Narrative: j. 1. A.

Introduction

Washington DVR’s 2019 CSNA draws upon secondary data and reports, DVR service data, and survey and interview responses to assess vocational service needs. The following sources and data collection methods were used to complete the required components of the assessment:

• Analysis of 2017 American Community Survey data.
• Analysis of DVR service data for cases that closed in program years 2017 & 2018 (July 1, 2017-June 30, 2019).
• Surveys of subject matter experts, existing research, and DVR service data information on supported employment needs and programs.
• Survey and interviews of stakeholders about unserved and underserved populations, undertaken by Washington State University, Social and Economic Sciences Research Center (SESRC).
• Interviews of Workforce Development Council (WDC) representatives and DVR liaisons to WDCs about people with disabilities served by other parts of the workforce system.
• Existing research and DVR service data about youth and students with disabilities.
• Survey of community rehabilitation programs (CRPs) and DVR data about services provided by CRPs.

Washingtonians Living with Disabilities

American Community Survey (ACS) data for 2017 indicate that 12.9% of Washington’s residents --942,318 individuals – are living with a disability. The rate of disability for Washington’s population has remained nearly constant over the past five years.

More than half of all people with disabilities are in their prime working years, between the ages of 18 to 64 years. For working age individuals with disabilities, 40.5% are employed, 5.4% are unemployed, and 54% are not in the labor force. The unemployment rate, which excludes individuals not in the labor force, is 11.8%. Compared to people without disabilities, people with disabilities are three times as frequently unemployed or out of the labor force as people without disabilities. Although disability and illness are commonly cited reasons for not working, the need for vocational rehabilitation services well exceeds available resources.

DVR service numbers are significant when compared to the 26,096 unemployed working age adults with disabilities but represent a very small portion of the 259,784 individuals with disabilities who are out of the labor force. During program years 2017 and 2018, DVR closed cases for 9,503 customers who were participating in a service plan. Completion of services led to employment for 5,115 individuals.

Washingtonians with disabilities earn about one-third less and are twice as likely to live in poverty as people without disabilities. Lower earnings are attributable to both low hourly wages and less than full time work. Washingtonians with disabilities earn an average of $27,052 annually. DVR customers who obtained employment in program year 2018 had median earnings of $12 per hour and $19,682 annually.

Unemployment and low earnings are related to lower education levels and reflected in high rates of poverty. Compared to people without disabilities, Washingtonians with disabilities are nearly twice as likely to lack a high school diploma or equivalency and about half as likely to have a bachelor’s degree or higher. Nearly 18% of Washingtonians with disabilities live below the federal poverty level, compared to a statewide rate of about 9%. More than 28% of people with disabilities have incomes below 150% of the poverty level.

DVR’s service population in program years 2017 and 2018 was similar to that of working age people with disabilities statewide, with a few notable exceptions. DVR underserved females, in comparison to the gender make-up of working age adults with disabilities. Although minority groups were proportionately represented in DVR’s service population, several groups had lower than average rehabilitation rates. Additionally, Black/African American and American Indian/Alaska Native populations are underrepresented in DVR’s workforce.

County and regional comparisons show that DVR services were not provided in proportion to the population of working age people with disabilities in some counties. Regions 1 and 2 served a larger percentage of customers than would be expected from the population data, although cases more frequently closed without a job in Region 1. Region 3 -- especially Pierce County -- and rural areas in regions 1 and 3 are underserved, compared to their share of working age individuals with disabilities.

Need for Supported Employment Services

DVR Service Data for Most Significantly Disabled and Supported Employment

DVR reviewed cases that closed during the two-year period July 1, 2017-June 30, 2019 and consulted with experts to assess service rates for individuals with most significant disabilities (MSD) and the need for and availability of supported employment services.

DVR implemented an Order of Selection on November 1, 2017 and prioritized services for individuals with the most significant disabilities. Since that time, the proportion of active cases with MSD determination and needs for supported employment have grown.

Nearly two thirds of closed cases during the review period had MSD determinations, compared to about 50% prior to entering Order of Selection. About half of MSD customers had supported employment needs identified on their IPE; 75% of these customers had a cognitive disability and 16% had a psychosocial disability.

DVR service data suggest that DVR has greater challenges assisting individuals with psychosocial, physical/mobility, and vision impairments to move from eligibility determination to plan development than individuals with cognitive disabilities. Since the need for supported employment is assessed in the plan development process, service needs are likely to be greater than indicated by the data for customers in plan.

When compared to individuals determined significantly disabled (SD) or not significantly disabled (NSD), MSD cases were equally likely to have an employment outcome but were much more likely to close before plan. MSD cases with supported employment needs were more successful in obtaining employment than cases overall.

Supported Employment Services and Systems

Funding for supported employment services is segmented among DVR, DSHS/Developmental Disabilities Administration (DSHS/DDA), the Health Care Authority Division of Behavioral Health and Recovery (HCA/DBHR), and DSHS Aging and Long-Term Services Administration (DSHS/ALTSA). DBHR and ALTSA have program oversight responsibility for Foundational Community Supports (FCS), which provides resources for supported employment. Coordination among these lead agencies is complicated and insufficient. Ideally, DDA and FCS services are complementary to and braided with DVR’s services, to enable individuals to access resources from both systems when needed and as appropriate to their needs.

DVR services are time-limited, whereas both DDA and FCS can be ongoing. DVR typically provides assessment, job placement, intensive training services, and support services needed by the individual to obtain a job and achieve stable job performance. DDA or FCS long-term supports begin when the customer reaches stabilization on the job. DDA and FCS can provide job placement services and short-term supports for customers ineligible for DVR services; however, the range of services is more limited than those available from DVR.

Supported employment resources have expanded statewide with the startup of FCS in 2018 but availability of long-term supports is insufficient to meet the need and is often a determining factor in access to VR services. DVR customers with behavioral health needs may not qualify for FCS or be connected to behavioral health services. Additionally, permanent adoption of FCS is not yet assured. DVR could also expand long-term supports by encouraging supported employment providers to focus on developing natural supports within customers’ workplaces.

Definitions and understanding of eligibility for services, readiness to participate, and long-term support differ among the three programs. To effectively serve customers, these differences need to be bridged and staff and providers need to be knowledgeable about the different systems and services. Additionally, customers and their families or advocates need better access to benefits planning and understanding of the impact of work on other benefits, to make an informed choice about pursuing employment.

DVR-DDA Collaboration

Services and interagency coordination are in place and function well, for the most part, for customers with intellectual and development disabilities. DVR and DDA work collaboratively with county agencies, employment service providers, and school districts to effectively coordinate transition and vocational rehabilitation services for mutual customers. Respective roles and responsibilities are defined by a memorandum of understanding. DDA and DVR both contract with community rehabilitation programs (CRPs) to provide employment services to customers.

Shared customers of DVR and DDA are highly successful in getting jobs. According to a January 2019 report by the Joint Legislative Audit and Review Committee (JLARC), Washington leads the nation in helping DDA clients get jobs and 80% of DDA supported employment customers who use DVR services get a job. However, few earn a living wage and only 10% earn more than the federal poverty level. Earnings are below poverty level for 99% of individuals with high support needs, who work an average of 21 hours per month. Individuals with low support needs work an average of 88 hours per month and have higher earnings, though only 35% make more than the poverty level. 

For shared DDA-DVR customers, service capacity and availability to those who qualify are not major impediments to accessing supported employment services. Challenges pertain to conflicts in service models and processes, lack of procedures for coordination in some offices, confusing communications, and inadequate access to benefits planners. The path to accessing services can be confusing to customers and their families or advocates, especially with recent changes to practice that require customers to apply to DVR first, which can also lead to a referral to WorkSource.

Sometimes DVR’s “ability to benefit from services” criterion conflicts with DDA’s philosophy that all people can work or the vocational assessment or the job goal developed through DVR’s service planning process conflicts with an existing job placement.

Coordination could be improved by clarifying roles in the transition process, agreement on readiness of referrals, joint participation in presentations to customers about services, engaging customers earlier, and holding each partner accountable for outcomes.

DVR-FCS Collaboration

Foundational Community Supports (FCS) is a Medicaid demonstration program that funds supported employment services for targeted populations, including people with behavioral health conditions, long-term care needs, or physical impairments that necessitate assistance with work activities. The demonstration program is intended to show that supported employment services reduce the overall healthcare costs of Medicaid-eligible individuals. During the demonstration phase, the number of customers that can be served is limited and the program is nearing that capacity.

FCS supported employment provides job placement and retention, with the expectation that participants will be connected to other needed health services, such as outpatient behavioral health and long-term care. Ongoing supported employment services can be provided for the individual to remain employed.

The State Health Care Authority’s Division of Behavioral Health and Recovery and DSHS Aging and Long-term Support Administration are responsible for developing and supporting the statewide provider network. FCS services are provided by community health, behavioral health, tribal, and social service agencies, which include community rehabilitation programs. Gaps in service delivery arise when providers do not have policies and procedures for sharing information with other agencies, to facilitate customer access to services provided by other agencies.

Coordination of services for customers shared by FCS and DVR is in early stages. DVR has established standard operating procedures for working with individuals who are eligible for FCS to support coordinated service delivery for mutual customers and is in the process of implementing an interlocal agreement with DBHR to provide a collaborative framework for serving people eligible for FCS.

The episodic nature of behavioral health conditions and differing philosophies about readiness for employment present challenges to coordinated service delivery. With the exception of CRPs, DVR has limited experience partnering with FCS providers to serve customers, particularly community health and behavioral health agencies. Knowledge about those service systems and how to work effectively with FCS customers is inconsistent across DVR and its service providers. Additionally, when a customer receives FCS services from a provider that is not a DVR contractor, they cannot use the same provider for DVR services. Providers must be vendors for both FCS and DVR services for coordination to function optimally.