Results of Comprehensive Statewide Assessment of the Rehabilitation Needs of Individuals with Disabilities and the Need to Establish, Develop and Improve Community Rehabilitation Programs: Attachment 4.11(a)

The 1998 Amendments to the Rehabilitation Act require that a needs assessment be conducted jointly with the State Rehabilitation Council (SRC) every three years to collect data about the rehabilitation of New Yorkers with disabilities. The needs assessment must identify the vocational rehabilitation needs of:

Individuals with the most significant disabilities, including their need for supported employment services;
Individuals who are minorities and individuals who are unserved and underserved by vocational rehabilitation; and
Individuals who are served through other components of the workforce investment system.

In addition, the assessment must identify the need to establish, develop and improve community rehabilitation programs.

VESID submitted its last needs assessment report and plan two years ago, with the Program Year 2005 (July 1, 2005) State Plan. Since that time, VESID has worked cooperatively with the SRC, the Employment Service Systems Research and Training Center (ESSRTC), particularly Hunter College and the Center for Essential Management Services (CEMS), the State Workforce Investment Board and the New York State network of community rehabilitation providers to implement comprehensive needs assessment activities. These activities have enabled VESID to better identify and address the rehabilitation needs of individuals with disabilities in New York State.

As described in the Program Year 2005 State Plan’s Statewide Needs Assessment, Attachment 4.12(a), VESID and the SRC committed to working cooperatively with the ESSRTC to implement a comprehensive employment practices study, as one part of a broader needs assessment strategy. The purpose of the study is to identify practices that lead to quality employment outcomes, and refine that knowledge to formulate a model that predicts employment success. Specifically, factors related to consumer characteristics, counselor practices and service delivery are being examined in detail. In addition to these factors, employment outcomes are influenced by economic factors, such as the unemployment rates and the growth of local economies. The influence of these economic factors and other contextual factors on the decisions of consumers and counselors will be considered. Since outlining this initial plan in 2005, the objectives of the study have been focused as follows:

To describe best practices by identifying exemplary Vocational Rehabilitation Counselors (VRCs) who will report on what contributes to their success in creating employment opportunities for consumers.
To use existing data from VESID’s extensive database to derive profiles of counselors’ caseloads, service patterns and outcomes.
To collect additional data concerning organizational culture, counselor competencies, external factors and consumer satisfaction with services to include in analytic models identifying best service and administrative practices in collaboration with the VESID System Redesign Initiative (Designing Our Future).
To explain the variation in outcomes using the predictor and moderating variables specified in the conceptual framework.

VESID is committed to making effective use of the findings from the comprehensive needs assessment, moving from research to practice, and using what is learned to shape policy, training, operations and practice.

Characteristics of Individuals Served

During FFY 2006, the characteristics of individuals with disabilities who participate in VESID services, to some degree, reflect the unique diversity of the population in New York State:

30.3 percent are Black or African-Americans, a higher percentage than in the general population in New York State (14.3 percent).
13 percent are Hispanic, a slightly higher percentage than in the general population in New York State (12.5 percent).
1.9 percent are Native Americans (American Indian/Eskimo/Aleut).
1.9 percent are Asian-American.
0.7 percent are Pacific Islander.
18.1 percent are SSI recipients and 13.6 percent are SSD beneficiaries.
2.5 percent are TANF recipients and 13.8 percent are Safety Net participants.

Based on an analysis of individuals who are closed after receiving VR services, at the time of services:

Almost 41 percent had mental and emotional (psychosocial) disabilities, nearly 10 percentage points higher than the national average for VR agencies;
Almost 31 percent had cognitive impairments, slightly more than 4 percentage points above the national average for VR agencies. Individuals with traumatic brain injury equal 1.5 percent; and,
Close to 24 percent had physical impairments and less than 5 percent had visual or communication impairments.

Assessment Activities

Previously, a needs assessment study was conducted by the SRC and CEMS in 2001 and was reported in earlier State Plans. The study resulted in identifying potentially unserved or underserved cultural groups, including Native Americans, Asians, African-Americans, Eastern Europeans and Hispanics. Potentially underserved disability-related populations include those who are deaf, chronically mentally ill, dually diagnosed, or who have acquired brain injury, and degenerative conditions. Other groups mentioned included older persons, students in transition, persons in rural areas and persons who had involvement in the criminal justice system.

Additional assessment activities were conducted over the past two years including:

Focus groups with exemplary counselors and identification of promising practices;
Consumer satisfaction survey with preliminary results;
A review of a study of VR services to Chinese Americans in New York City;
An analysis of VR services to individuals with mental health impairments;
A study of the training needs of supported employment providers;
An implementation plan for the Designing Our Future initiative, with an emphasis on unserved and underserved groups by the Access to Services Team; and
An analysis of individuals served through other components of the workforce investment system.

Identifying Practices of Exemplary Counselors

One of the first objectives of the ESSRTC needs assessment was to describe best service practices of exemplary counselors, and how their work and behavior contribute to high levels of employment success for consumers from diverse racial, ethnic and linguistic groups. To achieve this objective, VESID identified 28 counselors from across the State who have demonstrated consistently high performance in providing high quality services to diverse populations as demonstrated by outcome measures. The ESSRTC conducted six focus groups with these exemplary counselors.

A content analysis of the transcripts from these focus groups is currently underway and a report should be available shortly (prior to the start of this State Plan Program Year) to identify those practices that likely lead to high performance results. This information will be used to explore how management and organizational practices can better support high performance in counselors, leading to quality employment outcomes for consumers.

The subsequent objective of this aspect of the needs assessment is to identify and provide detailed descriptions of counselor actions to create clear, evidence-based management practices that promote positive outcomes for consumers, including individuals from diverse racial, ethnic and linguistic groups.

Consumer Satisfaction Survey

During 2006, VESID mailed consumer satisfaction surveys to 5,003 individuals with VR Status 26 (employed) and Status 28 (not employed) closures. Five hundred ninety-five surveys (11.9 percent) were returned. CEMS, in cooperation with the VESID Monitoring Unit and the SRC Quality Assurance and Improvement Committee, is conducting a full analysis of the findings from the survey. Preliminary findings yielded the following summary results:

36.6 percent of the Status 26 closures and 11.9 percent of the Status 28 closures were employed full time.
80 percent of the respondents rated VESID services as very good or good.
76.7 percent agreed or strongly agreed that the time it took to begin receiving services met their needs.
91.1 percent agreed or strongly agreed that they were treated courteously by VESID counseling staff.
84.8 percent would recommend VESID to another person.

VESID and the SRC will work with the ESSRTC to examine more closely the comparison of satisfaction responses and ratings to various unserved and underserved populations, including racial and ethnic minorities. As VESID and the SRC continue to analyze the findings, VESID will explore implications for policy, procedures, practice and training, and gather additional survey data on consumer satisfaction.

Access to Services for Chinese Americans

VESID reviewed a study conducted by the Center for Independence of the Disabled of New York (CIDNY) in August 2004 entitled, “Barriers to VESID Services for Chinese-Americans with Disabilities in New York City.” The report recommended several best practice solutions that emphasize interagency collaboration to be fully inclusive. VESID, through its continued efforts under Designing Our Future, can engage in additional steps to better determine how many individuals with disabilities statewide are experiencing language-related barriers to service. One recommendation from the report that begins to address access to vocational rehabilitation services is the need for translation of written communications including brochures, applications, guidelines and correspondence. This study was shared with the Designing Our Future Access to Services Team and will be further discussed by the SRC to recommend specific actions that VESID could initiate to address issues raised by the study for all major populations in the State who have Limited English Proficiency.

Services to Individuals with Mental Illness

The New York Association of Psychiatric Rehabilitation Services (NYAPRS) is a statewide association of community mental health and rehabilitation providers who are involved in providing employment services to individuals with severe and persistent mental illness. The previous needs assessment that was conducted by the SRC and CEMS in 2001 found that individuals with chronic mental illness were one of the underserved populations. At the request of the NYAPRS Employment Committee during 2006, VESID conducted an analysis of the service delivery process of individuals who have identified a mental illness as a primary disability when participating in vocational rehabilitation services. This analysis was shared with the NYAPRS Employment Committee, of which one of the members is the chair elect of the SRC. A summary of some of the key findings includes:

Individuals with mental illness made up 19 percent of all individuals served in all statuses;
22 percent of the individuals determined to be eligible during FFY 2005 were individuals with mental illness;
VESID’s active caseload (Status 10 – 24) consists of 19 percent of individuals with a mental illness or 9,724 individuals;
In FFY 2005, the number of individuals with mental illness who achieved an employment outcome (Status 26) increased by 30 individuals, while the overall number of employment outcomes for all consumers decreased by more than 500;
The percentage of individuals with mental illness who achieve an employment outcome after receiving services (RSA Performance Indicator 1.2) is 46.9 percent for FFY 2005, about 7.4 percentage points lower than the 54.3 percent achieved for all VESID consumers and below the national standard for all consumers of 55.8 percent.

VESID and the NYAPRS Employment Committee will continue to explore how to improve services to this population that research has often identified as underserved by the vocational rehabilitation and workforce development system. VESID and NYAPRS will consider how a pilot project or other efforts under the Designing Our Future initiative could be developed to improve outcomes for these individuals.

Improving Supported Employment Services Provided by Community Rehabilitation Programs to Individuals with the Most Significant Disabilities

In the previous needs assessment attachment, VESID described changes in contracts with community rehabilitation programs to better provide vocational rehabilitation and supported employment services to diverse groups of individuals with disabilities, particularly underserved individuals with the most significant disabilities. Essentially, VESID contracted for supported employment with more community rehabilitation providers that specialized in working with individuals with severe and persistent mental illness and individuals with brain injury. VESID also funded a comprehensive assessment of training needs of staff from VESID-funded supported employment providers throughout New York State. The Community Rehabilitation Program Region II Rehabilitation Continuing Education Program (under the Center for Rehabilitation Synergy at the State University of New York at Buffalo) conducted the assessment. Through an intensive effort that included survey and focus groups with managers and direct service staff, the assessment generated 14 proposed recommendations for further consideration to improve supported employment services provided through community rehabilitation programs for individuals with the most significant disabilities. A few of the key recommendations included:

Development of a statewide Staff Development Planning Tool to maximize consistency between providers and offer a suggested plan for comprehensive staff training.
Development of an on going needs assessment process that takes place as part of each training workshop.
Development of a task force to address the joint training needs of schools and providers to maximize the outcomes for students transitioning to adult services. Also, allow school personnel to attend supported employment trainings and include them in marketing efforts.
Creation of a “Guide to Staff Training and Development” to be used as a resource for supervisors to build support for staff training. Additionally, each workshop should have a supervisor’s guide to integrate workshop content into daily operations. Development of a training plan that considers providing the rotation of training topics over an extended period of time.

VESID is in the process of reviewing the proposed recommendations and setting priorities that address the training needs of its supported employment community rehabilitation provider network. Over the next year, we will develop a training strategy to address the most important recommendations. It is likely that VESID will issue a Request For Applications (RFA) for an organization to coordinate and implement a training program for community rehabilitation programs that provide supported employment services.

Designing Our Future

VESID continues to work on its Designing Our Future initiative, a statewide process for designing a future vocational rehabilitation service delivery system. The Designing Our Future initiative has systematically assessed the critical changes needed for an effective vocational rehabilitation program responding to the needs of unserved and underserved populations, including minorities and individuals with the most significant disabilities. VESID submitted an implementation plan to the Board of Regents in May 2006. The implementation plan was accepted by the Regents and VESID is in the process of initiating the first phase of changes in policy and piloting several key initiatives from the plan. There are several teams charged with the responsibility of designing new processes for:

Improving access to services;
Expanding partnerships through the workforce system, transition activities and interagency cooperation;
Enhancing the use of technology to facilitate service delivery;
Improving communication with internal and external stakeholders, including business and industry;
Expanding service delivery methods and strategies;
Improving VESID internal capacity, structure and resources for monitoring, training, procurement and business processes; and
Evaluating the effectiveness of implementation and measuring outcomes.

The Designing Our Future Steering Committee has established specific goals for increasing employment outcomes for FFY 2007 and FFY 2008. Specifically, VESID will increase employment outcomes by 3 percent from the FFY 2005 level during FFY 2007. This would mean that 13,689 individuals with disabilities will achieve an employment outcome. For FFY 2008, the Designing Our Future Steering Committee has established a goal of increasing employment outcomes by 5 percent from the FFY 2007 target. This would mean that 14,372 individuals with disabilities will achieve an employment outcome. As these work teams progress with their pilot activities, VESID will be evaluating findings and making operational, policy and service delivery changes to better meet the needs of consumers.

The ESSRTC has also committed to assist VESID to measure the effectiveness of the Designing Our Future initiative. The ESSRTC has offered to construct a fidelity scale that reflects the anticipated changes. The scale will have the capacity to provide data on the extent to which plans were implemented and the quality of the implementation. The measures can then be used to assess the relationship between the changes and consumer outcomes.

Under Designing Our Future, the Access to Services Work Team has a particular responsibility to demonstrate initiatives that can improve services to unserved and underserved groups. This team is:

Conducting focused outreach efforts to identified unserved and underserved populations in Nassau and Suffolk Counties (Long Island);
Developing a survey in English and Spanish of individuals from empowerment zones, community-based disability groups, ethnic and Limited English Proficient (LEP) groups, and other traditionally underserved populations, to learn what they know about and expect from VESID VR services; and
Developing a Linguistic and Cultural Sensitivity Awareness Program based on a Linguistic and Cultural Competency curriculum that was created by the local Independent Living Center. Pilot training using this curriculum is planned for the Nassau and Suffolk County VESID offices.

Another significant assessment activity related to Designing Our Future is the VR Fiscal Management Project. A cross-functional team of VESID staff from all levels of the organization has been involved with a consultant to examine all fiscal processes, particularly those related to purchasing services on behalf of consumers, and determine how the service processes can be improved through new technology applications.

Individuals Served Through Other Components of the Statewide Workforce Investment System

Under the VESID Designing Our Future initiative, strategies for integrating vocational rehabilitation expertise at the one-stop centers are being implemented by VESID. In addition, VESID has continued to pursue increased accessibility and improved services for customers with disabilities as an explicitly stated goal among all workforce partner programs. VESID has played a key role in promoting the concept that the Statewide Workforce Investment System embraces a vision to close the employment gap for individuals with disabilities and develop a comprehensive strategy for employment of individuals with disabilities.

Over the past several years, State Education Department’s Commissioner Mills has urgently championed this priority as a member of the State Workforce Investment Board (SWIB). The SWIB responded by charging the SWIB Systems Integration Subcommittee to explore how the workforce system can more effectively assist individuals with disabilities to enter employment.

Prior to the initial meeting of the Subcommittee, VESID shared VR data with the New York State Department of Labor (DOL) for all people served in all statuses during 2003. DOL examined how many VR consumers had work activity in 2004, based on the Unemployment Insurance database. DOL found that more than 44,000 or 52 percent of VESID consumers served in 2003, had work activity in 2004. This is well above the annual 13,826 Status 26 closures claimed in FFY 2004. This indicator suggests that VR clients are more engaged in the job market than VESID is able to capture without access to wage data from other sources, such as the Unemployment Insurance database. The data analysis also indicated that for 2003, WIA Title I (one-stop services to adults, dislocated workers and youth) was serving 3,248 one-stop customers who self-identified as individuals with disabilities. A significant number of these one-stop customers (862) were also VESID consumers. WIA Title III (Wagner-Peyser Employment Services) served 15,659 individuals who self-identified as having a disability; VESID consumers comprised 2,975 of these individuals.

Finally, 81,551 individuals were classified as disabled who were served by the TANF Welfare to Work program in 2003 and 4,011 were also VESID consumers.

During 2005, VESID staff participated in two interagency design teams charged by the SWIB Systems Integration Subcommittee to examine communication among one-stop partners and the intake, eligibility and referral processes among the partners for consumers with disabilities. These two design teams made recommendations to the Systems Integration Subcommittee in November 2005. The Subcommittee reviewed the recommendations in early 2006 and prepared recommendations for the SWIB.

In February 2006, the SWIB accepted several recommendations from the Subcommittee including:

Creating and deploying a standard method to inform consumers of the full range of partner services, using multi-media approaches;
Ensuring access for all consumers and a common method across one stops for all staff to assess functional abilities of individuals with disabilities; and
Streamlining the intake and eligibility process for VESID and other partner programs for consumers with disabilities.

VESID has approached the NYS DOL to continue efforts to implement these recommendations and to continue to share information so that we can continuously assess how individuals with disabilities are served by all components of the Statewide Workforce Investment Systems and sustain our efforts to close the employment gap for individuals with disabilities in New York State.

Next Steps for Continuing Statewide Needs Assessment

Over the next year, the ESSRTC will analyze VESID and New York State data, using information from the VESID case management system from the most recent five fiscal years to identify consumer characteristics and service variables that are predictive of employment outcomes. This will permit an identification of consumers who are being underserved in terms of not achieving proportional outcomes when compared to other groups. It will also identify those services which tend to occur more frequently for those who are likely to succeed. As the study proceeds, additional data will then be collected on organizational climate, counselor competency, consumer satisfaction and consumer outcomes. As the information from the study is gathered through these different strategies, the information will be used to develop a model that predicts key employment outcomes so that practices known to be successful can be selected for future consumers. The study will result in the development of recommendations about administrative and service practices that achieve optimal outcomes.

In summary, VESID is engaged in a multifaceted and continuous process of assessing the vocational rehabilitation needs of individuals with disabilities in New York State. Some of these processes are research-oriented, as the analyses that are being done by the ESSRTC Consortium and the University of Buffalo study of supported- employment training needs at community rehabilitation programs. Others run closer to practice, where VESID can make adjustments to program interventions or develop training plans, such as the activities done in Suffolk and Nassau Counties for unserved and underserved under Designing Our Future. These pilot activities hold promise to affect statewide policy, procedures and practice in the future.

VESID has made other operational changes to improve services to unserved and underserved individuals including individuals with the most significant disabilities:

VESID has raised its economic need thresholds to match the 200 percent of poverty income levels, widely considered as the criteria for “low income” families and individuals.
VESID has worked with the New York State Office of Temporary and Disability Assistance (OTDA), responsible for the TANF welfare-to-work programs, to redesign the Local Interagency VESID Employment Services (LIVES) initiative geared toward assisting TANF individuals with disabilities to access VR services and engage in countable work activities leading to employment.
VESID has initiated a pilot project in Brooklyn and Queens to better serve individuals with chemical dependencies through a cooperative consortium with the New York State Office of Alcoholism and Substance Abuse Services (OASAS) and their network of treatment and vocational service providers.

As VESID and the SRC continue to conduct and gather findings from all of these needs assessment activities, the information will be used to:

Recommend the development of training programs throughout the State to disseminate the best service and administrative practices to vocational rehabilitation practitioners and managers;
Establish more consistency and greater accountability for quality services and outcomes;
Shape policy, procedures and operational activities that will improve services to individuals who are minority, unserved, underserved and most significantly disabled; and
Enhance services from community rehabilitation programs, including supported employment, and improve coordination of services with other components of the statewide workforce investment system.