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High-Performing States in Integrated Employment

Research to Practice 32

Originally published: 2/2003

Introduction

Between 1988 and 1996, the number of individuals supported by state mental retardation/developmental disabilities (MR/DD) agencies who participated in some type of community employment increased by 200% (Butterworth, Gilmore, Kiernan, Schalock, 1999). Despite this increase, many agree that outcomes in community employment are in great need of improvement and vary widely among states. The purpose of this report is to highlight the successful practices of states that have been identified as "high-performers" in integrated employment for people served by state MR/DD agencies.

What does it mean to be "high-performing?"

We defined "high-performing" as: a high rate of individuals with MR/DD in integrated employment; a high percentage of individuals with MR/DD in integrated employment; and/or growth in integrated employment over time. Rate refers to the number of people in integrated employment per state population. Percentage of people in integrated employment is based on the total number enrolled in day and employment services throughout the state. We also considered residential outcomes as an additional indicator of overall commitment to community inclusion (Prouty and Lakin, 2000).

Using the above criteria and data from ICI's national data collection for day and employment services for people with developmental disabilities, ICI staff selected 13 states and interviewed key informants to explore the organizational variables that have resulted in successful integrated employment outcomes (see table at right). Respondents included state vocational rehabilitation (VR) and MR/DD administrators, non-profit service providers, and disability advocates.

Findings

The following brief summarizes the data collected from participating states. Although common themes emerged, the states also had unique differences. While we acknowledge that all states encounter a number of barriers to supporting people in the community (including limited funding and resistance from traditional VR providers and/or families and individuals, to name a few) this publication specifically highlights "what's working" among states. These seven themes are:

1. Clearly defined goals and data collection
2. Strong agency leadership
3. Interagency collaboration
4. Ongoing training and outreach
5. Communication through relationships
6. Local control
7. Flexibility and respect for innovation

Criteria used to determine high-performance in integrated employment (IE)

State	IE rate FY'90*	IE rate FY'99*	% change in IE rate FY'90-99	% in IE FY'90	% in IE FY'99	% change in IE	% in 1-6 pers. residence FY'99**
CO	54	66	13	44	42	-5	86
CT	74	100	35	39	59	51	77
DE	17	56	227	17	35	106	66
FL	15	23	36	21	30	43	58
MI	10	90	817	7	38	443	97
MN	47	117	150	33	52	58	86
NH	67	75	12	55	50	-9	96
OH	17	59	252	9	23	156	50
OK	10	39	271	12	37	208	51
SD	42	167	299	9	61	578	59
UT	24	39	66	30	40	33	66
VT	40	97	144	29	35	21	100
WA	41	70	71	48	58	21	77
Natl.avg	25	47	133	21	30	43	62

*Integrated employment rate- Integrated employment cases per 100,000 state population
**Data from Prouty and Lakin, 2000

1. Clearly defined goals and data collection

Clearly defined goals and data collection mechanisms that track these goals are key in overcoming systemic barriers to integrated employment. Like many other states, the challenges Delaware has faced are philosophical ones. Resistance to change from community rehabilitation providers operating facility-based services, in addition to lack of financial incentives, have impeded the state's MR/DD agency from realizing greater success. To address these challenges, the state created a comprehensive strategic plan and measurable goals for supported employment outcomes. Florida also has measurable goals and has implemented statewide performance indicators, with the goal of 30 percent of adults receiving services participating in integrated employment. South Dakota has an informal goal of increasing employment by 20 percent and has been closely measuring employment service outcomes for over ten years.

Changes in administration can make it difficult to sustain integrated employment efforts on a statewide basis. In order for the effort to be maintained more seamlessly, Washington has relied on comprehensive data collection and effective use of this data. This has been critical in planning for future employment needs of individuals with disabilities.

2. Strong agency leadership

Strong agency leadership can do much to further integrated employment in states. In Michigan, participants identified many forward-thinking leaders at the state and local levels in the mental health and rehabilitation systems and at the Developmental Disabilities Council. In the late 1980s, the directors of these three groups were instrumental in establishing a state commitment to integrated employment and were also able to direct financial resources for this purpose. The current state directors are continuing this commitment. Although the Michigan Department of Community Health has required its 49 community mental health service programs for persons with mental illness or developmental disabilities to report outcome data, administrators chose not to establish formal goals or targets. Instead, outcomes are reported and published for local communities. "Widespread dissemination of the outcome reports has kept the state moving in the intended direction."

In Delaware as well, strong and dedicated leadership from the VR agency has been very important. The leadership has been on several levels, through facilitating and funding training, fostering involvement in the use of PASS plans and IRWE to offset additional costs for people with disabilities who want to work, and through service delivery.

3. Interagency collaboration

Interagency collaboration was identified as key to the expansion of integrated employment. For over ten years in Ohio, formalized collaborative efforts between the state's VR and MR/DD agencies were identified as instrumental in making integrated employment successful. These agencies have worked hard to better streamline their funding mechanisms. Operating in four counties, Project MORE was a collaboration among the Ohio Rehabilitation Services Commission (Ohio's VR agency, which also was the project lead) and the Departments of Mental Health, Education, and MR/DD. Through local demonstration activities, the project sought to create a structure with consumers, families, service providers, and employers as equal partners in the effort to increase employment for individuals with disabilities.

In addition, Ohio's MR/DD and VR agencies developed a joint vision statement in 2002 that stated that it was the mutual goal of both agencies to provide services to persons with disabilities geared toward wrapping services around a paycheck rather than a benefits check. Both agencies held a series of regional meetings to communicate this joint vision statement to staff and to reiterate the commitment of both agencies. These agencies, in conjunction with the Ohio Association of Adult Service Directors, are developing regional Technical Assistance Teams to enhance local collaborative efforts to improve outcomes for persons with MR/DD.

In Florida, the Departments of Education, Vocational Rehabilitation, and Developmental Disabilities have cooperative agreements, participate in Agency Partners Meetings, and keep the exchange of information constant around employment issues. Coordination also exists on the local service delivery level.

Early interagency coalitions in Connecticut established long-lasting relationships that are still fostered today. It is clear that these early partnerships continue to be nurtured and valued for their capacity to create better employment outcomes for individuals with disabilities.

4. Ongoing training and outreach

Many state stakeholders highlighted the importance of training and outreach to promote integrated employment. In Colorado, respondents felt that this message was communicated aggressively. "We presume that people with disabilities can work." A "tremendous amount" of training, conferences, and other educational events is provided related to integrated employment, both for programs already supporting people in the community and for those that are facility-based. Florida officials have worked hard to develop a high quality model for a training curriculum for employment specialists, but have had difficulty broadly administering training because of limited funding.

At the onset of its supported employment initiative in the 1980s, Connecticut had a strong and highly visible investment in training at multiple levels including managers, line supervisors, and front-line staff. Many of the state's MR/DD staff who led early supported employment initiatives continue to provide leadership in this area, and the MR/DD agency continues to support the state's annual supported employment conference. This is a collaborative venture developed by state agencies, the state University Center for Excellence in Developmental Disabilities Education, Research, and Service (UCEDD), and provider groups.

5. Communication through relationships

Relationships that foster communication among staff can often result in better service delivery outcomes. Much of Vermont's success in integrated employment was attributed to its small size (a factor also cited in New Hampshire and Delaware). Fewer bureaucratic layers enable people to work closely with each other and align the priorities of their agencies. Local relationships were cited as the key to successful practices. Despite turnover in the coordinators for integrated employment, this group in Vermont has been close-knit. Originating from the grassroots level and promoted by state VR and DD leaders, dissemination of the value base for integrated employment was targeted to programs that were receptive to change and likely to create a structure that would make integrated employment possible.

Respondents from Michigan also reported that open dialogue and debate are mechanisms that have helped overcome barriers to integrated employment. Communication at multiple levels helps to sustain the momentum for an ongoing commitment to integrated employment for people served by their MR/DD agency.

6. Local control

Although a state-level commitment to integrated employment is critical, practical implementation of employment supports happens at the local level. In Washington, success in supported employment "didn't happen by a stroke of luck, it took 25 years." The bifurcated system in this state allows one level of government to concentrate on supported employment. Counties are in control of planning and coordination and have a great deal of autonomy in funding decisions. The emphasis on local economic factors has come down from the state administration. Informants believe that this local control makes all the difference. Respondents noted that it has been difficult to sustain integrated employment efforts on a statewide basis. When changes in state administration have altered the focus on integrated employment, local leaders worked to continue the momentum.

7. Flexibility and respect for innovation

A high level of trust and respect between the state and its providers can encourage creative problem-solving and innovative employment supports. Perhaps the most important factor in New Hampshire is the state administration's respect for and support of new ideas among its service-providing agencies. The overall culture of the state seems to allow for values-based supports and flexible services. For instance, the state MR/DD agency has contracted with a small, innovative provider for use as a consultant to help other agencies think more creatively about community employment supports and the transition from facility-based services.

Providers themselves have also noted the state's flexibility and have cited it as a boon for the expansion of integrated employment. For instance, when a woman who was receiving services from the MR/DD agency and working at home expressed an interest in office space but lacked the financial means, the provider asked the state if they could temporarily set her up in their agency offices. Although not an ideal location and against regulations that were meant to promote greater community inclusion, the state trusted that the provider was working with the woman to eventually establish a more integrated work environment. It is clear from this example that the state was allowing the agency to consider the individual first and the policy second.

Conclusion

These interviews with key informants yielded much rich information about state and local integrated employment, and several themes emerged across states. Clear leadership, organizational variables that promote integrated employment, communication among stakeholder agencies, and respect for innovation are some of the most important ideas that were brought to light through the research. The enclosed checklist is offered as a planning tool for states to identify effective mechanisms for promoting employment in their state and to help them create a sustainable plan to increase their capacity to expand opportunities for integrated employment for individuals served by their MR/DD agencies.

Sources Cited

Butterworth, J., Gilmore, D., Kiernan, W. E., and Schalock, R. (1999). State trends in employment services for people with developmental disabilities: Multiyear comparisons based on state MR/DD agency and vocational rehabilitation (RSA) data. Boston: Children's Hospital, Institute for Community Inclusion.

Prouty, R., and Lakin, K. C. (2000). Residential services for persons with developmental disabilities: Status and trends through 1999. Minneapolis, MN: University of Minnesota, Research and Training Center on Community Living.

The authors would like to thank Sheila Fesko from the Institute for Community Inclusion, as well as the research participants for their efforts in this project.

For more information, contact:
Allison Cohen
Institute for Community Inclusion
UMass Boston
100 Morrissey Boulevard
Boston, Massachusetts 02125
617.287.4361 (v); 617.287.4350 (TTY)
allison.cohen@umb.edu

This document was supported in part by cooperative agreement # 90DN0126 from the Administration on Developmental Disabilities, Administration for Children and Families, U.S. Department of Health and Human Services. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not necessarily represent official Administration on Developmental Disabilities policy.

This publication will be made available in alternate formats upon request.

Strategic Planning Tool for States

Strategies for success: Clearly defined goals and data collection
Current examples in my state:
Ways my state could expand opportunities:

Strategies for success: Strong agency leadership
Current examples in my state:
Ways my state could expand opportunities:

Strategies for success: Interagency collaboration
Current examples in my state:
Ways my state could expand opportunities:

Strategies for success: Ongoing training and outreach
Current examples in my state:
Ways my state could expand opportunities:

Strategies for success: Communication through relationships
Current examples in my state:
Ways my state could expand opportunities:

Strategies for success: Local control
Current examples in my state:
Ways my state could expand opportunities:

Strategies for success: Flexibility and respect for innovation
Current examples in my state:
Ways my state could expand opportunities:

Copyright 1992-2008, Institute for Community Inclusion (ICI). ICI is affiliated with the University of Massachusetts Boston and Children's Hospital Boston. Permission to use, copy, and distribute all documents on this site, in whole or in part, for non-commercial use and without fee, is hereby granted provided that appropriate credit to the Institute for Community Inclusion be included in all copies. Alternate formats are available upon request.

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