With the involvement of service providers, advocacy organizations, and consumers, the Office of Vocational and Educational Services for Individuals with Disabilities (VESID), in cooperation with the Office of Mental Retardation and Developmental Disabilities, the Office of Mental Health, and the Commission for the Blind and Visually Handicapped, has developed guidelines for Supported Employment to assist in establishing a common base of accepted practice and procedures for supported employment. These guidelines are intended to facilitate quality service delivery as well as cooperation among supported employment service providers and the New York State agencies that serve individuals with disabilities.
| Supported Employment is paid competitive work that offers ongoing support services in integrated settings for individuals with the most significant disabilities. Supported employment is intended for individuals for whom competitive employment has not traditionally occurred or has been interrupted or intermittent as a result of a most significant disability, and who need ongoing supports to maintain their employment. This employment outcome is obtained by providing intensive service and is maintained through the provision of extended service. The level of employment participation may be full- or part-time based on the interests and abilities of the individual. |
Through the authority of Chapter 515, of the Laws of 1992, VESID has been assigned the responsibility for administering, establishing standards, and monitoring the intensive service component of supported employment programs. VESID also has responsibility for the provision of extended service to individuals who are not eligible for such service through other sources.
Supported Employment service may be provided to any individual who is determined by VESID or CBVH to be eligible for vocational rehabilitation service, and who meets all of the criteria stated below.
Comment: Comprehensive assessment:
May include, to the degree needed, an appraisal of the patterns of work behavior of the individual and services needed for the individual to acquire occupational skills and to develop work attitudes, work habits, work tolerance, and social and behavior patterns necessary for successful job performance, including the use of work in real job situations to assess and develop the capacities of the individual to perform adequately in a work environment. |
All supported employment programs funded by VESID/CBVH resources are required to comply with applicable regulations, and to have the following characteristics, unless differences are specifically described in the approved contract.
Programs must be explicitly designed to serve those people with the most significant disabilities who a) may require intervention and/or advocacy on their behalf with employers, co-workers, and/or families to ease their integration into the workforce, and (b) will require ongoing support service to maintain their employment.
| Comment: The resources for supported employment services are reserved for the employment of people having the most significant disabilities who cannot work in the competitive labor market without ongoing support. |
The program must include the provision of assistance necessary to maintain the person in employment, with no end date or time limit placed on this assistance.
| Comment: The provider's program must proactively coordinate the delivery of support service on an ongoing, long-term basis as needed to maintain integrated community-based employment. |
Integration of persons with most significant disabilities into a work force of persons without disabilities must be emphasized. An integrated setting is one which provides the person with the opportunity for regular interaction in the immediate work setting with people not having disabilities and who are not caregivers, to the same extent that individuals who do not have disabilities in comparable positions would have this opportunity. Natural supports, such as car pooling, and job training provided by co-workers, should be used whenever possible to facilitate integration.
| Comment: Interventions might include advocacy with co-workers and supervisors to include the employee in the normally occurring training and activities in the work place, encouraging social participation at such times as breaks and lunch, and fostering skills necessary to participate in companywide employee social/recreational events. |
Programs offering supported employment must provide intensive and extended service including, but not limited to: community-based assessment, job development and placement, job site training, advocacy, ongoing and related necessary supports. Where needed, services to employers must also be made available, either directly by the program or by the program arranging for such services through other agencies, including VESID or the Commission for the Blind and Visually Handicapped (CBVH). Employer services include, for example, co-worker training, job modification, rehabilitation engineering, assistive technology, or other employer requested technical assistance.
Intensive services are provided both on and off the job site as frequently as necessary to teach performance of the duties as required by the employer and to foster social integration skills, but never less frequently than twice monthly face-to-face meetings with the consumer at the work site; unless on-site interventions are waived by VESID/CBVH. If on-site interventions are waived, a minimum of two face-to-face meetings with the individual each month are still required.
| Comment: Training should be directly related to the site's specific demands and requirements for successful, integrated employment and services should be customized to meet the individual needs of the consumer. Intensive training may be provided for up to 18 months, which may be exceeded if the VESID counselor and consumer agree this is necessary in order to meet the goal of the IPE and VESID approves a waiver for this extension. |
The intent of supported employment intensive intervention is to provide all the services necessary to assist the person with:
Extended services are provided both on and off the job site, as frequently as necessary, to assess employment stability; and, based upon that assessment, to coordinate or provide the specific services needed to maintain employment stability. Extended Services must include at least two face-to-face meetings with the consumer at the worksite (unless there is a waiver for the meetings to take place off-site) and one face-to-face meeting with the employer. Under special circumstances, particularly at the request of the consumer, extended services may be provided off-site but it must still consist of at least two monthly meetings with the individual. The required monthly contact with the employer continues unless the individual does not want the employer contacted. If the individual has not disclosed to the employer their disability or involvement in a Supported Employment program, then contact with the employer would be prohibited.
Providers must establish a written Extended Support Service Policy, which describes the methods and the funding source(s) being used for the provision of such services. The policy must include:
Compensation must be in accordance with the Federal Fair Labor Standards Act (FLSA) and the New York State Department of Labor Minimum Wage Order Guidelines for rehabilitation programs. Federal regulations require competitive wages for an employment outcome, or for individuals in Supported Employment. If such individuals are earning below the competitive wage, they must be working towards a competitive wage.
| Comment: Placement is expected to be in the type of work and level of integration most appropriate to the individual's abilities and interests. The consumer should be earning competitive wage at the time of transition from intensive service to extended service; i.e., not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals who do not have a disability. Such competitive wage earnings, however, will not be a requirement for VESID to rehabilitate the individual into supported employment as long as the extended service plan continues to address competitive wage as a goal. |
Establishment of an hourly minimum employment goal as cooperatively determined with each person.
| Comment: The Rehabilitation Act states that supported employment services will include placement in an integrated setting for the maximum number of hours possible based on the unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of individuals with the most significant disabilities. Chapter 515, of the Laws of 1992 defines paid competitive work as an expectation that the provider will strive for an employment outcome averaging at least 20 hours per week. However, individuals who cannot achieve this goal will still have access to supported employment services as long as their service outcome needs are documented within the IPE. Providers should request a waiver from VESID stating the justification for fewer hours. This justification must be based only on the consumer's needs and issues. |
The provider must request and receive a written waiver from the VESID/CBVH counselor under any, and each, of the three circumstances described below. Each waiver request must include an appropriate justification.
Through the framework established by federal law and regulations, and Chapter 515 of the Laws of 1992 in New York State, the following expectations are established as provider responsibilities:
Services are to be provided through a consumer-centered decision-making process that leads to coordinated and comprehensive service planning. Participants should include the consumer and family, VESID or CBVH counselor, and, as appropriate, Office of Mental Health/Office of Mental Retardation and Developmental Disabilities, other service providers, and other support service representatives. Decisions regarding entry into a Supported Employment program, the employment goal, and service delivery require coordination with and approval by the State VR agency.
For the program to be reimbursed by VESID/CBVH, the program participant must have an active VESID/CBVH case and written authorization from VESID/CBVH for the provision of Supported Employment service to that individual. The written authorization must be issued prior to the provision of services and must state the beginning and ending dates during which services are authorized. No backdating of authorizations will be allowed. Regardless of any individual authorization, total reimbursement may not exceed the contracted amount.
The intervention strategies will vary with the needs of the individual, the impediments to obtaining and maintaining employment, and the expectations of the employer. They should focus on issues related to fitting into the workforce and maintaining a job. For example, interventions might focus on problems of job performance and work skills, work behaviors, and related issues such as grooming, socializing, managing a paycheck, and banking.
In addition to job-site interventions, related services away from the job site may include assisting the trainee and his or her family to make any related changes in lifestyle or expectations needed to support the trainee's continued employment. This may include advocacy and benefits advisement. Job coaches should use any available community resource in meeting consumer needs as a means of assisting the individual in maintaining employment.
The service provider has the primary responsibility to ensure the quality and expertise of direct service staff assigned to deliver such services. Providers are encouraged to send staff to formal institutional training and/or design an appropriate structured in-house curriculum.
Supervisors should have or seek expertise in supported employment service delivery in order to provide appropriate guidance to staff who require ongoing supervision and support. Arrangements for supervision must take into account the fact that the majority of duties are performed away from the provider's central offices and in isolation from the informal collegial support of other staff.
Referrals to a Supported Employment program must address the reasons why the individual needs Supported Employment services.
The decision to accept a person into VESID or CBVH, and which program is most appropriate for that person, is made by the VESID/CBVH counselor along with the consumer. The VESID counselor uses the CaMS referral form when referring an individual to a Supported Employment program. A Supported Employment Provider or other source may refer a potential candidate for Supported Employment to VESID/CBVH. It is recommended that the referral be made on the VES-415, a form specific for this action; but, the referral may be submitted using another format. However, the following information must be included on any referral:
Upon receipt of a referral to the Supported Employment program, the provider should review the referral and accompanying documentation and ensure that the referral is correct, complete and appropriate. To do so, the provider will, at a minimum, need to: confirm that the individual has a disability they are contracted to serve, lives within a county they are contracted to serve for that disability, whether there is capacity remaining in their contract, whether (and with what funding source) the individual qualifies for extended funding, and whether sufficient extended funds remain to accept the individual into extended service when ready to transition. If any of these conditions are not satisfied, the VESID/CBVH counselor must be contacted before proceeding to ensure contractual and regulatory requirements are satisfied.
Receipt of a Supported Employment referral from VESID/CBVH does not constitute authorization to meet with the consumer nor to provide Supported Employment services, including any assessment of the individual. If the provider meets with or conducts an assessment of the individual at this point in time, as unauthorized services, there can be no payment. Once VESID/CBVH is notified that the program provider has accepted the individual, a written authorization is required in order for billable services to begin.
| Comment: The referral documentation must demonstrate that the individual meets the eligibility requirements for Supported Employment. A referral for the Supported Employment program must explain the employment impairments and the basis on which it has been determined that the individual will not be able to maintain a job without ongoing supports. These are essential elements to eligibility for Supported Employment and service delivery considerations. When a provider receives a referral, it must first determine that the necessary information is provided. |
The VESID/CBVH counselor makes the initial determination that an individual is appropriate for Supported Employment. Once this has been done and the individual has been placed into the Supported Employment program, if further observational assessments are necessary, they are considered part of Supported Employment services and must be community-based (situational) rather than facility-based (simulated).
In a situational assessment, the person's skills in relation to specific job duties and work behaviors are assessed in conjunction with the person’s ability to function in the community. The assessment should take into account the individual’s strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice, support needs, environmental preferences, and possible accommodations. Situational assessments should consider the following:
Once sufficient information has been obtained, the provider should prepare a written Individual Intensive Service Plan, which summarizes the relevant information, outlines the consumer's goals, and describes what intensive services will be provided to accomplish the goals. This service plan must be consistent with the VESID/CBVH documented goal. Any change in goal must be discussed with and approved by VESID/CBVH and the record must document approval of any change in goal. The service plan should provide the framework for how the job coach or other staff will assist this individual in achieving his/her employment goals. If the job goal is for other than an individual, integrated placement in the community, the plan must provide justification for placement in such a less-integrated setting.
Job Site and Worker Compatibility Analysis
This is a comparative evaluation of job analysis and individual assessment data to determine matches on key factors, such as transportation, motivation, physical skills, orientation and mobility, appearance, communication, social skills, work behavior skills, reinforcement needs, family supports, financial considerations, individual preferences and goals, etc. It may also serve to develop alternative strategies that might facilitate matches on important factors. All job development efforts are to be reported on the VES-416 report form.
Job placement refers to completing arrangements to start a worker at a particular job, including:
The record should document the potential for job advancement, and integration opportunities available. The worksite information is to be reported on the VES-416 report form.
Each consumer is to receive services in a continuous process leading to obtaining and maintaining community placement. Multiple services are provided during intensive training that may include:
This process must be reported in both the Interagency Supported Employment Reporting System (NYISER), and on the Intensive Training Progress Report Form (VES-416). The Intensive Training Progress Report (VES-416) must indicate what services were delivered in the areas of assessment, job development/placement, intensive training, stabilization, and retention of employment. The VES-416 report form must be submitted monthly until at least 90 days satisfactory employment following stabilization has been reported, or until it is reported that the individual has exited the Supported Employment program.
The VES-416 report form should include, as appropriate:
| Comment: It is important to make sure that this information is current especially at the time of transition to extended service; and, when reporting 90-day post stabilization retention of employment. |
| Comment: Providers should be aware that payment may only be made for direct services which have been provided. While report writing and travel to deliver service are allowed, it is important that they also be identified on the narrative as a service provided. Direct services are defined in the RFA for Supported Employment as the following:
|
The consumer should be transitioned from intensive service to the long-term funded extended service when stabilization on the job site has been achieved. Stability is that time when the individual's work performance plateaus, and the job coaching and related interventions have faded to the lowest level necessary to maintain the individual in employment. The determination that stability has been achieved must be clearly explained in the case documentation.
| Comment: Intensive service is a training process driven by the identified barriers and service needs of the individual with the goal of achieving stability in employment. These identified barriers and service needs should be articulated in the assessment information and the intensive service plan. The achievement of stability means that the individual has achieved a level of performance, adjustment and reliability, which has been observed over a period of time, such that all concerned parties (the individual, the service provider, the employer and VESID/CBVH) agree that with continued support the job is secure. The minimum period of time this must be observed is 3 consecutive weeks. Factors to be considered and addressed:
All parties must agree that so long as ongoing supports are provided, the job is secure. Employer satisfaction with the employee's job performance as well as consumer's satisfaction with the job and with support services provided should be assessed through a structured format as part of the process of determining that the job is secure and stability has been achieved. Case documentation must show the consideration of each of these factors and the agreement by all parties. While stabilization can occur within a broad range of interventions, it appears usually to occur with intervention needs at somewhere between 15% - 30%. It should be clearly understood, however, that while the percentage of intervention may show that the consumer has achieved increasing independence in performing the job, it is not sufficient in itself to determine that stabilization has occurred. The consumer is regarded as in training until stability is achieved. Employment begins with the transition to extended service. It is from this point that the count towards 90 days in employment begins. |
Supported Employment providers must also submit Monthly Supported Employment Status Reports to the VESID District Office. These reports should list new referrals received during the month, consumers on a waiting list, active consumers, and consumers who left intensive service in the previous month, stabilization and transition date, provider and funding source for extended service, and date of achievement of satisfactory employment for 90 days following transition, as applicable.
There are several purposes for documentation. Documentation should demonstrate that individuals obtain their Supported Employment services in a way that promotes consumer choice and maximizes their success in the employment setting. Documentation also substantiates that services are provided in compliance with applicable laws, policies, procedures, regulations, and contract requirements. It describes the quality, quantity, and effectiveness of services provided. It helps to identify and address individual and/or systemic program issues. It enables approval for payment of bills submitted under the authorization.
The following summarizes VESID's current documentation requirements:
| Service | Documentation | Why |
|---|---|---|
| Referral of individual to VESID for Supported Employment services | VES 415 | Indicates why person needs supported employment. |
| Authorization of Supported Employment Service | VESID/CBVH authorization | Authorizes provision of Supported Employment services (under contract). |
| Plan for Supported Employment intensive service | Provider developed Supported Employment Intensive Service Plan | Identifies pertinent issues to be dealt with, employment goal, rationale if not an individual placement in the community, services needed to achieve the goal, etc. |
| Comment: The case record should provide the basis to support the appropriateness of the service plan. | ||
| Job Development Job Placement Monthly progress |
VES 416 Report Form |
|
| Extended Service | Provider developed Supported Employment Extended Service Plan | Identifies:
|
| Monthly program status | Agreed upon format | Identifies:Identifies individuals entering, being served, or exiting contract during the month, and other information as required. |
| Individual's quarterly progress | NYISER | State Reporting database |
| Quarterly Narrative | NYISER | State Reporting database |
Providers must maintain internal documentation which should include copies of the above materials within the case records as well as:
For all individuals, there is an expectation of ongoing support services to maintain employment, with funding through Extended Service. Ongoing services are described by federal regulations:
From 34CFR361
(38) Ongoing support services, as used in the definition of "Supported Employment"
(i) Means services that are --
(A) Needed to support and maintain an individual with a most significant disability in Supported Employment;
(B) Identified based on a determination by the designated State unit of the individual's need as specified in an individualized plan for employment; and
(C) Furnished by the designated State unit from the time of job placement until transition to extended services, unless post-employment services are provided following transition, and thereafter by one or more extended services providers
throughout the individual's term of employment in a particular job placement or multiple placements if those placements are being provided under a program of transitional employment;
(ii) Must include an assessment of employment stability and provision of specific services or the coordination of services at or away from the worksite that are needed to maintain stability based on --
(A) At a minimum, twice-monthly monitoring at the worksite of each individual in Supported Employment; or
(B) If under specific circumstances, especially at the request of the individual, the individualized plan for employment provides for off-site monitoring, twice monthly meetings with the individual;
(iii) Consist of --
(A) Any particularized assessment supplementary to the comprehensive assessment of rehabilitation needs described in paragraph (b)(6)(ii) of this section;
(B) The provision of skilled job trainers who accompany the individual for intensive job skill training at the work site;
(C) Job development and training;
(D) Social skills training;
(E) Regular observation or supervision of the individual;
(F) Follow-up services including regular contact with the employers, the individuals, the parents, family members, guardians, advocates or authorized representatives of the individuals, and other suitable professional and informed advisors, in order to reinforce and stabilize the job placement;
(G) Facilitation of natural supports at the worksite;
(H) Any other service identified in the scope of vocational rehabilitation services for individuals, described in §361.48; or
(I) Any service similar to the foregoing services. (Authority: Sections 7(27) and 12(c) of the Act; 29 U.S.C. 705(27) and 709(c))
The intensity, frequency, and duration of interventions should be continually adjusted to meet the individual’s needs.
Extended services are the ongoing support services furnished by the provider once the individual has stabilized in employment. Extended services assist the individual to maintain, or in some cases, regain employment. This may often consist only of regular oversight of the consumer, and with contact with the employer regarding the consumer’s job functioning, in order to determine if and when more intensive services may be needed to retain the job due to fluctuations in the individual’s symptoms or other factors that may impinge on satisfactory job performance and retention. It is the expectation that needed interventions to resolve such difficulties and maintain employment – or in some instances to regain employment – will be provided as a part of the extended services.
Consistent with the required Extended Support Service Policy and regardless of the extended funding source, each worker placed under this program must be provided with an Individual Extended Service Plan, which includes the following basic information:
The plan must also describe what services are planned, who will be providing them, how they are funded, whom to contact if problems arise, and how to make direct contact to obtain help with those problems. The individual should sign the plan indicating agreement, and the record should document that the individual received a copy of the plan. Both the employer and the employee should be assured that help is available if a problem arises.
Funding for extended services is most often provided through the resources of other agencies (Office of Mental Retardation and Developmental Disabilities, Office of Mental Health Special Employment Programs, Community Support Services, business and industry, other private sources, etc.) or as appropriate through the VESID Extended Services Fund. Providers must work directly with the source of extended service funding to obtain such resources. No time limits are permitted for extended services.
Following transition to the long-term support, Extended Services will continue to include:
The VESID Extended Services Fund is intended to provide for ongoing support services to individuals who meet the criteria to be eligible for Supported Employment but who are ineligible for extended service from any other existing long-term funding source. Any provider having an intensive Supported Employment contract must also be an Extended Service Provider or have made provisions with another agency as described on the RFA and/or contract to provide extended services to their intensive service consumers. If it expected that VESID funding for extended services will be needed, the VESID District Office should be contacted as soon as this anticipated need is known.
It is the purpose of extended service to provide those interventions necessary to maintain the individual in the job, to restore stability when it begins to fail, and to replace an individual in a new job when a job is lost or when appropriate to career development. Ongoing meetings with the individual and monthly contacts with the employer are required for routine interventions, to monitor their work performance and adjustment, and to determine at the earliest time when destabilization appears to be occurring.
In the normal course of events there may be fluctuations in the amount of interventions a consumer requires. A number of factors could cause an individual to require a substantial increase in interventions in frequency and/or intensity in order to maintain or regain stability in the job and/or to explore employment alternatives. Examples of such factors include change of work duties, equipment or routine, change of supervisors or co-workers, change in residential status, medical problems, or the cyclical nature of the individual's disability, loss of the job, or the need to change jobs because of the individual’s disability.
When job stability has been lost, services that are necessary to restore stability in the current job or to place and stabilize in a new job should be provided under extended service. Post-employment services or intensive services should only be sought if it becomes evident (must be documented in the case record) that the time needed to address and resolve the issues will be beyond a reasonable period of time (longer than 12 weeks or more than 60 hours). In this circumstance, services should continue to be provided under extended service and VESID/CBVH should be contacted.
If the service needed for re-stabilization is a short-term discrete service (e.g. hearing aid, assistive device) that is not available through the extended service funding, or if the provider documents it is unable to provide the intensive services required for re-stabilization through extended service, the provider should confer with VESID/CBVH to determine if such services may appropriately be provided through a post-employment service or if it would be more appropriate for the consumer to return to VESID/CBVH authorized intensive service.
Many individuals in Supported Employment are experiencing their first opportunity for community work. In accordance with the principle that individuals have choices and may grow and develop when exposed to new opportunities and experiences, additional reinterventions may be provided to people who are substantially underemployed within their work environment. Supported Employment providers should strive to place (replace) individuals in employment situations suitable to their capacity, and that offer upward mobility or a career ladder, or provide services or other resources to individuals that will enable them to achieve full opportunity for personal growth and advancement in employment.
Case reopening by VESID/CBVH may be considered if the individual is determined by the VESID/CBVH counselor, in consultation with the consumer and provider, to be substantially underemployed because of his/her disability, and to require VESID/CBVH assistance to achieve appropriate employment. Such individuals must meet eligibility requirements for VESID/CBVH service as well as for Supported Employment. Case reopening may not be appropriate for those individuals who are functioning well on the job but desire a job change for reasons unrelated to their disability. Consideration should be given as to whether this is appropriate career development and if significant barriers consequent to the most significant disability are preventing such changes.
Seasonal employment may be considered as a supported employment outcome if it is based on the informed choice of the consumer as to employment alternatives, the reasonable expectation that the individual will be offered a similar position during the next employment season, and the expectation that the individual will work long enough (90 days minimum after transition) to be considered rehabilitated during the work season. These considerations must be clearly documented and the seasonal nature of the employment goal must have approval from VESID/CBVH. The Supported Employment provider will use extended service for the readjustment period in subsequent seasons.
If the consumer is placed into another job during the off-season, then extended funding may be used to maintain them in that job. Otherwise, if Supported Employment services are not being provided to maintain the individual in a job, then the consumer must be removed from extended funding until he/she resumes the seasonal job.
On-the-job trainings are not appropriate for supported employment consumers except under special circumstances such as the need for a specific technical skill that is required to be taught by the employer.
The following documents are available on VESID's Supported Employment website at: http://www.vesid.nysed.gov/supportedemployment/home.html or by contacting VESID at (518) 473-4818: