcome needs are documented within the IPE.

Waivers

The provider must request and receive a written waiver from the VESID/CBVH counselor under any of the three circumstances described below. Each waiver request must include an appropriate justification.

1. Under 20 hours per week - If the consumer is otherwise ready to transition to extended service but is working fewer than 20 hours per week on average per pay period, a waiver is required before transitioning may take place. Justification for this waiver may only be based on limitations that result from the disability or the consumer's informed choice.
2. Off site interventions - If the mandated minimum of twice-monthly face-to-face interventions are not provided at the worksite, a waiver is required. The interventions 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 interventions. 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 interventions. (There is no waiver for monthly employer contact. If the individual has not disclosed the disability, then employer contact is prohibited by law. If the consumer does not want the employer contacted, the case record should clearly reflect this choice).
3. 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. This is a cumulative total including all job placements. Time spent while not in a job placement is not counted toward the 18 months. Justification must be based on the consumer's informed choice and the feasibility of achieving the employment outcome.

Service Expectations

Through the framework established by federal law and regulations, and Chapter 515 of the Laws of 1992 in New York State, the following expectations are established as provider responsibilities:

1. 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.
2. 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.
3. Pursue the goals detailed in the VESID/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.
4. Report in a timely fashion as required to VESID/CBVH on programmatic and fiscal details.
5. Deliver supported employment services in accordance with federal/state standards and any additional contractual obligations.
6. Administer programs in ways that promote the continued availability of existing supported employment services, which operate at a reasonable and necessary cost.

The consumer's employment goal must be documented by VESID/CBVH and sent to the provider before Supported Employment services begin. Any changes to that goal require that VESID/CBVH approval be documented.

In order for a program to be reimbursed for Supported Employment services provided to a consumer of VESID/CBVH, the following must be in place prior to service delivery:

1. An active VESID/CBVH case in status 18 by the time service begins.
2. Written documentation from VESID/CBVH authorizing entry into the Supported Employment contract and identifying the IPE employment goal. Either an IPE signed by both the VESID/CBVH counselor and the consumer or, for VESID consumers, the “CAMS Supported Employment Letter to Provider” can be used, or other signed documentation as deemed appropriate by VESID/CBVH.

COMMENT: An IPE without signatures of both the Vocational Rehabilitation Counselor and the consumer is not a valid document.

The intervention strategies will vary with the needs of the individual, the impediments to obtaining and maintaining employment, and the expectations of the employer. They should focus on issues related to fitting into the workforce and maintaining a job.

In addition to job-site interventions, related services away from the job site may include assisting the trainee and his or her family to make any related changes in lifestyle or expectations needed to support the trainee's continued employment. This may include advocacy and benefits advisement. Job coaches should use any available community resource in meeting consumer needs as a means of assisting the individual in maintaining employment.

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 institutional 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. When the referral originates from VESID/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 VESID/CBVH alone. The decision as to which program is most appropriate for that person is made by the VESID/CBVH counselor along with the consumer.

The VESID counselor uses the CaMS referral 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 VESID/CBVH. For all referrals from VESID/CBVH to a Supported Employment provider, the following information must be included; for referrals by a provider to VESID/CBVH, this information should also be included to the extent possible.

• VESID/CBVH ID Number
• Consumer's Date of Birth
• Consumer's Name, Address, and Telephone Number
• VESID/CBVH District Office
• VESID/CBVH Counselor's Name and Telephone Number if known
• Provider's Name and Contract Number
• Consumer's Disability(ies)
• Significance of Disability Status (determined by the VESID/CBVH VRC)
• Functional Limitations that are Significant to Employment
• Educational/Vocational History that Demonstrates the Need for Supported Employment
• Current Vocational Interests
• Suggested Vocational Goal
• Health Information
• Attitudinal / Behavioral / Environmental Factors
• Assistive Devices / Transportation / ADL Needs
• Medical, Psychological, and other Pertinent Documentation
• Other Concurrent Services or Treatment

COMMENT: It is highly recommended that referrals to VESID/CBVH use the VES-415 referral form - a form specific for this action; but, 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 goal and service.

Upon receipt of a referral to the Supported Employment program, the provider should review the referral and accompanying documentation and ensure that the referral is correct, complete and appropriate. To do so, the provider will, at a minimum, need to:

• confirm that the individual has a disability they are contracted to serve and lives within a county they are contracted to serve for that 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 any of these conditions are not satisfied, the VESID/CBVH counselor must be contacted before proceeding. If all of these conditions are satisfied and the provider agrees to accept the referral, they must notify VESID/CBVH.

Receipt of a Supported Employment referral from VESID/CBVH does not constitute authorization to meet with the consumer nor to provide Supported Employment services, (including assessments). If the provider meets with or conducts an assessment of the individual before the services are authorized, there will be no payment. Only after VESID/CBVH has been notified that the provider has accepted the individual, can a Service Authorization be issued.

COMMENT: The referral documentation must demonstrate that the individual meets the eligibility requirements for Supported Employment. A referral to Supported Employment must explain the employment impairments and the basis on which it has been determined that the individual will not be able to maintain a job without ongoing supports. These are essential elements to eligibility for Supported Employment and service delivery considerations. When a provider receives a referral, it must first determine that the necessary information is provided. It should also be noted that the provider may decide not to accept any individual into their program.

Service Authorization

In order to authorize Supported Employment service, VESID/CBVH must inform the provider in writing that supported employment services have been approved and identify, by letter or by copy of the signed IPE, the IPE goal for which services are to be provided. In addition, there must be a financial authorization which tells the provider the number of hours that are approved and the time period in which they may be provided. The provider record must contain documentation from VESID/CBVH for both of these requirements.

Service Delivery and Reporting

Assessment

1. The VESID/CBVH counselor makes the initial determination that an individual is appropriate for Supported Employment. Once this has been done the individual is placed into the 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).
2. 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 strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice, support needs, environmental preferences, and possible accommodations. Situational assessments should consider the following:
   1. feasibility of the goal through Supported Employment;
   2. ability to relate to the expectations of a work environment;
   3. ability to learn specific job duties;
   4. relationship with co-workers;
   5. response to supervision;
   6. suitability of the vocational goal;
   7. identification of ongoing support services (type, intensity, frequency) needed for the individual to maintain employment, including assistive technology;
   8. potential to benefit from job coaching intervention;
   9. possible training strategies (method, duration); and,
   10. job and task analysis including possible accommodations.

Intensive Service Plan

1. Once sufficient information has been obtained, the provider should prepare a written Individual Intensive Service Plan, which summarizes the relevant information, outlines the consumer's goals, and describes what intensive services will be provided to accomplish the goals. This service plan must be consistent with the VESID/CBVH documented goal. Any needed changes to that goal must be discussed with and approved by VESID/CBVH and the record must document approval of any change in goal.
2. The service plan should provide the framework for how the job coach or other staff will assist this individual in achieving his/her employment goals. If the job goal is for other than an individual, integrated placement in the community, the plan needs to provide justification for placement in such a less-integrated setting.

Job Development / Placement

1. Job Site and Worker Compatibility Analysis is a comparative evaluation of job analysis and individual assessment data to determine matches on key factors, such as transportation, motivation, physical skills, orientation and mobility, appearance, communication, social skills, work behavior skills, reinforcement needs, family supports, financial considerations, individual preferences and goals, etc. It may also serve to develop alternative strategies that might facilitate matches on important factors. All job development efforts are to be reported on the VES-416 report form.
2. Job placement refers to completing arrangements to start a worker at a particular job, including:
   1. Arrangement of a job interview or job site visit;
   2. Negotiation with the employer regarding the terms of the placement and training program;
   3. Identification of key performance criteria and training standards;
   4. Arrangement of necessary travel, benefits, and accommodations to enable the trainee to report to work on the start date; and
   5. The record should document the potential for job advancement, and integration opportunities available. The worksite information is to be reported on the VES-416 report form.

Intensive Training and Reports

1. 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:
   1. Job orientation and assessment;
   2. Transportation or travel training;
   3. Job skill training at the work site;
   4. Development and maintenance of production levels as expected by employer;
   5. Advocacy with co-workers and/or employer to promote acceptance of the worker and his/her integration with the work force;
   6. Advocacy with consumer's residence, treatment services, and benefits programs to promote support in relation to the employment;
   7. Provision of reasonable accommodations; and
   8. Periodic reassessment and alteration of strategies, as appropriate.
2. This process must be reported in both the Interagency Supported Employment Reporting System (NYISER), and on the Intensive Training Progress Report Form (VES-416). The VES-416 must indicate what services were delivered in the areas of assessment, job development / placement, intensive training, stabilization, and retention of employment. The VES-416 report form must be submitted monthly until at least 90 days satisfactory employment following stabilization has been reported, or until it is reported that the individual has exited the Supported Employment program.
3. The VES-416 form should include, as appropriate:
   1. A summary of progress as it relates to the Supported Employment intensive service plan and/or notes about any significant changes to the plan.
   2. Information regarding the job, including average hours worked per week and hourly wage earned.
      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.
   3. A job description/task analysis at placement.
   4. A summary of the individual's performance and progress and continuing support needs.
   5. The basis for determining that the placement is satisfactory, including that
      • it matches the approved IPE goal,
      • is consistent with the individual's interests, abilities and limitations, and that
      • both the individual and the employer are satisfied with the placement and with the level of support provided.
4. 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.
   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 RFA for Supported Employment as the following:
   • Assessing the individual;
   • Advocating for the individual prior to employment;
   • Developing jobs and placing the individual with an employer;
   • Assessing the individual's involvement in volunteer or unpaid work to help determine his/her skills;
   • Identifying necessary on-site supports to maintain employment through the individual's involvement in situational assessment;
   • Hours of on-site intervention;
   • Hours of off-site intervention including social, travel, money management or any other life skills training and for interventions needed for the consumer to remain employed; and
   • Report writing and staff travel to provide these services.
5. The narrative report should also address the need for additional assistance from VESID/CBVH (e.g., adaptive equipment, training, or services from sources other than the primary service provider).
6. The report must indicate when stabilization has been achieved and the basis for this recommendation, as documented in the case record.

The consumer should be transitioned from intensive service to the long-term funded extended service when stabilization on the job has been achieved.

1. Stability is that time 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. The determination that stability has been achieved must be clearly explained in the case documentation.

COMMENT: Intensive service is a training process driven by the identified barriers and service needs of the individual with the goal of achieving stability in employment. These barriers and service needs should be articulated in the assessment information and the intensive service plan.

The achievement of stability means that the individual has achieved a level of performance, adjustment and reliability, which has been observed over a period of time, such that all concerned parties (the individual, the service provider, the employer and VESID/CBVH) agree that with continued support the job is secure. The minimum period of time this must be observed is 3 consecutive weeks.

Factors to be considered and addressed:

• knowledge of the essential tasks of the job;
• attendance and punctuality within acceptable standards;
• social adjustment in the work place;
• other known barriers or destabilizing factors;
• any other factors as identified during assessment and/or noted in the intensive service plan; and
• extraneous causes that may impact on job security, such as an anticipated change in bus routes, layoffs, strikes, moving, etc.

All parties must agree that so long as ongoing supports are provided, the job is secure.

Employer satisfaction with the employee's job performance as well as consumer's satisfaction with the job and with support services provided 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 VESID 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.

Documented Responsibilities

Providers must maintain internal documentation which should include:

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

Extended Supported Employment Services

For all individuals, there is an expectation of ongoing support services to maintain employment, with funding through Extended Service. The intensity, frequency, and duration of interventions 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 once the individual has stabilized in employment. Extended services assist the individual to maintain, or in some cases, regain employment. This may often consist only of regular oversight of the consumer, and with contact with the employer regarding the consumer's job functioning, in order to determine if more intensive services may be needed to retain the job. It is the expectation that needed interventions 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 Service Plan

Consistent with the required Extended Support Service Policy and regardless of the extended funding source, each worker placed under this program must be provided with an Individual Extended Service Plan. It is to be developed at the time the individual is to transition 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 VESID/CBVH.

The Plan should include the following basic information:

• Name of individual who will be receiving services
• Type of job placement (individual or group)
• Employer
• Job title
• Wages and hours
• Date of transition to extended service
• Service needs of the individual both on/off the job site
• The plan should describe 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 help is available if a problem arises.

COMMENT: Funding for Extended Services is most often provided through the resources of other agencies or as appropriate through the VESID 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 on the RFA and/or contract to provide extended services to their intensive service consumers.

The VESID 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 determined to be not eligible for extended service from any other existing long-term funding source. If it is expected that VESID funding for extended services will be needed, the VESID District Office should be contacted as soon as this anticipated need is known.

Following transition to the long-term support, 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.
• Ongoing assessment of employee's job satisfaction and whether there is a need for intervention.
• Minimum of one contact each month with the employer to monitor the consumer's job performance. If the consumer is not disclosed 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 different intervention.
• Intervention as needed on or off the job site to reinforce job-related skills.
• If requested by the consumer and appropriate, placement in another employment situation.

Continuity of Interventions

The purpose of extended service is to provide those interventions 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 contacts with the employer are required for routine interventions, to monitor their 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 service. This might also include placement and stabilization in a new job. Return to intensive service or a post-employment service through VESID/CBVH should not be requested unless there is expectation that substantial intensive services will be required to restore stability in the current (or a new) job placement. The case record should document the basis for this belief. In this circumstance, services should continue to be provided under extended service and VESID/CBVH should be contacted.

If the consumer is referred back to VESID/CBVH the counselor will need to determine eligibility and appropriate service needs. This process will be expedited if the provider forwards complete documentation including recommendations for service that explain what is needed and why.

Supported Employment providers should strive to place individuals in employment situations suitable to their capacity 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 VESID/CBVH may be considered if the individual is determined by the VESID/CBVH counselor, in consultation with the consumer and provider, to be substantially underemployed because of his/her disability, and to require VESID/CBVH assistance to achieve appropriate employment. Such individuals must meet eligibility requirements for VESID/CBVH service as well as for Supported Employment.

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 VESID/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 (OJT)

On-the-job trainings should be utilized in conjunction with supported employment services only under special circumstances (i.e. need for a specific technical skill that is required to be taught by the employer) and must meet the requirements of VESID/CBVH policies and procedures.

ADDENDA

Summary of Reporting Requirements
Documentation Name and Purpose

• Referral
  • Explains why the individual needs Supported Employment. Should be in both provider and VESID/CBVH record. These are the findings of the comprehensive assessment.
• Significance of Disability
  • Statement of determination of most significant disability by VESID/CBVH. Should be in both provider and VESID/CBVH record. May be in referral document.
• Authorization for Supported Employment
  • authorizes entry into contract with identification of employment goal on IPE - could be letter such as the CaMS generated Supported Employment letter to provider - or a copy of the fully signed 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.
• Plan for Supported Employment - Intensive Service
  • Developed by provider and consumer, copy sent to VESID/CBVH. Identifies pertinent issues and the IPE employment goal
• Extended Service 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 VESID/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 (ordinarily in the case notes) 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.
• VES-416
  • Must be submitted by provider to VESID/CBVH every month until it is reported that the individual has maintained satisfactory employment for 90 day following transition to extended service, or it is reported the individual has exited Supported Employment. Submission of the VES-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 Program Report
  • Provider reports to district office manager individuals who have entered, 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 VESID/CBVH must be in provider record if any of the waiver conditions occur.

REFERENCE MATERIAL