Extended Services: Analysis of Implementation
From Supported Employment Consortium Resources, November 3, 1997
Supported employment is a combination of two service phases: time-limited employment services primarily funded by state vocational rehabilitation agencies, and extended services such as periodic job skills reinforcement and on-going support, funded by non-vocational rehabilitation sources. The provision of extended services is a defining characteristic of supported employment. The required minimal level of support for extended services is two contacts per month for job maintenance purposes. West, Johnson, Cone, Hernandez, and Revell (1997) examined issues and practices related to the provision of extended services to supported employment consumers. The study addressed (1) the scope and nature of services provided during the extended service phase, (2) funding sources and methods utilized, and (3) the impact of funding methods on service quality.
SCOPE OF EXTENDED SERVICES
The survey participants were representatives of 385 randomly selected supported employment provider agencies located in 40 states. Of the 385 participating programs, 89% (345) vendored by public funding agencies to assist individuals with significant disabilities to successfully maintain competitive employment through extended supported employment services. The mean extended services caseload was 27 individuals. Respondents were asked to identify the primary staff person providing extended services. The job coach/employment specialist who made the initial placement was identified by 56.2% of the respondents, followed by a designated staff person (24.3%) and any available job coach/staff person (17.7%). Some respondents (1.8%) indicated that their agency utilized individuals from outside the agency to provide follow-along services. On and average, 41% of the individuals in extended services received more than two follow-along contacts per month.
Respondents were asked to identify up to three primary reasons extended services were needed for consumers. Monitoring of work performance was identified far more frequently than other needs, with 42.9% of respondents indicating this was a primary need. Facilitating job changes and career movement, the second most frequently reported activity, was reported by only 27.8% of the respondents. Also reported infrequently were assessment of job satisfaction (12.8%) and training in new skills (11%). Perhaps this indicates that career development and self-determination are being given less attention during extended services than maintaining individuals in their current jobs.
FUNDING SOURCES AND METHODS
In contrast with time-limited services where vocational rehabilitation agencies are the predominant funding agency, extended services are funded through a variety of sources. These sources include state mental retardation or developmental disabilities agencies (27.2%), mental health agencies (20.7%), other state/local public agencies such as labor or health (18.4%), and vocational rehabilitation agencies (11.2%). Extended services funding has also drawn from the Medicaid Home and Community Based Waiver (HCB), with 9.5% of respondents reporting this as a primary funding source. All other sources represented 3.8% of responses to this question. A substantial portion of respondents (9.2%) did not have funding agreements for extended services. They reported ongoing services were being funded by subcontracts funds (as for work crew and enclave contracts) or from other facility revenues such as case management funds.
Respondents were asked to identify the primary method by which they were reimbursed for providing extended services. Three extended services categories emerged:
- fee for service agreements (27.3%) which establish a time specific fee rate for a defined service.
- contractual or slot-based agreements (44.3%) which define a unit of service on a daily, weekly, or annual basis.
- other funding methods (28.4%) which included overhead costs built into work contracts, grant-funded services, absorption of costs by other facility budgets, and other unique agreements.
About 74% of the respondents indicated their primary funding method allowed for sufficient attention to consumer choice. On key questions regarding conversion of resources, 40% of the respondents indicated their primary funding method did discourage movement from segregated services to community-based employment. Respondents primarily funded through HCB Waivers were more likely to respond that using this source for extended service funding did not discourage them from moving consumers and resources from segregated to community-based employment, while those funded primarily by state vocational rehabilitation agencies were more likely to indicate the funding did discourage them from moving consumers and resources to community based employment.
For Additional Information Contact:
RRTC Research Department
Rehabilitation Research and Training Center on Supported Employment
Virginia Commonwealth University
VCU Box 842011
Richmond, VA. 23284-2011
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