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{\author ici}{\operator me@noginn.com}{\title ici_pub_141}}

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\par \fs48\b Innovations in Employment Supports: New Hampshire's State Division of Developmental Services\b0\fs24\par \par \fs36\b Research to Practice 34a\b0\fs24\par \par By: John Butterworth, Allison Cohen Hall \par \par Suggested audiences: Policymakers, Researchers \par \par Originally published: 5/2004 \par \par Between 1988 and 2001, New Hampshire's Division of Developmental Services transformed the state's day and employment services from a facility-based model, with 61% of individuals supported in sheltered workshops or facility-based day habilitation programs, to an inclusion model that supports 94% of its individuals in the community. Fifty-four percent of the individuals served work for at least part of their week in integrated employment. Two things are striking. First, stakeholders in the state are firm about their commitment to the broad value of community inclusion, with employment as a principal vehicle for achieving that goal. Second, stakeholders are clear that much remains to be done, including expressing concerns about both individuals who are not currently working and the quality of the outcomes for individuals who are working. \par \par ============== \par \par In FY2001 New Hampshire's Division of Developmental Disabilities reported that 51% of individuals receiving day and employment supports were working in integrated employment for at least part of the work week. This places New Hampshire among the top five states based on the percent of individuals in integrated employment.  \par  \par ============== \par \par \b New Hampshire\b0  \par   \f3\'B7\tab\f0 Integrated Employment    51%\par  \f3\'B7\tab\f0 Community-Based Non-work    43%\par  \f3\'B7\tab\f0 Sheltered Employment    6%\par  \par \b Nation\b0  \par   \f3\'B7\tab\f0 Integrated Employment    22%\par  \f3\'B7\tab\f0 Community-Based Non-work    18%\par  \f3\'B7\tab\f0 Sheltered Employment    24%\par  \f3\'B7\tab\f0 Facility-based non-work 28%\par  \f3\'B7\tab\f0 Facility-based services (not specified) 8%\par  \par These data were collected as part of the National Survey of State MRDD Agencies administered by the Institute for Community Inclusion, University of Massachusetts Boston. ICI staff collected descriptive information during a series of on-site and telephone interviews conducted in 2002.   \par \brdrb\brdrs\brdrw30\brsp20 \pard\par \par Several factors were consistently highlighted as contributing to New Hampshire's employment outcomes to date: \par   \f3\'B7\tab\f0     \par \b A focus on values change more than structural change.\b0  Driven by the Laconia State School class action lawsuit, the state invested heavily in values-based training as the transformation to a community-based service system began. This has remained the primary focus of state level training initiatives, reflecting a belief that the primary goal is a quality life and full participation in the community. Community inclusion was described as the driving value for the service system. \par     \par \i The richness upon which the system is based was values driven from the start... I would credit that probably as much as anything else to the success of the closure of Laconia State School and the development of the community system....    \i0  \par   \par  \f3\'B7\tab\f0 \b Elimination of facility-based services.\b0  The state has significantly limited funding for facility-based services, including sheltered employment. This change was gradual and came about as services became more consumer-directed. For a time funding guidelines required that individuals participate in the community in groups of no more than 3 individuals with disabilities. These guidelines are not currently formal regulations but are understood as expectations for service delivery.   \par  \f3\'B7\tab\f0 \b Broad emphasis on self-determination.\b0  New Hampshire's focus on flexibility is also reflected in a strong emphasis on self-determination and individual control over financial resources. Beginning with early demonstration activity developed at the area agency level and funded by the Robert Wood Johnson Foundation, NH has invested heavily in supporting self-determination including implementation of self-directed funding models.     \par \i People can go out and hire their own job supports... anybody can go to any vendor they want.     \i0  \par   \par  \f3\'B7\tab\f0 \par \b Minimalist approach to policy.\b0  Consistent with the state's political philosophy, New Hampshire has emphasized local control and opportunity for innovation in the design of its service system. DD services are managed by 12 area agencies that are independent nonprofit corporations. Area agencies and local providers are important sources of creativity and commitment to integrated employment. The state encourages these ideals, but assumes that services are best organized at the local level.     \par \par     \i People [in state government] have yielded a lot of autonomy and control to the different area agencies.    \i0  \par     \par \i     There is... little state government.  There isn't that much that the state says be here now, learn it this way or be here now, do that.    \i0      \par   \par  \f3\'B7\tab\f0     \b Flexible implementation of funding nurtures innovation at the individual level.\b0  Despite implementation challenges, the Medicaid HCBS Waiver has been used to foster considerable flexibility in the design and implementation of services.   \par  \f3\'B7\tab\f0    \par     \b Person-to-person quality improvement.\b0  In the mid 1990's NH shifted from a formal program review structure for quality assurance to a more community-based approach. A consultant provided extensive training on continuous quality improvement and the Quality Assurance office was disbanded to shift the investment of state program specialist time to more informal program and individual contact. Six program specialists spend most of their time in the field working with local providers to facilitate change. On a more formal level state the program specialists are responsible for reviewing 10% of the individuals supported by DDS each year. These reviews are at an individual level, and focus on whether the individual's preferences and needs are being addressed fully.     \par \par     In the late 1990s the state also hired John Vance, Director of a small innovative employment supports provider, on a half time basis to provide targeted technical assistance to providers to expand access to integrated employment. John is able to provide hands-on support over an extended period of time to support provider capacity development.      \par   \par  \f3\'B7\tab\f0     \b Data, data, data.\b0  While New Hampshire has not emphasized specific goals on a statewide or provider contract level, providers described the employment outcomes data collection system as an important factor in the state's focus. The state collects outcome data every six months from providers. Perhaps more important, it is clear that there are regular conversations about employment outcomes using these data at both a statewide and local level. In addition to individual employment outcomes the data system tracks the number of businesses, currently 765, that employ DDS consumers in order to emphasize untapped opportunity and the importance of outreach.   \par  \par For more information contact: \par \par John Butterworth, Ph.D.,\par Institute for Community Inclusion, UCEDD\par University of Massachusetts Boston\par (617) 287-4357\par  john.butterworth@umb.edu \par \par Jeanne Cusson\par Program Planning and Review Specialist\par New Hampshire Division of Developmental Disabilities\par (603) 271-5014\par  JCusson@dhhs.state.nh.us \par \par Institute for Community Inclusion\par UMass Boston\par 100 Morrissey Boulevard\par Boston, Massachusetts 02125\par 617.287.4300 (v); 617.287.4350 (TTY)\par  www.communityinclusion.org \par \par This project 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. The opinions contained herein are those of the grantee and project participants and do not necessarily reflect those of the Administration on Developmental Disabilities.  \par \par This publication will be made available in alternate formats upon request. \par }