1. Prior to developing an Individualized Plan for Employment for Supported Employment a meeting is convened to include the Vocational Rehabilitation Specialist, the person for whom Supported Employment is being considered, parent or legal guardian if appropriate, the DHHS Service Coordinator, and a representative for the prospective service provider. If a face-to-face meeting is not feasible a conference call is acceptable. The purpose of the meeting is to:

   • Agree on supported employment as an appropriate employment outcome for the person’s Individualized Plan for Employment.
   • Agree on necessary specific supported employment services and include in the person’s Individualized Plan for Employment. Also include the expected extended services needed, and the source(s) of the extended services (or the reason for believing that the sources will become available to the person). If appropriate for the person, include an hours per week work goal to be achieved by the time of transition to extended services.
   • Assist the person to make an informed choice of service provider(s).

2. Make necessary arrangements and authorizations for services. Cost not to exceed the Supported Employment Fee Schedule Appendix C or other approved written agreement. When using Appendix D the milestone payment is based on the average number of hours worked per week during the month prior to achieving the milestone. Payment can move up or down in payment schedule if client works more or less hours than originally planned.
3. Review and evaluate progress according to the schedule in the person’s Individualized Plan for Employment. Record results in the service record. Modify, terminate, or continue services as needed.
4. As the person approaches or reaches stable job performance, reassess the need for extended and post-employment services. Amend the person’s Individualized Plan for Employment if necessary.
5. Make arrangements for transition to extended services.
6. Evaluate progress in extended services for at least 90 days to assure that the services are available and that a stable job performance is being maintained.
7. Prior to determining the person rehabilitated VR staff will complete an employment assessment to determine the employer is satisfied with the person's job performance and the person is satisfied with the job. This employment assessment will include personal contact with the client. If it has been determined direct contact by VR staff will be disturbing for the person, personal contact will include the client's service provider in a face-to-face meeting or conference call. If appropriate determine the person rehabilitated.
8. Update the extended services provider and social security information per the instructions found in “Easter Seals and Outsource EW Monitoring of Supported Employment Cases.”

Supported Employment Report Guidelines – Other than persons with Mental Illness

1. Initiate Services – No report is necessary. Service Provider needs to be aware that:

   • Date of initiated services should not be prior to the beginning date listed on the VR Service Authorization.
   • Person must have signed an Individualized Plan for Employment (IPE) with VR prior to services being initiated.

2. Start Job – Verbal or written report is required. At a minimum the report should include:

   • Name, address, and telephone number of business where person is employed.
   • Name of immediate Supervisor.
   • Job title and duties.
   • Work schedule, wages, and benefits.

3. 30 Days – Written report is required. At a minimum the report should include:

   • Average hours worked per week for previous four weeks on the job.
   • Average intervention hours per week for previous four weeks on the job.
   • Brief narrative describing progress on the job.

4. Stabilization – Written report is required. At a minimum the report should include:

   • Average hours worked per week for the previous four weeks prior to achieving stabilization.
   • Average intervention hours per week for the previous four weeks prior to achieving stabilization.
   • Brief narrative describing stabilization.

5. 90 Day Post Stabilization – Written report is required. At a minimum the report should include:

   • Average hours worked per week for four weeks prior to achieving milestone.
   • Average intervention hours per week for four weeks prior to achieving milestone.
   • Brief narrative describing progress on the job including statement of employer’s satisfaction with performance and person’s satisfaction with the job.
   • Update information on wages, benefits, job title, duties, and Supervisor.

6. 180 Day Post Stabilization – Written report is required. At a minimum the report should include:

   • Average hours worked per week for four weeks prior to achieving milestone.
   • Average intervention hours per week for four weeks prior to achieving milestone.
   • Brief narrative describing progress on the job.

7. 270 Day Post Stabilization – Written report is required. At a minimum the report should include:

   • Average hours worked per week for four weeks prior to achieving milestone.
   • Average intervention hours per week for four weeks prior to achieving milestone.
   • Brief narrative describing progress on the job.

General Requirements

1. Supported employment services are intended for those individuals for whom, because the severity of his/her disabilities, competitive employment has not been achieved, or has been intermittent or interrupted, and who will need continuing support to maintain integrated competitive employment.
2. The concept of “place and train” is central to supported employment. The individual is placed into an integrated competitive employment setting, and then provided with the necessary training and other supports and services needed to acquire job performance skills.
3. The primary role of vocational rehabilitation in supported employment is to provide the initial training and other supports and services needed to achieve stable job performance. Other agencies, organizations, and individuals (including natural supports at the workplace or in the community) have the primary role of providing the extended continuing services needed to maintain the employment and stable job performance.
4. The Nebraska VR program goal of economic self sufficiency should be emphasized from the outset with the client, his or her family, and potential service providers. The goal is expected monthly earnings equal to or greater than the current Substantial Gainful Activity [SGA] amount determined by the Social Security Administration, with the same benefits (worker’s compensation, paid holidays, paid vacations, paid sick time, health insurance, etc.) provided by the employer to individuals who are not disabled.

Requirements for all placements

Integrated setting

An integrated setting means a setting typically found in community competitive employment in which individuals with disabilities interact with non-disabled individuals (other than those who are providing services to them) to the same extent that non-disabled individuals in comparable positions interact with other individuals.

Earnings

1. The client must be compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals who are not disabled, at the time of transition to extended services.
2. Any limitations in the client‘s work hours or level of pay must result directly from disability-related impediments that cannot be overcome by services.
3. Benefits include worker's compensation, paid holidays, paid vacations, paid sick time, health insurance, etc.. The client must receive the same benefits as are available to any other employee of the company or service provider (when the service provider is the employer).

Nature and scope of services

Supported employment services may include—

1. Assessment of supported employment service needs

   • This is a specialized functional assessment that is supplemental to the comprehensive assessment of rehabilitation needs and not available from other sources. It is conducted at integrated work settings in competitive employment, for one or more of the following purposes —

     • determine the most suitable supported employment placement for a client
     • determine the client’s need for specific supported employment services, and the nature and scope of those services
     • determine the need for rehabilitation technology as an on-site support service
     • determine the effects of the client’s physical or mental impairments on the functional capacities necessary to perform work in supported employment
     • determine an hours-per-week work goal that will maximize the client’s vocational potential at the time of transition to extended services.

2. Job placement in integrated competitive employment

   • This service leads to placement in an integrated work setting in competitive employment for the maximum number of hours possible based on the unique strengths, resources, interests, concerns, abilities, and capabilities of an individual with the most significant disabilities. This service is provided only in connection with integrated competitive employment placements. It is not provided in connection with enclave, work crew, or transitional employment placements in pre-determined work settings.
   • The job placement service includes only those activities directly related to obtaining a suitable job placement for the client such as:

     • job development,
     • accompanying the client to job interviews,
     • assistance with completing application forms, and
     • accompanying the client to required medical exams and drug screening tests.

3. Job analysis and intensive on-the-job skills training at the work site

   • This supported employment service leads to stable job performance in the job placement. It includes—

     • Job analysis of the work to be performed, and the employer’s performance expectations and requirements.
     • Provision of intensive skill teaching and instruction, and intensive behavior management, in accordance with a written plan, to enable the client to acquire skills and master the work to be performed, to regulate behavior in accordance with the employer’s requirements and expectations, and achieve stable job performance.
     • Systematic reduction of intensive skill teaching, instruction, and behavior management services to the lowest intervention level necessary to maintain stable job performance.

4. Other services at or away from the work site

   • These are other services contributing to stable job performance. These services may be provided at the work site, the client’s residence, or other community location. These services are specific to the actual job situation and are necessary to assure success. When the client has need for these services, they are obtained from the provider and are included in the milestone payment schedule. Examples include—

     • Development of natural supports This supported employment service is intended to develop natural supports (e.g., coworkers) who will reinforce and maintain stable job performance after the transition to extended services.
     • Job retention services until transition to extended services These services are intended to reinforce and stabilize the job placement through regular contact with employers; the client with the most significant disabilities; the client’s parents, guardians or other representatives; and with other professional and informed advisors of the client. Job retention services are provided between the time the client is placed in employment and his or her transition to extended services, when VR funding ends.
     • Other training and related services This includes other training and related services contributing to employment and stable job performance. These services may be provided at the work site, the client’s residence, or other community location. Examples include, but are not limited to, grooming and hygiene training, transportation training, resume development, mock interviews, and similar training and related services.

Conditions and Criteria

1. Eligibility

   • An individual is eligible to receive supported employment services if:

     • The individual is eligible for vocational rehabilitation services;
     • The individual is determined to be a individual with a most significant disability (Priority Group One); and
     • A comprehensive assessment of rehabilitation needs of the individual, including an evaluation of the rehabilitation, career, and job needs, identifies supported employment as the appropriate rehabilitation objective for the individual.

2. Rehabilitation plan for supported employment

   • For each client for whom an employment goal of supported employment is appropriate, the Individualized Plan for Employment must include—

     • A description of the supported employment services to be provided, not to exceed 18 months in duration (unless a longer period to achieve job stabilization is established in the Individualized Plan for Employment).
     • A description of the extended services needed, and identification of the source of extended services (including natural supports) or, if the identification of the source is not possible at the time the Individualized Plan for Employment is developed, a statement explaining the basis for concluding that there is a reasonable expectation that the sources will become available.
     • If appropriate, a weekly work requirement to be met by the time of transition to extended services.

   • Move the client into Milestone: Services Initiated and Activity: VR Services until the he/she achieves stabilization.

3. Duration of services

   • Supported employment services are provided until the client achieves stable job performance and is transitioned to extended services, or for a period of time not to exceed 18 months. Under special circumstances, where there is joint agreement that additional time is needed to achieve the client’s identified rehabilitation objectives, a longer period of time can be stated in the client’s Individualized Plan for Employment.

4. Hours of work

   • Placement in an integrated work setting must be for the maximum number of hours possible based on the unique strengths, resources, interests, concerns, abilities, and capabilities of the person. If appropriate for the person, the Individualized Plan for Employment can include an hours per week work goal to be achieved at the time of transition to extended services.

5. Service providers

   • Supported employment services may be obtained from any service provider having a written agreement with Vocational Rehabilitation for the provision of supported employment services. Transitional Employment services can only be provided by a clubhouse certified by the International Center for Clubhouse Development (ICCD) as part of continuing sequential job placements leading to job permanency.

6. Extended services

   • Extended services are those services provided by a State agency, a private nonprofit organization, employer, or any other appropriate resource (including natural supports), from funds other than funds received under the Rehabilitation Act, and after a person with the most significant disabilities has made the transition from Vocational Rehabilitation support. Extended services may include—

     • Followup services These are monitoring and assessment services intended to assess, reinforce, and maintain a stable job placement. They include regular contact with employers; the person with the most significant disabilities; the person’s parents, guardians or other representatives; and with other suitable professional and informed advisors of the person. Monitoring to maintain employment stability must at a minimum consist of twice monthly meetings with the client at the worksite; or under specific circumstances, especially at the request of the client, twice monthly meetings away form the worksite.
     • Arrangement and coordination of specific services These are service management services involving the arrangement and coordination of specific services from other providers needed to maintain job stability, at or away from the work site, based on an assessment of job stability.
     • Provision of specific services These are specific services, available from the provider, needed to maintain job stability, provided at or away from the work site, based on an assessment of job stability.

7. Stabilization

   • A person is considered to have achieved stable job performance when:

     • Supported Employment-Other than Persons with Mental Illness

       • Person’s performance meets employer’s expectations.
       • Level of intervention has remained constant for 4 or more weeks indicating maximum independence.
       • Extended supports are sufficient to maintain the person on the job.

     • Supported Employment-Persons with Mental Illness

       • Person has remained on the job for a minimum of 4 weeks.
       • Person’s performance meets employer expectations.
       • Extended support services are sufficient to maintain the person on the job.

     • Transitional Employment-Persons with Mental Illness

       • Person is 90 days away from completing the first in a series of temporary job placements.
       • Person’s performance meets employer expectations.
       • Extended supports are sufficient to maintain the client in continuing sequential job placements until job permanency is achieved.

8. Transition to extended services

   • The person must be transitioned to extended services funded by a source other than funds available under the Rehabilitation Act when he or she—

     • is stabilized in the job,
     • has made substantial progress toward meeting any hours-per-week work goal in the Individualized Plan for Employment, and
     • extended services are available and can be provided without a hiatus in services.

   • Move the client into Milestone: Services Initiated and Activity: Employment Followup in QE2 when the he/she is transitioned to extended services.

9. Successful Outcome

   • A person with the most significant disabilities who is receiving supported employment services will be regarded as having achieved a successful employment outcome when the person has maintained the job for 90 days after the transition to extended supports provided by the provider. The VR Specialist must contact the client prior to agreeing to the outcome. The client must be satisfied with the job and with the VR closure. Inactivate the client within one week from contact.
   • A transitional employment outcome may only be claimed once by the service provider. When the person obtains a permanent job the provider may claim an employment outcome after the supported employment criteria are met.
   • For Supported Employment (SE) vendors, providing SE services under a performance based contract, only one successful outcome can be claimed if prior to closure a second employment site is determined appropriate and necessary. The successful outcome cannot be claimed until the successful outcome criteria is met for the second work site. If, however, the client decides not to pursue a second job, and all parties agree to end the search for a second job, a successful outcome can be claimed for the first job when the successful outcome criteria is met.
   • If following a successful closure it is determined by the SE vendor, providing SE services under a performance based contract, and the client that a second employment site is appropriate and necessary the client will be referred to VR. VR will serve the client in the Employment Program not in Employment Warranty. When the criteria for a successful outcome is met the SE vendor can claim a second successful outcome.
   • See the Successful Employment Outcome manual chapter.

Types of supported employment placements

Individual placement

Definition

An individual supported employment placement is one in which the person is placed in an integrated work setting in competitive employment. The employer-employee relationship is between the person and the business.

A business may employ several persons with most significant disabilities as supported employees. Each is an individual placement as long as the person’s work team is not exclusively made up of persons with the most significant disabilities (see enclave or work crew placement).

Principles

1. Individual supported employment placements reflect the normative pattern of working in most communities.
2. The extended supports necessary to maintain the placement may be provided by an extended services provider, “natural supports” in the workplace and community (e.g., coworkers, supervisors, family members, etc.), or a combination of the two.

Planning the individual placement

1. An individual placement must be in the best interests of the person served, considering such things as: the person’s ability to work with co-workers who do not experience a disability, or the amount, type, or immediacy of intervention required to deal with work problems.
2. The work setting for the placement should be assessed to determine whether it can accommodate the physical presence of a job coach without interference with work methods or processes.
3. The specific services included in the person’s Individualized Plan for Employment are based on needs identified in the comprehensive assessment of rehabilitation needs, and any specialized assessment of supported employment needs (see Assessment of supported employment service needs).

Enclave or work crew placement

Definition

An enclave or work crew supported employment placement is one in which the person works as part of a work team or work crew exclusively made up of other persons with most significant disabilities. A job coach is usually present.

Enclave is a work team within a single business or firm, responsible for a particular product or process (e.g., preparing mailings).

Work crew is a group of workers, with a job coach, who usually travel from place to place or business to business providing a service (e.g., house cleaning). Work crews often operate as small businesses offering custodial, grounds keeping and similar services.

Principles

1. Enclaves and work crews are legitimate types of supported employment outcomes.
2. The work crew or enclave must offer “permanent employment” in the sense that it can reasonably be expected to last at least 24 months.

Planning the enclave or work crew placement

1. An enclave or work crew placement must be in the best interests of the person served, considering: the person’s ability to work independent of a work team of coworkers who also experience a disability, or experiencing problems at a work site requiring immediate job coach intervention.
2. The person “owns“ the job. It is expected that the person is a bona fide employee of the service provider or the company for which the work is being performed. Unemployment Insurance wage reporting may be the easiest way to check the person’s employment status: Is the employer (or provider) reporting the persons' wages to UI for UI purposes? Will the person qualify for UI if he or she is terminated?
3. The Individualized Plan for Employment for an enclave or work crew placement should state the criteria for making the transition from services provided by VR to extended services from the extended services provider. Examples of transition criteria include—

   • Hours or days worked per week
   • Consistent (stable) quantity and quality of work performed (i.e., no significant change for 6-8 weeks)
   • Reduction in the amount of on-the-job intervention or supervision required
   • Acquisition of work habits (punctuality, attendance, etc.)
   • Acquisition of job related interpersonal (social) skills (with supervisors, co-workers, customers)

Transitional employment placement for persons disabled by mental illness

Definition

Transitional employment is a series of time limited (6-9 month), part-time entry level job placements in an integrated work setting for persons with the most significant disabilities due to mental illness. The person is paid the prevailing wage. The position is “owned” by the provider, who guarantees the business no absenteeism. On and off site services and supports are provided by the provider to maintain the TE position. In transitional employment, the person engages in continuing sequential job placements until job permanency is achieved.

Principles

1. TE is a type of supported employment specifically for persons with severe and persistent mental illness. TE is most appropriate for those without much work experience, with intermittent work experience, or those who have not worked for a long period of time.
2. The client must express a desire to work, and have fully assessed the potential impact of employment on benefits.
3. The outcome of TE is permanent employment with on-going support services. This is the same outcome as any other type of SE.
4. TE programs achieve this outcome through a series of temporary job placements. Each placement is usually between 6 and 9 months.
5. TE may use individual placements or group placements in an enclave or work crew. The TE provider negotiates access to the jobs and guarantees the work will be completed.
6. The services purchased by VR up to the transition to extended services may include—

   • intensive on-the-job skills training at the work site
   • social skills training
   • regular observation and supervision of the person
   • regular contact to reinforce and stabilize a job placement
   • facilitation of natural supports
   • other services as determined by the assessment of the rehabilitation needs of the individual

7. The transition from VR to extended services provided by the TE service provider occurs when the person has stabilized on the job and is 90 days away from completing the first in a series of temporary job placements. The temporary job placement must be for a minimum of 6 months.

Planning the transitional employment placement

1. The VR-MH-client team mutually agree on the permanent employment goal for the person, based on a comprehensive assessment of the rehabilitation needs.
2. The plan states the sequence and the objectives for temporary job placements leading to permanent employment.
3. The plan states the VR responsibilities for initial services up to the point of transition to extended services from the TE provider.
4. The TE plan states the TE provider’s responsibilities for providing extended services. These include continuing sequential job placements until job permanence is achieved.

Community Supports Program (CSP) placement

Definition

Supported employment services may also be provided for a client who has selected the Community Supports Program (CSP) placement option through Health and Human Services, Division of Developmental Disabilities. This option allows a client to select and hire his/her own provider, such as a family member, neighbor, or other trusted person in the community to provide the initial job coaching and necessary ongoing supports. The provider selected does not have to be a specialized provider. Supported employment would be included under the “Community Living and Day Supports” service category available under the CSP service model.

Principles

1. Vocational Rehabilitation’s (VR) provision of supported employment services in the CSP service model follows the policies and procedures outlined in this Manual Chapter.
2. VR would not participate in the selection of the CSP provider.
3. VR would not participate in job placement assistance.
4. HHS Service Coordinators should agree to refer any client, interested in working with VR, who selects the CSP service model and is considering employment supports to VR.
5. VR will accept the DHSS background check. Confirmation that the background check was completed and the CSP provider has been approved by DHSS can be obtained by contacting the local DHSS Service Coordinator. A task entry stating confirmation has been obtained will be entered into QE2.
6. If DHSS is terminating a service contract with a CSP SE Provider the local DHSS Service Coordinator will provide the local VR Office with written notification in the form of an email. The email will include the name of the CSP SE Provider, his/her address, Social Security Number, type of termination, and the date of the termination. The email should be printed and placed in the client's case record. The email should then be forwarded to Cathy Callaway. She will be responsible for formally notifying the CSP SE Provider that VR is terminating it's Service Agreement with them. VR cannot provide payments to a CSP SE Provider for milestones occurring after VR's Service Agreement termination date.

Planning the Community Supports (CSP) placement

1. At the time of referral a meeting should be convened to include the client, parent or guardian, the CSP provider(s), the DD Service Coordinator, and the VR Specialist. The purpose of this meeting is to:

   • Agree on supported employment as an appropriate employment outcome for the client considering skill level, employment opportunities in the community, transportation, and other critical factors.
   • Ensure the selected CSP provider has the skill and resources to provide the needed service considering his/her work record, knowledge of the community, and skills to provide job coaching.

2. Develop and approve a Service Agreement. NOTE: The Service Agreement will be with the CSP provider who will be the sole or primary provider of service. If there are multiple providers a primary provider will be designated. The SE Milestone/Outcome payments will be paid to the primary provider. The primary provider will be responsible for determining the appropriate amount of the Milestone/Outcome payment the other providers will receive and will pay them directly for the services they provided. VR staff will explain in detail the payment process to the CSP providers.
3. The CSP provider will be provided a packet of information to include:

   • Description of VR’s supported employment program.
   • A definition of terms
   • Copy of the milestone payment schedule which includes reporting requirements
   • Report forms
   • Billing process for services rendered
   • Job Coach Training Manual