Developmental Services - Support Waiver
Supported Employment
The following definitions and guidelines
are being adopted as guidance by The State of Maine, DHHS-Developmental
Services for interpretation of Supported Employment.
These are
effective beginning January 1, 2008
What is Supported
Employment?
Supported employment facilitates competitive work
in integrated work settings for individuals with the most
severe disabilities (i.e. psychiatric, mental retardation, learning
disabilities, and traumatic brain injury) for whom competitive
employment has not traditionally occurred, and who, because
of the nature and severity of their disability, need ongoing
support services in order to perform their job. Supported
employment provides assistance such as job coaches, transportation,
assistive technology, specialized job training, and individually
tailored supervision.
Supported employment is a way to move
people from dependence on a service delivery system to independence
via competitive employment. Recent studies indicate that the
provision of on-going support services for people with severe
disabilities significantly increases their rates for employment
retention. Supported employment encourages people to work
within their communities and encourages work, social interaction,
and integration.
All of the below, is taken from, The Department of Labor, Federal
Guidelines for Employment.
Definitions
An Employment Specialist/Work Support
staff is
a person who is hired by the placement agency to provide specialized
on-site training to assist the employee with a disability
in learning and performing the job and adjusting to the
work environment.
Natural supports are support 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 together at the invitation of a supervisor
or co-workers. These natural supports are particularly effective
because they enhance the social integration between the
employee with a disability and his/her co-workers and supervisor.
In addition, natural supports may be more permanent, consistently
and readily available, thereby facilitating long-term job-retention.
Basic Components
Supported employment services should achieve
the following outcomes: opportunity to earn equitable wages
and other employment-related benefits, development of new
skills, increased community participation, enhanced self-esteem,
increased consumer empowerment, and quality of life.
The types of supported employment services used depend on
the needs of individual consumers. The following are the
basic components of supported employment:
Paid Employment - Wages
are a major outcome of supported employment. Work performed
must be compensated with the same benefits and wages as other
workers in similar jobs receive. This includes sick leave,
vacation time, health benefits, bonuses, training opportunities,
and other benefits. (Section 21 and Section 29 allow for the
use of a Federal Special Worker Certificate)
Integrated Work
Sites - Integration is one of the essential features
of supported employment. Individuals with disabilities should
have the same opportunities to participate in all activities
in which other employees participate and to work alongside
other employees who do not have disabilities. (For
further guidance)
Ongoing Support - A key characteristic
which distinguishes supported employment from other employment
programs is the provision of ongoing support for individuals
with severe disabilities to maintain employment.
Supported
Employment Models
Several supported employment models are
being used to provide the benefits of work for people with
severe disabilities.
Individual Placement Model - A person with
a disability is placed in a job in a community business which
best suits his/her abilities and preferences. Training is
provided on the job site in job skills and work related behaviors,
including social skills, by a job coach. As the employee
gains skills and confidence, the job coach gradually spends
less time at the worksite. Support is never completely removed.
The private or public vocational rehabilitation agency furnishing
the job coach is always available to the employer for retraining
for new assignments, assisting in dealing with challenging
behaviors, supplying periodic consultations with co-workers
and employer, giving orientation and training for co-workers.
(Self employment is encouraged and supported within this
model)
Enclave Model - A small group of people with
disabilities (generally 5-8) is trained and supervised among
employees who are not disabled at the host company's work site.
Persons in the enclave work as a team at a single work site
in a community business or industry. Initial training, supervision,
and support are provided by a specially trained on-site
supervisor, who may work for the host company or the
placement agency. Another variation of the enclave approach
is called the "dispersed enclave." This
model is used in service industries (e.g.,
universities, restaurants, and hotels). Each person works
on a separate job, and the group is dispersed throughout the
company.
Mobile Work Crew - A small crew of persons
with disabilities (up to 6) works as a distinct
unit and operates as a self-contained business
that generates employment for their crew members
by selling a service. The crew works at several
locations within the community, under the
supervision of a job coach. The type of work
usually includes janitorial or grounds keeping.
People with disabilities work with people
who do not have disabilities in a variety
of settings, such as offices and apartment
buildings.
Small Business Model - Within a small business,
there may be up to six employees with disabilities,
but not more than the number of employees without disabilities.
The small business operates like any business, generating
work and paying employees from revenues received. The small
business is located within the community
Guidelines for use of Employment Services in Medicaid Programs
for Developmental Services
Employment Services are presently available within Developmental
Services through Home and Community Based Waiver Programs: Section
21, Comprehensive Waiver and Section 29, Support Waiver. There
is a very limited amount of grant dollars available to individuals
who are not eligible for MaineCare. This document is to provide
guidance for planning and provision of employment services.
Please refer to Sections 21 or 29 of the MaineCare manual for
further information.
The following are the service definitions for Supported Employment
for both Section 21 and Section 29:
Employment Specialist Services include services necessary to
support a member in maintaining Employment. Services include:
(1) periodic interventions on the job site to identify a member’s
opportunities for improving productivity, minimizing the need
for formal supports by promoting natural workplace relationships,
adhering to expected safety practices, and promoting successful
employment and workplace inclusion; (2) assistance in transitioning
between employers when a member’s goal for type of employment
is not substantially changed, including assistance identifying
appropriate employment opportunities and assisting the member
in acclimating to a new job. Employment Specialist Services
are provided by an Employment Specialist who may work either
independently or under the auspices of a Supported Employment
agency. The need for continued Employment Services must be documented
in a member’s personal plan as necessary to maintain employment
over time.
Employment Specialist Services are provided at work locations
where non-disabled individuals are employed as well as in entrepreneurial
situations. Employment Specialist Services may be utilized to
assist a member to establish and or sustain a business venture
that is income producing. MaineCare funds may not be used to
defray the expenses associated with the start up or operating
a business.
A member may not receive Employment Specialist Services while
enrolled in High School.
On Behalf of is a component of Employment Specialist Service;
and is included in the established authorization and is not
a separate billable activity.
Employment Specialist Support must be provided by a Certified
Employment Specialist.
Work Support is Direct Support that is a therapeutic and supportive
service provided to improve a member’s ability to independently
maintain productivity and employment. This service is commonly
provided after a period of Employment Specialist Services to
provide long term employment support and encompasses adherence
to workplace policies and productivity. It may also include
offer training and assistance in areas such as hygiene, self-care,
dress code, and related issues. Work Support is provided in
a member’s place of employment and may be provided in
a member’s home in preparation for work.
On Behalf of is a component of Work Support; and is included
in the established authorization and is not a separate billable
activity.
A member may not receive Work Support while enrolled in High
School. A member may have services authorized while still enrolled
in High School; however, the start date of the service may only
begin after the date of graduation or termination of enrollment.
Work Support must be provided by a Certified Direct Support
Professional.
Caps for Employment Services:
| Section 21 |
Employment Specialist- up to 120 hours/year (Hours used
in this category are deducted from the 600 hours of work
support
Work Supports- up to 600 hours per/year |
| |
|
| Section 29 |
Employment Specialist-up to 60 hours/year (Hours used
in this category are deducted from the 300 hours of work
support
Work Supports- up to 300 hours/year |
Supported Employment under Section 21 and 29 Waiver Programs
- People who are interested in pursing work should discuss
this with their planning team and assure it is a goal within
their plan. They should then be referred to Vocational Rehabilitation.
No persons should request supported employment services through
the waiver program without utilizing the services of Vocational
Rehabilitation Services. Supported Employment Supports are not
to be used for services that are available under section 110
of the Rehabilitation Act of 1973), thus it is V.R.’s
role to work with the person to develop an employment plan,
assess abilities, and determine whether long term support is
needed.
- The statewide standard agreement form developed between
VR. and Developmental Services should be utilized after the
VR. worker has done an assessment and determines the projected
need for support.
- The person centered plan should identify the needed employment
services as well as the support allocation needed. This information
should be provided through Vocational Rehabilitation and/or
the provider agency
- Supported employment does not include sheltered work or
other similar types of vocational services furnished in specialized
facilities (federal guidelines). The employment setting needs
to be in an integrated setting.
- If a person is found to be “too severe” and
denied Vocational Rehabilitation services an appeal processes
should be considered. If an appeal is not successful or not
sought by the consumer and he/she desires to pursue work, job
development and on going support can occur under Section 21
and Section 29. The time used for development and on going support
must fit within the yearly allocation.
- If an individual has gone through VR, obtained a job,
and loses his/her position and needs re-employment support
in a similar position or profession Section 21 and 29 funds
may be used to support re-employment. If the person requires
significant re-training or is seeking employment in a new
profession then they should reapply to V.R.
- People are still eligible for accessing Community Supports
in conjunction with Employment Supports.
- If more than one person is working at a business using
Section 21 or Section 29 Employment Supports, billing can
only occur for the support person’s time at that site
for those individuals, not the time worked by each consumer.
- Sub-minimum wage is allowed in a competitive setting utilizing
an appropriate Department of Labor Special Worker Certificate.
It should be noted that it is the goal however to support people
wherever possible to receive earnings at or above minimum wage.
The person and their team should review annually and make recommendations
for achieving minimum wage or above. In addition it also should
be noted that VR cannot close a case successfully under sub-minimum
wage.
Integrated Setting in Employment Services
Determining whether
an employment site is integrated should be evaluated on an
individual basis, reflecting the following environmental and
employment factors
- The job is one that is available to the general public;
- The individuals with disabilities employed work under similar
work conditions as others without disabilities in similar
positions including access to lunch rooms, restrooms, breaks, performance
and attendance expectations
- The individuals with disabilities perform their work duties
with ongoing interaction with other workers without
disabilities, supervision and contact with customers, suppliers and
general public to the same degree as workers without disabilities in
the same or comparable occupations;
- The individuals with disabilities are part of the fabric
of the company, organization or individual acting as
the employer, including invitation and participation with company-wide
events such as holiday parties, outings and social activities.
- Individuals with disabilities may receive additional employment
supports from a provider agency. While the preferred model has
individuals with disabilities on the employers’ payroll,
it is permissible that wages through community provider
agencies; and
- On a case by case basis, support models that rely on enclaves,
and mobile work crews can be regarded as employment
in an integrated setting when the above listed conditions exist.
- The preferred model of employment for Individuals with
disabilities has the employer providing
primary supervision to the employee with disability in a manner
identical to other employees. It is permissible, one a case
by case basis to have the support agency offer and provide
this supervision as long as the above conditions are met.
(Adapted from the New York Department of Labor, Employment
Network)
