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.edu National Core Indicators (NCI)
Agenda • NCI • Sample • Results • Policy Implications • Questions National Core Indicators (NCI)
NCI State Participation 2014-15 National Core NH WA ME VT Indicators MT ND MA (NCI) Adult MN NY OR WI RI SD ID MI Consumer CT WY PA NJ Survey IA OH* NE DE NV IN IL MD 25,820 • WV UT VA Wash DC CO CA* MO KY KS adults NC TN 33 states • OK SC AR AZ NM As of 2016-17: AL GA MS 46 states, the LA TX District of Columbia and 22 FL AK sub-state regions HI New in 2015-16 New in 2016-17 CA*- Includes 21 Regional Centers OH *- Also includes the Mid-East Ohio Regional Council
NCI Offers Unique View • Individual characteristics of people receiving services • The locations where people live • The nature of their experiences with the supports that they 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 100% 90% 80% 70% 60% 50% 37.2% 40% 31.1% 30% 14.7% 20% 9.5% 7.5% 10% 0% Parent or Group home ICF Independent Other Relative's home home/apt National Core Indicators (NCI)
What do people do during the day? 100% 90% 80% 70% 40.4% of people in Paid Community Job were 60% also reported to take part in at least one other 50% 43.7% kind of day activity or program 40% 30% 19.9% 19.0% 20% 14.8% 10% 0% Integrated Employment Unpaid Community Activity Paid Facility-Based Work Unpaid Facility-Based (N=22,527) (N=22,064) (N=22,181) Activity (N=21,924) National Core Indicators (NCI)
People's daily activities by residence type • People in ICF 100.0% (59.5%) and group home settings 80.0% (54.9%)were more likely to 59.5% participate in 54.9% 60.0% unpaid, facility- based activities 43.8% 39.2% People in • 36.9% 40.0% independent 27.8% 32.3% 19.7% homes were the 20.2% 12.5% 22.8% 22.8% 20.9% most likely to 18.5% 18.1% 18.2% 17.6% 17.0% 20.0% 15.2% have paid 13.5% 11.2% 10.7% 10.6% 3.5% community jobs (27.8%) and 0.0% those in ICF ICF or Specialized Group Home or Independent Parent/relative's Foster care/host Other Institutional Setting Agency Operated home/apartment home home least likely Apartment (3.5%) Paid Community Job Unpaid Community-Based Activity Paid Facility-Based Job Unpaid Facility-Based Activity National Core Indicators (NCI)
Who has job, wants job, job goal National Core Indicators (NCI)
State Variation Percentage in integrated community employment 100% 90% 80% 70% 60% 50% 41.7% Average: 17.0% 40% 30% 20% 10% 4.5% 0% CT VT NH CO SD MN OK SC IN ME UT LA TN DE PA OH CA NY MI KS MEORC NC GA AR IL VA TX MO FL KY DC NJ HI National Core Indicators (NCI)
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. Community Based Employment Support: • An individual job without supports (competitive) • An individual job with supports (individually supported) • Group supported National Core Indicators (NCI)
Types of employment support Per ercentage of of to total nu number in integrated em employment N Per ercentage of of 20 20,464 (N (N=3,1 ,185) In In integrated 3,185 15.6% 100.0% em employment In In individual l job obs 1,730 8.5% 54.3% Com Competitiv ive 821 4.0% 25.8% em employment Ind Individ idually 909 4.4% 28.5% su supported In In gr group-supported 770 3.8% 24.2% Type of of em emplo loyment 685 3.3% 21.5% su support no not t spe specified 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 Hours Wages Hourly (in two weeks) (in two weeks) 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 National Core Indicators (NCI)
Types of jobs Building and ground Food prep and cleaning/ Retail service maintenance 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 100% 91.7% 91.7% 91.3% 90% 80% 70% 60% 50% 40% 34.3% 28.8% 30% 25.6% 20% 10% 0% Competitive Individually-supported Group-supported Likes job Would like to work somewhere else National Core Indicators (NCI)
1970s American Community Survey
1980s Supported Employment
1990s – 2000s ADA 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
Employment First Efforts 50 Any activity Formal policy 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 and Day Supports IDD Agencies: Nation 700,000 605,301 600,000 500,000 Total Served 400,000 300,000 200,000 Integrated Employment 100,000 115,557 0 1990 1993 1996 1999 2004 2008 2014 Source: ICI National Survey of State IDD Agencies
Employment and Day Supports Facility-based work 100% 49.1% 50% 18.8% 0% 1988 1993 1999 2004 2009 2014 Source: ICI National Survey of State 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 100% 80% 60% 40% 20% 0% Source: ICI National Survey of State IDD Agencies 2014
High-Performing Framework
Holistic view Community Workplace & Labor Individuals & Employment Market Families Supports Individual Employment Outcomes Community State Policy Rehabilitation & Strategy Provider Practices Federal Policy
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