Monday, February 13, 2006

Who Moved Voc Rehab's Cheese? Part II

This is the second installment of a two part series entitled Who Moved Voc Rehab’s Cheese? If you missed Part I, you can read my opening commentary at the following link Who Moved Voc Rehab's Cheese? Part I

On January 19, 2006, four senior managers from Rise, Incorporated met with Minnesota’s new Vocational Rehabilitation Director, Ms. Kimberly Peck, to discuss ideas for improving our State’s vocational rehabilitation (VR) services for youth and adults with significant disabilities. My colleagues and I offered a number of suggestions to Ms. Peck based on our direct observations and experiences in working with the VR program over the past 33 years. Here is a summary of our discussion points and some recommendations we made for revitalizing the program and incorporating systems improvements.

1. The national-state VR program needs to modernize its branding and marketing as a public service. The time has come to overhaul the communication strategy of VR by eliminating its presentation of “rehabilitation” in favor of “customized employment.” I had much more to say about this topic in my post last year entitled “What if we eliminated the word “rehabilitation” from our work?

No, I am not talking here about wrapping the same old VR program into shiny new packaging. I am talking about a better way of presenting the abilities of adults with disabilities to prospective employers and humanizing our services with more respectful terminology. The term “rehabilitation” seems to imply that something is wrong with people who live with disabilities. Disability is a natural part of human living and people with disabilities are not damaged goods who need to be “fixed.” We need to move ahead with a new service philosophy that emphasizes abilities and a strategy to customize employment to fully employ all human potential. This approach positively communicates the capacities of people with disabilities to work with appropriate accommodations and customized supports.

2. If we want real change, we need to refocus our vision about customized employment across VR as well as multiple disability service systems. We need to create higher expectations throughout Minnesota that anyone of working age can and ought to work. And everyone who wants to work should be given this opportunity. To me this means launching an aggressive marketing and education campaign to make Minnesotans more aware of the unacceptable unemployment rate of individuals with disabilities. Also, we need to educate the public about the promise of customized and supported employment so people are aware of the possibilities for workforce inclusion of adults with complex lives. Finally, we need to communicate why the average Minnesotan should care about customized employment and what they can do to become part of the solution.

3. If we expect to improve job placement outcomes in the workforce, we need to know where we are at. This means it is important for us to measure what we do and establish a beginning baseline. We need to start by identifying, with the highest degree of accuracy possible, the unemployment rate of Minnesotans with disabilities. When we try to extrapolate national data we are not speaking with full integrity nor authority about the extent of our local need. This is a very challenging task because of wide variations in the definitions of disability across multiple health, education, children's and adult's disability service systems.

How do we get an accurate count? Well, I would begin by identifying the top three or four applicant populations within VR and then move to gauge the unemployment rate of each high priority group. For example, we already know that adults with serious mental illnesses (SMI) constitute one of the largest applicant pools for VR services. By working closely with the Minnesota Department of Human Services (DHS) and Minnesota counties, we should be able to identify with some degree of accuracy the annual percentage of adults with SMI who are working and not working by examining county and community case management services. This starting point gives us a reasonable measure of the scope of the problem on a statewide basis as well as within specific county areas. Unemployment mapping gives us the opportunity to work collectively with State, regional, county, and local agencies in developing specific and measurable performance improvement goals.

A similar procedure can be used to measure the employability of adults with developmental disabilities or traumatic brain injuries. It may not be possible to count every single Minnesotan with a disability and determine his or her employment status. However, we can do a much better job of measuring the unemployment rates of high target groups with the cooperation of other State agencies, counties, schools, and disability advocacy organizations. It will take us time to collect this data, but it will be well worth doing.

4. We need to refresh partnerships at all levels to better integrate professional expertise and fiscal resources to obtain shared performance goals. No reasonable person believes the VR service system can serve everybody. Nor should it have to if we truly believe in the value of making choices. However, VR can offer leadership and encourage partnerships to insure all Minnesotans are given an opportunity to work. If not VR, then who?

Of course, this means developing a statewide workplan to address and improve employment outcomes for all Minnesotans with disabilities. This means revisiting State interagency agreements and designing new strategies to better serve specific disability populations. In addition, this means developing a framework to encourage regional and local service communities to work together to address specific performance goals based on identified local needs. We are already doing this you say?

Well, the main problem with existing interagency agreements is that most of them have no "teeth" or accountability in their design. Yes, they offer a blueprint but leave way too much room for wide interpretation of agreements at the local level. In my opinion, we don't need more cooperation and coordination among agencies. What we need is real collaboration. To me, collaboration occurs when two or more organizational entities share a vision, goals, expertise, resources, division of labor, and rewards to meet a shared objective. In this case, it is measurable improvements in the job placement rate of Minnesotans with disabilities in our workforce.

To be successful, Minnesota VR must share its collaborative performance goals with other State agencies such as the Department of Education (DOE) and DHS. However, it also means developing collaborative partnerships at the regional and local levels with specific Workforce Center partners, Minnesota Family Investment Programs (TANF and welfare-to-work), secondary and post-secondary education institutions, community rehabilitation programs, regional adult mental health initiatives, adult mental health centers, adult day training & habilitation programs, veteran’s administration services, supported employment providers, and other partners with similar job placement objectives.

To illustrate my point, consider the following example. If we know a specific county has an unemployment rate of 70% for adults with serious mental illness (SMI), why can’t we develop a new framework and encourage all stakeholders to work together to meet a consensus self-improvement goal? A community-wide workplan with new performance targets could be established. For example, a goal could be developed to reduce the unemployment rate of adults with SMI in this county by 10%. In other words, 40% of adults with SMI receiving case management services will be engaged in competitive or supported employment.

With effective leadership, each community can examine what agency stakeholders may be able to contribute to the overall workplan to make a county-wide performance goal viable. It would likely include a blend of expertise, advocacy, business marketing and job development services, blended and braided funding streams, and a consensus about division of labor to get the job done in an agreed upon time frame. To support such an agreement, we will need a cross-agency outcome measurement system to measure our collective performance data and support self-improvements within each service community.

5. We need to re-redesign and widely train about funding models to map pathways into the workforce for a larger number of people with disabilities. Interagency agreements often lack accountability unless they include formal agreements to share fiscal resources and division of labor. VR may not have the resources to serve all Minnesotans with disabilities but its resources can be used effectively to stimulate funding partnerships to increase desired outcomes. This is best accomplished by developing collaborative funding models with other stakeholder organizations.

Sometimes it does not take any funding to stimulate these collaborative agreements. For example, I personally witnessed VR clients being placed unnecessarily on waiting lists in 2004 despite the availability of federal grant funds to serve them. How does this make any sense?

If county-wide or regional interagency agreements are formally developed, it would make sense to do a regular audit of all available funding opportunities particularly for high target populations needing services in each geographic region. By conducting an annual audit of resources with partner agencies, it would give VR a better grasp of existing resources, emerging funding streams, and determine optimal ways to use its own funds to meet identified local needs. Of course, this means that partner organizations must step up to the plate to help with funding job placement or ongoing employment services for specific service populations (i.e., adults with developmental disabilities in adult day training & habilitation programs).

The launch of new cost sharing agreements will help to better integrate and braid available funding streams to meet identified needs within specific service communities. Also, it would logically mean developing agreements with community employment providers to maximize resources in support of unserved or underserved groups of high priority to VR and local communities. Finally, this would also mean encouraging all partners to work hard in eliminating the silly games played about who is the last payer of services.

Employment funding models should be developed with local high schools and colleges, counties, community rehabilitation programs, supported employment programs, mental health centers, day training & habilitation programs, welfare-to-work programs, One-Stop Workforce Centers, and other venues where people with disabilities come for job placement assistance. Employment funding models should also be designed to support the job placement and ongoing employment support needs of specific disability populations based on various eligibility factors. This means there is a need for sophisticated service mapping in support of adults with developmental disabilities, serious mental illnesses, traumatic brain injuries, deaf/hard of hearing, blindness, and other disability conditions. Logically, refreshing agreements with local high schools to co-fund job placement and training programs for youth and young adults in transition from school-to-careers would also make great sense.

Finally, each service community must work hard to avoid duplication of effort and maximize all available resources in order to serve the highest number of people possible. Once various funding models are skillfully crafted, it is then important to cross-train VR counselors and direct service practitioners from local communities to encourage real collaboration and integration of services to achieve shared outcome objectives.

6. If we want to change the future, we need to increase our collaboration with secondary education programs to support their school-to-career transition goals. The Individuals with Disabilities Education Act (IDEA) mandates that special education programs address the vocational and transition needs of youth with disabilities. Expectations about work need to be imbedded early on during secondary education so youth with disabilities and their families embrace job placement in the workforce as a goal within reach. And high schools need VR’s expertise and support to drive appropriate career planning, training and education, and job placement outcomes.

In particular, a strong foundation for customized and supported employment must be laid so all young adults graduating from high school receive assistance they need to work and contribute to their economic self-dependence. Together, secondary education and adult employment systems must do a better job of increasing the percentage of youth with disabilities who enter the workforce. This means we need to work with mutual goals to minimize outcomes in expensive, disability service programs. Wherever possible, it also means working to divert enrollment within life-long disability benefits programs such as Social Security. If we want to change the future, then increasing our attention to more effective school-to-work transition is absolutely critical.

7. If we want to change the future, we need to encourage business leaders to take greater ownership and share in our job placement goals. Business leaders are only beginning to recognize that hiring people with disabilities is good business. The emergence of the United States Business Leadership Network (BLN), and its local state chapters such as the Minnesota BLN, is a very good start. However, business people cannot tackle this high unemployment problem alone. Most employers do not see the abilities and hidden job potential in people with the most significant disabilities. If they could, we would not have the high unemployment and underemployment rates of adults with disabilities reported in our national studies.

Most business leaders do not have a good understanding about supported employment despite progress made throughout the United States in the last three decades. And a majority of employers have not been exposed to the idea of customized employment. Customized employment is a method of developing individualized jobs to fit the assessed interests and abilities of youth and adults with significant disabilities. Customized employment is also designed to meet the identified needs of a business. Yes, it's a win-win situation!
These job outcomes are obtained through careful and detailed negotiations with employers about job descriptions and tasks to match the abilities of job seekers with significant disabilities. Customized employment can also include physical workplace accommodations or perhaps specific supports needed by employees to perform a job successfully. The goal is to carve out or create meaningful job roles inside the workforce that match the assessed interests and potential contributions of traditionally underserved workers with complex needs.

As most people know, demand-side employment is now the buzz. Progressive employment service providers are working hard to supply qualified workers to meet the labor needs of businesses and industries in a highly competitive workforce. However, people with the most significant disabilities are rarely viewed as qualified workers in a demand-side employment paradigm. We cannot change our future until business leaders take an active interest and recognize there is another way to employ the skills of highly underrepresented individuals.

I am not talking here about charity but real work for real pay. We need to launch new and more aggressive marketing approaches so business leaders begin to see abilities in brand new ways. We need to reach a place where employers recognize that being “qualified” can also mean tailoring jobs so they are a better fit to who people really are. The best way to educate employers about these possibilities is by exposing them to successful outcomes so they can see for themselves how customization can increase job opportunities yet maintain high standards of good business practice.

There are many solid reasons why business leaders should consider customized employment when traditional job placement approaches will not work. I shared a number of these ideas in recent commentary called Customized Employment: Making the Business Case

8. If we want to change the future, we need to establish a taskforce to address major policy barriers impeding the employability of youth and adults with disabilities. Former rock n’ roll legend, Frank Zappa once said: “America is the land of a million laws, poorly conceived and randomly enforced.” Public policies that protect us are good. Public policies that deny, restrict, discourage, or block people’s access to working are not good. There is no doubt that a significant percentage of the unemployment rate of people with disabilities can be traced back to one or more bad public policies.

As a senior manager of customized and supported employment programs, I am guessing that I spend 50% of my time trying to figure out how to navigate around ineffective and inflexible rules that minimize access to services or indirectly discourage working. Some of these policy barriers are rooted in federal law, in State regulations, in county or local rules, or within the arena of public education. And of course, many dubious policies are products of our own making.

Public policy barriers are no small matter in the important work we do. If we want to enhance greater access to services, encourage self-dependency, and increase employment outcomes, we must work together to name and correct each and every one of them. Of course, this means collaborating with national and State advocacy bodies and trade associations who share similar concerns so we can impact positive changes in national policy. Also, it means working locally with interested stakeholders in our State and communities to influence desired changes closer to home. If a policy restricts or discourages people with disabilities from working, then it ought to be on our radar screen.

9. If we want to attain and maintain performance excellence, we need to create a shared statewide resource that focuses on best practices, training, and assistive technology applications to support direct service practitioners across all VR and disability service systems. How do we nurture and sustain performance excellence inside Minnesota? We need to invest in ongoing management of good training and informational resources to insure direct service practitioners are incorporating promising practices in their daily work. This is a very challenging task because of the many venues where employment services are delivered. With that said, we need to find a way to unify our training and resource information to offer timely information to the field that is based on documented research and evidence-based practices.

What does best practice look like for a secondary education professional working in the arena of school-to-career transition? What are evidence-based practices (EBPs) in the delivery of supported employment for adults with mental health disabilities? How can an adult day training & habilitation professional increase customized employment in the workforce for adults with developmental disabilities?
What does best practice look like in the job placement of adults with traumatic brain injuries? What types of assistive technology devices or products are being used to support the functionality of adults with significant physical disabilities in the workplace? Why not unveil a Minnesota Showcase of real people who are now employed in the workplace because of their access to best practices and creativity?

In addition to resource information, Minnesota also needs to reassess its need for minimum professional standards required of its direct service practitioners such as job placement specialists or employment consultants. Should there be licensing standards or a certification process for direct service practitioners within specific disciplines? (i.e., mental health) How do we insure that people with disabilities are receiving the very best employment services and outcomes Minnesota has to offer? Agency CARF accreditation is a start but is not prescriptive in defining minimum competency standards for employment service practitioners.

Yet the quality of our employment programs is directly related to the knowledge, skills, and abilities (KSAs) of direct service practitioners who work for them. And most importantly, our participants' outcomes are driven by the KSAs and problem-solving capacities of these professionals. For this reason, we need to work to create better systems of training and access to information to support Minnesota’s broad network of employment service professionals.

Clearly, such an effort means developing and unifying collaborative agreements with universities and colleges, professional trade associations, disability advocacy organizations, employment service providers, and professional development programs such as the Rehabilitation Continuing Education Programs (RCEPs). The hunger for knowledge in the field is great and we must do a better job of organizing our fragmented education and staff development systems. Even launching a unified web site with a maintained library of updated resources and training information will go a long way in supporting the professional growth of a wide range of direct service practitioners from broad disciplines.

10. We need to advocate for improvements in our public transportation infrastructure to enhance the employability of adults with disabilities. If we truly want people to work in the community and be self-reliant then we cannot ignore the issue of public transportation. Nothing is more frustrating then job opportunities lost because a potential worker cannot get to a job offered by an otherwise willing employer. Access to public transportation is a community-wide problem and the answers must be addressed within regional and local jurisdictions, especially the outlying suburbs and rural areas of our State. The collaboration of State, regional, county, and local transportation advisory boards is crucial to helping Minnesota address the resource needs of its citizens who are dependent on public transportation to make a living. The VR program and its community employment partners must play an active role in identifying all resource opportunities to address gaps in services and build an infrastructure that will support as many people as possible. Without reliable access to transportation, many people with disabilities will continue to remain unemployed or be limited to participation in institutional or facility-based service settings. We can do better than this.

11. We need to rebuild strategies to address the hidden underemployment and ongoing career development needs of adults with disabilities. One of VR’s greatest challenges is supporting the career ladder needs of adults with disabilities. Although no one seems to have complete statistical data about this underemployment issue, we know from experience that many adults with disabilities are not fully using their talents and job potential. The federal Rehabilitation Act does encourage career advancement of people with disabilities into jobs with good pay. However, VR’s case management system is cumbersome at best in encouraging it. The career trajectory of people with disabilities is oftentimes as unique as the individuals we serve. Yet, VR often closes the cases of people who are working substantially below their education, training, and skill levels. Yes, people can return to VR for post-employment services but this occurrence tends to be the exception rather than the rule.

You don’t believe me? Well, I would recommend that you gather a random group of former VR clients with mental health disabilities together for more discussion on this topic. I am confident that you will hear specific concerns about not finding jobs that are more stimulating and in line with their education, training, and skills. Further, I am certain that many people who live with other disability conditions have experienced the "glass ceiling" inside the workplace.

So how do we improve upon this situation? This is a complicated topic because of the dimensions to the problem. However, I do believe that VR has a role in providing leadership to address it. A big part of this problem is building higher expectations about job placement performance and enhancing VR's case management flexibility to achieve it.
Another issue related to this problem is business marketing. We need to do a much better job of persuading business leaders to hire qualified people with disabilities in employment positions that require higher levels of skill and wage compensation. Further, it would be prudent to fund transitional employment and career development strategies to support people in taking incremental steps to get better jobs and higher wages. This would logically include a strategy for customized employment so specific career ladder positions are functionally tailored to the unique abilities of job applicants with disabilities.

Once again, VR does not “own” this problem. However, it is a nagging by-product of the existing service system as we know it. And it can be changed. Today, the VR system is still driven by a series of steps that leads ultimately to a successful job and rehabilitation. I would respectfully suggest that there are really only two status codes that matter from the viewpoint of consumers....working and not working. And when people ARE working, our own work is often just beginning. In summary, some people need more time and career development guidance to increase their skills and find better jobs crucial to their self-support. For this reason, we owe these individuals an opportunity and the means to improve themselves.

No, I am not suggesting that VR never close its cases. Nor am I suggesting that it should pay for all services that are needed. We all recognize there are not enough resources within the VR system to accomplish this goal. However, VR needs to take a leadership role in encouraging career ladder opportunities and forming dynamic partnerships to maximize resources and increase access to these necessary services. Clearly, some of these services can be offered through existing supported employment programs that offer ongoing support. And perhaps, community colleges and universities could be trained to support their graduates in obtaining customized jobs following their education? We need to examine all possibilities and potential resources to break this glass ceiling for as many people with disabilities as possible.

In his recent State of the Union Address, President Bush addressed his critics with the following comment: “Hindsight is not wisdom and second guessing is not a strategy.” I guess the same criticism could be leveled at someone like me who is examining lost opportunities and criticizing the "State of our VR Program" some thirty years later. With that said, I believe I am standing on firm ground. First, there is very little I have expressed here that I have not been saying for three decades. I have a track record in this regard. Second, people who know me best know I am not an “enemy’ of the national-state VR program but rather an ally who wants better performance from all of us.

Third, I am fortunate to work in Minnesota where the job placement rate of adults with disabilities is one of the highest in our nation per capita. And Minnesota’s VR system is indeed among the very best in the United States. Minnesota Rehabilitation Services (RS) has enjoyed a long history leading in many of the discussion areas I identified above. However, we are still a long way from making substantial headway toward our goal. Despite our progress, we are not working as effectively as we could be in so many of these areas cited. In my view, Minnesota must move forward with progressive ideas if it wants to better serve its citizens and maintain its reputation as a national leader.
Sure, it’s easy to find fault in any human services system. And criticism is nothing more than shallow rhetoric unless it is accompanied by constructive suggestions for change. I have tried to offer some ideas and “food for thought” in this two part series. Our national-state VR program may be undergoing an identity crisis but its missteps can be corrected with effective new leadership. In Minnesota, our residents with disabilities are counting on us. May a new vision and bold innovation guide our future.


Blogger Aaron said...

Really interesting information ! I really enjoyed reading this !

7:37 AM  
Blogger Don Lavin said...

Thanks for stopping by Aaron! Glad you enjoyed the article.

8:50 AM  

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