Working in the Community: Status and Outcomes of People with IDD in Integrated Employment

Dorothy Hiersteiner: HSRI

dhiersteiner@hsri.org

John Butterworth: ICI UMass Boston

John.Butterworth@umb.eduNational Core Indicators (NCI)

Agenda

• NCI

• Sample

• Results

• Policy Implications

• Questions

National Core Indicators (NCI)

NCI State Participation

HI

WA

AZOK

KY

AL

NC

PA

MA

TX

AR

GANM

NJ

MO

NH

OH*

IL

LA

NY

Wash DC

FL

CA*

SDOR

MN

UTCO KS

MS

TNSC

WIMI

INVA

DEMD

New in 2015-16New in 2016-17

CA*- Includes 21 Regional CentersOH*- Also includes the Mid-East Ohio Regional Council

As of 2016-17:46 states, the District of Columbia and 22 sub-state regions

MEVT

CTRI

WY

AK

NV

ID

NE

MT ND

IA

WV

2014-15 National Core Indicators (NCI) Adult Consumer Survey• 25,820

adults • 33 states

NCI Offers Unique View

• Individual characteristics of people receiving services

• The locations where people live

• The nature of their experiences with the supports thatthey receive (e.g., with case managers, ability to make choices, self-direction)

• The context of their lives – friends, community involvement, safety

• Health and well-being, access to healthcare

• The activities they engage in during the day including whether they are working

National Core Indicators (NCI)

Goals of NCI• Document the effect of services on the day-to-day lives of the people

who receive them

• Document the experience of program participants

• Manage service delivery and improve policy and practice

• Track key performance goals and outcomes

• Assess the impact of regulatory activities on individual experience

• Respond to the demands of consumers and families for information on system responsiveness

• Assess the impact of financial actions

National Core Indicators (NCI)

What do NCI Data show about employment?

National Core Indicators (NCI)

Sample

• 2014-15 National Core Indicators (NCI) Adult Consumer Survey

• 25,820 adults from 31 states, Washington, D.C. and one sub-state entity

• Excluded people under 22 in public school

23,321 remained in sample

The numbers presented in this presentation may differ slightly from those found in the NCI Adult Consumer Survey report. The report demonstrates the average of state averages, while this presentation demonstrates the average of all respondents.

Residence type

37.2%31.1%

9.5%14.7%

7.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Parent orRelative's home

Group home ICF Independenthome/apt

Other

National Core Indicators (NCI)

What do people do during the day?

14.8%19.0% 19.9%

43.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Integrated Employment(N=22,527)

Unpaid Community Activity(N=22,064)

Paid Facility-Based Work(N=22,181)

Unpaid Facility-BasedActivity (N=21,924)

National Core Indicators (NCI)

40.4% of people in Paid Community Job were also reported to take part in at least one other kind of day activity or program

People's daily activities by residence type

• People in ICF (59.5%) and group home settings (54.9%)were more likely to participate in unpaid, facility-based activities

• People in independent homes were the most likely to have paid community jobs (27.8%) and those in ICF least likely (3.5%)

National Core Indicators (NCI)

3.5%11.2%

27.8%

15.2%18.2%

10.6%10.7%

17.6% 18.1%

20.2%

36.9%

12.5%20.9%

22.8%

19.7%

18.5%

13.5%17.0%

59.5%54.9%

22.8%

39.2%

43.8%

32.3%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

ICF or SpecializedInstitutional Setting

Group Home orAgency Operated

Apartment

Independenthome/apartment

Parent/relative'shome

Foster care/hosthome

Other

Paid Community Job Unpaid Community-Based Activity Paid Facility-Based Job Unpaid Facility-Based Activity

Who has job, wants job, job goal

National Core Indicators (NCI)

State Variation

National Core Indicators (NCI)

41.7%

4.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CT

VT

NH

CO

SD MN

OK SC IN ME

UT

LA

TN

DE

PA

OH CA

NY

MI

KS

ME

OR

C

NC

GA

AR IL VA

TX

MO FL

KY

DC NJ

HI

Percentage in integrated community employment

Average: 17.0%

Only people living in the community are included in the rest of this presentation.

--Group homes and agency-operated apartments --Independent homes or apartments--Parents’ or relatives’ homes --Foster care/host home.

--Total number of people remaining in the data is 20,464.

National Core Indicators (NCI)

Community Based Employment Support:• An individual job without supports (competitive)• An individual job with supports (individually supported)• Group supported

Types of employment support

N Percentage of 20,464

Percentage of total

number in integrated

employment

(N=3,185)

In integrated

employment

3,185 15.6% 100.0%

In individual jobs 1,730 8.5% 54.3%

Competitive

employment

821 4.0% 25.8%

Individually

supported

909 4.4% 28.5%

In group-supported 770 3.8% 24.2%

Type of employment

support not specified

685 3.3% 21.5%

Independent home/apt: more likely to have individual jobs (competitive or individually supported)

Hours and Wages

• Paid community jobs

Worked 30.16 hours in a two-week period

Earned $225.59 or $7.71 per hour

National Core Indicators (NCI)

Hours

(in two weeks)

Wages

(in two weeks)

Hourly

wage

In Competitive 30.58 $266.80 $8.66

In Individually

supported 26.34 $226.75 $8.76

In Group-supported 32.05 $186.62 $6.02

Types of jobs

Food prep and service

Building and ground cleaning/

maintenanceRetail

In competitive 28.1% 20.5% 22.0%

In individually-supported 23.6% 27.5% 22.9%

In group-supported 7.7% 44.7% 11.3%

National Core Indicators (NCI)

Satisfaction

National Core Indicators (NCI)

91.3% 91.7% 91.7%

25.6%28.8%

34.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Competitive Individually-supported Group-supported

Likes job Would like to work somewhere else

American Community Survey

1970s

SupportedEmployment

1980s

1990s –2000sADA

Rehabilitation Act Amendments

IDEA

TWWIIA

Workforce Investment Act

CMS

Customized Employment

Policy Influences

CMS Employment Guidance

CMS Settings Rule

Department of Justice

WIOA

Federal initiatives ACL, DOL, SSA

APSE. (2014). Employment First Across the Nation: Progress on the Policy Front. Policy Research Brief. RRTC on Community Living University of Minnesota, 24(1).

Employment First Efforts

Any activity

Formal policy50

Employment and Day SupportsIDD Agencies: Nation

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

1990 1993 1996 1999 2004 2008 2014

Total Served

Integrated Employment

Source: ICI National Survey ofState IDD Agencies

115,557

605,301

Employment and Day SupportsFacility-based work

0%

50%

100%

1988 1993 1999 2004 2009 2014

49.1%

18.8%

Source: ICI National Survey ofState IDD Agencies

CMS feedback to Kentucky

States cannot comply with the rule simply by bringing individuals without disabilities from the community into a setting; compliance requires a plan to integrate beneficiaries into the broader community.

26

Participation in integrated employment services varies widely

0%

20%

40%

60%

80%

100%

Source: ICI National Survey ofState IDD Agencies 2014

High-Performing Framework

Holistic view

Federal Policy

Community

& Labor

Market

Workplace

State Policy

& Strategy

Community

Rehabilitation

Provider

Practices

Individuals &

Families

Employment

Supports

Individual

Employment

Outcomes