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Innovations in Employment Supports: Colorado's State Division of Developmental Services

Research to Practice 39

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Originally published: 7/2005

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History

Between the years of 1985 and 1996 Colorado experienced significant growth in integrated employment for people with mental retardation and developmental disabilities (MR/DD). Several factors were consistently highlighted as contributing to Colorado's employment outcomes during this period. These included:

Beginning in 1997, the state started to lose momentum in its quest to provide integrated employment. According to a report published by the Colorado Department of Human Services (2002), 83% of people enrolled in integrated employment programs had jobs in the community in 1998. This report noted a substantial drop in this data by the year 2000, with only 71% of people enrolled in integrated employment having community jobs. Colorado also experienced a decline in the number of people with MR/DD participating in integrated employment who worked half-time or more. The report on Community Supported Employment (2002) further detailed that in 1993 72% of people who were enrolled in integrated employment services were working half-time or more, but by 2000 this number was only 25%. Several factors were linked to the decline. Prior to 1996, the state Division for Developmental Disabilities employed a staff person whose full-time responsibility was to promote community employment. Funding restrictions eliminated this position. A stakeholder noted that, "the ability of the state to have that same level of presence and direction was diminished substantially." Before 1997, Colorado had placed a moratorium on new funds for sheltered workshops. This policy was abandoned because of a powerful lobby by sheltered workshop advocates. Training and technical assistance was also scaled back because of a lack of funding, a problem which is exacerbated by high turnover among agency staff.

Additionally, a statewide systems change effort altered the funding structure significantly. Previously, the system allocated funding based on a managed care "slot-system." The state defined the services to be provided for each slot, with an accompanying funding amount. Provider agencies enrolling individuals in integrated employment programs received a 25% higher rate of funding than for other services. This encouraged the growth of integrated employment. The incentive was paid to providers up-front to offset the cost of job development and initial employment supports. The system also allowed providers the flexibly to meet individual needs. While the amount per person allotted was determined by the state, at the local level providers funded support individually. For example, if one person was less costly to support, the provider could apply this extra funding to other individuals for whom services were more expensive to provide.

In FY2001, Colorado DDD reported that 34% of individuals receiving day and employment supports were working in integrated employment for at least part of the work week. Through the mid-1990s Colorado was a national leader in supporting individuals in integrated employment, with DDD supporting 50% of individuals in integrated employment programs in 1993.

Under the current funding system, local CCBs receive pooled funding equal to the average rate per person. CCBs negotiate fees and services with providers individually. Providers are only paid for specific services rendered, eliminating the previous incentive. While the rate per person CCBs receive has increased over time, the pool of funds allotted to the CCBs is perceived as inadequate to pay providers sufficiently to cover their costs for integrated employment. Most stakeholders noted that the large-scale devolution of employment funding to local groups without administrative and financial support from the state has been an impediment to the continued growth of integrated employment.

The systems change initiative was also part of the impetus for the growth of a new service option-community participation (CP). CP was first introduced in 1987 and conceived as community connection services for those for whom work was not perceived as a realistic option because of medical condition or age. In many cases, CP has become an outings and recreation program that family members in particular value because it is perceived to be a stable and safer alternative to working in the community. Some stakeholders referred to it as "van therapy." There is also the perception that congregate CP is a more cost effective service option because of its minimal up-front costs when compared with the initial costs of integrated employment. Stakeholders believed that combination of the above mentioned factors has lead to the overall decline in integrated employment over the past decade. Policymakers, service providers, and advocacy groups concerned with this decline have recently come together to reinvigorate employment for people with MR/DD.

Chart: Percent Served in Colorado's Integrated Employment Program between 1988-2001*

1988: 21%
1990: 44%
1993: 50%
1996: 43%
1999: 42%
2001: 34%

These data were collected as part of the National Survey of State MR/DD Agencies administered by the Institute for Community Inclusion at University of Massachusetts Boston. ICI staff collected descriptive information during a series of on-site and telephone interviews conducted in 2004.

* These data were collected as part of the National Survey of State MR/DD Agencies administered by the Institute for Community Inclusion at University of Massachusetts Boston. ICI staff collected descriptive information during a series of on-site and telephone interviews conducted in 2004.

Building a New Coalition and Focus: 2004 to Present

Following a statewide tour of the Colorado developmental disabilities service system in 2002 and the publication of Issue Paper 2003, DDD developed a strategic plan to address concerns related to service provision. A component of the strategic plan focused upon the creation of a number of ad hoc committees, including a committee to focus on employment and community participation.

The Ad Hoc Committee on Employment and Community Participation brought together a number of stakeholders to promote integrated employment opportunities for all people with disabilities. The committee members included representatives from: the state-level DDD administration, the state Division of Vocational Rehabilitation, local Community Centered Boards, advocacy groups and self-advocates, parents, and service providers. The group's mission centered on three factors:

  1. raising the priority for integrated employment,
  2. ensuring equality of opportunity for all individuals to participate in paid community employment
  3. promoting the use of natural supports in the workplace. This committee began meeting in the winter of 2004 and in August of that year released its Interim Report on Employment Recommendations.

Development of a consensus definition. A key piece of the group's early work was to develop a consensus definition of "community employment." It settled on "One-person, one-job arrangements within typical businesses with wages paid by the employer at a prevailing wage, and which includes regular meaningful interaction with non-disabled persons." This definition provided the group and others concerned with integrated employment with a benchmark by which to judge integrated employment services and outcomes.

Emphasis on increasing informed, self-determined choice. Self-determination and informed choice has been an important theme among the group. There was a concern that the growth of community participation or community-based non-work was due in part to the lack of informed choice among individuals. The consensus definition of community employment specifically stated that person-centered planning should be evident in the process of deciding to pursue employment services, and that individuals should receive experience and information to facilitate choice-making. Increasing the support and opportunity for community employment exploration is one way to ensure greater access to real choice.

The Ad Hoc Committee's recommendations addressed the following themes:

  1. Strengthening guidelines for the number of people participating in integrated employment, the collection of employment data, and informed choice.
  2. Increasing the dissemination of good employment outcomes and best practices.
  3. Increasing DDD partnership with stakeholders-specifically the Division of Vocational Rehabilitation, school systems, and the business community-to promote integrated employment.
  4. Identifying additional sources to fund integrated employment initiatives and increasing the current reimbursement rates for integrated employment.
  5. Creating small work groups to include those not on the original committee in order to increase grassroots participation from a wide range of stakeholders in the transformation of DDD policy and practice.

The Ad Hoc Committee has volunteered to regroup to monitor the progress towards implementing the recommended action steps to increase integrated employment in Colorado.

References

Ad Hoc Committee on Employment and Community Participation. (2004, August). Interim report on employment recommendations. Submitted to the Division for Developmental Services, Colorado Department of Human Services.

Colorado Department of Human Services: Division for Developmental Disabilities. (2002, June). Community Supported Employment. In Colorado accountability focus series: Outcomes of services and supports. Retrieved October 10, 2004, from www.cdhs.state.co.us/ohr/dds/CI2000.htm

Colorado Department of Human Services: Division for Developmental Disabilities. (2003). Issue paper 2003. Retrieved December 7, 2004, from www.cdhs.state.co.us/ohr/dds/issues03.htm

Colorado Department of Human Services: Division for Developmental Disabilities. (2003, July). Strategic Plan: 2003-2008 for the Colorado Developmental Disabilities Service System. Retrieved December 7, 2004, from www.cdhs.state.co.us/ohr/dds/DDS_center.html

For more information on Colorado's integrated employment system, contact:

Allison Cohen
Institute for Community Inclusion, UCEDD
University of Massachusetts Boston
(617) 287-4361
allison.cohen@umb.edu

Al Orlofsky
Colorado Division for Developmental Disabilities
(303) 866-7460
al.orlofsky@state.co.us

For more information on the Institute for Community Inclusion Access to Integrated Employment project, contact:

John Butterworth, Ph.D.
Institute for Community Inclusion, UCEDD
University of Massachusetts Boston
(617) 287-4357
john.butterworth@umb.edu

This project was supported, in part, by cooperative agreement #90DN0204 from the Administration on Developmental Disabilities, Administration for Children and Families, U. S. Department of Health and Human Services. The opinions contained herein are those of the grantee and project participants and do not necessarily reflect those of the Administration on Developmental Disabilities.

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

ICI: promoting inclusion for people with disabilities