CHS Employment Services – we can support you

Are you Deaf? Hard of hearing?
Want a job? CHS Employment Services can help! If you are culturally Deaf,
oral deaf, deafened or hard of hearing, CHS Employment Services
offers assistance to find a job, and works with employees
and employers to put the right supports in place
to help you both succeed. Our services are free-of-charge
to job seekers aged 18 and over, and employers looking
for qualified staff. Andy is hard of hearing. After suffering hearing loss
due to noise exposure, Andy needed assistance
updating his resume and finding a new career. CHS helped him get a job. Emily is Deaf. After high school, Emily needed support
getting her first job. She worked with her
CHS employment counsellor to find work as a hostess
at Swiss Chalet. CHS helped her get a job. CHS Employment Services
can support you with: Career guidance
and interview preparation, Resume and cover letter services, Leads and referrals
to potential job interviews. CHS Employment Services
are specialized services which cater to people who are
Deaf or hard of hearing which offer support
when looking for work. Our experienced
employment consultants are knowledgeable
about the unique needs of people who are Deaf
or hard of hearing and can communicate
in the language of your choice. We can offer suggestions
for assistive technology and communication
and safety strategies to make the workplace
more accessible for Deaf or hard of hearing
employees. For Deaf or hard of hearing people
with literacy challenges and Deaf immigrants whose first
language is not English or ASL, CHS employment counsellors
can address those needs as well. If you or someone you know
is Deaf or hard of hearing, unemployed or underemployed, or needs supports
and accommodations at work, contact CHS Employment Services. We’re here to support you! Contact us today! Phone: 613.521.0509 TTY: 1.888.697.3650 Email: [email protected]

Discover the Sault: Employment

If you plan on seeking employment in Sault Ste. Marie, following the proper steps in the application process, is necessary for success. In order to work in Canada you need a Social Insurance Number. Before beginning to work an employer will ask you for this number. To learn how to obtain a SIN, watch the Settlement Services video. To apply for a job in Canada you typically need to send a cover letter and resume to the employer. Your cover letter and resume are very important because they create the employer’s first impression of you. The main purpose of these materials is to get you a job interview. Your resume must include your contact information, your relevant experience and specific examples of all accomplishments and results. Your cover letter must have the name of the employer, your contact information, and a creative opening with the job title you wish to apply for. Be exciting in this letter, and focus on what you can bring to the job and employer. All of these tactics will help you achieve an interview. The interview is extremely important. This is your chance to convince the employer that you are the right person for the job. At an interview you should bring:
A copy of your resume. A list of references and contact information and any other documents that will add to your credentials. Sault Ste. Marie offers many employment assistance agencies, such as the Sault Community Career Centre. These agencies exist in order to assist citizens with their job search. In order to find available positions in Sault Ste. Marie you can begin looking in places like job search portals online, local newspapers and company websites. Sault Ste. Marie businesses are constantly in search of skilled professionals and offer careers in a variety of sectors including, trades, healthcare, hospitality, administration, entrepreneurship and much more. It may be a good idea to compare your credentials from your home country, with that of Canada. Please refer to to help with this comparison and for any additional information that you may require regarding employment in Sault Ste. Marie. This is your Sault Ste. Marie…… a great place to work and grow!


Hi guys..This is Pooja from Welcome to our video channel on jobs and careers Today I will be talking about the career opportunities for MBA Entrepreneur Management Masters in business and administration in
entrepreneur management is a course that deals with developing ones skills of networking,
leadership, creativity, spontaneity, team management, flexibility, foresight, expertise
and innovative approach. Aspects of how to deal with business from small to large group
of team is taught. Strength and weaknesses, strategy and analysis are other factors for
study and research. It deals with knowledge of overcoming the challenges faced by an entrepreneur,
while executing his idea into a successful business venture. Skills will be bestowed
on managing growth and development, securing finance, social impact, researching market
and modernisation. Specialization that are available include
IT, retail, environment, biotech, healthcare, marketing or finance. One, on completion of
the bachelor’s degree in business related area, can join in this course who have interests
based on management of business as an owner. The course is a one year period program. Lotus Business School in Pune, Delhi Institute
of Technology and management Delhi, Conspi Academy of Management studies in Kerala, NMIMS
in Mumbai, Entrepreneurship Development Institute of India in Gujurat, Xavier Institute of management
Assam, Symbiosis center of management Maharashtra, are a few of many colleges providing with
the course. Universities of Sheffield, Southampton, Nottingham, Toledo, Brunel University London,
AUT University, The university of Sydney are some of the many universities abroad providing
this course. Doctors degree can be taken in this field through further studies. MBA degree in entrepreneurship holder can
become: • Company’s CEO
• Corporate Manager • Employee Supervisor
• Business consultant • Department Manager
• Corporate Vice president • Management Analyst To work abroad one must have an experience
of atleast 2 to 4 years as an entrepreneur. There are also companies that seek for entrepreneurs
to lead and venture innovative ideas in one company so as to bring about growth and development
directed towards company’s profit. Some companies that help train and become
an entrepreneur are as below: • Nirman, Bangalore
• Rockwell Industries Ltd. , Hyderabad • HW wellness solutions private ltd., Pune
• Orbit Corporate and Leisure Travels Pvt Ltd., Kochin The best one can do as an entrepreneur is
to own a business or company or corporation with one’s intelligence in innovative techniques
in that particular market segment. But it doesn’t limit just to owning a business. High
paid corporate job is an another option, ownership can take place eventually with experience.
Established businesses also need entrepreneurship for more assistance in sales promotion, market
research and MBA entrepreneurs can prove to be valuable assets with their problem solving
skills and foreseeing a matter in hand for the company in the long run. The salary of an entrepreneur is based on
the facts like how established he is, companies market profits and his experience and hand
in overall development of the company. One can earn upto 48lakhs INR as an MBA entrepreneur
based on experience, skills, development and innovative schemes introduced or generated. More on MBA in entrepreneur management course
and its further studies, with details on other courses as well is available on
Find jobs and new openings as a fresher and apply to apt jobs via the site. Register and
explore diverse jobs for a successful career we will be back with more such videos so stay for now connected with us do not forget to hit the subscribe button below

How to issue a Contract of Employment

Hi I’m Alex. Brogan at Human Resource Solutions That’s This video tutorial is on how to issue a contract of employment We will be looking at your responsibilities as an employer. Especially useful if you are a new employer or haven’t employed anyone for a while So we’ll look at what makes up a contract of employment and what you need to include in this to ensure it complies with UK law We are a UK based company and so the information we issue is based on UK law But much of it is best practice in fact and so will be useful even if you are not yourself based in the UK We will also direct you to where you can find the necessary templates which you can download for free and use to issue to your new employee as your contract documents OK let’s crack on and look at how to issue a contract of employment. What is a Contract of Employment? The employment contract is an arrangement between two parties where one party makes a job offer and the other accepts specifically it is where one person performs work under the direction of another So the employment contract establishes the respective rights, responsibilities and duties of an employer and an employee The contract of employment is NOT a single document as some people think in fact its effectively made up of several different elements. Three of these you can directly control.. ..and two you have less or indeed no control over You can control the job offer you make – verbally and in writing the formal written statement of Terms and Conditions you’ll issue within 8 weeks of the employee starting and your Company policies and procedures referred to in both of those documents These are sometimes referred to as the EXPRESS terms of the contract because they have been specifically and clearly agreed I want to talk about all three of these in some detail in a minute but first lets look at the elements of the contract that you have no or little control over: What you can’t control The employment laws of the country govern many of the conditions of the contract and can’t be superseded in any way by the contract so for example the minimum wage, individual parental rights to time off and pay, minimum annual leave entitlements and so on So any terms which seek to limit the legal rights of the employee are likely to be completely ineffective in law IMPLIED terms are almost too obvious to be written down but can be implied into most contracts of employment for example that your employee won’t steal from you their employer or give away any confidential information You as the employer must, in turn, provide a safe working environment and not ask the employee to do anything illegal, such as for example drive a vehicle that is not insured Terms may also be implied through custom and practice This is where arrangements have never clearly been agreed but over time have become part of the contract Examples of this might include finishing early on a Friday, regular overtime or a Christmas bonus For an entitlement to become established by custom and practice it must usually be shown to be automatically received, uninterrupted, long-standing, expected and well-known To a degree these can be “controlled “ by you as the employer but be aware that it is very easy to set custom and practice precedents month on month or year on year without really realising it! Ok lets return now to the three elements of the Contract of Employment which you definitely can and indeed must control Firstly the Job Offer Normally following the job interview you will decide who you want to offer the job to and verbally make them the job offer remember once they accept – a legal contract is in place and this can only be changed by mutual agreement So for example if you want to change the hourly rate of pay, or number of hours they work after you make the job offer you really can’t unless the new employee agrees to this In fact there are ways to do this but it is messy and can be avoided if you are careful when you make the job offer Its also worth remembering that although this is a verbal offer such things as the conditions outlined in the job advert and the job description or any other materials made available to candidates as part of the recruitment process will also form part of the contract of employment at this stage Generally it is advisable to confirm the job offer in a Letter of Appointment which should be sent to the candidate immediately after you make the verbal job offer (assuming they accept of course) This will ensure there is absolutely no confusion about the terms and conditions on offer The letter need only be a one page document and can be produced very quickly We will show you where you can get a free template for this towards the end of the video One very important point to be aware of is that if the offer is dependant on anything such as checking their references are acceptable or confirmation of certain qualifications etc then it is vital that you state that as a condition of the job offer In this way if the condition is not met then the offer can be withdrawn without breaking the contract The next element of the Contract of Employment to consider is the Principal Statement of Terms and Conditions This is the main document which lays out all the key terms and conditions related to the job This document is often referred to as the “contract of employment” – and for simplicity that’s fine we do it on our website in fact. Just bear in mind that it is not the only thing you need to consider when thinking about the contract This document MUST be issued to the individual within 8 weeks of their commencement date Now some companies if they have all the information they need will simply issue this document instead of a letter of appointment it contains all that information and more. That is perfectly acceptable However experience shows that, in particular those employers who are quite new to issuing contracts prefer to take their time and ensure everything in the Statement is correct It also allows the employer time to ensure any conditions surrounding the job offer such as checking references etc have been completed satisfactorily The Principal Statement must contain certain information as specified in law – lets have a look at this in more detail: It should contain the name and address of both parties to the contract This is very straightforward just make sure you use the legal name of your company The only complication might be if you run several businesses in this case you should be sure you are clear which one the new employee is contracted to work for and state this in the document The Job title and description – this usually follows the job title and description specified in any recruitment advertisement or literature and subsequent appointment letter On an aside – it is useful not to describe a job too tightly this will allow you some flexibility in relation to the duties and responsibilities of the post over time Next is the location of the job name and address of where the employee will be based, and any other places where they may be expected to work including any outside the UK If an employee has to work abroad for more than a month, you must state -how long they’ll be abroad
-what currency they’ll be paid in
-what additional pay or benefits they’ll get
-terms relating to their return to the UK This information can be given to the employee in a separate document. By the way if you send an employee to another country in the European Economic Area (EEA) then they must get the terms and conditions that are the legal minimum in that country for -working hours and rest breaks
-holiday entitlement
-minimum pay The date their employment in the new job started, and also the date of any continuous employment they may have with your company should be stated These dates will normally be the same unless the individual has maintained continuous employment with you and the post is just a different one such as a promotion Other circumstances might be where you have taken over an organisation with existing employees In this case their employment rights are maintained and so their continuous employment date is the start date with that organisation The fifth piece of information to be included in the principal statement of terms and conditions relates to pay It must specify when payment is made – so weekly, four weekly, per calendar month etc. It must also include details of the employee’s gross salary before tax, national insurance and any deductions this could be given as an annual, monthly, weekly, or hourly rate If the employees salary is variable in some way – for example dependant on piece work, overtime or commission then the method of calculating their remuneration must be specified. Remember: -All employees are entitled to an individual written pay statement.
-Pay slips/statements must be given on or before the pay date.
-Fixed pay deductions must be shown with detailed amounts and reasons for the deductions – e.g. Tax and national insurance -Part time workers must get the same rate as full time workers.
-In the UK most workers are entitled to be paid the National Minimum Wage. You should include the number of hours they are contracted to work per week Unless of course it is a zero hours contract with no agreed number of hours It is also advisable to include any working pattern they are expected to work especially if there is shift work involved. Shop and betting workers who are required to work on a Sunday under their employment contract can give three months’ notice to their employer, in writing, of opting out of Sunday work These workers must be informed of this right when they start work If someone works at night, there are rules covering the hours they work Employers must make sure that workers don’t work more than an average of 8 night hours in a 24-hour period and workers can’t opt out of this working limit You must keep records for 2 years of night workers’ working hours to prove they aren’t exceeding night working limits Employees only have to work overtime if their contract says so Even if it does, by law, they can’t usually be forced to work more than an average of 48 hours per week An employee can agree to work longer – but this agreement must be in writing and signed by them You don’t actually have to pay workers for overtime, however, employees’ average pay for the total hours worked mustn’t fall below the UK National Minimum Wage State whether the job is permanent, temporary or fixed-term and if it is fixed-term then state the end date of the contract If it is fixed-term but is dependant on something other than a date to end the contract then state what this is – for example the return of someone from maternity leave or the end of a project. It is perfectly in order to have a probationary period in a contract and state that the individual is employed subject to satisfactory completion of this trial period It could be anything in the region of 1 week to 6 months depending on the length of the contract Normally during a probationary period you might give less favourable terms such as a reduced notice period or no entitlement to certain other benefits such as occupational sick pay. All workers are legally entitled to 5.6 weeks’ paid holiday per year But you can include bank holidays as part of this statutory annual leave entitlement. This means workers who work a 5-day week must receive 28 days’ paid annual leave per year Part-time workers are also entitled to a minimum of 5.6 weeks of paid holiday each year, although this may amount to fewer actual days of paid holiday. So if a worker works 3 days a week – then their leave is calculated by multiplying 3 by 5.6, which comes to 16.8 days of annual paid leave If someone works irregular hours, then you should outline how their leave will be calculated (or at least refer them to another document which does outline this). Workers are entitled to a week’s pay for each week of leave they take. If their pay varies each week for example if they work overtime or shifts then a weeks pay is the average over the previous paid 12 weeks A collective agreement is one made in writing between a trade union and an employer covering such things as: terms and conditions of employment, trade union membership, negotiating arrangements etc. These should be incorporated into the contract and will affect the employee whether or not they are a trade union member You should outline the procedure for the employee if they are sick and unable to come to work either in the contract or refer them to a policy or handbook where this information is available Normally employees are entitled to statutory sick pay. This is paid for every day that would normally be worked, but does not start until the fourth working day of sickness and lasts for a maximum of 28 weeks. You can offer company sick pay which may give full or part pay for a set period of sickness. If you do you should outline this in the terms and conditions of employment In the UK by 2018 every employers will be required to enrol their workers into a workplace pension scheme. All new employees must be automatically enrolled but can then opt out of the pension scheme if they want to If you have not already started autoenrolment then you can find out the date you must start on the pension regulators website: If you do not yet have an occupational pension scheme you can opt in to the government National Employment Savings Trust (or NEST) which will allow you to meet your employers pension obligations under these new pension regulations The web address for that is Notice entitlements should be outlined. It is also acceptable to refer to the legal minimum as the notice period. Notice periods currently are: one week’s notice if the employee has been employed by the employer continuously for one month or more, but for less than two years two weeks’ notice if the employee has been employed by the employer continuously for two years and one additional week’s notice for each further complete year of continuous employment, up to a maximum of 12 weeks. For example if an employee has worked for 5 years then they are entitled to 5 weeks’ notice. Employees must give their employer a minimum of one week’s notice once they have worked for one month. This minimum is unaffected by longer service However contractual notice is the amount of notice that you set out in the terms and conditions of employment which can be longer (but not shorter) than the statutory notice. For example the statutory notice an employee must give to an employer is one week, however, an employer can state within the terms of employment that an employee must give one month’s notice The written statement must also contain grievance and disciplinary information either in the document itself or referenced in another document such as a handbook or separate policies. This should include: -who to go to with a grievance
-how to complain about how a grievance is handled -how to complain about a disciplinary or dismissal decision
-where the Grievance and Disciplinary rules can be found That concludes the required content of the Principal Statement of Terms and Conditions. Remember – the third element that forms the contract of employment relates to the company policies and procedures which have been referenced in the job offer and Principal Statement of Terms and Conditions Formal policies are not always necessary but the following 5 areas should be covered somewhere such as in a staff handbook or other document. For very small companies with only a few employees it would be sufficient just to describe them in a few paragraphs, perhaps referring to other documents or websites if necessary Incidentally if you have more than 5 staff you must, under current legislation, have a written health and safety policy. There are plenty of resources on our website to help you with this if you don’t have one yet. There are a number of other company policies which although not strictly required as part of the contract it is probably a good idea to have something written down on each of them – especially if the policy is particularly relevant to your business even a paragraph or two on each can be enough – so lets go through these: The first one is pay if how pay is reviewed and calculated in your company is very straightforward, then you probably don’t need anything written down however if it is more complex for example if it involves commission arrangements or overtime calculations it is probably a good idea to have something in writing It can also be useful to demonstrate how you ensure you pay at least the national minimum wage Working hours or shift patterns again this is worth clarifying if there is anything complex about it in you terms and conditions Company and personal property if you issue your staff with any company property such as vans, cars, phones, tablets, etc. you might want to be absolutely clear about their responsibilities with your property so for example can they use the phone to make private calls, can they smoke in your van etc. Also be clear about your employees personal property so if they get an expensive watch damaged at work or their car gets dinked in your car park who is responsible? We said before that there were some things which were too obvious to write down within the contract of employment confidentiality would probably come under that. However it does no harm to be absolutely specific about your expectations around this with your employees and what might happen if they divulge company sensitive information A few more to think about: Maternity, parental leave and flexible working arrangements these are entitlements based in law and so while you don’t need to have a policy until someone activates this for example by asking for parental leave or requesting flexible working it can be useful to have something written which describes your policy on this and how the employee can apply for them Dress code is probably only relevant if you have a company where your staff meet the public or have to wear a uniform however it could also be important if they are required to wear protective clothing This might also extend to wearing of jewellery, personal hygiene if appropriate and so on. And finally if your staff use email or the internet what restrictions if any do you want to place on that also what about social media are you happy that they might represent your company on twitter or facebook. OK let’s sum up then how you go about issuing a contract of employment to a new member of staff firstly make the job offer verbally and then and follow this up in writing either with a letter of appointment or with the full statement of terms and conditions if you are ready to do so If you haven’t already issued the full statement of terms and conditions ensure you do so within 8 weeks of their start date there are templates available to make this very straightforward and I’ll point you to these next And finally just ensure any of your company policies referred to or policies that you think need to be brought to their attention are both up-to-date and available. These don’t always have to be formal policies a paragraph or two describing your policy is often sufficient Let’s go ahead now and look at where you can find some templates to help you with this Firstly you can Google “contract of employment templates” or you can go to our website at So that will take you to our home page. If you go to the left menu you will see an option called Contract of Employment. Click on that it takes you to our contract of employment page. Part way down we have a section which contains a number of employment contract policy and document downloads. On there you will see for example we have a template for a letter of appointment we also have a template for a standard contract, one for fixed-term and one for zero hours. we also have a new template which is a contract of employment and integrated staff handbook. This is really good for small organisations which is maybe issuing their first or second contract. What happens when you click on one of those? It will download to your computer, or automatically open itself in Word. You will see that the red areas are the blanks which need to be filled out If you do that you have a fairly instant – in this case – letter of appointment. Its the same with all the other templates we have there. So feel free to go on to this site and browse. They are all free to download so feel free to browse around. So its Human Resource Solutions at Well that’s it – thanks very much for watching. If you have any questions at all get in touch via the web site. See you next time!

The Youth Employment Crisis: a Call for Action

Young people are the promise
of positive change in society. But there is not enough work for them. The current young generation
is worse off than 20 years ago. According to the International Labour Organization
– the ILO – there are in the world 74.5 million
unemployed young persons. In advanced economies, youth unemployment
and discouragement remain persistent. The youth unemployment rate is 13.1%, nearly 3 times the rate of adult unemployment,
which stands at 4.7% Young people with higher levels of education
are increasingly taking up jobs for which they are overqualified.. In developing countries, the challenge
is not only creating jobs, but also finding decent jobs for those young people who are underemployed
and working in the informal economy. More than 220 million are working poor. The economy will have to create 600 million
productive jobs over the next decade. There is no one-size-fits-all solution. In 2012, the International Labour Conference
made a call for action identifying five key policy areas
that require everyone to act together targeting all young people alike, including: Economic policies that increase and
creation of employment. Labour market policies for vulnerable youth. Education and training. Entrepreneurship and self-employment. Labour rights for youth. Investing in youth is an investment
in the present and in the future of our societies. We need to urgently address
the youth employment crisis. This is a call for action!

Employment for persons who use AAC

Welcome to this presentation of the
aac-rerc webcast series. My name is David McNaughton and along
with Anthony Arnold we will be presenting on successful employment for
individuals who use augmentative and alternative communication or AAC. Employment is a key issue in the lives
of many individuals who use augmentative and alternative communication our job is
part of how we define ourselves for many adults including individuals with
disabilities what we do is who we are. Michael williams is a graduate of the
University of California at Berkley. He has worked in a variety of jobs
throughout his life as a writer and editor as a technology consultant and as
a news radio journalist. He is also an individual who uses augmentative and
alternative communication. Michael describes you of importance of
employment in this way having a job may mean you can determine where you live
what you eat how you spend your leisure time how you feel about yourself and how
your neighbors and communities see you as a person in short having a job means
more control over what you do with your life despite the importance of
employment we know that obtaining and maintaining employment poses many
challenges for individuals who use AAC only a small percentage of individuals
who use AAC are employed despite their efforts to obtain and maintain work for
example a nationwide survey by light Stoltz and McNaughton identified 25
individuals who use AAC and who worked more than 10 hours per week in
community-based employment settings negative societal attitudes inadequate
educational preparation and the lack of appropriate community supports prevent
many individuals who use AAC from participating in the workplace clearly
it is a challenging situation but there is much we can learn from those who use
AAC and who are employed as part of the work of the aac-rerc we have worked with
individuals who use AAC and who are employed in order to better understand
their successful employment experiences we have conducted a series of studies
over the past 10 years a full list of references provided in the final slides
of this presentation we also have used this information as the basis for a
recent book in the Brooks AAC series transition strategies for adolescents
and young adults who use AAC so what can we learn from the success
stories in this presentation we will share what we have learned from speaking
with individuals use AAC we will talk about the types of jobs held by
individuals who use AAC and we will share with you what they’ve told us
about the benefits and challenges to employment we will discuss what they
describe is the key components to successful employment and provide some
information on what we think this all means for educational programs that
provide services for individuals who use AAC so the first question is what jobs are
held by people who use AAC we’ve seen a very wide range of successful employment
experiences we have seen individuals who use AAC workers teachers as consultants
as clerical staff as laborers as lawyers as analysts as counselors and as artists
we have seen individuals with cerebral palsy autism developmental disabilities
and other challenges work in a wide variety of employment settings we have
already spoken a little bit about why employment is important but it’s
worthwhile to look a little more deeply at the impact of successful employment
experiences because it could help us to understand why some employment
situations are successful while others are more challenging one of the most
important benefits of employment is the financial support it provides many
individuals with severe disabilities receive some income from the government
however typically this is a minimal amount of money and comes with
restrictions on how the money can be spent as individuals who use AAC have
become more active participants in society we’ve seen new expectations for
participation and independence and also a greater awareness of the financial
demands of living in the community of being involved in a long term
relationship and of getting married and raising the family for all of us employment is more than
just a paycheck it’s an opportunity to interact socially and to be involved let’s take a closer look at the role of
social interactions in the workplace and consider how strong social interaction
skills contribute to employment success Haley is a young woman who takes orders
and delivers lunches once a week to clients who work in local businesses
you’ll see a video clip in just a moment I should probably mention here that this
lunch delivery business is just one of three different activities that Haley
participates in each week Haley and her team have worked hard to make this
employment situation a success Haley has learned how to use the Print
key Romick corporation Vantage plus and she also reads about 200 words these
skills and her enjoyment of people helped to make this job a success let’s
watch the clip of Haley collecting lunch orders the entry in church would you like to
order lunch from Calgary with how’s the patient what are you having for lunch have a
nice day as you can see there are important
supports to Haley’s employment success her mother and vocational rehabilitation
staff act as support personnel in assist Haley and transportation money
management collection of orders and delivery and also in recruiting new
clients the business started while Haley was in high school and has now been in
operation for over five years it’s interesting to read how others see
Haley’s participation in the workplace this is what her mother had to say
Haley thrives on interaction with people she likes that what she does has a sense
of purpose helping others she also likes to be on the go she would
be miserable idling her time away at home or killing time in a segregated
setting a third benefit of employment is the
enhanced self-esteem for the individual that comes from the sense of having made
a contribution to society you the self-esteem associated with
employment was perhaps best summarized by one of the individuals who
participated in one of our employment studies when asked to speak about the
importance of employment he described the following incident after receiving
his first paycheck I cried at the checkout counter because this is the
freedom a paycheck will give me picking out my own stuff will add value because
nothing will feel like a handout I won’t have to wonder what medical assistance
will and won’t get for me as we talk about barriers it’s important
to talk about how to overcome them as well a closer look at some of our
success stories shows that many of these individuals had to overcome three major
barriers attitudinal barriers inadequate educational preparation and a lack of
appropriate community supports including poor transportation and poor supports
for activities of daily living I’d like to introduce Anthony now because I think
his story helps to illustrate how through hard work and perseverance many
of these barriers can be overcome over time I’m Anthony Arnold and Norton
entertainment alternative communicator from Grand Forks North Dakota
I’m the remote proper for the pranky Roma company and I also do a lot of the
beta testing on new newer communication devices such as new ikkaku working for
companies such as the brand pyramid company is a great goal to have in mind
but it did take years of preparation to get to this point I’d like to believe my
transition to adulthood independent living and employment started to happen
on the day my parents learned of my diagnosis of cerebral palsy because the
longer you were put off the educational and rehabilitation the less likely it
isn’t that you will achieve the goals you want after my parents learned about
my cerebral palsy they started taking me to therapies into preschool program one
of the first developments was the creation of the communication board with
six symbols communication is a very important element for employment and
independent living so you want to start laying the groundwork as early as
possible or again you will witness your results and the result will not be the
one that you want in elementary school I was fortunate to have a resource room
teacher who was determined to teach me how to read come hell or high water I
must say that reading is a necessary skill to attain if you’re hoping to
obtain employment someday I can’t name a job where they don’t require basic
reading skills during elementary school they also taught me how to spell and
write which is a skill I had to use every day I had the pranky Roma company
I was fortunate to have had a communication device in second grade and
I must say it really allowed my teachers and my parents to not only educate me
but to prepare me for independent living and employment someday after graduating
from high school I tried college at the University of North Dakota because I
thought that was the traditional thing to do beyond high school but I quickly
found it wasn’t for me so I left after my
second semester and started looking for employment
I took a part-time job at the library of the University of North Dakota
they had me kind of locking books on their online system the position only
lasted for nine months because of the coven funding right after I left the
library I learned that the Brandt pyramid company was basically on the
ground floor of employing augmentative and alternative communication to be
removed Prabhu sugars in the technical service department I had always been
interested in working for an assistive technology company someday after seeing
how much independence and iTouch Parker gave me for things like school
socializing going shopping ordering food and the restaurant and talking on the
phone I decided that there must be others like myself that might need this
gift more than I do so I made working for the friend pyramid company or
somewhere else where I could give people these same opportunities part of my
career goal I had to go through some hard core trading but through PRC
distance learning on the internet and some in-house training right now the
brand pyramid company’s headquarters in will stir Ohio since I started remote
troubleshooting I feel that I’ve gotten some great feedback from customers in
Italy and help here is a sample code Peralta company
please understand I’m using the communication device for a community
how may I help you well my son Kurt obeyed I don’t get much to bitchin
speech there but somehow or other he could sing with you see race but I don’t
know how to do it you have to do something special to get us to sing or
with what they do okay do you have a 128 Petaluma rotator you have the 128
program how do i do either the hundred twenty how many together feet is it in a small
key okay so since I started remote troubleshooting I feel that I’ve gotten
some great feedback from customers that we have helped I am most excited about
working with parents of young children who are just beginning to use a
communication device and other assistive technology I feel I’ve known that when
they hang up after being helped if they have a better outlook on their child’s
future and probably begin working much harder to get more accomplished than
they did before to me that’s really the reward of the
job I do so clearly challenges exist however we
know enough about successes that we can start to identify key components for
employment in addition to overcoming the barriers mentioned earlier we need to
develop employee knowledge and skills that are valued in the workplace
identify and develop jobs that are a good match for the skills and interests
of the AAC user and ensure that needed supports are available to maintain
employment success individuals use AAC are employed in a
wide variety of full and part-time jobs including work as clerical staff
laborers public educators and teachers technology consultants policy analysts
counselors writers and artists so a variety of skills and abilities can
result in successful employment the greater a person’s physical and
cognitive challenges the greater the need for employment support teams to
think creatively about how to identify a variety of employment opportunities how
to work with employers to modify job activities and how to ensure the ongoing
provision of supports however some skills and knowledge are
common to all employment situations and can help smooth the transition to the
workplace these include communication skills personal areas of expertise and a
strong work ethic next we will discuss each of these in more detail the ability to communicate effectively
in the workplace is frequently described as its key skill by both individuals who
use AAC and their employers individuals with disabilities who are perceived as
competent communicators earn on average more than three times as much as
employed individuals who are only able to participate in limited conversations
it is inappropriate to think that there is some threshold of communication
skills required for employment however compared to their counterparts who can
communicate effectively individuals with limited communication skills are more
dependent on the availability of skilled communication partners and more limited
in their job options adding to the challenge of preparing for communication
in the workplace is the fact that whereas some vocabulary is easily
anticipated some is job specific Ric Creech uses AAC and once worked for the
Pennsylvania Department of Education he noted the workplace requires an expanded
vocabulary because in the workplace employees use words that they do not use
anywhere else additionally the speed of workplace
communication can often be a challenge for individuals who use AAC frequently
identified ways of dealing with this challenge include the use of
pre-programmed vocabulary and also the use of communication techniques such as
email to take the place or augment face-to-face communication as Haley and
Anthony’s stories make clear strong social interaction skills are also
critically important the ability to show an interest in others and to be a
positive social presence in the workplace goes a long way to making
employment a success finally our research provides evidence
that strong literacy skills are important especially for those
individuals with more severe physical disabilities literacy skills are
important not only for obtaining a job but they also support an individual in
moving between different jobs at a worksite once they are employed
in today’s changing economy it may be unrealistic to think that an individual
is going to be performing the same task for years and years and years instead
what we more frequently see is an individual moving between a number of
different work activities or projects while maintaining employment the ability
to read and write goes a long way to supporting this movement between
different activities while maintaining employment with a single employer something that’s important for anyone
who was seeking a job is that they’ve developed a personal area of expertise
that is of interest to an employer for Pam Kennedy this meant taking advantage
of her high school experiences when it came time to look for a job Pam Kennedy is a young woman who uses
augmentative and alternative communication she uses the v-max with
series 5 software and speaking dynamically Pro and co-writer in order
to communicate with others Pam also works as the editor and project manager
for the aac-rerc writer’s brigade I’m going to take a moment to talk about
the aac-rerc writers brigade because i think it’s an interesting example of how
individuals who use AAC can learn important employment skills while making
meaningful contributions to society the aac-rerc writers brigade is a project
that helps individuals who use AAC learn new writing and editing skills so far
over 14 people have been involved in the aac-rerc writers Brigade and have
written over 140 publications these publications have appeared in a wide
variety of journals more information is available at the aac-rerc website it’s interesting to see how Pam’s
experiences while in school prepared her for her job as the project manager of
the writers brigade while Pam was in high school she was an active
contributor to her high school’s newspaper and was the editor during her
senior year shortly after graduation she was hired to write a newsletter for her
school district she now makes use of those same skills and supporting the
writing development of the participants in the aac-rerc writers brigade another way of developing personal areas
of expertise is on-the-job training as I mentioned in today’s rapidly changing
economy it’s difficult to think that an individual will perform the same task
throughout his or her work life instead that individual is more likely to have a
career a series of work activities joined by a common interest
thus it really doesn’t make sense for an individual to spend a large amount of
time and pre-vocational training for a specific task rather the best place to
learn most skills is on-the-job where the individual learns to deal with the
wide range of work requirements and supports that exist in the real world
I think Anthony’s story provides a good example of this prior to working for the
print Irama company Anthony had to use PRC technology personally and also had
some experience in working with computers but the highly specialized
skills that he needed to work as a PRC tech support were best learned through
both through a brief period of intensive training and through the mentorship and
support that he received in the early weeks of his new job finally a promising new approach to
ensuring that a job taps into an individual’s personal area of expertise
is the use of job carving job carving involves determining a person’s skills
and interests and then matching these skills to some portion of duties in an
existing job I think Haley’s story provides a very
good example of this although it would be very challenging for her to complete
her whole job independently she is still able to participate in the workforce by
completing that portion of her job activities that take advantage of her
strong social skills employment especially full-time
employment is going to present many challenges for individuals with severe
disabilities there’s not only the difficulty of obtaining the job but
ongoing issues such as scheduling transportation arranging personal
assistance services and dealing with negative societal attitudes to obtain
and maintain employment is going to require a strong commitment on the part
of the person who uses AAC I think the strength of the work ethic
that’s often observed for individuals who use AAC can be seen in the following
quote this quotation was provided by an individual who uses AAC and was employed
full-time at the time of our research study he said the following if somebody
asked me why I work full-time I would ask him or her the same thing
why wouldn’t I work I’m not rich everybody works yes I have disabilities
however it does not mean that I’m not a human being why did I go to school why
does anybody go to school it is to learn me to if I did not go to school and did
not want to work what is the difference between a dog and me last time I checked
I was still a human being we have talked about developing employee
knowledge and skills that are valued in the workplace we are now going to carry
on and discuss identifying and developing jobs that are a good match
for the skills and interests of the individual who uses AAC when discussing the components of a good
job match individuals who use AAC go beyond simply talking about the money
although that is important they describe their interest in participating in a
fulfilling work activity having a job that involves appropriate time
requirements and also the importance of a committed employer when thinking about identifying a
fulfilling work activity clearly first of all the work activity should be a job
in which the individual either alone or with support is able to meet the work
demands however as with anyone these work goals are most easily addressed if
the job is one that is intrinsically motivating and incorporates the
individuals interests and skills Soloman rahman is a full-time employee
at the u.s. Department of Navy he uses an echo 14 to communicate and he assists
in the development of a document database for technical records some of
his work is done from home some of this work is done from his office at the US
Department of the Navy the database he is creating is used by Navy maintenance
personnel at their job sites via a secure internet network Soloman stories an interesting one
Solomon and his brother his parents in his grandparents emigrated to the United
States from the Soviet Union when Solomon was fifteen years old
both Solomon and his family are enormous ly proud of his service to his new
country and he has received numerous awards for his work with the US Navy another important feature of a good job
match is that there is an appropriate time requirement for the work activity
individuals with severe disabilities often speak of the challenge of creating
a balance between workplace activities and everything else that is needed in
order to make employment a reality transportation the time needed to
prepare and eat meals get dressed personal hygiene etc some individuals
have dealt with this challenge by telework that is working from home in
communicating with fellow employees via email as we talk about employment for
individuals who use AAC it is important to realize that part-time work or
volunteer work can often provide many of the same benefits as a full-time job for
example Haley participates in three different workplace activities each week
this gives her more variety in an opportunity to interact with a wider
circle of people it also provides some redundancy so if one job goes into a
slow period and her work isn’t needed she has other work activities as options
Rebecca a young woman with physical and cognitive challenges also participates
in a variety of activities however in her case these are volunteer activities
each week she volunteers in an elementary school classroom helps as a
guide at the local museum and also performs as a member of a dance troupe
these are all volunteer activities but provide many of the same benefits as
paid employment including an opportunity to contribute to society and to interact
with others for more information please visit Rebecca’s website just as in any employment situation a
committed employer is critical to a successful work experience what is
perhaps unique about the hiring of an individual who uses AAC is that there
will be a need for increased effort both at the beginning of the employment
process as well as the provision of ongoing supports for example setting up
assistive technology assistance with meal times employers who have not had
experience with individuals with disabilities sometimes express concerns
about the costs associated with hiring and individuals disabilities the need
for additional supervision and the possibility that the individual might
not have the essential job skills the good news is that employers who have
hired individuals who use AAC typically describe it as a very positive
experience and express their interest in hiring additional individuals who use
AAC in the future I think the importance of a committed
employer and how to develop that commitment over time can be seen in
Paul’s story Paul is a 31 year old man with a diagnosis of autism he uses a hip
talk which is pre-programmed with a small number of phrases as part of his
AAC system he works as a bagger at a local grocery store you Oh what is interesting about Paul’s
situation is that his employer was initially very reluctant to hire an
individual with autism a trial employment period demonstrated that not
only was Paul able to complete the essential job requirements of bagging
groceries in an efficient manner but he also had the best on-time record of any
of the stores baggers and as you heard on the tape he was the only bagger that
consistently remembered to thank the customer for shopping at the grocery
store another way of ensuring a committed
employer is by being your own employer so a number of individuals use AAC are
exploring self-employment and micro-enterprise activities as ways of
participating in the workforce micro enterprises are a relatively
recent development so it might be interesting to talk about them for a few
moments a micro-enterprise is a small business that is a form of
self-employment and requires the support of other people in order for it to be a
success so as with Haley she needed the assistance of vocational rehabilitation
personnel and her family in order for her lunch delivery business to be a
success the business is based on the interests and talents of the individual
with a disability and some of the priorities in the creation of the
business include an emphasis on participation in the community
interaction with others and gaining a sense of self-worth
while making money is always nice making a profit is not the number one priority
of the micro enterprise Ben’s story provides an interesting
example of the development and operation of a micro-enterprise
then is 28 years old and has a micro-enterprise that raises chickens
for their eggs the eggs are then sold to local stores and restaurants then uses a
DynaVox for with a single switch and an auditory scanning system business
friends Coast side firms I had help from my friends and family my firm
specializes in raising pans for eggs we are certified – again – can supply local
businesses being an individual will see people’s many challenges when I was
getting started with the local help these obstacles have mostly been
overcome hello I’m Dustin and I’m Ben social
director and his friend and helping with all his egg deliveries in the egg
business as well my favorite thing to do is Benny we have a great time doing it
together I studied this in college Ashley and when I started working for
Benny as his social director I was really excited to find out that I would
be also a part of his organic egg business because I did have the
background to be able to add something to it and yeah we’ve some great time
doing it and I’ll tell you more about me a little bit later this is our Byrne
office everything starts here running your own businesses aren’t
enough being nonverbal makes it even harder since I own the business it is up
to me we’ll make the final decisions regarding operations
if someone doesn’t understand what I want done or if I can’t communicate with
an employee or other business owner directly it can be frustrating running a
business has a lot to do with social interactions and networking this has not
been easy for me sometimes a friend like Dustin will be my interpreter we use the
verbal scanning method when conversing with business associates having a
DynaVox has made this part of my life easier now I can directly communicate
with employees and anyone else I need to talk to I still need help programming
the device but we have worked out a good system to do that I don’t meet an
interpreter as much anymore being able to initiate conversations and
respond to people has made others aware that I can understand them and that they
can speak directly first around yourself with good people it’s important to trust
the people you work with and for them to trust you as well I have been lucky
enough to be able to work with friends and family also make sure that the
people you work with not only understand your condition but they also understand
how you communicated at first some of our clients didn’t realize I could
understand them they would talk about me like I wasn’t there once it was
explained to them that I am totally cognitive they treated me with more
respect and understanding the DynaVox has helped a lot when dealing with those
types of experiences I remember a client of ours almost right the first time she
heard me use my time relax she really opened up after that
also be assertive don’t let other people make decisions without your input even
though I can’t say everything I want to the people around me know that I make
the final decision and last but not least have fun while working
don’t let the tedious aspects of the work get you done and keep your
employees and clients happy and things will run much more smoothly we’ve talked
about developing employee knowledge and skills that are valued in the workplace
and identifying and developing jobs that are good matches with the skills and
interests of the individual who uses AAC we’re now going to discuss ensuring that
needed supports are available to maintain employment success there are three key areas of support for
individuals who use AAC in the workplace supports are needed for workplace
participation job completion in the development and maintenance of positive
co-worker relationships so as we’ve spoken about just getting to the
workplace and receiving appropriate supports in the workplace compose
enormous challenges as I mentioned earlier telework can provide a creative
solution of this problem both Solomon and Pam do most of their work from home
and interact with their co-workers via the internet our research tells us that
the use of telework for individuals use AC as both benefits and drawbacks
benefits include that through the use of telework individuals can often
participate in work activities that would be extremely challenging if daily
transportation to and from the workplace was required individuals use AC also
appreciate the increased flexibility with respect to the coordination of work
and other activities such as medical appointments that is possible with
telework drawbacks include the concern that there may be reduce social contact
with co-workers when telework is used in also the blurring between home and work
environments it can be hard to get away from the office when the office is at
home however for all of the individuals in our study they describe the benefits
of telework as outweighing the drawbacks AAC and other forms of assistive
technology enable many individuals with severe disabilities to demonstrate their
confidence in the workplace the effective use of assistive technology
however requires more than merely the provision of a device
Randy Horton an individual who learned to make effective use of an AAC device
after 96 hours of training describes the importance of organized instruction
saying people without disabilities receive 12 years of writing and language
teaching during school usually a consumer is given 2 to 6 hours of
teaching how to use the device extensive intensive teaching during implementation
is the key to success in addition while an AAC device can be very helpful in the
workplace it is important to remember that every device at some point is going
to break down it is important to ensure that there is always a backup to the
backup typically a low-tech option perhaps a paper communication board so
that when a device does break down the individual still has a way to
communicate and participate in the workplace another key area of support
and perhaps most challenging is support for activities of daily living in the
workplace many individuals with severe disabilities will require assistance
with feeding and toileting routines and it can be difficult to access reliable
and professional attendant care services while some individuals who are employed
full-time in the workplace have received professional personal care attendant
services some individuals have been forced to rely upon the assistance of
family members challenges of obtaining appropriate personal care attendant
services in the workplace have led many individuals with severe disabilities to
consider part-time employment or self-employment this remains an area in
need of social policy change communication in the workplace is about
more than negotiating work activities it is also about being able to participate
in the social interactions that maintain a positive work environment in order to
establish and develop positive co-worker relationships it will be important that
the individual who uses AAC has the communication skills and social skills
needed in the workplace often this means that the individual who uses AAC will
need to take responsibility for initiating a positive co-worker
relationship Jim Prentiss has provided an excellent
example of how to do this Jim Prentice communicated using a touch talker a
dedicated voice output communication device he worked as a statistical record
keeper for the Westinghouse corporation in Pittsburgh Pennsylvania
he described the importance of establishing a positive social climate
he wrote when I’m started to work I’m sure that all the employees surrounding
my work station probably thought I was someone from Mars I rode in on my
motorized wheelchair and had some sort of device attached to my chair
I rode past them and they really didn’t know whether I was able to talk if they
did talk to me they weren’t sure I was able to answer them they never saw
someone coming to their work with a communicator I stopped them in their tracks before
they were frozen on the spot and said good morning my name is Jim how are all
of you doing today big smiles came on their faces
and they seemed to answer in unison we were fine and it’s nice having you work
with us that sure broke the ice I felt like one
of the team then I made sure I programmed a few jokes into my
communicator so that would make my conversations more friendly and
comfortable for them it worked clearly Jim Prentice had the
communication and social skills needed for workplace success before he started
work at Westinghouse these skills played a key role in his developing positive
co-worker relationships at his worksite we’ve talked about key components for
employment success for individuals who use AAC developing employee knowledge
and skills that are valued in the workplace identifying and developing
jobs that are a good match for the skills and interests of the individual
who uses AAC and ensuring that needed supports are available to maintain
employment success for those of you who work with children
and young adults who use AAC clearly these key components have important
implications for educational programs these include the need to ensure that we
teach skills that are valued in the workplace that we support the
development of effective and efficient communication skills and that we help
individuals who use AAC develop a strong work ethic when we think about developing valued
skills clearly it’s ideal if there’s a close match between the interests of the
individuals and the targeted skills in Pam’s case for example her interest in
writing supported her in the development of the writing skills needed for her
work with the aac-rerc writers Brigade in Anthony’s case his interest in
computer technology positioned him for an employment opportunity with the
prentke romich company while the development of skills that are related
to a particular job is very useful while the development of skills that are
related to a particular job are very useful it’s also interesting to think
about skills like literacy that are usable in a variety of job settings
literacy should not be considered a prerequisite for employment 48% of the
participants in the light a tile study all of whom were employed individuals
whose desi were unable to read a newspaper and so would be considered to
have limited literacy skills however participants in the study who
demonstrated better literacy skills frequently enjoyed jobs with better pay
reported higher levels of satisfaction and had more opportunities for
advancement finally it should be clear from any of the examples used in this
presentation social skills play a critical role in employment success key
skills include the ability to introduce oneself in one’s use of an AAC system
and the ability to deal with communication breakdowns next it should be clear that effective
and efficient communication skills are critical for the workplace we have seen
individuals be successful with a wide variety of AAC technologies but clearly
it is important that they enter the workplace already skilled in their use Brian’s lazarenn ski and Baker have been
active in developing and researching the impact of specialized post-secondary
programs targeting employment literacy in assistive technology skills the
augmentative communication and empowerment supports program was
developed to provide adults with significant physical and speech
disabilities with training in the use of their AAC devices these individuals had
received a device through their educational or vocational programs but
most needed additional training in the operation of the device over a six-year
period 17 adults with significant physical and speech disabilities
participated in the intensive summer program after a two-week immersion
program in one year follow-up training and support most participants reported
that learning to use an AAC device had substantially helped them in many major
life activities including communicating with unfamiliar people or in groups
maintaining a source of income and acquiring new skills such as how to
engage in advocacy activities finally employers frequently described
the importance of a strong work ethic that is an employee’s demonstrated
interest in completing an activity to a high level of quality for adolescents
with severe disabilities having any kind of impact on the environment let alone
completing a task to a high level of quality is often challenging at the same
time some adults who use AAC and who are employed have reported that they were
sometimes in their first job before they got honest feedback on their performance
as children and young adults they had known nothing but praise and so had a
little experience with corrective feedback for caregivers and educators who are
trying to raise self-determined children this is a challenging situation it is
important that young adults be provided with support and recognition for their
effort but it’s also important that they receive realistic feedback on their
performance some parents and caregivers have spoken of the importance of
providing young children with regular opportunities to complete small
activities or household chores in order to build a sense of how to begin and
complete a task in his article heading for work Micah Williams wrote about how
young children fused AAC contributed to their families LD age eleven had the
responsibility for dusting non-breakable areas with a feather duster and walking
the dog candace age eight was responsible for helping to sort the
laundry and remembering her library book on wednesdays the importance of early
experiences in building a strong work ethic for all individuals including
those with severe disabilities was succinctly summarized by faith carlson
in her presentation entitled how can you expect to get a job if you don’t start
in preschool an important next step is that students
have an opportunity to explore job interests and matches through part-time
and summer employment part-time and summer employment helps teenagers
explore an interest in particular work activities gives them a better idea of
the time commitment associated with different jobs and introduces them to a
variety of potential future employers Carter and colleagues at the University
of Wisconsin have done some very interesting work in this area they’ve
developed a three-part intervention package that includes first intentional
student planning so the development of planning document used by the student
teachers parents potential employers to identify long term and short term
employment goals second community connectors so there are school employees
who assist in identifying available jobs and the supports that are available
there and finally an employer liaison who works to create links between the
school and potential employers this program had a dramatic effect on the
summer experiences of the students with severe disabilities who participated
more than 65% of the students in the Employment Program participated in some
type of employment during the summer only 18% of the individuals who did not
participate in the program had a similar experience Scot palms description of his experience
in applying for his first job I think there’s a wonderful job of illustrating
how while terrifying it also provides a valuable learning experience for the
future Scott wrote my job developer came up with the idea of me giving a speech
to the City Council about my job I was scared to death I had just put my speech
Giving Program into my Liberator but I did not know if it would work when I
needed it the night of the speech came my scared
feeling was replaced with a blend of emotions I was excited but nervous I was
excited because I knew I could do it I was nervous about how it would turn out
I invited my speech pathologist to be there and she was in the audience
after some technical issues with the mic I did the speech something started to happen I began to
have the feeling that I was in charge of the entire room everybody was listening
to me it was really intoxicating I had never had a full room of people
listening to me before the speech was a huge success since giving that speech
Scott has gone on to create a successful business palm-tree enterprises he has
obtained contracts with two school districts to provide support services
for children who use AAC we’ve
a wide variety of issues related to employment for individuals who use AAC
I’d like to close by asking Anthony to tell the story of his experiences while
planning for work while still in middle school when I think about school and my
preparation for employment I always remember a teacher of love saying
Anthony stop dreaming you will never work at the pranky Roma company after C year I celebrated my eighth
anniversary there I am proud to say I taught that teacher something I did meet
up with her once and a conference where I was representing the company and I
received the best apology I ever experienced she thanked me for teaching
her what is actually possible for people with disabilities so thank you there is more information
on employment and transition strategies for adolescents and young adults who use
AAC in our recently completed text I would also encourage you to visit the
aac-rerc comm website for additional and updated information on these topics we would like to thank Neider
who provides funding for the aac-rerc finally I would like to provide some
additional references and resources in the following slides thank you and I
hope you’ve enjoyed this presentation you you

Employment/Day guidance: Making the New Medicaid HCBS Settings Regulation Work In Your State

Good morning, everyone. This is Samantha Crane from the Autistic Self Advocacy Network. We are right about to start our Webinar. This week’s Webinar is about employment and day services under the new home and community based services rule. I will just wait for another minute or so to make sure that everyone can sign on. All right. We’re ready to start the Webinar. Welcome, everyone, to the fourth of a series
of Webinars about the home and community based services rule that came out earlier this year. This Webinar’s topic is employment and day guidance. And we’ll be discussing how the final rule applies to nonresidential home and community based services including employment services and day services. This Webinar series is presented by the Collaboration to Promote Self Determination. And I’m presenting this on behalf of the Autistic Self Advocacy Network. Just to give a quick introduction of myself, my name is Samantha Crane. I’m an attorney with a background in disability law. I have a history of working at the Bazelon Center for Mental Health Law and I focused on Olmstead
and community integration issues. I am now the director of public policy at the Autistic
Self Advocacy Network. And just because I have to, I will say my views in this Webinar are based
on my analysis of regulations and programs but
they are of course not legal advice. They’re more just focusing on my own take of what the regulations mean. Everyone� I think most people on this Webinar have some familiarity with the HCBS rule at this point. But I’ll just go through some of the key points of the final rule so that I
can refer back to them when I’m discussing the employment and day services. One thing that the rule requires is that any setting, any service that gets funding through federal funding through Medicaid home and communitybased services program needs to be provided after a person has a center planning process. That includes the people chosen by the individual to decide on services. It needs to present a person with a range of options
and the information they need to make an informed choice. It needs to be reviewed periodically, and most importantly, it needs to involve
a conflict of interest protections. Typically, we’re not going to see service providers as part of the personcentered planning process. And by “service providers,” I mean people who are providing services under the
plan. You could definitely have a service provider that’s only there to run the person centered planning process but aren’t represented in
the person’s service plan that’s developed through that process. But we want to make sure that a service provider that’s going to be providing day services
or employment services to the person isn’t also guiding the person centered planning process because then they can steer the person toward their own services instead of allowing the
person to make an informed choice. The settings have to be integrated into the community. They need to maximize opportunities to seek employment and work in competitive integrated settings. They need to maximize people’s opportunities to control personal resources and receive services in the community. They also need to be consistent with the person’s individual choice, right to privacy, dignity
and respect, freedom from coercion and restraint. And they need to facilitate autonomy, independence and choice of services and supports. These requirements, again, are in the final
rule, and they apply to all kinds of services, including both residential and nonresidential services. These are very general requirements. Another thing to keep in mind is that these requirements are all separate. They� all three of them need to be met, so not only does the setting have to be integrated into the community but also it needs to provide rights such as dignity, privacy and respect. It is not enough to show that only one of
these factors is met. We need to show that all of them are met. The final rule really focuses on the nature
and quality of individual experiences more than
it focuses on specific issues, such as the number of people who can be served or the exact model of service that the person is using. But what really is important is that the person has
to have maximum opportunities for community integration, and that’s to opportunities need to explicitly include the opportunity for competitive integrated employment. We need to maximize opportunities also to control personal resources and engage in community life. One of the things that we really need in order to maximize those opportunities is allowing people to manage their money to the extent
that they are interested in and able to do that. And we need to maximize a person’s opportunity
to participate in the community. Now, a steady income is going to really improve a person’s opportunity to participate in the community. If you want to see a movie, you need to be able to afford to go to the movie. If you want to go out to dinner with your friends,
you need to have at least enough pocket money
to pay for dinner with your friends. When a person is not making a living wage
or not economically self sufficient, their opportunities to participate in community life are going
to be a lot lower. The regulations also include a set of� a
set of kinds of places that are presumed to be institutional. And, again, these are both residential and nonresidential settings. They need to be� if a setting is a publicly or privately own facility that provides inpatient treatment like a hospital or if it’s on the grounds of a public institution or immediately next to a public institution, then it’s going
to be presumed institutional and not eligible
for home and communitybased services funding. States can still run these programs but just not
through their home and communitybased services setting. There’s also a catchall. So any place that has the effect of isolating individuals receiving HCBS from the broader community are also going to be presumed institutional. And one of the examples that CMS has given for this kind
of a setting is, for example, a place where a bunch of disability-specific services are colocated and operated by the same provider. So let’s say you have a campus where a person is living
and also receiving day services and also receiving medical care and also� you know, there is
a store that caters specifically to the people with disabilities living in that place so
that they almost never have to go off of that campus, that kind of a setting is going to be presumed isolating and presumed institutional. If a state wants to use HCBS funding for services in this kind of setting, they’re
going to have to get� they’re going to have to
send in a proposal to CMS justifying that specific setting and get an exemption from CMS that
sort of says, yes, this is, in fact, not isolating people. CMS is not going to give that exemption unless it actually finds that the setting is not isolating. It is not just whether the setting is good or whether or not people chose it. It actually has to be nonisolating. This is just what I’ve said. The setting is designed specifically for people with disabilities, then it is going to be presumed isolating. Some examples of isolated settings are farmsteads or disabilityspecific communities, gated communities, residential schools and colocated and operationally related settings
or facilities which is what I just explained. That’s a bunch of specific services on one
site all to serve people with disability or people with disabilities in general. These are examples that CMS itself has given as potentially isolating settings. If a state does want an exemption to fund
a setting that falls under this category, it
is not only going to have to send a request to CMS, but it’s also going to have to go through a public comment period to allow people, stakeholders, and advocates the ability to comment on whether the setting is actually isolating. Now, why are we specifically talking about residential versus nonresidential settings? The reason is that they really make a distinction in the regulation. In particular, CMS offered a whole set of additional requirements for providerowned residential settings. That is a place like a group home or an apartment that’s owned by the same organization that provides the services to
the person with a disability. Those extra requirements were very detailed,
and CMS announced that it would issue guidance
on how to apply the requirements to nonresidential settings as well. But it hasn’t yet issued that guidance about nine months later. And it’s made clear that the regulations do apply to nonresidential settings. It is only these specific part of the regulations that’s just about providerowned residential settings. That, of course, doesn’t apply to nonresidential settings. But every part of the rest of the regulation does. And CMS has taken the position that states
should be able to figure out how to apply these general parts of the regulation to nonresidential settings. And even if it hasn’t come out with further guidance, this should be clear enough for states to be forming their transition
plans in the meantime. So a lot of people are really wondering, if it’s so clear, what should we
be taking away from it? An example of the kinds of settings that we’re talking about are adult day services also
known as adult daycare. Many of these services have historically been provided in segregated settings. So we’re going to really need to wonder how these new regulations are going
to apply to it. Right now, the regulations heavily disfavor segregation or any other isolated setting. It is likely that states will have to think about how they are providing adult day services. In fact, the Department of Justice has issued findings that these services are unduly segregated under Olmstead which is
an ADA case that says that states need to provide services in an integrated setting. So if something is violating Olmstead, it’s likely that it’s also violating the new home and communitybased services rule. And we’ll get to that a little bit more later. Other examples of nonresidential services
are habilitation services. These can include home based habilitation to help people gain skills in activities of daily living or it can involve day habilitation which is often centerbased. A bunch of people go to a center and they learn various life skills or engage in support groups and otherwise are sort of supposedly learning how to live independently. It can also include expanded habilitation services. This is where we get into employment services. It includes prevocational services, which are to prepare an individual and get people very general employment skills like following directions, attendance, how to complete a task, how to be safe in the workplace. And I’m sorry, someone has said that I’m cutting in and out. If people can hear me or cannot hear me, can you please� if you can’t hear me, can you please raise your hand. Maybe I should say, if you can hear me, please raise your hand. I’m worried that a lot of people won’t raise their hand just because they aren’t necessarily tuned in. I will try to remain on the line and avoid cutting in and out. If I keep cutting out, please just let me know. I hear a lot of people saying I’m fine. Great. So prevocational services, they tend� they are actually required to involve placements where a person is not paid more than 50% of minimum wage. So a lot of your traditional sheltered workshops which paid less than minimum wage, these are often going to be covered or are currently covered under prevocational services. So when we’re talking about whether sheltered workshops can be covered under home and communitybased services funding in the future, that’s the category
that we’re really talking about. Expanded habilitation services can also include educational services and supported employment services. Supported employment is when a person is� has a job, typically an integrated one
where they’ve got just a very normal job and they
are getting support in order to keep that job,
such as job coaching or help to get back and forth from the job, help with training that person while they’re on the job. Some states as I have already noted have said they are waiting on additional guidance from CMS on how to apply the new role to nonresidential settings. But CMS has said really don’t wait up on this. You should be able to apply the final rule to these nonresidential settings just based on the text of the rule. Well, how are we going to do that? We are going to apply the general requirements to nonresidential settings, including day programs. We’re going to go through sort of one by one
how are we going to implement these requirements. First, there’s the obvious one that all HCBS
has to offer people opportunities to seek employment and work in competitive integrated settings
to the same degree of access as people not receiving Medicaid home and communitybased services. So that means that people could theoretically
work in a rural setting. They could be getting services at home or in other settings where interaction might be limited for reasons other than disability. So if a person can work at home who doesn’t
have a disability, then the person with a disability could get services that help them work at
home, too. A person could work on a regular farm, and so a person with disability could also work
on a regular nondisabilityspecific farm as long
as they’re interacting with the community to
the same degree as nondisabled people who work on a farm. It is also important to note that even though a person isn’t required to seek employment under these regulations, there’s no part of
the regulation that means that you can’t have
the opportunity to seek employment or control
your personal resources in the future. So if you have a placement that’s not itself competitive, integrated employment, that placement still has to be offering an opportunity for competitive integrated employment. You can’t block off that option. When we talk about segregated habilitative programs these have a really bad track record of placing people in competitive integrated employment. So when we’re deciding whether or not a sheltered workshop is going to meet
these requirements, you’ve got to consider that. You’ve got to decide, well, if it has only
got 5% placement rate into competitive integrated employment, that’s not evidence that it is providing people real opportunities to go
to competitive integrated employment if they
decide that’s what they want. You also have to make sure that it’s providing people information and encouraging people
to go into competitive integrated employment. If a setting isn’t giving people the confidence
and sort of telling people, yes, you can go work
a job if you want to, people will support you
and we can help you find that job and it will
be okay. Then people aren’t really having the opportunity to seek competitive integrated employment because they’re not even aware
that that’s an option for them. We’ve also seen that nonresidential services, like residential services, need to offer the opportunity to control personal resources. That might include providing counseling and financial competency. It might include simply allowing a person to get their paycheck or get their benefits themselves instead of having to go through a thirdparty payor or intermediary. If a person needs benefit counseling in order to maintain their benefits while earning a paycheck, they might also need to do that. We also need to make sure that there’s a conflict of interest provision. If a person is� or an organization is providing a person with employment or day services, then they can’t really be running the person centered planning process unless there is some serious conflict of interest protections in there. And that, again, applies to sheltered workshop operators just like it applies to residential services providers. Informed choice. People need to not only have an informed choice but that informed choice needs to include nondisabilityspecific settings. And by nondisabilityspecific settings, I mean settings that are not just for people, disabilities like placement in an integrated competitive work environment or receiving
day services on a oneonone basis or in a setting that’s used by people without disabilities as well. It is not enough that the states have some nondisability specific settings on their roster. It needs to be� the state needs to offer nondisabilityspecific settings for that particular person. That person needs to have some nondisabilityspecific settings in their set of choices and in a way that meets their needs, right? You can’t just offer someone a nondisabilityspecific setting that you know won’t provide for some of their needs. That really has to be on there. Otherwise, the person does not have an informed choice. It is also important to note that informed choice is not everything. A person needs to have informed choice but that doesn’t mean that they can end up receiving services at a place that’s actually not integrated and have it be funded by home and community based services. Informed choice is one requirement. Integration is another requirement. They are both independent of each other. The final rule also includes specific standards that apply to providerowned or operated residential settings. As I said, these are just for residential settings. But you can look at them and sort of infer what will that mean
for a providerowned day or other nonresidential
setting. For example, recipients in a providerowned residential setting need to get� need to
have rights as tenants. They need to have a right to privacy. They need to have a right to control their own schedules and activities. They need for have a right to an accessible living environment. And, as I said, many providerowned settings,
like hospitals or nursing facilities, are automatically going to be presumed institutional, not HCBS. If you think about how that kind of� can
we imply� can we imagine some parallel standards for nonresidential settings, an example might
be the ability to set a person’s employment goals,
a right to an accessible workplace, including accommodations, protections by� from employment law such as the Fair Labor Standards Act and
the Family Medical Leave Act. These are� that could be an analogy to the requirement that people
have tenant protections. These standards, again, are supplements to
the other requirements that are general and don’t focus on nondisabilityspecific settings and nonresidential settings. We’ve seen already a few different state responses that address nonresidential settings. As I mentioned, some states have already said,
we are not even going to talk about this until
we receive guidance. CMS has told you, you can’t do that. But some states have already sort of said,
well, we’re going to go ahead and address nonresidential settings in our transition
plan. A good example is Tennessee which submitted
its transition plan on May�30th, 2014. It decided to take the new rule as an opportunity to create�
to sort of debut a program that it clearly had
been working on for a while before the regulation
came out. Their new program is employment and Community First CHOICES. As Tennessee announced, it will be geared towards promoting and supporting integrated, competitive employment and independent living as the first and preferred option for all people with intellectual and developmental disabilities. It will be operated as a managed longterm support services and supports program. So some managed care provider will take on this contract. This is as far as we know the first sort of combined employment first and housing first program that we’ve seen. Under the new program, consumers would be
able to choose from three models of service delivery ranging from consumer direction where a person manages their own support budget, all the
way through sort of basic managed longterm services and supports where it is the company that’s
sort of deciding which services the person needs
and will get. It’s going to be provide transition services
to use with disabilities under age 21 so that
they can transition to independent living and employment. And it will also offer employment supports to adults even if the adults aren’t
at the nursing facility level of care. That often gets used as a benchmark for whether or not
a person can get HCBS. It is going to target new HCBS recipients,
and then it is going to expand to existing recipients. And just as an aside, existing recipients have already been getting employment first services through a preexisting program. Now, I can’t really� I can’t really express whether or not the Tennessee program is well thought out or is going to be great in terms
of the details. They’ve just got this concept paper. But it is a great example of how it can be an opportunity to really rethink the way
that you provide services and change your default model for employment and day services. Another example is Wisconsin. Wisconsin really has some interesting interplay between the overall health and human services program
and a lot of their programs which are actually extremely innovative and very focused on employment first. Wisconsin relies pretty heavily on sheltered workshops to provide nonresidential services
to people with developmental and intellectual disabilities. And it submitted a letter to CMS basically taking the position that they really should only have to offer some integrated services and that as long as they have some integrated options, they can also offer sheltered workshops and have them covered by home and community based services program funding because that’s how they interpret it� the requirement
in the final rule, that people be able to exercise informed choice. CMS has already responded to the letter, though, and has reiterated that integration is a key component of the final
rule that a setting that is not integrated won’t
be covered by home and community based services program funding. They very carefully avoided saying in a blanket statement that any particular model is segregated because they want states to do that work on
their own before coming to CMS. They don’t want to be saying, you know, this is good, this is bad before they actually see the state plan. What we would expect in the future for Wisconsin is they’re going to have to come up with a
state plan. They are going to have to say whether or not they are going to cover sheltered workshops and justify whether or not they think that sheltered workshops comply with the rule. And then we’re going to see CMS approving or disapproving this transition plan based on
its interpretation of whether or not these particular sheltered workshops comply with the rule. That said, for reasons that I’ll get to later, I’m not going to� I’m not going to predict
that sheltered workshops are going to have an easy time complying with the rule. I’ll discuss that in just a second. The thing that we need to think about in deciding whether a nonresidential service complies
with the final rule is that the new CMS rules are meant to� the new home and community based services rules are meant to mirror the case
law in Olmstead. Olmstead was a case in 1999, the Supreme Court said that a state that provided services to people with disabilities in segregated settings and not in integrated settings was violating the Americans with Disabilities Act, that it was actually discrimination to segregate people based on disabilities in terms of the services and
where they get them. The terms of Olmstead settlements are going
to be very informative in deciding what kinds of nonresidential settings are integrated and
which kinds are not integrated. We know that CMS in issuing its final rule was trying to be consistent with Olmstead. It said so in its notice of final rulemaking. So when we look at recent Olmstead enforcement actions, we can see what kinds of settings
might be considered integrated and which kind are
not integrated. This is sort of a sidebyside comparison of Olmstead versus the final rule. Olmstead applies to all statefunded services, not just home
and communitybased services. So that’s one difference. But also in the home and community based services final rule, it doesn’t just
say that people need to be integrated but it has
a whole lot of more detailed discussion that
is sort of fleshing that out. DOJ has actually addressed nonresidential services in a bunch of recent lawsuits against various states over nonresidential Medicaid funded services. In the United�States versus Rhode�Island,
the Department of Justice took the position that sheltered workshops are isolating and states should instead offer supported employment
in integrated settings. And it obtained a consent decree that requires Rhode�Island to phase
out its sheltered workshops over the course of
about ten years and increase supported employment services. Similarly, in U.S. versus Virginia, the DOJ
got a consent decree requiring states to provide supported employment to people with intellectual and developmental disabilities. And in a pending case in Oregon, the Department of Justice
issued a findings letter saying segregated employment services violate the ADA. So if something violates the ADA, there is a pretty good chance that it is also going to be considered isolating under the final rule. And now I’ve actually gone through my slides
in record time. But I also see that there are a ton of questions. So I will open up to questions. First, whether or not we will have materials
I can email. Yes, materials will be sent out to all registrants at the end of the Webinar. Our second question was whether the new rules address the maximum amount of support a person can get in a vocational integrated setting. The answer is no. There are no maximums in the home and communitybased services rule. It is intended to serve as a floor. So I can say that at a minimum, a person needs to be getting the
support that they need in order to be integrated into
the community to the same extent as a person without� who doesn’t receive Medicaidfunded home and communitybased services. That is going to be dependent on exactly what kind of supports a person needs. If, for example, a person can use the public transit system independently, then they might not
be entitled to assistance getting to and from
work. But if a person can’t use the public transit system independently, then they might need transit to and from work to be covered as
one of the supports. They might need communication support. They might need job coaching. It really just depends on what a person needs
in order to actually achieve employment. Another person asked when we assume or presume that certain settings are isolating, are we
not short circuiting the participation of individuals and their families in making those determinations? And the answer is not� I don’t think so. Choice, as I said a couple of times, is really only one of the many requirements
for home and communitybased services. We could, for example, say that some people
in their families want the person to live in
an institution. But straightforwardly, institutional settings can’t be covered by
HCBS funding. They need to be covered by some other funding stream. And if a person chooses to live in an institutional setting and the state
wants to fund that type of setting, they have to�
they have to find another way of funding it. The goal of home and communitybased services funding is to really increase people’s substantive integration into the community. So HCBS funding is really going to be restricted
to placements that are actively integrated. Now, if a person and their family thinks that it’s wrong, that CMS has made the wrong decision in terms of whether a placement is actually integrated or not, let’s say CMS thinks, yeah, this is an isolated setting but the residents
in the setting are like, that’s ridiculous, we
feel completely integrated, we go wherever we want, we feel like this is just the same as independent living in my own apartment, they have the
option of making their voices heard through the public comment process. The final rule requires that states open their transition plans to public comment which means they have to, you know, say exactly which
kinds of settings they’re going to cover through
the home and communitybased services funding. And they’ve got to let the public� and that
includes people with disabilities and their families� comment on whether or not they think these decisions are reasonable before the transition plan actually gets sent to CMS. And we’re now discussing the sort of full transition plan
that� as opposed to the work plan. Many states have sent a transition plan to
CMS already. It is really sort of a work plan, a work plan how they are make these decisions rather a description of services. Those descriptions of services have not come out. As far as I know, no state has come out with
one. But when they start doing that, people with disabilities, their families and service providers will have an opportunity to comment and provide input on which services they find actually integrated and actually segregated. Now, it’s just a comment process. You know, people can’t override the rule necessarily
by saying, you know, that HCBS funding should
be available for something that obviously isn’t available for. But it’s a great way for people to be saying what their actually experience
is with the type of settings are. One person� another person has asked if
a person chooses not to participate in competitive employment, can they continue to choose a segregated day program while having home and community based services funding pay for that program? Now, the answer is not� if it’s an actually segregated day program, if it is
not providing community integration of any kind,
then home and communitybased services funding should not be available for that program. But the person should be able to choose an integrated nonworkday program. And by that I mean access to recreational activities, volunteering, assistance with visiting friends and family during the day, assistance with
going about one’s daily chores or daily business. Any sort of program that’s not work but also is
not segregated or isolating. People have the autonomy to sort of decide
what they want to do during the day. So we should see programs where a person is self directing
and deciding what they need assistance with during the day. So that will be funded through home and community based services. You won’t have to work, but it still has to meet basic integration requirements. Another person says: I have an adult child
with profound disabilities. Should I start looking for institutional settings? The answer is no. Home and community based services need to
be integrated but they still need to be adequate. So a person with profound disabilities who really� if you and the person with the disability decide that the work is not the
best option for them, they do have a right to,
again, integrated day services. And those might just be help caring for the person during the day. If they don’t want to leave the house during
the day, then they don’t have to. There’s no forced socialization requirement in here. Just as a person without a disability can decide not
to leave the house all day, a person with a disability can decide not to leave the house all day. The important thing is that the person have access to the supports they need in order
to leave the house if that’s consistent with
their needs and priorities. But if they need help during the day in order
to function and live and they don’t really want
to leave the house, they have a right to services
in the home during the day. The same person asks whether the ADA requires integration appropriate to the needs of the individual and how that interacts with categorical restrictions on services. And the answer is that the ADA, as we saw in the recent DOJ litigation, is really focused on integration� on making sure that everyone’s maximally integrated. The DOJ has basically come out with a position that anyone who can be in a segregated day services program can be in an integrated day services program. And they came to that decision based on countless years of research and innovative interventions that really help
people find competitive integrated employment with adequate support. Now, if a person is truly homebound and really can’t leave the house or is sick or can’t
leave� you know, can’t participate in sustained activity during the day, then they’re probably not supposed to be in a sheltered workshop to
begin with. They should be getting more intensive in-home support. But in general, anyone who can work in a segregated setting, can work in
an integrated setting. I’m just going through some more questions. The� one health has asked: How does the community rule affect adult training facilities that support people in a segregated setting
like a day program? And the answer is it really is� it affects every facility in which people
are getting home and community based services
funding. So if a person is getting training in a particular skill and they are getting that training for a significant number of hours
out of their day, then that training needs to
be delivered in an integrated setting. That can include a place where other people are without disabilities are getting jobrelated training, it could be at home, it could be in small
groups that are really focused on spending a lot
of time in the community as part of the training. It could be in a lot of places. It just needs to meet basic integration requirements. Another question says that� asks me to clarify how a provider can participate in the planning process. And I should clarify that a provider can’t lead or facilitate the personcentered planning process but they can theoretically participate in the planning process to the
extent that all providers are participating in order
to just sort of say these are things that we
offer. So a planning process could involve a person visiting a bunch of providers or talking to
a bunch of providers about the kinds of services they offer. And obviously, yes, absolutely, the provider can participate in the process to
that extent. It can be there saying, Here’s what we offer. But they shouldn’t be leading or facilitating the process and also offering services to be chosen through that process. That gives them a conflict of interest. Unless there is some sort of barrier that
makes sure that the person facilitating the process isn’t being given a financial incentive to
divert people into services chosen by their employer, then they really shouldn’t be involved. Another person asked, does a family or guardian’s choice of a nonintegrated setting overrule Olmstead requirement for the most integrated setting? And that’s kind of a complicated question. In general when the Department of Justice has settled Olmstead disputes, they
have included for a person to remain in an institutional or isolated setting if that’s what they choose or if that’s the choose of their guardian. At the same time, the DOJ has really required
a lot of outreach to both people and their guardians, if they have one, to make sure
that they really understand the integrated options available to them and really help them find
a place in the community. When we are talking about the home and community based services rule, though, that’s a different question. The home and community based services rule isn’t sort of saying what can be funded
at all or where a person can go, it’s saying
what kinds of services can get HCBS funding. And the rule, just by its own terms does not allow funding through HCBS of a segregated setting. Absolutely just straight out. You can’t get home and community based services in a setting that doesn’t offer access to the community
to the same extent that you would have for a
person without a disability. So while a family or guardian can still try
and choose a nonintegrated setting, if they can
find an alternative funding source for it, it’s
not going to be paid for through home and community based services. The reason is that home and communitybased services are a dedicated funding stream that is specifically earmarked for community based services. It is not for just whatever services individual people may decide that they want. It is specifically earmarked for a specific kind of services. So services that aren’t communitybased won’t be funded. One person who’s a provider has asked that
they currently have individuals living in one bedroom apartments of up to 15 units. They’re owned by the agency, and we’re assuming the people
don’t want to move to another apartment setting
or in with roommates. Do they have a choice to stay in their current apartment? Their answer is I’m not really sure based on the description whether or not it’s integrated. Because it is a provider owned residential setting, it is
going to have to� yeah, because it is a provider
owned residential setting, it is going to have to
meet a whole bunch of requirements that are sort
of discussed in greater depth in the CMS rule. Now, it’s possible that even if your apartments don’t meet the requirements of that rule right now, then it will be possible to bring them
into compliance of the new rule and allow people
to stay in the apartment. The other thing to remember is that the new
rule requires transition into compliance within
five years. So you have until around 2019 or 2020 actually, depending on when your state submits the transition plan, in order to bring these apartments into compliance with the new rule. So I think CMS is trying as hard as it can
to not uproot people. And as part of that, it’s giving a lot of time to come into compliance. Another question, which I find very interesting, is whether the new rules are going to result
in more people pursuing funding through local dollars rather than through the HCBS waiver. And will CMS be tracking that data? The answer is, you know, it’s been raised so just to rephrase the question, if a state wants to fund a particular service that doesn’t meet the new
rule as a result it can’t be funded through HCBS,
will it decide to use its local money to fund those placements? The answer is probably can do that as long as it is complying with Olmstead. Olmstead requires the state to provide services in integrated settings as well. They couldn’t drop their whole home and communitybased services waiver and only fund the segregated placements through local dollars, that might be a serious Olmstead violation. If it wants to keep less integrated options
open, it certainly could fund through local dollars. There’s some political concerns associated
with that. So, for example, a state might decide that it just doesn’t have room in its budget to be funding these placements through local dollars. It is not getting the federal financial participation that it normally gets from Medicaid through the Medicaid HCBS program. And if it is not getting that financial participation and it is not able to get the service funded through some other Medicaid program, then it might just decide that it’s cost prohibitive. I don’t know if CMS is actually going to be tracking this move. I think it’s probably something that statelevel advocates need to
pay attention to. And if it turns out that they’re seeing this in more than one state, we should probably get together an effort to track it a bit more. But I’m just not entirely sure given the cost associated with it, I’m not sure how many
states are going to choose that option. I’m just looking through a few questions. There are a few questions that I have already answered so I’m skipping past that. How are advocacy groups assuring that states are funding HCBS services adequately to meet these requirements? And the answer is there are a lot of different avenues that groups are using. The first resource that I’d really recommend to you, which unfortunately I forgot to put in the presentation, is the It is a Web site put together by a coalition of disability organizations to track not only state transition plans but also state level advocates’ responses to those plans and resources for advocates to use when responding to state transition plans. The other thing I would recommend is ASAN’s HCBS tool kit which you can find at There are a few ways as both of these resources discuss for statelevel advocates to really keep states accountable for their transition plans. One very important way is the notice and comment process. So the new rule requires states to open up
to notice and comment when they submit a transition plan. That means they’re going to publicize the transition plan. All people in the state can read it. And they can send in comments about specific providers, about their idea of what should be covered, about any issues they have with the transition plan. They can send those comments both to the state and also to CMS, so that CMS is aware of what people’s concerns are. We extremely, extremely encourage people to
be doing that. Largely because we know that providers are going to be using that comment process very extensively. We need to make sure that people with disabilities and their families are heard at least as much as the providers
are. It is really them who are going to be using these services every day and who are really going to suffer if the services aren’t sufficiently integrated. The other way that people can be using the
rule to advocate is just to educate more people
about what the rule means, give out information,
help people understand that they’re not� that
even as states are changing their model, everyone
is still going to have a right to services, you know, regardless of their level of disability. They are just going to be getting services ideally in a more integrated setting. Another person similarly asked: What about individuals with behaviors? Let’s say someone has a habit of, you know, yelling or acting
out when they’re in public and people are concerned about the person being in an integrated setting as a result of those behaviors. The rule really requires that the services be tailored to the person’s individual need. So a person with behaviors might need� you know, might
need behavioral interventions, might need supports that they need in order to avoid the behaviors. They might need someone to help them figure
out where they can get services that are both integrated and that aren’t likely to trigger their behaviors. For example, let’s say a person gets overwhelmed and starts having behaviors when they’re in
a crowded place. Well, the rule doesn’t require that a person be in a crowded place. It just requires that a person be integrated into the community. A lot of nondisabled people avoid crowds. So a lot of nondisabled people who want to avoid crowded places might instead go to the museum on off hours, might go to the park, might
stay at home a lot of the time, might go to support groups. The new rule would definitely allow a person to stay in places that are safe for
them and to have supports when getting into a stays where the behavior might be an issue. So they might find themselves going to support groups. They might find themselves spending a lot of time with family or with one-on-one support persons. One person asks: Does a setting differentiate between paid staff and the general public without disabilities? Absolutely. So when we’re deciding whether or not a person has access to the general community, it’s not enough to say, well, you know, the person
is living in a building with a bunch of other people who don’t have disabilities if every single person living in the building who doesn’t have a disability is paid staff. Paid staff are necessary. They’re important. But they don’t count as true integration for the purposes of the rule or for the purposes of Olmstead. If a person’s main access to people without disabilities is paid staff, they’re not in an integrated setting. That said, you know, if a person is in a rural setting or is choosing to work from home,
then they might naturally not be interacting with many people other than paid staff. And that’s okay. They just need to have the same level of access as a person without a disability. If a person without a disability working from home is not going to be interacting with a whole lot of people over the course of their day, that’s fine as well for a person with
a disability. We just don’t count the paid staff one way or the other. One person asked about transportation and
can we really require it for community events and recreation. The answer is it is going to really depend on the location of the person’s housing and the location and their ability
to use public transportation. If a person is living in a building where they can’t easily get anywhere and they also don’t have access to informal transportation supports, then
what I would argue is they’re not able to access
the community to the same extent as people without disabilities. People without disabilities who live in that setting might typically have
access to a car or have access to public transportation that’s not accessible to the individual with
a disability who’s living there. If the� if the state chooses to offer housing placements in areas that aren’t very walkable, aren’t very accessible, aren’t really giving
a person a way of independently getting from
point A to point B, then in order to show that the person has access to the community, they might need to supplement that placement with transportation. Another person has asked: What are the actual models for a person with serious disability related needs to get out into the community? And are we just saying that the person should choose to stay at home all day? No, we really are not saying that a person can choose to stay at home all day if they have significant access needs. And I want to make that very clear. A person might need to be at home all day if they are medically fragile or if they really just don’t like interacting with people and that’s a reflection of their preferences and not their access or service needs. So I want to make clear that that’s where
I was coming from when I was saying that a person
can choose to stay at home all day. If a person has significant support needs
and wants to go out into the community, we have
a lot of great models for them to access the community without being restricted to disability specific settings. So let’s say you’ve got a person who’s got very significant needs, they need help in order to get from point A to
point B at any time, right? They need significant mobility support. They need navigation assistance. They really can’t find their way around on their own without support. Right now a person with those needs might
be getting shuttled from their home to a day setting or be getting day services within
the context of a kind of a community where they’re getting residential and day settings in the same place and in a disability specific place. Well, to make that integrated, we could instead have a person� instead of going on a shuttle from their home to a segregated day setting, they could have assistance to go out into
the community and participate in activities, including socialization activities, that are consistent with what the person and their family really want and need. So this could include the person, you know, visiting friends, other people in the community that they have a relationship with. It could include them having assistance to go to the movies or go to the park or go to any other place that they really enjoy being. It could include assistance with gardening or hobbies that they really enjoy doing. And it can� by gardening, I mean, they could even just sort of have a person, take them
for a walk in a place where they get to sort of, like, interact however they want with their outside environment. It really depends on the person’s abilities
and interests. So it’s not going to be� it is not going to look the same for every person at
the same level of need. We have a lot of people who, you know, have very significant service needs, and they really like watching movies all day. They might want to go out and watch movies all day. We have other people who really like going
to parks. They might go to the park. It is really going to be responsive to the individual. Another person has asked: Can people� will
they remove the option for family members to be
paid staff, and how are think of the things we
are discussing affecting self directed services? The answer is I have not heard any rumors associated with the new rule that would remove the ability for family members to be paid
staff. We strongly support self direction. And the rule itself supports selfdirection. So if a person wants to self direct, they should be
able to do that. That should be part of what it means to be able to choose the services and supports you get through home and community based services. Familyprovided support where it’s available
and when a family member is actually available
to provide it can be incredibly useful to people and incredibly helpful when it comes to helping out people who have significant needs and
who have a very good relationship with their family member who can provide for those needs. So we’d strongly oppose any movement to disallow family members from acting as paid staff. Will states be able to receive federal funds for transportation? The answer is typically yes. Home and communitybased services waivers can include transportation. I know some of them don’t, but I believe that they often
do. And, finally, a person has asked: How do we ensure that individuals are not unduly influenced by providers or parents with low expectations? Especially if they have developmental or intellectual disabilities. The answer is really going to be found in the personcentered planning process and in the sort of substantive rules of the home and community based services regulations. The person centered planning process is supposed to involve not just parents but also case managers. And those case managers are really going to have to be educated about
what to expect from people. One thing that’s really useful about the new rule is that it’s really saying, look, we think that integration and competitive employment is a goal for everyone, even people with significant disabilities. Even people with intellectual disabilities. Everyone can do this with the appropriate
supports. When we are talking about, you know, making
sure that everyone has access to truly integrated services, one of the reasons why we strongly favor CMS’ decision to make sure that people
are in truly integrated environments is because
a lot of the time people are currently funneled
into segregated settings based on people’s assumption that they can’t handle an integrated setting. By saying that everyone needs an integrated setting, that’s really consistent with their needs. We’re basically saying those low expectations are, you know� it is time to
end that. It is time to basically start with the presumption that people can be integrated,
can work if they want to and, you know, let’s
just find a way to do it. I’m going to read out the next couple of questions and then I might end the Webinar
early because we just went through things very quickly. One person has asked: Are we going to be focusing on making sure that people get increased waiver funding, that they actually need in
order to get adequate services, especially people
with significant service needs? The answer is yes, but also in that really most cases, congregate settings including sheltered workshops are actually pretty expensive compared to integrated settings. So, for example, a person with very� even
with very significant service needs, if they can
be put in a supported employment placement, we
find that they end up needing job coaching and
all of these supports only for the first month or
couple months of their placement. Once they’ve been in that placement for a
while, their coworkers and other people around them
in the employment setting often find themselves stepping up and basically saying, look, we
can handle this. We can supervise this person just the same as we supervise all of our employees. And we don’t really need a job coach to be watching them every moment of the time that they’re in this setting. So a lot of people, once they’re in an integrated placement, they� it is actually a good deal
for the state. Now, this is not the case for there are exceptions to this. There are some people who have significantly� sufficiently intensive support needs that in their individual case,
it might cost the state more. But overall, the state is not necessarily going to have to allocate more funding in order to comply with the rule. For every person that costs more, there are going to be a lot of people who cost less. So they are really going to be saving money. We, of course, think that all states should
be increasing their funding for home and community based services, if for no other
reason because there is a huge waiting list and a
lot of people aren’t getting home and community based services at all in the first place. But we don’t anticipate that the final rule itself
is going to make these services cost more or
is going to result in people not being able to
get services because they cost too much. And the final question I’m going to read aloud before we end early is: Can a family provide a housing option where they fund a home in
a neighborhood setting and then the agency provides the staff to support a person in
the home? The answer is absolutely yes. The rule� the home and communitybased services rule
has a bunch of extra requirements for settings that are owned by the service providers. But a lot of residential settings are not owned by the service provider. People can live in their own home or in a home that’s owned by their family and get services in their own home. And that’s actually something that the new rule requires a person to be able to do. They need to be allowed to be getting residential services in a nondisabilityspecific setting. Nondisability-specific setting usually means a person’s own home or a place that’s not
own by the residential service provider. Thank you, everyone, for patiently listening
to our question and answer� extended question
and answer period. I hope that everyone found this educational and useful. Oh, I just got one more question in, and I’ll read it aloud. Oh, a couple more� one more question. Florida has a waiver CDC plus that allows for oneonone activity choice for severely impaired person but the funding is not sufficient for cover the time required to avoid the person sitting at home for the majority of time. That is definitely a problem. And we recognize that as a problem, but we don’t feel that problem
is caused by the new rule. We believe that the new rule should actually free up funds for people
to get more hours of oneonone time because states will be saving money on a lot of congregate settings. So we do believe that people should be advocating for more hours, absolutely. It’s simply that we don’t feel that the new rule
is causing that problem. So I hope that clarifies everything. Thank you, everyone, for tuning in. We will be sending out the slides at the end of the day today and the video and transcription of this Webinar should be available by the beginning
of next week. Please tune in next week, the 28th, at the same time for the next installment
in our series on Home and CommunityBased Services
rule. And I hope everyone has a great day. Byebye.