Publications: Best Vocational Practices
Best Vocational Practices
The purpose of this paper is to state the position of the North Carolina Association of Rehabilitation Facilities (NCARF) on best vocational practices. NCARF is the professional association for Community Rehabilitation Programs (CRPs) in North Carolina which currently provides Adult Developmental Vocational Program (ADVP services, supported employment (SE) services, Vocational Evaluation services, and Work Adjustment Training services to over 10,000 citizens with disabilities and/or other barriers to employment. (link coming soon)
While self-determination, evidenced-based services, supported employment, community-based services, informed consumer choice, and person-centered planning are all components of service delivery that are considered best practices and require a wide array of services that take into consideration all of the above, there are times these methods would appear to be oppositional to one another. For instance, if a person with a disability has had the opportunity to work in the community and chooses to work in a sheltered setting, then consumer choice runs contrary to community-based services and supported employment.
When we eliminate any service, then we limit choices to what the experts deem appropriate and not what the consumer deems desirable. This creates a major dilemma for service providers who desire to offer services that are best practice, but also meet the consumer need at a reasonable cost. Currently, reimbursement is dictated by service subsidies that do not cover the actual cost of providing services.
NCARF sees best practices as an array of services designed to meet the varying needs and desires of people with a broad range of capabilities in the most integrative work setting possible.
Community Rehabilitation Programs (CRPs) are agencies that offer many different kinds of vocational services to persons with many different kinds of disabilities. These services include sheltered employment settings, affirmative enterprises, supported employment and job placement in the community with no long-term support.
Many CRPs have workers without disabilities who work beside consumers doing production work. The ratio of non-disabled workers to disabled workers may be greater than 50 percent. Some CRPs have mechanized their production operations to the point that their plants operate as and compete with companies manufacturing similar products. In the rural parts of our State, many CRPs are among the largest employers in the area. In those CRPs that have affirmative enterprises, consumers work in an integrative setting, receive fringe benefits and make above industry-accepted prevailing wages, usually in a full-time employment status.
Some CRPs have contracts or arrangements with local school systems that provide school-to-work transition programs. These students transition directly from school into the work force with a reduced need for services. Other CRPs have developed retirement programs for senior consumers. Some CRPs have developed day services for consumers for whom work services are inappropriate. Many of these activities take place in the community.
CRPs have used the ADVP environment as CRPs have developed strong supported employment services. Ninety-five percent of all supported employment is provided by CRPs. This is indicative of CRPs strong endorsement of supported employment. The necessary long-term support and follow-up services are generally funded through the CRP’s production efforts.
The North Carolina Division of Vocational Rehabilitation is funding the up-front cost of supported employment, evaluation and work adjustment training, which includes community job placement for individuals with no long-term support needs. The Division of MH/DD/SA Services is funding a portion of the affirmative enterprise, sheltered work and presumably long-term support for those persons in supported employment. The source of funding for these services is ADVP.
Over 10,000 consumers receive ADVP services. We are currently being reimbursed at about 60 percent of the cost of services. The rest of the funds come from agency-generated production revenue. The bulk of that revenue is from the contract work performed in our agencies. This contract work provides employment and earning opportunities for those who are working in the agencies and offers training as well as temporary employment for those who will be working in the community.
It should be recognized that profits from the contract work pay for at least a portion of the in-house services that are not reimbursed, but this source of funding is not available for those consumers who work in the community and need long-term support.
- The most integrative service that CRPs offer is that of community placement with no long-term supports, but for the most severely disabled, this service does not allow for success. The next most integrative service is the individual placement model of supported employment (SE). Next is the group model of SE. These services offer the greatest chance for success, but many barriers exist that hamper full development of SE.
- One-half of the equation for successful service delivery of SE is one over which agencies have no control - the economy and unemployment rate. If the economy is good and unemployment is low then placements are much easier to make. When the economy is bad, placements are harder to make and as companies downsize, people with disabilities may be the first to get their hours cut and/or be laid off.
- Group homes have no incentives and many disincentives to having residents work in the community. It is much easier and economically feasible for their residents to work the traditional workweek offered by ADVP than to work afternoon or evening shifts with weekend work in the community. Special Assistance rules cut funding that pays for housing at a rate of more than a dollar for dollar earned. There is also the issue of providing transportation for those who live in rural areas and supervision for the hours they may be at home during the day.
ICF-MR rules make community work nearly impossible for that population. The need for constant programming and supervision rule out a realistic supported employment approach.
There are attitudinal barriers that must be addressed for parents, consumers and service providers. Many parents do not want their adult children in the community. If the consumer still lives at home and the parents work, then a job in the community may be a frightening option. The job may not last and the hours may leave the consumer with unsupervised time. Many families and other care providers rely on ADVP to provide daily respite from care provision for loved ones. Consumers that have not had the chance to experience community employment are afraid to leave their peers and the familiar work situation. If service providers (particularly in rural areas) do not do a good job, huge gaps may be created in the social life of consumers. In many areas of the State, jobs are seasonal and based on tourism, agriculture or the commercial fishing industry. This fluctuation in the need for employees creates significant problems for individuals who need constancy in their lives.
- We do not really know much on a statewide basis about the need for services or the desires of consumers or their satisfaction or dissatisfaction with current services. The Division has failed to provide a way to assess this with any accuracy. We do not know how many consumers are receiving services nor do we have completely accurate waiting list numbers. Each LME/Area Authority counts consumers differently. For example, some CRPs count each unfunded consumer they are serving as waiting for services while other CRPs count only those sitting at home. CRPs do not report the number of long-term follow up hours they provide supported employee consumers because they are not paid for it. Some report it to their LME but the LME fails to report it to the State.
In addition to being at a 60 percent level of funding for enrolled consumers, CRPs are providing vocational services to consumers who have no funding. For many years CRPs had a policy of not turning anybody away from services. Now profit margins on contract work are much smaller and the percentage paid by the State is less. It is no longer economically feasible for CRPs to exercise that option.
CRPs have a long history of providing vocational options for persons with disabilities. Creativity and innovations have been hallmarks of the programs. We were first to provide and continue to provide supported employment and have advocated for funding for that program for years. We provide the service even though no funding is available for long-term support. When unemployment went up and funding went down, many CRPs responded by creating their own businesses that would employ consumers.
Following are suggestions for overcoming some of these barriers:
- Develop a strong working relationship with the school systems and provide for comprehensive transition services beginning at age 16. CRPs are in a unique position to do this. Many already have a relationship established with the school systems and all have a relationship with the business community. The occupational diploma is a new tool that can be used to gain an audience with schools. If efforts are put into providing excellent transition services, most of the issues we are grappling with today will not exist in ten years. But, as Dr. Visingardi acknowledged on page 6 of his recent Communication Bulletin #005, “a small percentage of consumers will continue to require intensive, high cost, facility-based services…”. He was referring to consumers who are in institutions, but we believe the same truth applies to consumers who are being served in CRPs and ADVP centers.
- Fully fund existing services so that CRPs are not so dependent upon sub-contract production income and can truly focus on the provision of community-based services.
- Plan for transition into community services in a methodical way that provides for removal of the barriers.
- Develop a system of data collection that reflects the real picture of vocational services in the State.
- Provide technical assistance to CRPs in maximizing available resources.
- Do away with excessive paperwork and billing requirements that increase the cost of service delivery.
- Work with the Department of Aging to develop a plan for transitioning seniors into age-appropriate services.
- Assure that funding options such as CBS services are available for vocational services just as they are for residential services.
By working together, the Division of MH/DD/SA Services, CRPs and consumers can determine what the desired services are and then meet that need in an efficient and effective way.
Adopted by the NCARF Board of Directors February 13, 2003