Memorandum of Understanding between The State Education Department Office of Vocational and Educational Services for Individuals with Disabilities and the Office of Mental Health

October 1999

INTRODUCTION:
The Office of Mental Health (OMH) and the State Education Department, Office of Vocational and Educational Services for Individuals with Disabilities (VESID) have jointly revised this agreement outlining functional criteria which indicate a readiness for referral for VESID services and/or a need for mental health services. This referral process is intended to enhance the services provided by each agency to individuals with psychiatric disabilities and to promote consumer choice and participation, to increase access to services, and to increase employment outcomes for these individuals.
FUNCTIONAL CRITERIA:
The following functional criteria should be present when making a referral to VESID. These are criteria include:
1. The individual has a current diagnosis of mental illness or referral information indicates the presence of mental illness that presents a substantial impediment to employment and requires vocational rehabilitation services to prepare for, secure, retain or regain employment.
2. The individual desires to make a change in his/her current vocational role or status and requests access to vocational rehabilitation services. This request could be prompted by a change in the individual’s abilities, capabilities, tolerance, strengths, resources, and/or priorities. This request could also be prompted by a factor or change of factors external to the individual, including environmental expectations for change.
3. The individual is committed to obtaining employment as indicated by consumer declarations that employment is desired and seen as positive and possible.
4. The individual's communications and interactive behaviors indicate a readiness and willingness to participate in a psychiatric rehabilitation process e.g., a willingness to discuss, declare and actively work towards vocational aspirations. Reasonable accommodations may be needed to assist in the vocational/psychiatric rehabilitation process.
5. The individual has demonstrated successful management of and is coping with his/her psychiatric symptoms as they relate to achieving his/her vocational goals.
6. The individual has met, or is in the process of meeting, the basic needs of food, shelter, and health care.
7. The individual is available to participate in vocational services and is not impeded by other obligations.
PROCESS FOR REFERRAL:
Several factors combine to ensure a successful referral between VESID and mental health providers. For the purpose of this agreement, a mental health provider is defined as a facility or program licensed, operated or funded by the Office of Mental Health. Nothing in this agreement shall be interpreted as restricting access to VESID services for persons with mental illness, including people who are self-referred or referred to VESID from private practitioners. Referring representatives from each system should be familiar with the services that are offered and the limitations of these services. In addition, knowledge of eligibility criteria and required documentation is essential. Telephone contact is encouraged prior to a formal referral to clarify issues of concern, establish important service linkages and expedite any remaining referral issues.
The following are the referral processes to be used between the mental health system and VESID. These processes address the required referral information, reasons for referral, consumer involvement, other information when available and recommended, and ongoing interagency staff communication.
REFERRAL FROM THE MENTAL HEALTH SYSTEM TO VESID
1. Determination to Refer - The mental health provider will determine, using the functional criteria, when an individual should be referred for consideration of eligibility for VESID services. There must be consumer involvement, concurrence, and informed choice in the decision to make the referral.
2. Required Referral Information - With the release of information form signed by the consumer (or guardian, if appropriate), the mental health provider will forward the following information with a referral to VESID.
  1. Consumer Identifying Information - Name, address, telephone number, social security number, date of birth, and gender.
  2. Diagnostic/Functional Assessment - The diagnostic/functional assessment must be conducted by a physician, psychiatrist, psychologist, certified social worker, nurse practitioner, or other qualified health professional skilled in the assessment and treatment of mental or emotional disorders. The assessment should be the most recently available and should include a DSM IV diagnosis.
  3. Social, Educational and Work History - A description of the individual's skills and social support strengths including their primary employment factors (Appendix A).
  4. Alcoholism/Substance Abuse Assessment - An assessment of the individual’s level of alcoholism and/or substance abuse and impact upon work, if applicable.
  5. Current Living Situation - Information on housing and financial support.
  6. Reasons for Referral at This Time - Statement of why referral is being made at this time, including:
    1. Agency and consumer expectations;
    2. Suggested services that would be needed to achieve goals; and
    3. An indication of prior referrals of this individual to VESID, how this referral is different, if known, and what information the individual, collaterals, and/or referral source provides that indicates an increased likelihood that the person will benefit from VESID services.
3. Other Information to be Included When Available - The following information should be provided to VESID by the mental health provider when available.
  1. Psychiatric Rehabilitation Readiness Determination - This assessment is available through Clinic, Continuing Day Treatment, Partial Hospital and Intensive Psychiatric Rehabilitative Treatment programs licensed by the Office of Mental Health.
  2. Known medical conditions, or medications.
4. Referral Process: The outcome of the referral process will be a decision on VESID eligibility. Consistent with the 1998 Rehabilitation Act Amendments, the eligibility of consumers referred to VESID will be determined as soon as possible, but no later than 60 calendar days after the individual has applied. An individual is considered to have applied for services if all of the following three criteria are met: a) such services have been requested, b) available information to begin the assessment process has been provided, and c) the individual is available to receive services.
REFERRAL FROM VESID TO MENTAL HEALTH SYSTEM
1. Determination to Refer - VESID often serves individuals with mental illness who may not be actively participating in the mental health services system. Such individuals may have barriers to employment, which could be addressed by the mental health system. Upon consent and agreement with the individual, VESID may connect such individuals with the mental health treatment system. VESID may make such referrals for assessment, treatment, pre-vocational services, psychiatric rehabilitation, skill development or other necessary supports.
2. Required Referral Information: VESID must provide the following information when referring an individual to a mental health provider for service.
  1. Consumer identifying information - name, address, telephone number, social security number, date of birth, and gender;
  2. Reason for referral whether for assessment, treatment, pre-vocational services, psychiatric rehabilitation, skill development, other necessary supports, or combination thereof; and
  3. Indicators of consumer involvement and concurrence in the decisions to make the referral.
3. Other Information to be Provided When Available - VESID will provide the following additional information to support the referral for mental health services, if available and appropriate.
  1. Assessment information, such, situational assessment and diagnostic vocational evaluation.
  2. Individualized Plan for Employment (IPE), formerly the Individualized Written Rehabilitation Program.
  3. Summary of issues which previously prevented the individual from successfully participating in mental health or vocational rehabilitation services; and/or
  4. Summary of individual’s strengths which indicates ability to benefit from mental health or vocational rehabilitation services.
4. Referral Process: Once a referral is received from VESID, the mental health provider will schedule an initial interview. Upon completion of the interview, the description of services to be provided and a timetable for the services will be shared with VESID, with the consent of the consumer. The individual will be encouraged and supported to assume responsibility for managing their mental health services.
INTERAGENCY SYSTEMS CONSIDERATIONS
1. OMH and VESID will encourage and provide assistance to OMH field offices, county mental health directors, community mental health providers, and VESID district offices to identify a point of contact to facilitate service delivery, foster interagency cooperation and address systems issues. OMH and VESID will commit to working with these key system stakeholders to:
  1. Determine what access, referral and service delivery processes are identified as needing modification and/or improvement;
  2. Identify local best practices and disseminate information to address local interagency collaboration issues;
  3. Identify the training needs of VESID counselors to more effectively serve mental health constituencies and develop a training plan to meet these needs; and
  4. Identify the training needs of mental health providers to more effectively use VESID services on behalf of their constitutents and develop a training plan to meet these needs.
2. Mental Health to VESID Referral: With the agreement of the consumer, the mental health system will initiate and provide ongoing services to support the vocational rehabilitation process. Formal contacts between the mental health provider and VESID should occur within two weeks after the initial interview by the VESID counselor and at regular intervals thereafter, as the consumer's needs indicate.
3. VESID to Mental Health Referral: With the agreement of the consumer, VESID will initiate and provide vocational rehabilitation services to support the psychiatric rehabilitation process. Formal contacts between the mental health provider and VESID should occur within two weeks after the initial interview by the mental health provider and at regular intervals thereafter, as the consumer's needs indicate.
4. The release of consumer information between the mental health and VESID service delivery system will be in accordance with the confidentiality guidelines established by each agency and all applicable New York State laws and regulations.
5. This agreement cannot be modified, amended, or otherwise changed except by a written statement signed by all parties to this agreement.

SIGNED BY

James L. Stone, Commissioner
Office of Mental Health

Richard H. Cate, Chief Operating Officer
State Education Department

APPENDIX A

DEFINITIONS PERTAINING TO OMH/VESID MOU

Eligibility for VESID Services

A person is eligible for vocational rehabilitation services if the individual:

Has a physical or mental impairment that is a substantial impediment to employment;
Can benefit in terms of achieving an employment outcome consistent with an individual’s strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice; and
Requires vocational rehabilitation services to prepare for, secure, retain or regain employment.

Primary Employment Factors

Eligibility for VESID services must be determined in relationship to the individual’s need for services to achieve an employment outcome. These primary employment factors must be assessed, documented and considered together when determining eligibility and planning services, relying on existing information available from the individual and other sources.

Strengths: the individual’s positive attributes or inherent expertise related to an employment field such as intellectual aptitude, motivation, talents, work and volunteer experience, work skills, work-related hobbies and transferable life skills.
Resources: the individual’s sources of available support, including financial, social, information, and technological, on which the person can rely to prepare for and meet employment objectives. These resources could be available from the individual, the family, or other community or public sources.
Priorities: consistency with and the relationship to the individual’s employment-related preferences, based on informed choice among available options.
Concerns: employment-related issues that need to be considered in vocational planning such as financial, self-sufficiency, medical, residential, and family considerations.
Abilities: the individual’s existing physical, mental, or functional capacity to successfully engage in employment through natural aptitude or acquired proficiency.
Capabilities: the potential for an individual to develop the skills necessary for employment through the provision of vocational rehabilitation services.

Secondary Employment Factors

The employment goal must also reflect the individual’s interests and informed choice to the extent that those factors are consistent with the individual’s strengths, resources, priorities, concerns, abilities and capabilities.

Interests: occupational areas on which an individual has focused special attention.
Informed Choice: the active involvement of consumers contributing to the success of and satisfaction with their employment outcomes in the selection of, long-term vocational goal, rehabilitation objectives, vocational rehabilitation services including assessment services, service providers that contributes to the success of and satisfaction with their employment outcomes. While individuals are encouraged and expected to actively participate and make meaningful choices in conjunction with their vocational rehabilitation counselor, consumer choice does not mean they have complete control over their programs. In the collaborative decision-making process, vocational rehabilitation counselors apply their professional judgement; applicable laws, regulations, and policies; and sound planning considerations to the individual’s circumstances.