1. Building Partnerships to Expand Employment: Massachusetts DMR & the MICEO
John Butterworth
June 2007

2. MICEO
Collaboration between EOHHS, the University of Massachusetts Medical School and UMass Boston.
Focus on Medicaid infrastructure & the infrastructure needed to support employment
Goal is to improve employment services and outcomes for individuals with disabilities in Massachusetts who want to work.

3. MICEO Major Components
Medicaid Infrastructure Development
Comprehensive Employment Opportunities Infrastructure Development

4. Comprehensive Employment Opportunities (CEO)
Develop consistent state-wide strategies and policies that communicate a clear message of work as a valued outcome & result in seamless coordination of supports across state agencies on an individual level
Enhanced choice and self-direction of services and supports by providing ready access to information that helps identify and choose supports that make it possible to work

5. CEO…. (continued)
Enhanced capacity of the service system at the direct support level to provide a coordinated array of employment-related supports
Access to health care services and information for individuals with disabilities and support providers at all levels of the service system to ensure integration between health-related and employment supports

6. Major Project Areas EOHHS Policy Analysis and Development
Consumer Advocacy, Outreach and Training
Employer Outreach and Training
Employment Provider Outreach and Training
Clinical Provider Outreach and Training

7. Grant Leadership Team 7 representatives from disability community
State agencies VR
Department of Transitional Assistance
Massachusetts Commission for the Blind
Department of Workforce Development
Department of Mental Retardation
Department of Mental Health
Office of Medicaid

8. Sample Projects Snapshot Report Employment & Disability Summit
Mission Employment
MassWorks.org
ForEmployers.com
MassCHEC.org

9. SEE-Technical Assistance Project
DMR Technical Assistance Project
Peer Employment Benefits Network
EOHHS Task Force on Employment
Employment Standards Subcommittee
Employer Subcommittee

10. Research Analysis of MassHealth administrative data
Surveys of MassHealth members
Evaluations of specific EOHHS agencies to enhance service delivery
Outcome data reporting by state agencies providing employment services
Focus groups with MassHealth members
Interviews with key informants for policy analysis

11. DMR Employment Services Strategic Task Force Initiative
DMR Goal to Improve Employment Opportunities & Outcomes
Commissioner Priority
Identified by Statewide & Regional Quality Councils as Priority
Develop a Strategic Plan to Re-Design Employment/Day Services
Create Framework for Re-Procurement of Services in Fall for FY 2009

12. US Employment & Day Supports
Similarly, in the DD system, following the burst of movement during the early years of supported employment…
ICI CRP Survey 2003

13. MA Employment & Day Supports

14. State success in integrated employment varies widely
But… We know its possible.
Individual providers and states do much better
A substantial number of providers only support community employment now, including several who will speak
Percent supported in integrated employment by state MRDD Agencies – 2004
Source: ICI MR/DD Agency Survey

15. Charge – Statewide Employment Solutions Team
Develop an Employment Strategic Plan to improve employment outcomes
Develop recommendations to re-design employment/day services & build capacity
Inform planning and framework for re-procurement of services (RFR) for FY 2008

16. Who Is Involved? Statewide Employment Task Force
Regional Employment Solutions Teams
SELN

17. Capacity Building Activities
TA to community providers
Build capacity
Modify practices
TA to individuals
Address policy and practice barriers
Direct service staff training
5-day curriculum for direct support professionals

18. Key Activities of Statewide Team
Current Picture: Employment & day services
National Trends & Features of HP States
ID Strengths & Barriers in existing system
Discussed services & supports needed in “ideal” system for all adults
Created four Working Groups
Consulted with other states

19. Statewide Employment Solutions Team
Work groups on key issues
Work First
Contracts and Rate Structures
Day Supervision
Building Capacity

20. Regional Employment Solutions Teams
Focus varies by region
Training for providers (Southeast)
Career assessment strategy (Metro)
Transportation (Central/West)
North Shore Pilot Project (Northeast)
Interface between regional teams and statewide team informs the work of both
Selected individuals & agencies to receive TA

21. “System-Wide” Influences
Re-design of DMR’s Medicaid Waiver Program
Service definitions; Provider Choice; Portability; Participant- Direction
Transition Planning/Turning 22
Implementation of MASSCAP:
Identify needs & priority for services
EOHHS Joint Employment Procurement

22. Baseline: Number Participating by Activity
Over 5400 individuals in employment
Over 600 additional individuals in other services

23. 363
Individuals began work in a new individual job May 2005 through April 2006

24. Mean Hours Worked per Month
Over 5400 individuals in employment
Over 600 additional individuals in other services

25. Mean Monthly Wage DMR 2005 Over 5400 individuals in employment
Over 600 additional individuals in other services
DMR 2005

26. Percent Earning Minimum Wage
Over 5400 individuals in employment
Over 600 additional individuals in other services

27. DMR Percent in Individual Jobs by Provider
Over 5400 individuals in employment
Over 600 additional individuals in other services

28. How We Are Using The Data
Statewide & Regional Summaries & Trends
Provider Reports: Summaries & Trends
Comparison to State & Regional averages
Trends by Specific Variables
Website: Multiple Reports & Data Displays
Education: Staff; Providers: Consumers

32. Provider Name
Provider
Provider
Provider

33. Provider 1
Provider 2
Provider 3
Provider 4
Provider 5
Provider 6
Provider 7
Provider 8
Provider 9
Provider 10

34. Proposed Major Recommendations
Develop & Adopt an “Employment First” Policy
Re-design & Re-Structure Employment Services & Contracts
Development of standardized rates for services
Transportation Planning & Funding
Strategic Focus on Transition-Age Youth

35. Separation of work and day supports
Education & Promotion about Values & Benefits of Employment
Capacity Development of Employment Provider Network
Collaboration with EOHHS Agencies & Workforce System
Comprehensive Approach to Training & Professional Development within DMR

36. John Butterworth
(617)

39. Xxx

40. Develop & Adopt an “Employment First” Policy
Starts with a presumption of employability for working age adults
Will require:
Cultural shift in expectations
Consistent communication of “pro-work” message
Integrated into all aspects of service planning and delivery

41. Re-design & Re-Structure Employment Services & Contracts
Unbundle integrated employment from facility/center-based work
Review & clarify service definitions with specific quality standards
Use of community-based day service options to supplement job if needed
Promote participant-directed options
Flexible allocation of resources to support choice in services & providers

42. Development of standardized rates for services
Individual integrated employment as separate funding category
Rates based on adequate pay scales for staff
Flexibility to enable movement from sheltered or group to indiv. employment
Availability of risk pool to respond to job loss or change in support needs

43. Transportation Planning & Funding
Different approaches based on type of employment service
Transportation to a job needs to be integral part of job development process
Prioritize use of public & personal transportation alternatives
Development of cost allocation standards
Collaboration with HST and RTA’s

44. Strategic Focus on Transition-Age Youth
Facilitate and support direct movement into employment
Transition planning needs to be more career-focused
Education & training for families & youth
Partnerships with schools
Partnership with workforce system
Expand job experiences during high school years

45. Separation of work and day supports
Consistent approach to assessment of support needs & requirement of structured day program- “day supervision”
Increase number of hours individuals are working
Access to more flexible ‘alternative day’ supports
Collaboration with residential staff

46. Education & Promotion about Values & Benefits of Employment
For all stakeholders
Consumer friendly information & resource materials with pro-work message
Develop “Guide to Employment Services”
Information on service options & costs
Resources for benefit planning
Share employment outcome data

47. Capacity Development of Employment Provider Network
Comprehensive training offered/required for all front-line staff
Professional development opportunities
Provision of technical assistance
Address the diverse needs of the work force
Develop career pathways
Community colleges; Continuing education

48. Comprehensive Approach to Training & Professional Development
DMR Service Coordinators and AO staff
Quality employment services; customized employment; impact on benefits..
Integration & collaboration with residential & other non-employment service providers
Integrate into orientation – values; role in supporting work; problem-solving;

49. Collaboration with EOHHS Agencies & Workforce System
Partnership with MRC
Access & collaboration with Career Centers
Expanded use of other training resources & supports: for example- Benefits planners