ARTICLE
Audio (MP3) Listen in New Window Presentation (PDF) Open in new window BRS Update VR Field Restructure • Restructuring plan has been submitted to address some long-standing challenges that have been identified, like: • Decrease in VR applicants; • Current VR staffing doesn’t allow sufficient capacity for VR C to provide quality counseling & guidance; • Current VR staffing doesn’t allow for capacity for outreach activities to increase referral base, including transition-aged students. • Consumer’s experience should be improved in order to obtain quality outcomes. • VR plans to add VR Case Coordinators to the area offices. • Case Coordinators will be proportionally distributed across our offices where we see the greatest need to meet the needs of consumers to balance caseload. • Nurse / Doctor relationship • Change of expectations of the VRCs. Supported Employment • Reexamining Supported Employment & VR’s ability to fund SE for up to 18 months • Unintended consequences of the current rate structure • SE should be used for those consumers with the most significant disability. • Activities should be defined to demonstrate support needs, fading of supports, and independence. • Transition to Extended Services Rate Reform • Workgroup assembled to review VR employment services and identify necessary changes, including modifications to RBF • In addition to workgroup input, BRS researched other state models, received input from VR staff, considered DDRS/BRS goals and priorities, and most importantly looked at the needs of consumers • Modifications to RBF are targeted for implementation no later than July 1, 2015. A Little History… RBF was fully implemented in 2006 • Major shift in how employment services were funded • Added structure, ease of administration, and outcome expectations • Two Tiers - required early severity determination by VRCs • ‘One-size fits all’ approach • Unintended consequences – insufficient discovery; system not responsive to all SE consumers; incentivizes speed over quality Prior to RBF employment services provided at hourly rate • SE consumers were able to obtain necessary ongoing supports before ‘stabilization’ and VR closure • Assessment services (i.e. CBE) were more frequently utilized • Number of hours varied per consumer/individualized system • Flaws – too little structure; minimal expectations for fading, not enough focus on outcomes Rate Reform Workgroup Values and Principles: • Serves persons with varying disabilities, including those with the most significant disabilities • Focuses on career pathways and development • Designed to be individualized, strength-based, and flexible • Responsive at the point of service delivery • An unsuccessful outcome does not necessarily result in elimination from services • Discovery process directs the employment path/plan/outcome • Promotes economic self-sufficiency • Emphasizes participation of the individual’s support network • Recognizes the need to support long-term employment outcomes What should be accomplished with Rate Reform? • System should be responsive to all, including SE consumer with high support needs as well as consumers with minimal support needs • Refocus on Discovery, especially for individuals with minimal/no prior work experience • Develop a mechanism for providing adequate ongoing support services • Retain a system that is not difficult to administer • Retain a system that focuses on outcomes, but also recognizes quality over quantity • Improve the consumer experience Rate Reform Strategies Specific Work Group Recommendations: • Eliminate 2 separate Tiers - have 1 ‘tier’ • Milestone payment rates should recognize that most of the work is done before 90 days/closure • Ensure consumers can access additional ‘enhanced services’ including discovery and ongoing support services • Re-name milestones to better reflect the activities that ought to be occurring, i.e. 90-day closure v. retention Additional Strategies: • Preserve 3 core milestones that are consistent for all, regardless of support needs • Fund discovery and ongoing support services outside of, and in addition to, RBF • Implement ongoing support and fading plans for consumers receiving Supported Employment • Re-engage the VRC in the employment services process (should not be a ‘handoff’) • Reduce financial incentive to quickly reach ‘stabilization’ and closure Proposed RBF Model 3 Core Milestones: • Milestone 1: Placement • Milestone 2: 30 Days Employed • Milestone 3: Retention • Discovery and Ongoing Support Services funded separate from, and in addition to, 3 RBF Milestones • Discovery may include: CBE, job shadowing, job trials, work experience, etc. Proposed RBF Model – Ongoing Support Services Ongoing Support Services paid at Tiered Rate • Monthly rate based on number of SE hours needed (BDDS SEFA rates) • Ongoing Support Services and Fading Plan is a new expectation for consumers in SE • Expectation of increased communication and check points between consumer, VRC and EC • SE/Ongoing support services may be funded by VR for up to 18 months after placement • Fading should occur before identification of ‘stabilization’ (i.e. consumer reaches ‘independence’) and transition to extended services as appropriate RBF Workflow • M1 Placement paid at 5 days - provider submits SE plan • M2 paid at 30 days of employment - provider submits ongoing support and fading plan for SE consumers • M2 supports 1 month (30 days) of ongoing support after placement (similar to current process) • When needed, supplemental ongoing support starts at month 2 and continues until individual reaches most independent level/stabilization (up to 18 months). • VRC authorizes appropriate ongoing support in line with ongoing support/fading plan • Revisit plan at regular intervals and adjust as necessary; make a team decision regarding stabilization • M3 Retention paid after 90 days of employment (or 90 days after stabilization for SE) • For consumers receiving SE, once stabilization has been achieved and fading has reduced as appropriate, retention milestone will be authorized Discovery • Discovery includes necessary assessment activities to identify an appropriate job goal and services needed to achieve that goal, i.e. job trials, work experiences, job shadowing, interview preparation, CBE’s, etc. • Based on provided data, as well as sample scenarios, an average of about 20 hours is spent in current RBF Milestone 1 model. Ongoing Support • SE will be taken out of the milestone payments and be paid on an individual basis based on a consumer’s (with the most significant disability) need. • SE should be activity focused. • It is expected that SE hours will fade until the individual is at his/her most independent level (i.e., stabilization). Once stable, the 90-day retention payment is authorized. Summary • The proposed RBF model results in significant systems change • Extensive training will be necessary • Changes are driven by consumer need • Adequate discovery • Access to ongoing support services • More VRC engagement • More individualized process and more responsive to individuals with all levels of support needs • Individuals receive adequate supports before VR closure (reduces incentive for quick stabilization and closure) Comments • Additional comments can be sent to Theresa.Koleszar@fssa.in.gov • Comments received by September 26, 2014 would be appreciated