1. Follow VR processes from Referral to IPE Development, involving the client, authorized representative, and others, as noted:

• Referral

• • Initial Meeting 

Tip:  Review the referral source--along with the authorized representative, as applicable, involve staff from the agency that made referral or from agencies providing services or service coordination to those with behavioral health diagnoses or intellectual and developmental disabilities.  These agencies have information that may be used to expedite eligibility determination and can provide important information about functional limitations resulting in impediments to employment needed to determine the person's priority status.

• • Eligibility and Eligibility Extension 

When possible, obtain information about diagnoses and functional limitation from other providers of services (which may also be the referral source) such as, Developmental Disabilities Service Coordinator, a developmental disability service provider, or a behavioral health service provider. With proper releases of information, these providers may be able to supply information or identify other sources of information so eligibility and priority category determinations can be expedited. 

Once priority status is determined, review Planning Considerations when serving Candidates for Supported Employment in the Background and Training Information section, below.  This guidance provides support to determine whether Supported Employment is the best option for an individual and, if so, helps to begin the process of identifying needed/available extended services. This document should be referenced throughout the career planning process to formulate the IPE goal, as well as extended services needed to maintain employment.

Definitions relevant to Supported and Customized Employment and Extended Services for Nebraska VR are as follows: 

Discovery: A service authorized before developing a plan for employment.  The purpose of the service is to get to know a person, including their strengths, interests, and preferences for use in developing the plan.

 

Progressive Employment activities:  Activities to assess clients’ interests, skills, and abilities in an occupation or career pathway in a competitive work setting. Activities may include:

• • • Job shadowing
    • Volunteering
    • Individual and group business tours
    • Mock interviews with employers
    • On the Job Evaluation (OJE)

Also see Career Planning policy 

Supported Employment:   A continuum of services provided to an individual with a most significant disability to identify a job goal, complete job search activities, achieve job placement and maintain employment. These services are provided until the person's transition to extended services is complete.

 

Customized Employment:     A type of supported employment that results in competitive integrated employment for an individual with a most significant disability. It includes:     

• customizing a job description based on current or newly identified unmet employer needs matched with strengths and abilities of a person who can meet them 
• developing a set of job duties, a work schedule and job arrangement, and specifics of supervision (including performance evaluation and review), and determining a job location 
• providing services and supports at the job location and off-site, as needed. 

 

Extended Services:  Services needed to support and maintain employment long term, after a client has been determined to have stabilized in their employment.  Such services may be provided and funded under cooperative agreements with Nebraska Health and Human Services Division of Developmental Disabilities, Division of Behavioral Health, or by other paid or natural supports, and are identified in the IPE. 

• Benefits Orientation:  Refer for Benefits Orientation after eligibility and priority determinations to enable the client to become informed early on and make a choice about pursuing an employment goal and using applicable work incentives. 

• Career Planning 

Obtain VR Profile, as applicable, determine planning and readiness factors, identify need for and, as applicable, authorize Discovery and Progressive Employment activities to determine potential career matches based on interests, strengths, etc. If the plan is for Supported Employment, support the client to select a Supported Employment provider from those with a Nebraska VR Service Agreement.  (See Supported Employment -Independent Provider chapter if a client eligible for Developmental Disabilities services has an Independent provider enrolled with Medicaid who has been awarded a VR Service Agreement.)    

 

• Develop IPE with client, authorized representative, as applicable, Developmental Disabilities Service Coordinator, as applicable, and client’s chosen SE agency or Independent Provider.

 2. Authorize Milestones 1 and 2 to selected provider, as applicable, based on Milestone Payment Schedule specific to SE program: (1) Intellectual and Developmental Disabilities --Supported or Customized Employment Payment Schedules; (2) Behavioral Health Payment Schedule; or (3) Acquired Brain Injury/Autism -- Supported or Customized Employment Payment Schedule, and SE Fiscal  policy (See Forms, below.)

 

3. Provide/send copies of IPE to client, SE providers and DD Service Coordinator, as applicable. Throughout the course of the case, provide copies of all 30-Day Reports and Milestones forms to DD Service Coordinator, as applicable. 

 

4. Make and document contact with client at least twice in the first thirty days after placement to discuss satisfaction and progress on the job. Then, maintain contact with client and Supported Employment provider at least every 30 days throughout the course of the VR case to ensure:

 

• • Progress is being made in each milestone

 

• • Supports provided during Milestone 2-- job search and placement activities--are in line with IPE goal insofar as types of jobs applied for and number of hours work being sought.  During Milestone 2, 30-day reports on VR's standardized 30-day reporting forms may be considered a ‘contact’ with provider.  Review reporting forms and summarize details in Task Notes.  Contact client to discuss supports provided and activities reported by provider; ensure services and supports provided are consistent with the IPE. 

 

• • Call a meeting of client/authorized representative, SE provider, and DD Service Coordinator, as applicable, whenever progress has stalled, concerns are identified, or an IPE amendment is necessary. Problem-solve and identify needed actions to promote progress in meeting IPE goals.  Such meetings may be held virtually or in person, as appropriate, and based on VR policy Hosting/Initiating a Virtual Meeting.

 

• • When client has received a job offer, obtain details of job, and ensure employment is competitive and integrated Employment. Follow policy/procedure at:  Assessment for Determining Competitive Integrated Employment 

 

 

• • If job is determined to be competitive, integrated, and meets IPE goal, including the number of hours the client plans to work, authorize Milestone 3.  If these criteria are not met, hold a meeting to discuss actions necessary to ensure goal is met.  Plan amendment may be necessary, or additional action by the provider and client may be needed to progress toward goal achievement.

5.  Authorize Milestone 3—Stabilization -- in accordance with SE Fiscal policy (link above.)

6.  Document 30-day contacts with client and SE provider throughout the course of the case.

7.  Milestone 3 ends when client has stabilized, as follows:

• • The client has determined he or she is satisfied with the job, hours, schedule, and is regularly working, as planned (Confirmed by VR Specialist with client/authorized representative) 
  • The employer is satisfied with the client’s performance and plans to retain the client as an employee with regular work hours on an on-going basis (confirmed by VR Specialist with Employer if client has given consent to contact employer.  Otherwise, confirm with SE provider based on discussions with employer/their knowledge of the client’s performance.)
  • The SE provider reports that client is making progress to retain employment (learning job tasks, exhibiting acceptable work behaviors, supports for transportation, etc., are in place, as confirmed by VR Specialist in contact with SE provider.)
  • The client has been on the job at least 30 days and has worked the expected weekly hours during the 30-day timeframe.

8.  Authorize Milestone 4 – Transition to Extended Services -- in accordance with SE Fiscal policy (link above.)

9.  Client continues working with supports fading throughout the provision of services under the Milestone 4 authorization.  During Milestone 4, the VR Specialist maintains contact at least every 30 days with the client/authorized representative and SE provider.  During this milestone, which lasts a minimum of 60 days with no post employment services needed, the aim is to make progress in fading supports to the lowest extent possible to afford the client independence on the job while maintaining sufficient support for job retention. The need for a team meeting is signaled by the fading of on- and off-site supports to this level; the SE provider notifies the VR Specialist of the need to meet to discuss transition to extended services. 

A meeting is held to identify the end date of Milestone 4, which is also the date transition to extended services begins. The Milestone 4 form outlines the plan for Extended Services, agreed to by the team. Payment for the milestone is made upon submission of the completed Milestone 4 form and invoice by the provider. Milestone 4 end date should be extended to the date transition to extended services begins, if needed.

 

10. Transition to Extended Services:

• Behavioral Health SE cases remain open for 90 days after the date Transition to Extended Services begins.  The case may be successfully closed on the 90th day if no VR services were provided during the 90-day period, as the person is considered to no longer need VR services and able to remain stable in employment with continuing extended services. If, before closure, the client requires VR services to maintain their employment (during the 90 day transition period), such services are authorized and the 90-day transition to extended services begins anew.
• ABI/Autism and I/DD SE cases will remain open for up to 12 months following the end of Milestone 4 to fulfill current SE Service agreements that allow payment for job retention at 6 and 12 months after payment of Milestone 4.
  • Authorization of Milestone 5A and 5B:
    • Follow the local VR process for monitoring the Milestone 5A and 5B report to ensure timelines for authorizing these milestones are met in a timely manner.  The Supported Employment Authorizations Due report can be found in QE 2 at:   https://qe2.nebraska.gov/quest/case_management/report/supported_employment_auths_due_reports
    • 6 months following the end date of Milestone 4, Milestone 5A is payable if the client has retained employment.  The VR Specialist will contact the SE provider before the end of the 6-month period to authorize Milestone 5A, per the applicable Milestone Payment schedule.  If the client has retained their job, Milestone 5A is authorized and payable upon receipt of the completed Milestone 5A form and invoice.
    • 12 months following the end date of Milestone 4, Milestone 5B is payable if the client has retained employment. The VR Specialist will contact the SE provider before the end of the 12-month period to authorize Milestone 5B, per the applicable Milestone Payment schedule.  If the client has retained their job, Milestone 5B is authorized and payable upon receipt of the completed Milestone 5A form and invoice. 
    • If closing a case following payment of Milestone 5B, follow the process identified in the Successful Outcome chapter 
    • Or, follow the process identified in the Termination Chapter if the case is terminated after IPE without a successful outcome.

 

Nebraska VR may develop a Supported Employment plan for clients:

1) Identified as having most significant disability (Priority 1),

2) For whom competitive integrated employment has not occurred or has been interrupted or intermittent as a result of significant disability, and,

3) Who need intensive supported employment services and extended services after transition from support of Nebraska VR to maintain employment.

Supported Employment is provided by vendors under Service Agreements with Nebraska VR.  These vendors may also be providers of extended services following transition from VR services. Nebraska VR and supported employment providers work collaboratively to support clients to obtain and retain employment, which includes identification of the extended services plan before the VR case is closed. 

All supported employment job placements are in competitive, integrated employment as assessed by Nebraska VR.

Planning Considerations when serving Candidates for Supported Employment

NOTE:  This guidance applies to 0those who are not on the VR waiting list, are priority 1 category and who wish to pursue competitive integrated employment. See the accompanying Flowchart--IPE Considerations for People who are candidates for Supported Employment, which is attached to this chapter's forms.

Applicable regulations/definitions:  

Content of the Individualized plan, Supported Employment requirements [CFR 361.46 (b)]:  An individualized plan for employment for an individual with a most significant disability for whom an employment outcome in a supported employment setting has been determined to be appropriate must—

(1) Specify the supported employment services to be provided by the designated State unit;

(2) Specify the expected extended services need, which may include natural supports;

(3) Identify the source of the extended services or, to the extent that it is not possible to identify the source of extended services at the time the individualized plan for employment is developed, include a description of the basis for concluding that there is a reasonable expectation that those sources will become available;

(4)  Provide for periodic monitoring to ensure the individual is making satisfactory progress toward meeting the weekly work requirement established in the individualized plan for employment by the time of transition to extended services;

(5)  Provide for the coordination of services provided under an individualized plan for employment with services provided under other individualized plans established under other Federal or State programs;

(6)  To the extent that job skills training is provided, identify that the training will be provided on site; and

(7)  Include placement in an integrated setting for the maximum number of hours possible based on the unique strengths, resources, priorities, concerns, abilities, capabilities, interest, and informed choice of individuals with the most significant disabilities.

 

Extended services: CFR 361.5 (c) (19):  means ongoing support services and other appropriate services that are—

(i)   Needed to support and maintain an individual with the most significant disability including a youth with the most significant disability, in supported employment;

(ii)  Organized or made available, singly or in combination, in such a way as to assist an eligible individual in maintaining supported employment;

(iii)  Based on the needs of an eligible individual, as specified in an individualized plan for employment; 

(iv)  Provided by a State agency, a private nonprofit organization, employer, or any other appropriate resource, after an individual has made the transition from support from the designated State unit.

"Supported Employment Plan" in Nebraska refers to a plan for which milestones will be paid to a provider of supported employment services under a Service Agreement.

In determining that an employment outcome in a supported employment setting is appropriate, it is important to understand that the need for a Supported Employment plan is not dictated solely by a person’s diagnosis/the fact that they are a person with a most significant disability.  There may be a tendency to assume that a supported employment plan should be written for anyone who is a Priority 1 and would be eligible for any of VR’s SE programs:  Intellectual/Developmental Disability (I/DD), Behavioral Health (BH), Acquired Brain Injury (ABI), or Autism, but that is not a given.

Discussion about this point can be found in the 4/19/16 Federal Register publication of comments resulting in changes to WIOA regulations: “…supported employment should not be considered automatically as the first choice for individuals with significant disabilities or the most significant disabilities.  The State Supported Employment Services program (Supported Employment program) and supported employment services exist to support individuals with the most significant disabilities who need intensive services and supports to achieve an employment outcome.  Supported employment should be considered when determining an individual’s employment goal, consistent with his or her unique strengths, priorities, concerns, abilities, capabilities, interests, and informed choice.”

Technical assistance from RSA indicates Nebraska VR should not delay the writing of a plan until a provider is chosen or extended services are identified. Given this perspective, there should not be delay in authorizing a plan based on the absence of a provider or extended services plan, which might occur in circumstances such as, but not limited to the following:

• Person has not yet chosen a provider and/or the provider has not yet committed to providing services 
• Person is on the Developmental Disabilities (DD) waiting list and is not expected to be considered a priority for funding by the time of transition to extended services (and extended supports are expected to be needed)
• Person has not yet been determined eligible for DD services or funding priority—may not have applied, may be in process, may have chosen not to apply
• Services for which the person is eligible (such as Aged and Disabled Waiver) do not include any extended services/funding to support an employment endeavor
• Person meets criteria as having most significant disability but is not eligible for services from agencies/programs that fund extended services--DDD, DBH, etc. (Note that the Division of Behavioral Health (DBH) does not have a waiting list for SE, so extended supports should be available when the person is co-funded by VR and DBH under an SE Plan.)
• Extended services provider cannot be identified, even if funding IS available, including situations where a provider is not available or declines to serve a person for some reason

Given this perspective, and other circumstances that have arisen about the ability to locate a supported employment provider and/or identify extended supports at the time a plan is written, guidance is offered to support VR specialists in identifying meaningful plans to support employment outcomes for those with the most significant disabilities by:

• Developing an alternative plan—one that does not include provision of supported employment, and/or
• Identifying funding for extended services or, in the absence of such funding, alternative ways to address the need for extended services to assist with maintaining employment 

Questions to ask when considering whether a Supported Employment Plan is needed and/or an alternative plan (unsupported) may be appropriate:

• Review work history—are there contacts and supports available from past work endeavors whom the client chooses to consider as a contact for development of employment prospects and are the issues that resulted in job loss in the past resolved or being addressed?   
• Will assessment services/supports, such as a Trial Work Experience, be helpful in determining the person’s potential on-the-job performance before determining whether a supported employment plan is appropriate?
• If the VR Profile has been completed does it include useful information to develop an appropriate job match?
• Does the person have social capital:  Can their connections – who they know, who their family knows – be used to develop a prospective job / contact?  
• Can VR Placement services help with finding a job that meets the person’s goals, including a job customized for the person?
• After VR Placement services are utilized is Job Coaching under a service agreement authorization an acceptable method of supporting the person to learn the job?
• Is Job Development/Job Coaching under a service agreement authorization a possible means of providing support for the person to develop/identify and learn the job?
• Are there accommodations needed/available that will address and overcome barriers to succeeding in the job, and/or take the place of staff support on the job--such as assistive technology or low-tech supports? 
• Is the person already working a job or have they identified a job but need support to learn, stabilize, and maintain the job?

   

See Flowchart attached as a Form: If there is a need for extended services and the funding for such services is not readily identified or available consider these options:

• Are there other methods of paying for or providing extended services, such as:

           For SSA beneficiaries:

• • Use of work incentives?
    • Impairment Related Work Expenses (IRWE) for SSDI and SSI recipients
    • Plan to Achieve Self Support (PASS) for SSI recipients
  • Assigning a Ticket to Work to an Employment Network upon closure with VR? (Generally, a possibility if the person is working at or planning to work at a level of Substantial Gainful Activity-SGA), or,

 

For individuals whose disability occurred before age 26 who may or may not be SSA beneficiaries:

• Using funds from an Enable account?

For others:  

• • Is privately paying for extended supports a possibility?
  •  
  • Are natural supports available either on- or off-site, including supports to aid with emotional support, keeping a routine, personal care, independent living, transportation, or management of finances/earnings?  
    • Natural supports on-site might be provided by a co-worker, supervisor, or advocate
    • Natural supports off-site might be provided by a friend, family or authorized representative, payee, or others
    • Off-site paid supports might support and strengthen skills that will aid in maintaining a job—such as developing and following a schedule or daily routine, problem-solving, maintaining personal hygiene, etc. 

INACTIVE FORM: Individualized Employment Plan (IPE) Considerations for People who are candidates for Supported Employment

INACTIVE FORM: Payment Schedule Customized Employment Milestone-I/DD

INACTIVE FORM: Payment Schedule Supported Employment Milestone BH

INACTIVE FORM: Payment Schedule Supported Employment for Intellectual/Developmental Disabilities (I/DD)

INACTIVE FORM: Payment Schedule Supported Employment/Customized Employment Milestone ABI-ASD

INACTIVE FORM: Supported Employment Milestone 1-Initiate Job Search ServicesI/DD, ABI/Autism

INACTIVE FORM: Supported Employment Milestone 2-Customized-Employment Placement Report I/DD

INACTIVE FORM: Supported Employment Milestone 2-Employment Placement Report I/DD, ABI/Autism

INACTIVE FORM: Supported Employment Milestone 3-Job Stabilization Report I/DD, ABI/Autism

INACTIVE FORM: Supported Employment Milestone 30 Day Report -I/DD Customized

INACTIVE FORM: Supported Employment Milestone 30 Day Report ABI/Autism/I/DD

INACTIVE FORM: Supported Employment Milestone 4 - Behavioral Health Transition to Extended Services

INACTIVE FORM: Supported Employment Milestone 4 - Transition To Extended Services

INACTIVE FORM: Supported Employment Milestone 5A&B I/DD, ABI/Autism Employment Report