Self-Determination
in Employment for Persons with Significant Disabilities:
Creating a
Customer Directed Approach
By
Melinda Mast
Norciva Shumpert
Michael Callahan
Employment for All
Introduction
The new century is bringing changes
to both the generic workplace and to employment services for persons with
disabilities. As the new decade unfolds, there is a blending of the issues that
affect the average worker in our country and also the non-traditional, aspiring
worker with a significant disability. Within a week of being appointed as the
Secretary of the U.S. Department of Labor, Elaine Chao characterized the
changing face of the workforce in the
“In one sense, the new economy is
deconstructing work, with jobs that can't be pigeonholed into a traditional
workday or workweek, and corporate structures that, in some cases, are
eliminating the need for a workplace altogether. Workers themselves are
demanding more autonomy, more freedom, more customization of the terms and
conditions of their employment."
Secretary of Labor Elaine Chao
In her remarks, Ms. Chao not only states that employment is becoming more individualized and personally-directed in terms of the everyday worker, she also described the important changes that are beginning to occur in the disability field. The issues of autonomy (self-determination), freedom (choice) and customization (individualized jobs) are consistent with emerging concepts in the disability field.
Since the early 1990’s the disability field has been moving toward systems that embrace self-determination, choice and customization. Traditionally individuals with disabilities have been placed into positions of dependence on government funding systems and provider agencies. Beginning with the Robert Wood Johnson Self-Determination projects and the RSA funded Choice Demonstration projects of the 1990’s systems have been gradually moving toward true individualization, self-determination and control.
The tenants of self-determination and choice have provided the opportunity for individuals with disabilities to have more control over reaching their goal of participating fully in the life of their communities. While many self-determination and choice models have appeared over the past few years, a review of the literature of model programs and systems indicates that they share the same basic values: they are centered on the individual customer, the customer’s decision-making authority, his/her ability to make an informed choice and his/her ability to be a partner in directing the spending of public funds.
Projects that are successfully facilitating choice and self-determination share design elements that build the framework for each model. These include person directed planning, control and direction of funding, independent advice and support, use of non-traditional “providers”, control over methods, strategies and timeliness for reaching the desired outcome, individual contracts and outcome driven payment based on customer satisfaction.
Much of the discussion on customer control has focused on “control” of previously held government resources. While the field continues to struggle over this shift in who controls the purse strings, it is just beginning to mirror what is happening in other sectors of society. Over the years, there has been a shift away from federally controlled resources to state control, then local control and finally to those who actually use the service – businesses and citizens themselves. In the human service field, this has not been an easy shift. The culture of government and the private non-profit sector create an atmosphere that clings to the old system; a system designed to circumvent many of the basic tenants of self-determination and choice. However, individuals with disabilities, their families and others continue to seek increased power and control, forcing agencies to give them authority over their own service outcomes.
Nowhere is this more evident than in the employment arena. Two and a half years into the new century, employment services for persons with disabilities is seeing growing changes that are pushing the concepts of self-determination and choice and changing the way individuals access employment services. Not only do they want control over government resources previously held by service providers, they want real and meaningful work of their own choosing.
A Proven Model
Customization
A proven model for
employment services that are self-directed and controlled by the customer, must begin with customization – customization of
the process, the plan, the negotiations and the outcome. Customization is clearly person driven and
reflects a way to use creative approaches for assuring successful employment
outcomes for persons with significant disabilities. It uses individual discovery for uncovering
the strengths, preferences and contributions of an applicant rather than
comparative methods traditionally used in employment services. It offers an opportunity at a job that fits
an individual, what they need and what they have to offer and it individualizes
the employment relationship between employees and employers in ways that meet
the needs of both.
The steps in customization can be purchased or
authorized in a manner that ultimately reduces spending because it focuses on
what is real and what is needed to make the outcome real. In 2001 several self-determination projects
reported individuals spent an average of $500-$3,000 less than was traditionally
spent by a provider agency to assist a person with like impact of disability
into employment. Typical expenses in a
Control of resources & personal budgets
In the book Reinventing
Government, Gaebler and Osbourne pointed out that the best way to make
providers respond to the needs of their customers, was to put the resources in
the customer’s hands. In a
self-determined model, customers design and control a budget using funds
traditionally set aside for services.
These funds are usually held by a state agency (VR) or are given to a
provider agency that provides employment services. While these agencies are still able to hold
the funds, they now act as fiscal intermediaries or agents and set aside the
budgeted funds negotiated for an individual customer. Controlling funds offers individuals with disabilities
greater control over their employment outcomes.
This defines a
clear line of authority and approval for a provider.
Providers
Most control of resources
has centered on the individual with a disability hiring a service provider to
facilitate reaching an employment outcome.
This is an essential feature of a self-determined approach. However, traditional providers may no longer
be the only choice. Family members,
friends and others are coming forward as an alternative to a traditional
service provider agency. They are
committed and successful in assisting the individual who hires them. A critical feature of self-determination is
customer satisfaction and outcome based payment. In this customer-based model, the
relationship between the customer and the provider is contractual. Contracts are negotiated that identify the
work scope, the payment rate, the qualifications and procedures for payment,
evaluation and conflict resolution.
There remain many
questions: What do you look for in a
provider? Who determines how to define a qualified provider? How much is the provider paid? How are services broken down into billable
outcomes?
Advice
Advice and support assure that individual customers have the opportunity, the authority and choice in determining their goals, their needs, their budgets and the people who support them in these efforts. Individuals are encouraged to seek advice from persons of their choosing, whether that is a case manager, counselor or someone outside of the traditional system. Advice frequently becomes a line item in a personal budget especially when the “advisor” comes from outside of the system. As customer control becomes a way of “doing business” the use of an adviser, a mentor, a navigator, a counselor is providing the linchpin for success. By providing assistance individual customers and their families are able to have the degree of assistance they need and are able to learn empowering strategies that help them make good choices.
Steps to Employment
There are specific
measurable steps that have proven effective in assisting individuals into
customized employment situations. The steps result in products that
describe provider activities to be accomplished on behalf of the customer. The steps follow a sequence that offers
information for the following step. Information from the initial steps of
discovery and employment planning is used to develop an individualized budget
that then facilitates the succeeding steps in the employment process.
A general listing of the steps and their products are listed below with reasonable costs for each step.
- Discovery: A process for uncovering capacity and contributions used as a
substitute to comparison-based testing procedures. It seeks to answer the question
"Who is this person?" It
takes into account a customer's entire life experiences rather than single
instances of performance. It
requires a facilitator to spend time with the customer over a period of
days and weeks in order to discover past experiences, unnoticed abilities
and interests, preferences and contributions. True discovery tells a story
of the customer, describes his/her life and
reveals the unique qualities that can be contributed to an employer.
o
Product
– A Personal Profile that is a
comprehensive written document describing the individual customer’s life
experiences. The personal Profile is
focused on relating the discovered information to work. It identifies contribution, preference and conditions for
employment.
o
Reasonable
Rate -- $500 - $750 based on $20 per
hour
o Product -- An employment plan that includes the
customer's preferences, contributions, and conditions for employment; the types
of job tasks the customer feels should comprise the job; specific employment
sites where work could be developed; and employment leads & relationships
with possible employers
o Reasonable Rate -- $150-$400
for a completed plan
- Budget Development: Identifying the
funds (dollar amounts) necessary for achieving the goals identified in the
employment plan. Developing the
budget after the employment plan, allows the goals identified in the plan
to drive the development of the budget.
In this way, a customer’s budged reflects only what is needed to
meet the desired goals.
o Product – a budget with line
item categories identifying the steps, supports and
amounts necessary for the customer to achieve a successful job.
o Reasonable Rate –
individually developed
- Portfolio Development: A visual
resume for use during job development with an employer. It uses photographs and text to describe
the individual applicant and depicts the applicant's contributions and
preferences in ways that relate to the features of the desired job.
o Product -- A Presentation
Portfolio that illustrates the best of the individual applicant, through
supporting photos and text.
o Reasonable Rate -- $100 -
$250 plus materials (film, developing costs, binder, supporting materials)
- Job Development: Contacting
employers on behalf of an individual applicant. Contacts reflect those identified on the
employment plan and relate to the preferred job tasks and job sites that
were identified by the customer.
o Products – A job that is
based on the employment plan and represents the applicant’s choice. The job search is supported by documentation
on job development contacts, job summary and availability of characteristics of
the ideal work situation.
o Reasonable Rate -- $750 -
$2000 based on $20 per hour
- Job Analysis: A way to look at
the characteristics and routines of a job in order to identify the natural
supports available and the training strategies best used for the new
employee.
o Product -- Completed job
analysis process and document of specific duties, routines, job site
characteristics and employer supports
o Reasonable Rate -- $150-$500
based on $20 per hour
- Employer Directed Support Plan:
Implementation of a plan outlining the training and supports
necessary for success on the job that has been negotiated between the
employer and the new employee.
o Products -- Daily Routine
Chart, Monthly Support Analysis, a description of the supports needed to
maintain the job that are not natural in the environment
o Reasonable Rate:
individually developed
- Additional Supports: Worksite
Accommodations, transportations, and other reasonable supports
o Product – Written plan for
implementing additional supports and accommodations.
o Reasonable Rate --
individually developed
- Business Plans and Supports: A plan for
achieving a business endeavor.
o Product – A written Business
Plan that clearly defines the characteristics of the proposed business and
identifies needs and supports necessary to successfully implement the
business. Additional products and
activities include the development of the specific activities outlined in the
plan that result in the actual development of the business.
o Reasonable Rates –
individually established.
Additional features that
support purchasing or authorizing employment services are listed below.
· Independent
advice available to the customer to provide support through the purchasing
process with a provider
· Contracts or
work scope agreements between the customer and provider that clearly put the
customer in control. Contracts and work
scopes outline and describe the negotiated steps necessary to meet the
customer's goals. These might include
the process to be used and the products developed during the process, cost,
date of initiation and completion, and other stipulations identified by the
customer (such as weekly updates, time limits)
· Customer
satisfaction documents that indicate whether the customer was happy with the
service that was provided and if the service met the negotiated terms. When signed by the customer
these can serve as a mechanism for paying the provider.
·. Payment for specific employment steps rather than by the hour.
§
The specific steps have a set of products that are to be
delivered and approved by the customer before going to the next step in services.
§
Rates are established based on the negotiated number of hours
to complete each step and product.
· Development of a
“Conflict Resolution” process.
These features represent key
components in purchasing employment services from a provider. Once a customer (or a funder) determines they
want to purchase services in this manner, selecting a provider becomes more
focused. The interview questions for the
provider focus less on credentialing of staff and more on “How does your agency
get jobs for people? Do they follow this
type of customized employment structure…discovery, planning, and job
development rather than placement in a job opening? Are they willing to purchase from an
individual rather than a funding agency and to complete the services to fit the
individual’s time frames? Are they
willing to redo the steps until the individual applicant is satisfied? Have they ever customized a job description
before? Do they use a portfolio to
present to employers?”
Daniel's Budget
Daniel is a 28-year-old
young man who spent the years between graduating from high school at age 21 and
age 28 in a sheltered day habilitation program.
He learned how to do his laundry, make a grocery list, cook pizza in a
microwave oven and seal envelopes.
During the last week of every month, Daniel participated in a work
contract sorting and sealing envelops, that paid him about $1.00/day. Daniel had community jobs when he was in high
school but had not been employed since that time. But he repeatedly told staff he wanted to
work. When the agency began to shift its
employment services to a more self-determined model, Daniel was one of the
first to enthusiastically participate.
He began by interviewing
four providers including 2 supported employment (SE) staff from his day
habilitation program and 3 outside provider agencies. During the process, Daniel had good advice
and support from Rob, one of his home support staff and from an employment team
comprised of people he asked to participate – his VR counselor, his minister, a
church friend, his cousin, Rob, the SE provider and his case manager.
All of the providers gave Daniel a resume-type
description of their services. He
selected Mark, a staff member from the SE unit of his day habilitation program
and the steps toward identifying his preferences and contributions began. When the discovery process was completed,
Daniel’s employment team met and an employment plan and budget were identified. The plan identified that Daniel’s budget
would pay for the discovery and the plan that had already been developed; for
job development, a presentation portfolio, job analysis, job site support,
transportation for the first couple of months of the job, clothing and a palm
pilot as an accommodation to assist Daniel.
Daniel’s budget:
$3,500
|
Outcome |
Provider |
Cost |
Hours |
Funder |
|
Advisor |
Rob & team |
$0 |
|
|
|
Discovery/ Personal Profile |
Mark |
$750.00 |
Agency set rate |
VR |
|
Plan |
Mark & team |
$150 |
Agency set rate |
VR |
|
Portfolio |
Mark |
$200 |
$20/hr + materials |
VR |
|
Job Development |
Mark |
$800 |
$20/hr |
VR |
|
Job Analysis |
Mark |
$200 |
$20/hour |
VR |
|
Job Support |
Mark |
$1000 |
50 hours |
VR/DD |
|
Transportation |
Bus |
$100 |
|
DD agency |
|
Palm pilot |
Best Buy |
$200 |
|
Church donation |
|
Clothing |
Thrift shop |
$100 |
|
Daniel |
Daniel has a job at a law
firm where he works in the library putting case papers into file folders,
shredding documents, sorting case books by year for re-shelving, delivering
research materials and making copies.
After 3 months, he was supported on the job by co-workers.
Conclusion
The idea of customer control has taken on many faces. It is working in small not-for-profits as well as large state supported agencies and departments. Customer-directed approaches require strategic thinking and planning. They are a different way of doing business, one that clearly puts the customer in control. There remain many issues and unresolved questions. But for the agencies that have embarked on this approach, there is no turning back.
For further
information contact Melinda Mast,
References
Bach, Michael. (2000). Individualized funding and self-determination: Making sure the means does not become the end citing the Roeher Institute, “Towards Inclusion:
National Evaluation of Deinstitutionalization Initiatives” (1999);
Callahan, M. (2000). Personal Budgets: The Future of Funding. Journal of Vocational Rehabilitation, Volume 16, No. 1
Callahan, M. (2000). The Meaning of Choice: Implications for Systems and Providers. Report for the Presidential Task Force on Employment of Adults with Disabilities.
Diana McIver and Associates. (2000)
Economic
Federal Register,
Human Services Research Institute. (1999). The Robert Wood Johnson Foundation Self-Determination Initiative: Year One Impact Assessment Report. HSRI
Mast, Melinda: Client-Driven Systems: A Customer-directed Approach, a paper prepared for the 23rd Mary Switzer Memorial Seminar, October, 2001
Mast, M. Callahan, M. (2003). A Report to the Texas Department of Mental
Health and Mental Retardation: The
Nerney, T. Community Self-Determination: Freedom, Authority,
Support and Responsibility. www.self-determination.com/index-include.cfm?ID=12
Presidential Task Force on the Employment
of Adults with Disabilities. (2000). Recharting the Course:
Turning Points.
Proposal to Implement Individualized Funding for People with Disabilities www.bccpd.bcca/if/discdocs/IF98HTML