1. Employment First: Waiting on the World to Change Texas Transition Conference February 19, 2015

2. Integrated Employment Choice? Expectation?

3. Why Is Work Important?  Our culture expects people to be productive  Considered a means for gaining status, self definition and achievement of personal goals  Tied to various aspects of status: Possessions Prestige Power Control Influence

4. Public Policy Changes Changes in Expectations Innovations in Practice Movement to Increase Integrated Employmen t

5. Public Policy Changes  Americans with Disabilities Act (1990)  Individuals with Disabilities Education Act (IDEA) – integration, inclusion, increased emphasis on transition and employment  Ticket to Work and Work Incentive Improvements Act (1998)  Workforce Investment Act (1998) – emphasis on disability  Olmstead Decision (1999)  Changes in RSA Regulations: successful employment outcome must be in integrated setting (2001)  CMS: New suggested Medicaid Waiver service definitions emphasizing community employment (2011)

6. Changes in Expectations  Individuals with the most complex disabilities working successfully  Disability no longer seen as insurmountable barrier to employment  Expectations are changing  Individuals and families  Public systems & policymakers  Schools  Society

7. Innovations In Practice  Movement from medical model to social model  Mid 1980’s – Emergence of supported employment  “Train & Place” transformed to “Place & Train”  1990’s – Expanded use of “natural supports”  Mental health – employment as part of recovery  Ongoing innovation and expansion in use of accommodations and assistive technology  Innovations in transition practices focused on employment  Self-determination and self-direction  Changing workforce & workplace – flexible, more diverse, evolving use of technology  Universal Design

8. Yet despite efforts over the past two decades, employment participation of people with disabilities remains stagnant. Laura Owens, 20138

9. Insanity: doing the same thing over and over again and expecting different results. ~Albert Einstein

10. Changing highly ingrained culture and beliefs regarding employment of people with disabilities

11. 1601 Elizabethan Poor Laws  Enacted to aid the “deserving poor, orphaned, and crippled”.  People with disabilities labeled as “helpless poor” entitled to money and food from society, paid for through a tax on land owners

12. 1750 Act Passed by New England Colony of Connecticut  People with disabilities should be cared for by their closest relative. If such a person had no relative then the town or the colony itself took direct responsibility.

13. Paradigm Shift System versus Person-Centered System Disability In person Classify/Place/Train Professional Deficits – cannot do Dependence Person Centered Society Systems/Environments Educate/Empower Individual/support team Interests/Strengths – can do Interdependence What is the “problem”? Where is the “problem”? What is solution? Who is in charge/decision maker? Information focus? Outcome?

14. Social Model of Disability  Problems faced by people with disabilities arise primarily from social and societal forces rather than individual’s disability.  Access to full society resources, not individual “repair”, are key to success.

15. But the Medical Model is Still Very Much with Us… Individuals with Disabilities Families Service Providers

16. “There is nothing wrong with change if it’s in the right direction.” - Winston Churchill “All progress occurs because people dare to be different.” - Harry Millner “The key to change… is to let go of fear.” - Susanne Cash “The secret to change is to focus all your energy not on fighting the old, but on building the new.” -Socrates “Change is Good. You go first.” -Dilbert

17. Reinhold Niebuhr “Every time I find the meaning of life, they change it.”

18. Employment First: What Is It? General theme: Employment in the community is the first/primary service option for individuals with disabilities APSE Statement on Employment First Employment in the general workforce is the first and preferred outcome in the provision of publicly funded services for all working age citizens with disabilities, regardless of level of disability.

19.  Promoting a national conversation on employment  Spurring a national movement  Spreading across the country Employment First: Why It’s Important

20.  Employment as first priority  Broadly focused on all aspects of system  May begin in the grassroots, ultimately must be adopted and implemented by the system  Primary focus is not on eliminating facility-based services but on increasing integrated employment Employment First: Why It’s Different

21. Employment First IS NOT Employment First IS A clear public policy of employment as the first and preferred option for individuals receiving publicly funded services. Policies, practices, and resource allocation that prioritize employment in the general workforce. A type of service strategy. Just promotion of best practices.

22. It’s A Time of Enormous Opportunity

23. Employment First Movement now in 45+ States 29 States with an Official Policy Employment First

24. National Governor’s Association Initiatives

25. Senate HELP Committee Report Increase employment of people with disabilities by over 1 million by 2015

26. CMS Bulletin Highlights and provides guidance for implementation of CMS’s goal to promote integrated employment options through Medicaid waiver program

27. Federal Hiring Increased efforts by federal government to hire people with disabilities under “Schedule A”. February 2013 rules eliminated need for certification of “job readiness”.

28. Federal Contractor Obligations Stronger enforcement of requirements for federal contractors in employment of PWD. Stronger rules went into effect in March 2014.

29. National Disability Rights Network: “Segregated & Exploited” 2011 & 2012 reports stating that service system has failed in providing quality employment services and supports

30. National Council on Disability Report Federal Agency calling for phase out sub- minimum wage as part of overall systems change Make fundamental changes in transition

31. Oregon Lawsuit Claims placement in sheltered workshop is violation of ADA US Dept. of Justice is now a plaintiff in this suit

32. Requirements for expanding community employment increasingly part of settlement agreements with states

33. Federal Agency Investments to Incentivize Systems Transformation Administration on Intellectual and Developmental Disabilities  Partnerships in Employment Systems Change SSA, OSEP, HHS, DOL  Promoting Readiness of Minors in Supplemental Security Income (PROMISE) Office of Disability Employment Policy at the Department of Labor (ODEP)  EFSLMP Office of U.S. Special Education & Rehabilitative Services  Customized Employment Funding Strategies expanded in several state VR systems Centers for Medicare & Medicaid Services (CMS)  Federal Improvements to Medicaid Community First Choice Option Balancing Incentives Program and Money Follows the Person

34. It’s A Time of Enormous Challenge

35. Increasing scrutiny of services and outcomes

36. Growing Social Security Disability Roles (SSI & SSDI) Congressional Research Service: SSDI Trust Fund will Run Out in 2016

37. Short and Long- Term Fiscal Challenges at State & Federal Level

38. “A pessimist sees the difficulty in every opportunity. An optimist sees the opportunity in every difficulty.” ~Winston Churchill

39. Money Matters….and Drives Practice

40. Which is More Cost-Effective: SE or SW (Cimera, 2011)  Cumulative CostsSE: $18,813 SW: $46,855  Cost per Hr. WorkedSE: $11.88 SW: $17.12  Cost per Dollar EarnedSE: $2.02 SW: $9.39

41. Percent of Total Program Costs Cimera (2008)

42. Sheltered Work Prior to SE No Sheltered Workshop  Weekly Earnings: $137.20  Cost (sample): $4,543*  Cost (employed): $5,399* From Sheltered Employment  Weekly Earnings: $118.55  Cost (sample): $7,895  Cost (employed): $8,659 Source: Cimera (2011)

43. SE makes economic sense Regardless of disability or severity, SE costs less than SW  SE: $6,619  SW: $19,388 SE is more cost-efficient to taxpayers  SE: 1.21  SW: 0.83 SE is more cost-efficient to workers  SE: 4.20  SW: 0.24 Cimera, R. (2007, 2008, 2009, 2010)

44. Employment in the community cannot be viewed as an “add on” or something extra. It must be viewed by EVERYONE as a core component of the service delivery system.

45. Employment First: Where are we headed?  Individuals with complex disabilities fully accepted and supported in the general workforce  Individuals with disabilities expected to go to work  Major evolution of service delivery system  End of the “guarantee” 9-3 day program  Individuals with disabilities increasingly part of the economic mainstream  Individuals with disabilities making full use of their skills and abilities

46. We believe…  That all individuals can and should be contributing members in their communities  That everyone deserves the opportunity to find and develop their passions and interests  That local economies benefit from individuals who purchase good and services…And pay taxes  That individuals with disabilities, families, employers, employment agencies, schools, and entire communities CAN come together to include individuals with disabilities in all aspects of life

47. The Future of Employment First is YOU!

48. Thank You! Laura Owens, Ph.D., CESP 414-581-3032 lowens@transcen.org www.transcen.org