Webinar - Promoting leadership - Cross agency approaches to advance the use of customized employment

>> Good afternoon, everyone, and thank you for joining us for today's LEAD center webinar, Promoting Leadership: Cross Agency Approaches to Advance the Use of Customized Employment and Self Employment Strategies. This is Elizabeth Jennings and I'm pleased to have joining us today Lisa Mills, Ph.D., Systems and Policy Consultant, one of the LEAD Center subject matter experts. The National Center on Leadership for the Employment and Economic Advancement of People with Disabilities, commonly referred to as the LEAD Center, is a collaborative of disability, workforce and economic empowerment organizations led by National Disability Institute with funding from the US Department of Labor's Office of Disability Employment Policy. I'd like to invite our partner from the Office of Disability Employment Policy, Speed Davis, who's on the line, to join us today in offering a welcome. >> Thank you, Elizabeth. On behalf of the Assistant Secretary of the Office of Disability Policy, Kathy Martinez, and Supervisory Policy Advisor of the Workforce Systems Policy Team, Chris Button, I'd like to welcome each of you to today's webinar. This is a series of webinars presented by LEAD, discussing Customized Employment, Group Discovery and Self Employment and Discovery. In ODEP's experience with customized employment, we've learned that there often is a need for more than one agency to participate in the funding and provision of resources to make an employment plan for an individual successful. Today we have Lisa Mills, an expert in doing that type of collaboration, particularly at the state level. We are looking forward to an informative presentation from her and I hope you'll find it useful. Thank you. Back to you Elizabeth. >> Thank you so much, Speed. I'm going to invite Nakia Matthews to provide you with a few housekeeping tips. >>Good afternoon, everyone. The audio for today's webinar is being broadcast through your computer. Please make sure your speakers are turned on or your headphones are plugged in. You can control the audio broadcast via the audio broadcast panel, which you see here below. If you close this panel or if the sound becomes unintelligible, you can reopen it by going to the top menu item, communicate, join audio broadcast. If you do not have sound capabilities on your computer or prefer to listen by phone, dial the number here and enter the meeting code. I will paste this into the chat box for everyone. Real time captioning is provided during the webinar. The captions can be found in the media viewer panel, which appears in the lower right corner of the platform. If you want to make the media viewer panel larger, you can minimize some of the other panels like chat, Q&A, and conversely, if you want to make the panel smaller, if you don't need it, you can minimize it. Also, there are two links in the media viewer. One says show/hide header or chat. You can click those to hide some of those other things to maximize the viewing space. We will have a question and answer portion at the end of the webinar. Please use the chat box or the Q&A box to send any questions you may have during the webinar to me, Nakia Matthews, or Elizabeth Jennings and we will direct the questions accordingly. If you're listening by phone and not logged in to the web portion, you can email Elizabeth at ejennings@ndi inc.org. Please note this webinar is being recorded and the materials will be placed on the LEAD Center website. If you experience any technical difficulties during this webinar, please use the chat box to send me a message, Nakia Matthews, or you may email me, nmatthews@ndi inc.org. >> Thank you. For those who are new to the series, the LEAD Center mission is to advance sustainable individual and systems level changes resulting in improved, competitive integrated employment and economic self sufficiency outcomes for individuals across the spectrum of disability. On today's webinar we're going to discuss reasons for aligning resources across systems to support the implementation of Customized Employment, Self Employment and Discovery. We're going to learn how state agencies can adopt policies and service delivery strategies that support these innovations, and we're going to learn how a cross agency approach to blending and braiding funds can enhance services for the job seeker and enhance return on investment for all agencies. Today's webinar builds upon a series of webinars completed over the past three months. If you are interested in more information about group discovery or customized employment, please feel free to view the archives on the website and we'll provide a link to that at the end of today's webinar. I'd now like to invite Lisa Mills to continue with this information, and thank you so much, Lisa, for being with us today. >> Thank you, Elizabeth. I appreciate the opportunity, and I hope that everyone who's joined today finds this webinar useful. I've been working around customized employment for eight to ten years now, and recognizing that there are increasing opportunities for systems to work together to utilize and implement these strategies but there are also increasing demands for having these strategies available. So I'm going to talk a little bit about both today. If you are new to customized employment, ODEP is the creator of the concept of customized employment and established the definition in the Federal Register all the way back in 2002, essentially means individualizing the employment relationship between employees and employers in ways that meet the needs of both to create a win win employment situation that works for the business and works for the employee. That is really the definition of customized employment as an employment outcome. It's also a set of strategies that we use in helping people achieve that kind of employment outcome. It's intended to be a flexible process based on individualized match of what each person has to offer in terms of their strengths, their interests, and the conditions they need to be successful in the workforce, and to match those as best as possible with the identified needs of an employer. Customized self employment is perhaps a less discussed concept but is, in a sense, taking the concept of customized employment and applying it to supporting an individual to set themselves up in business rather than be the employee of a business. So essentially involves an individual providing goods or services to another business or to a community in ways that meets the needs of that business and community and the entrepreneur. So all businesses and all communities have unmet needs and things that they were willing to pay for to have done and we're seeing increasingly, obviously in the business world, businesses turning to contractors as they reduce, sometimes reduce the number of people they're hiring as employees. So there are increasing opportunities for self employment that can also, I've been self employed for 25 years and one of the huge reasons I do it is because the flexibility it offers me, so that other things that are important for me in life can also be attended to. So again, with self employment, it's a different process for getting to the outcome but it's intended to be flexible in the same way to look again at strengths, interests, and conditions for success and to look at the strongest match between what the person has to offer and what the local community where they live or businesses in the area would need from them. One of the things I wanted to spend time talking on this webinar is "why now?". If customized employment is a concept around since 2002, what would be the reasons why state and federal agencies would begin a really focused effort on working together to develop strategies to support these models, and part of what we've learned in the past 12 years is that customized employment has kind of proven itself as a strategy that can work successfully across a variety of people with disabilities, variety of different circumstances, and beyond that. It's an approach that once you understand what's involved, I think it always resonates with me because it feels just like commonsense that can work with many people who maybe have had a long period of time out of the workforce or perhaps have never worked due to disability that occurred at birth or in childhood, and so the model has proven to work for very significant barriers to employment, including TANF recipients have benefited from using the model. So it's a good return to work model. It's also a very good model for people who maybe have no employment history. It also has been recognized as an evidence based practice. The office of the assistant secretary for planning and evaluation at the US Department of Health and Human Services looked at customized employment and determined that it is indeed an evidence based practice. So we have more than a decade of time and evaluation saying this is a good, solid approach. And something that not a lot of people know is that customized employment is also being recognized as an effective HR strategy that has advantages for business. And so I wanted to touch a little on that today so you can see some of the parallels developing between the efforts ODEP is making and the efforts around employment of people with disabilities and what has been happening in the HR field. And in 2010, this book called A Workforce of One was published by the Harvard Business Press. It was written by a couple of HR experts with Accenture. They talk about revolutionizing talent management through customization and they approach they basically did case studies of some very large U.S. corporations in their effort to adopt customized employment practices, and the benefits that that had for the business, and one of the things one of the two quotes from the book that really struck me, there's not one mention of disability in this book. So this has been written with a very different focus but it rings so true with what we have been developing as the concept of customized employment to assist people with disabilities to go to work. One of the quotes is "we saw first-hand how customization fosters a workplace that is happier and more engaged and how organizations achieve marketplace advantage through improved employee performance and productivity. Why? Because when jobs are customized to individuals, people's work tasks become better aligned with their actual strengths." Again, it's commonsense but it's being recognized as a legitimate, cutting edge HR strategy and it is essentially the same concept that we've been developing, ODEP has been developing over the years. So what they have done is really talk about the way that businesses can capitalize on difference in their workforce, the differences they have in their workforce, and by identifying people's each employees' unique strengths and customizing their employment situation, they can both keep people longer because they're happier in the work they do, but they can also get the most out of them as workers and basically create a competitive advantage for the business. Now, this approach, this HR approach, is really distinct from ODEP's approach in that it's a post hire customization strategy. This is what businesses do with people after they have hired them in order to get the most out of them and to have them have the best possible experience so they don't lose good people to their competitors. ODEP's approach, I think, is even is very relevant, very complimentary in that it's the approach of customized employment is really to customize prior to hire or at the point of hire to get people into the best possible match. So these two strategies can work together. We can both work with businesses around customizing at the point of hire and then also customizing after hire as this book really illustrates the advantages of. As you probably know, discovery is the foundation for customizing employment. It is the first step in the customized employment process. It's almost taken on a life of its own nationally in terms of people recognizing the strategy as a solid first step in assisting any job seeker to develop a plan for going to work. It obviously provides a very different approach to determining what employment is suitable for people and discovery has as a core principle not to question whether people are employable but to say we need to understand the conditions for success that the person needs, the interests they have towards the labor market, towards the available jobs and careers, and the particular strengths they have and contributions that they can make to employers. So it basically, it gets away from some of the past strategies around evaluating people's employability or their likelihood to succeed to really saying we're going to assume employability and it's about finding the right path for the person. So it is certainly an alternative to traditional testing and we've been encouraged to see that it is sometimes used if a screening process concludes someone is not employable, we're increasingly seeing VR agency, Medicaid agencies, others saying let's try discovery and see if we can see a path to employability for people. Interestingly, I think discovery also has a lot of parallels with what's out there generally in terms of career planning and career assistance. I don't know, I'm hoping people on this call are familiar with this book. It's been around forever, at least in my book. It was first published in 1970. It's called "What Color Is Your Parachute." It's basically a hands on, easy to use book for people that are hunting for a new job or career. He has, since the '80's, early '80's, always had a chapter addressing folks with disabilities and going to work, and it has sold over 10 million copies and has been called I think it's been called one of the 25 most influential nonfiction books by the Library of Congress. So this is a really one of the seminal books in this field, and the interesting thing is when you pick it up and you read it, if you pick up the 2013 edition, the essential message, in fact I think the title of chapter five is "you need to understand more fully who you are," and so basically, again, I see this as a mainstream publication and approach that is directly supporting the customized employment approach, in this case directly supporting discovery. So the guidance is that people need to have a complete picture of themselves in order to go hunting for the right job and finding the right career and that basically what's on your résumé is only a small piece of what you need to be thinking about in terms of how a job or career matches who you are. And I think, you know, for those of us who are doing this individually, we certainly don't want to put a lot of energy into finding a job or career that ends up being the wrong one, but when we're using public dollars to assist people with that, I think the stakes are even higher in terms of making sure that we are helping people find the job or career that really is a good fit so that they will not necessarily have to return for additional services because we didn't do good up front work with people, and I think that's what discovery really offers, a real holistic approach that we need. So why now? Again, if we've had these concepts for ten years, what would be the urgency for creating the systems types of arrangements and agreements and supports. You are probably aware of the we are now strongly focused on Employment First for people with disabilities. It has more than half of the states in the U.S. now have Employment First initiatives, and the expectation that we will public systems will support people with disabilities to work has never been stronger. Also, every system is being pushed to prioritize people with who have the most significant barriers and the most significant disabilities and to serve them first and certainly to not exclude them from services. So in general, there's decreasing tolerance now, I think, for concluding people aren't employable or simply saying they aren't interested in working. Every system is being pushed harder to address those issues. So we need strategies that can work for people who might otherwise have been deemed not employable in the past. What we've learned over the 10 or 12 years of implementing customized employment, Speed mentioned this in his opening, the importance of coordinating resources for these strategies in particular, and the ASPE report they found it was clear that a coordination of state agencies was vital for state agencies was vital for being able to support the customized services. Start-up USA, dedicated to self employment also has come to the same conclusion, that braided resources are critical for assisting people with disabilities to achieve self employment, so we know that both strategy, both outcomes that we're talking about today would really benefit and in some ways need braided funding to be successful. ODEP has, over the years, studied the implementation of customized employment and found that when there were multiple funding sources involved that that allowed for more creative planning that ultimately led to more successful outcomes and of course we are driven by achieving the best possible and the greatest number of outcomes, so there's much more attention now to the importance of multiple funding sources. And as early as 2004, just two years after ODEP adopted the concept of customized employment and defined it in the Federal Register, the T TAP project, which was also an ODEP US Department of Labor funded to assist community rehabilitation providers to move away from subminimum wage and support people in customized employment, they found very early in their work that a diversified funding base was a really important strategy for customized employment. So almost everyone who's taken a close look has concluded the same thing, that we really do need multiple funding sources to make these strategies work. And of course that is a huge that still is a huge challenge. The good news is that we know that all systems can actually participate in funding customized employment services. There are ways and we see this happening in pockets, though not to the scale that we need, across the country where special education, workforce, Vocational Rehabilitation, and the Medicaid waivers are all able to support the customized employment process. And so in this illustration, I laid out the process steps that are typically associated with customized employment in the left column and then noted the ways in which each system could support the implementation of those service strategies. Some of this we're just beginning to recognize the opportunities, and some of it is the result of federal guidance that has changed or regulations that have changed, new opportunities where we're able to implement these strategies across a variety of funding streams. So, for example, if you look at discovery and production of an individual profile which is the outcome of discovery, it has a lot of relevance in terms of age appropriate transition assessment under special education, which is an activity that needs to be done for all students receiving special education, all transition age youth. So we are already seeing how discovery and profile can be used and embedded as an activity under something that they're already doing. In the workforce system, you may have heard this if you tuned in to earlier LEAD Center webinars that we are piloting the use of small group discovery as both an orientation option and then to also offer individual discovery under core or intensive services. So the workforce system has some unique opportunities, particularly in relation to small group discovery because it's done because it fits the way that they typically provide other orientation services. Voc Rehab, there's been discovery done as an alternative to the job club. So using again the small group model that we have been talking about and implementing that as an alternative to job club, and also probably more common is as an alternative to vocational evaluation or traditional community based assessments or work trials to use discovery. Under Medicaid waivers, again due to some new guidance that came out in 2011, there is more opportunity, again, to use the small group concept that we are developing through the LEAD Center, under the funding categories known as prevocational services and small group supported employment services, and to deliver individualized discovery under individual supported employment services and a new service definition that waivers can now include called career planning. I just want to make a note. ODEP does not support sheltered work or small work crews or enclaves that typically pay subminimum wage and segregate people, but the funding categories that Medicaid has used to typically pay for those models have been prevocational services and small group employment and we see an opportunity to use those funding categories differently in a way that will support people on a path to individual integrated employment. So the use of the small group discovery model can be implemented, we think, under those categories. It should always be done by someone who's trained to, in small group discovery, and where there's a commitment to carry forward the results of that process to assist the person to obtain an integrated competitive job. Under customized employment plan, special education, it can be part of the IEP transition plan as all students are expect today have a post-secondary employment outcome. This is gaining more and more attention nationally that every student should have a post-secondary employment outcome in their IEP. The development of a plan can be supported through that. Workforce, the Integrated Resource Team model or the intensive service model can support the development of these plans. In Voc Rehab, as an alternative to a job development or placement plan, providers can be funded to develop a customized employment or self employment plan. And again, under the Medicaid waivers, individual supported employment services or the new service called career planning can result can support the development of a customized employment or self employment plan. The next part of the customized process I cover here is the use of a visual or traditional résumé or the alternative if you're pursuing self employment would be a self employment marketing plan. The visual résumé isn't always used but we found I certainly have found in the work that I've done that it contributes a tremendous amount in terms of facilitating successful negotiations with employers, and particularly for individuals with significant disabilities or folks who have very limited work histories and who wouldn't be able to produce an impressive traditional résumé. So again, there are opportunities in schools, in special education they do something called the summary of performance. It's required, and these kinds of this kind of strategy of having a visual résumé or plan would be something that would help meet the obligations around summary performance. Workforce can develop or fund this through core intensive services supported by the Integrated Resource Team. In some VR states I've worked in where we've developed a fee structure, fee schedule for customized employment, it's been paid for as an alternative to the work trial. So instead of people going through a work trial, they pay to create a visual résumé after discovery. And again, under the waiver, the same services, individual support employment or career planning can fund each of these pieces. And customized job development, obviously the final piece of the customized process is the job creation, employer negotiation, or the launch of a customized self employment business. Adult many schools that have good outcomes have involved adult employment service providers at this point, and engaged with them to do that work for students so they leave school with a job. It can be supported through the workforce system under core intensive services. Voc Rehab can pay for customized job outcome or self employment outcome as an alternative to a traditional hire, and under Medicaid waiver, individual supported employment services. I'm sorry I took so long with that. I did want to walk you through the opportunities that are really there now to be taken for each system to be able to support the customized process. Our goal is not to have any one system pay for the entire process for people but the first step could be that each system has the ability to support the process for people who would benefit from it. The policy changes that can help us advance this in practice, I think one of the most important things is that we need to acknowledge discovery customized employment and customized self employment as distinct service strategies. It is a different process. It has a different focus. And it really can't be well supported through the existing structures, funding structures that we have in place. We have seen efforts to say, well, we'll just pay you for the regular process but you can do these customized things. It hasn't worked as well as it could work. If there is a distinct set of services and distinct funding structure for customized employment and self employment. So my recommendation is that we need to start there in terms of supporting systems to acknowledge these as distinct service strategies and to develop the appropriate mechanisms to fund them and call them what they are and count them as customized employment services. The other thing that's incredibly important when you introduce a new set of strategies is that those people in your system who authorize services, who write service plans, really need to understand what this is and when and why they would use it. And sometimes we have done great work with providers to develop their capacity to deliver the service. We have set up fee structures to allow the service to be delivered, but then we find that it does not get used, and a lot of people who could benefit don't get access to it because we haven't taken the time to do the necessary education of people who are writing plans and authorizing services. So I think that's a really important piece that sometimes gets overlooked. But if this happened in each system, we would have that capacity for each system to independently support customized employment, customized self employment. That's a lot of the work that I do now, is trying to make sure that every system has taken the opportunity to embed these services in their offerings that they can provide to people. But the real challenge, of course, we know is that we have a very fragmented system. Disability services in general is extremely fragmented, but employment services in particular, we have a very fragmented approach at the federal level, state level, local level, and I think it really does limit the ability of any one system to provide that comprehensive process to people. The other huge issue impacting all this is that each system is experiencing its own resource scarcity. Each system is seeing resources constrained, seeing demand for their services increase. And that is really creating a huge pressure so that no system really can commit to financing what I call an individual's entire employment life cycle, which is all the supports they need, all the way from making the choice that they want to go to work to the long term supports they may need to keep employment and advance in employment, and we don't have any one system who is charged with that is supporting that entire process. We have the ability of each system to participate but in some cases because of resource scarcity, it has led to kind of behavior that's more about shifting responsibility to other systems or trying to step back and not participate than it has the actual braided collaborative efforts that we really need to see. One of the things I think that would move us forward is to really recognize the importance of the funding systems taking responsibility for working out how to support these strategies and how to do that in a cross systems way. We've seen a lot of efforts or a lot of expectation, I should say, of providers of services needing to figure out how to blend and braid resources from different systems to support an individual with a disability to take advantage of customized employment or self employment, and to some extent, we have left the responsibility to the providers to do all that work and to figure all that out, and I think we need to shift that and say, look, the responsibility for making this work really needs to also be shared by the funding sources so that they are laying out models for how systems would work together to serve a person, and we are not just dependent on providers having the wherewithal and philosophical commitment to juggle a lot of sources of funding that are not necessarily designed to work well together. I think there are some principles that, when systems jointly commit to this set of principles, I think we see really good things happening in terms of working out shared responsibility and shared investment of resources, and the principles that I think are very important are first that no one is unemployable, that we simply need to find the right strategy for people and when we all commit to that goal, then we use our resources differently. We don't test we don't spend money testing employability. We invest in finding the best possible path to employment for people. The second principle, that is no wrong door, that people could enter through any of these systems and that we can still find a way to have a collaborative approach to service delivery and financing of services, that there are coordinated eligibility and enrollment processes. This seems essential but it is a very complex thing to figure out, but where systems have been able to coordinate and actually streamline the ability of people to figure out what systems are eligible for and to become enrolled with those systems, it allows for bringing together of systems into this Integrated Resource Team that the workforce system has really been championing this model. It allows that to happen in a much earlier point in a person's process so that I think one of the things that's needed is that we need to bring systems together around people at the planning stage rather than only at the resource allocation stage, because I think we will get better outcomes and better investment of resources from different systems if the systems are involved together in the plan. So if I am from one system and I essentially work a person through a plan and then I go looking for other systems to help fund it, I may not get the same reaction as if I engage those systems in the planning, and there's a plan where all systems that ultimately fund services and supports have been involved in. The next principle, cost sharing rather than shifting. This goes back to how systems react to scarcity and the importance of them seeing that a shared investment in people is much better outcome than either cost shifting or assuming responsibility for funding a person's entire range of support needs. And of course systems are much more interested in cost sharing rather than cost shifting when they can share the benefits of the outcome so that when successful outcomes can be counted across systems, that is to me the biggest incentive for cost sharing. I think that one of the first steps to take, if you're from a state interested in taking this forward, it's the importance of guidance to the field. I think there still is an absence of good guidance to the field in terms of how we systems expect that people could be served well in in customized employment and self employment and how multiple systems could and should be involved in that. One of the basic principles is how, if we expect that multiple systems will be involved, how would this no wrong door principle look in practice and ultimately how would each system deal with an individual and have the result be this ent greated planning and integrated planning and resource team. Regardless of what door I come through, special education, Voc Rehab, Medicaid waiver, how will each of the systems implement some really early steps to provide the possibility for an integrated planning and resource team which involves other systems, and then really some I think some detail of expectations around stages of the customized employment process and how each system could be involved. Now, you remember the illustration I walked you through, gives you a variety of ways that each system could participate in a customized employment process and it really is down to each state a negotiation and agreement between the systems. It says this is how we these are the different ways we think that the process could be supported by the different systems. And I don't by choice, I don't prescribe one way because of course that doesn't allow for any creativity and negotiation at the local level around what could it look like when certain systems would fund certain pieces of the process and then other systems would fund other pieces. But I think having this discussion as a systems level and trying to develop guidance to the field helps you identify where the gaps might be or where the overlaps might be so that the systems can agree how those should be addressed as they jointly serve people. And also, braiding of services and funding around an individual. I think there's a great need for the field, for people who are putting these services in practice every day to understand how this could occur, what it would look like, and to get that guidance from the agency that they are accountable to. So at the state level, for state systems to come together and issue joint guidance about how customized employment or self employment should be supported and could be supported and how what the expectations are for different system partners being involved. Seems really important for moving things forward. We have a lot of regulation that still is broadly interpreted, is prohibiting a lot of braiding of services and funding and without guidance I think that most implementers and practitioners at the direct service level will not do these things because they believe they're not able do those. The coordinated eligibility enrollment I touched on before as something that's pretty challenging to achieve but we have wonderful examples in the country, I point to Maryland, don't know if anybody is on the call. Certainly some of the ways they have used information technology systems to their advantage to allow people to go to a web portal, essentially submit their application information, and have that pre populated pre populate applications to more than one system that would be involved in supporting them in employment, and I know of course I'm oversimplifying that. We could probably have a webinar just dedicated to how they have done that, but the idea that we could establish which systems a person is eligible for and to get them enrolled so that we could have that be something that happened very early on in the process which would then facilitate the braiding of resources. We've seen good examples of systems that have recognized gaps as people try to access other systems and have stepped in. There's an example in New York where the American jobs center, even if they have someone they refer to the Vocational Rehabilitation program there, they serve them during the period of time it takes for the person to become eligible for Voc Rehab and to go through that initial process prior to an Individual Plan for Employment. The workforce system serves them during that time and then keeps the case open so that even when Voc Rehab takes over and is funding an IPE, the workforce system can still participate as a partner. So I think there are opportunities as systems start talking to each other to find gaps and to figure out creatively how they can be filled. One of the other challenges with braided services, especially around customized employment or self employment, is that we're talking about hand off of an individual from one system to another in a coordinated way, and I think there needs to be some negotiation around if one system is going to pay for discovery and profile, for example, that that work product that's developed and paid for by that system, for example, special education or Medicaid, would be accepted and used as a source for Voc Rehab, for example, doing an Individual Plan for Employment. And I think when we have operated in our silos and individual systems have served people in a process that doesn't involve other systems, we haven't really encountered this issue, but now as we look at customized employment, look at the strategies, we're seeing how important it is that if we're going to cost share, that the pieces of the puzzle that other systems are going to be done actually meet our requirements and our pieces that we will use, and embed in our process so that we're not repeating efforts, and I think that this requires some alignment of expectations up front and standards across the systems for what each of these distinct strategies around customized employment are. So what does it mean, what does VR accept as a good discovery and profile and then if Medicaid is going to pay for that or special education is going to pay for that, that they have agreed on those standards so that braided services can actually be useful in practice. I went back to this is a repeat of the earlier slide, but just to talk about, as you can see, every system can potentially fund each part of the customizing process. You can see that the pattern for one person might vary quite a bit from person to person if they are youth in transition, they might have the discovery and profile happen through special education. They might then go to the workforce system or Voc Rehab for the plan and the hire and then they might go to Medicaid waiver for long term support. There's just a variety of different ways that people could get through this process using braided funding. And the challenge is really to allow each of those strategy each of those possible paths to happen, but I think, again, educating people who are on the front lines who are doing this work about the different ways that they could accomplish this would lead to more of those practices and examples being put in place. I'm finishing up with a couple of things that I think are really important, fundamental challenges as we want to take customized employment and self employment to scale. There are things that I think challenge some of the just structures we have in place for providing employment services, and these are things I think we can't forget about, and that really need to be put on the front burner, certainly at the federal policy level but also at the state policy level. And the one the first thing is that these strategies developed in many ways to serve and to provide a successful model for people who have the most significant barriers to employment, and while there are certainly pressures now to serve those people and to not conclude they are not employable and to actively encourage them to pursue work, we still have a system fiscally that is set up with core incentives not to serve the most challenging folks. We still have performance measures that if you talk to people in the field say we are discouraged and financially discouraged from serving people. So we've got a great concept out there that's a strategy that is proven that it can work, but taking it to scale and embedding this kind of capacity to provide these services across the country, we're being we're kind of pushing back against something that says these folks are still we still don't have the right incentives in place with the right incentives to serve people with the most significant barriers. The second challenge, customized employment by its very nature is an individualized approach to employment, and ODEP said one person at a time, one employer at a time, and for me this is one of the key challenges in embedding this model into our existing employment service system. We still have performance measures across systems that drive prioritization of the quantity of outcomes achieved versus quality, and we still see typical traditional job placement and development measures that are really numbers driven. These methods work for the agencies who achieve adequate numbers as providers of service. They achieve adequate numbers each month to cover their costs and have a good business model. It certainly works for the systems to meet those numerical targets, but the people it doesn't work for are the people who get left behind by the process. It works for the people with disabilities who are placed, but my concern is really that we still have the most common approach is to go talk to employers about their interest in hiring people, the positions they have available, and then we come back and look at who we've got and we try to make the best match, and I've heard just recently, just last week in Iowa, a provider telling me essentially that's how they do it, and I'm aware that that has been the typical approach, and the provider produces enough numbers each month to do well, the funding source is happy with the numbers, but if you're a person who's never the good match and who really needs an individualized approach, someone pounding the pavement for you and talking to employers about you, you're not going to do well in that kind of model. So customized employment is a great strategy for folks like that but again, I think because culturally we've done it that way for so many people for so long that it's hard to figure out how we will embed the customized approach when it's needed for people with disabilities who have who just would not do well in that approach. And I think the last thing that I wanted to share is we're still seeing a lot of kind of efforts to embed customized employment and self employment into existing structures, in existing service categories, and as I said early on in the session, I think one of the things that could really help us move this forward is to recognize these as distinct strategies and processes that each system must take time to figure out how they will support rather than saying let's give the provider community some training in this, but then let's just expect that they will embed some of these strategies in the existing service models that we pay for, instead of saying, look, this is a distinct process, it works, if we have fidelity to that process, it will work, but if we kind of blur the lines and say just use some components of this in continuing the traditional model, that we will not necessarily get the outcomes that we have the real potential of getting. So we are at the point now for questions. >> Thank you, Lisa, so much. That was a really excellent and informative presentation and I, for one, learned a lot and greatly appreciate your expertise on the line today. So would like to open up the webinar for questions. If you have a question you'd like to ask of Lisa, please insert it into the Q&A box or into the chat box. Lisa, to start we had an individual who asked could you please give examples of customized employment in an actual work setting. >> In an employment setting. >> Yes. >> I'm assuming. Okay. Yes. Yes, I can talk about some of the providers that I've worked with in terms of looking at a business, approaching a business about issues that are causing less than causing slow down or other existing employees to be distracted from the primary reason they were hired, and trying to identify those pieces that a person could do to contribute. So an example in terms of putting somebody in at the right time would be there are coffee shops or pizza places, other places where they have very high demand time frames and the demand doesn't continue consistently, and a customized position could be a position that simply customized to the hours that that business experiences that high demand and to the person who would prefer and whose conditions for employment say I really would like to be working at this time. So we have people who are night owls who don't like to get up early and who actually be great contributors to a pizza business or a late night delivery business where it would fit their conditions for success. It would add to that business if focused contribution a focused contribution that would really enhance the business' operation. There are other examples around taking tasks that people they already have hired as employees are doing that really isn't what they were hired to do and really isn't the best use of their time and their expertise, and saying if we could have somebody who filled the role of doing these tasks, could we improve your business' bottom line, your business' efficiency by making sure that those workers could stay focused on what their expertise really is, what you're paying them primarily to do. And a good example of that would be somebody who operated a sophisticated piece of equipment who might have to stop and reload supplies or unpack supplies or do something before they could continue to operate that equipment. There's lots of examples of that where equipment needs checks or supplies reloaded, and if a person was put in place just to do that for them as could that actually create business efficiency. There's an example I remember of a guy who one of his strengths was being extremely neat, and they found that out through discovery, and he had also had a really strong ability to match things, and they found a business that was a shoe store that essentially people would customers would come in, try on shoes, not always put them back in the right boxes, not always put the box that was the right shoe size in the right place, which led to later customers coming in and being fairly upset or frustrated by that because they couldn't find matching shoes or couldn't find the right sizes where they should be, so they hired somebody who his job was just to keep all those shoes organized and put in the right place, put back in the right place, and essentially increased their sales as a result and also obviously customer satisfaction. So I think, I mean, I could talk a lot about a lot of different examples. I hope that gives you some examples of either being able to address a business need that nobody was addressing, fit into a business and provide a contribution at a certain point that they really need extra help, or relieve existing employees of some of their duties that really don't fit with why they were hired that allow those employees to be more productive for the reasons they were hired. >> Thanks so much, Lisa. For those of you who are on the line who didn't have a chance to participate in our previous webinar series, the webinars for May, June, and July all discussed group discovery and customized employment and are filled with other examples of customized employment in various employment settings. They also provide, and Nakia provided the link to the archives in the chat box, but those webinars also provide samples of visual résumés, which is another question we got in and posted with the archives is a template for a visual résumé. Our next question for you, Lisa, is I am an Employment Network service provider. How do I get the systems together to the table to braid the funding and support services. >> Well, my first comment is to go back to the earlier slide which where I said it shouldn't be your job, but I do understand because you're doing the work with people that you want you have a huge vested interest in making sure this happens, and I would suggest that you look at the one of the systems that you have the best working relationship with and talk about the benefits of potentially bringing partners together to discuss guidance to the field around shared funding and support of customized employment as a distinct set of strategies. It doesn't have to be limited to customized employment, of course. We need braiding, blending and collaborative funding across all the work we do, but I do believe it needs one LEAD system in a state to say we want to cost share and we want to talk together about what it would look like if we did this and how we could get better outcomes for people. But my primary point would be at a systems level, we need systems to see their responsibility in making the dollars work together and making things work together, and that's one of the key principles I think at the federal level, the more expectation and support for that at state level systems is so important. So providers are not the ones who are trying to figure this out. >> Thank you, Lisa. The next question is can you point to a state or to states that have adjusted their provider rates of reimbursement and their contractual expectations to support customized employment? >> Yes, I think there's an increasing number of states who are either piloting that at the moment or who have implemented specific fee structures to support that. I come from Wisconsin and we were able to do that in the Voc Rehab system there. It initially started as a pilot and then became a separate fee structure, services available to support unemployment, people who would have traditionally had a traditional pros test but they took it further and said you know customized employment doesn't necessarily need to be limited only to people who need supported employment, that good customization and hire could actually reduce the number of people who would need ongoing on the job support and the rehab council actually pushed for them to extend availability of customized employment services beyond the consumer base that was supported employment. So I think Florida is currently piloting customized employment strategies and I wonder, Elizabeth, if it might make sense to potentially post a resource, develop and post a resource on the LEAD Center website with good examples because I think that would be really important. There was a report and I'm not sure it's out yet, but I think it was funded by ODEP around how customized employment was being implemented nationally and we should probably try to get a link to that report. Speed, you may be aware of that report and where that's at. I'm not sure if he's still on the line, but that report would be a great basically what they did is look across the country at how customized employment was being implemented across the different systems, so Voc Rehab, Medicaid, workforce, and if we could post that on the LEAD Center website, I think that would be a great resource. >> Absolutely. That's a great idea. Okay. Lisa, we have another question for you, which is how do you assess various businesses to find out what their needs are? >> It's a very different form of job development, and there's really good training available for people wanting to learn how to do that work. It's a certain conversation that you need to have with a business because you're not simply saying do you have any job openings. You're actually engaging them in a very different conversation. It works well in a bad economy because oftentimes they will say we don't have we're not hiring, and what you're trying to do is help them to recognize that they may have some needs that it's actually in their best interest to fill to address them, even in a bad economy. Not all needs will rise to the point where an employer will say yes, I want to hire somebody to take care of the needs for me, but I think one of the things that really works well about it is allowing the employer to participate in identifying their own needs in whatever way they're comfortable. Some employers will say you come in, you look around, you ask questions, interview my staff, and then come back to me and tell me what you found. Other employers will not want somebody external being in their business and will want information on what they're supposed to be looking for and what are some good strategies to identify needs that they might warrant as something they'd want to invest in hiring somebody to meet, but they will want to do that themselves. And there's an old story that Mike Callahan tells about a guy who works at a Sears store and he said that the manager of that store wanted no one in there to do that, wanted no outsiders in identifying what Sears might not be doing well, but he took it upon himself and went to every department head and said "get me a list of the things that aren't getting done and the things that are affecting the satisfaction of our customers." And he got back basically lists from every department and created a customized position for a guy who he ended up going around and providing doing specific things in each of the departments. So he didn't get placed in one department. He actually had specific jobs in each of the departments where he contributed to meet to address their top needs. So it is something where people need training to do it because if you don't present this opportunity and hold concept of customized employment, if you don't present it to businesses in a way that makes sense to them, you're going to find it's a tough row to hoe in terms of getting them interested, moving forward, looking at their needs and looking at how a person could potentially be hired to meet those needs. >> Thank you, Lisa. Also again, if folks have a chance to view some of the archives from June, July, and August, our presenters on those archives provided additional information to what Lisa provided today about assessing business' needs and even gave a little walk through of some specific examples of how they did that. Going back to the question about states that have adjusted their policies and procedures to allow for customized employment and any reports that may be available, we now have Speed Davis unmuted and wanted to invite him to comment. >> Thank you. Yes indeed. We have been serving over the last year the states we've identified 15 to 18 states and one or more agencies that have adopted either discovery or the full customized employment process and we are going to be publishing that hopefully on our website within the next month or two and we'll have links to actual policies or copies of the policies. We'll have links to fee schedules, et cetera, HBCS waivers. We'll have all the information that will help someone learn how another state did this process. >> Great, thank you so much, Speed. So Lisa, the next question is a little bit complicated. I'm going to provide some information up front. The question is regarding how work ready programs, if they play a role here, and just to clarify, the state of Georgia has a work ready program where they test people and then make work recommendations based on their scores. Georgia has a goal to have one hundred percent work ready certification and many employers are requesting that test be completed as part of the employment application process. So do you have any insight as to how a work ready program plays a role within blending and braiding resources? >> Yes, I think it has a very strong role it can play. There are a lot of states very focused on college and career readiness for youth and also for adults who are finding their way back into the workforce for whatever reason to be work ready in the eyes of employers. I do think that many times for people with disabilities, if all that is done is the administration of these tests or the evaluation as compared to people without disabilities, that they will often, unfortunately, come up as not work ready, and I think discovery again provides a supplement to that kind of testing that would help determine the conditions for success and I think that those are very important because, again, I would guess that I could be work ready for one type of work and not work ready for another type of work, and depending on how those things are administered, I could be excluded from fitting into that category. So actually think if your goal is to have everyone achieve work readiness, that discovery could actually be a good tool to augment what you're already doing in terms of honing in on people who perhaps on the first run of your efforts around determining work readiness, they don't appear to do well, that they would be given some additional enhanced effort that included some of the principles of discovery. And this will create a path to determining, you know, where is their strongest work readiness, in what areas, and what are the conditions for success that if they were in place would create would allow a person to actually pass that criteria. So actually think if your goal is to achieve that, that discovery adapting some of the principles and strategies associated with discovery could actually help reach that hundred percent target. >> Great, thank you, yeah. The next question is can you explain how to manage conflicts between service providers regarding how services can be implemented. I work with students with mental illness who need support in the job search that are there in school frequently until age 21, VR in my area is not able to intervene and the schools do not have the resources to send the student into the community with job assistance. >> Okay. My initial reaction is this doesn't sound like it's an issue with service providers. It sounds like, and I don't know all the details, but it sounds like this is an issue with VR policy. It certainly is not prohibited at the federal level to regulation or statute that a Voc Rehab agency cannot participate with a student who is still enrolled in school. And we've seen the best outcomes for obvious reasons when Voc Rehab has actually gotten involved and opened a case and served a student while they're still in school, and that has allowed for the involvement of service adult service providers who do the type of services you're talking about that students need. The job search process, that has allowed for those service providers to become involved with students and be funded to do that work. So again, I talked a lot about guidance to the field and some of the issues that I hear we hear about locally oftentimes are this can't happen because of rules, and of course in many cases it's an interpretation of rules. Sometimes propelled really by resource scarcity and a desire to say, you know, we're not going to get involved if somebody else is receiving services from another system because we think that's a cost saving measure, and actually there is no prohibition on that, but it's been a policy that's been adopted at the state or local level that doesn't necessarily have to be in place. So I guess what you're describing to me should not be happening because it is possible for Voc Rehab to serve students and we've seen great seen great results around a variety of strategies, including individual placement and support or IPS, customized employment, project search. There are so many different ways that VR can serve students who are still in school and that that policy goal with students leave school with a job in place, that seamless transition goal we talk about can actually be achieved. But if you're in a place where Voc Rehab says we do not serve you until you leave school, it is extremely difficult to achieve that goal of seamless transition. >> Thank you, Lisa. I have to say working across states, this is a conflict I hear frequently, so I appreciate you providing that insight to all of us on the line. The next question is which is a better option, Vocational Rehabilitation or workforce to provide individuals with the employment skills they will need? >> Well, I guess again, my whole approach is based on braiding, and so I believe that both systems obviously have something to contribute and for any single individual, it would depend on their unique situation, and to the extent that both systems could share a role in that, to me creates the best possibility for the best outcomes. Again, someone made the point recently that, you know, when employment services like training are the responsibility of multiple systems, then nobody they end up being nobody's responsibility. So these overlaps where two or more systems can pay for the same thing will also lead to nobody paying for it. So I really think that there isn't an absolute answer to that question but that what really matters is based on what the person is looking for, what makes the most sense, and I think this is a one example where it's important for systems, certainly at the state level but also at the local level, to come together and say what do we think about this question, what guidance do we want to give to people who work in AJC's, case managers, VR counselors, about what to do when they're jointly involved with a person who has this need. And I think that the best outcomes come when the systems actually talk about that and come up with some guidance for how to determine when each system will pay and even more importantly, what are the possibilities for the system sharing the responsibility to pay. >> I wonder if we could follow that up by inviting Speed to add a few comments about Integrated Resource Teams within workforce centers and how those can be helpful in these situations. >> Integrated Resource Teams are a valuable tool for American Job Centers. They provide a locus for the partners that the American Job Center has entered into agreements with to discuss what needs to be shared, what agencies within that team and devote what resources to helping a particular individual achieve their employment outcomes. So that's the mechanism for, at the local level, for what Lisa is trying to achieve at the state level. >> Thanks, Speed. And just so we're all clear on the line, American Job Center is the new term for what was previously called workforce centers or "One Stop" Centers. So Lisa, our last two questions are related to self employment. The first is can you please provide an example of customized self employment. >> Yes, and I'll just apologize to the person who asked the prior question. If you feel like I dodged your question, I didn't mean to, but I really didn't want to be make any decisive view because I always feel like it needs to be decided between systems and on an individual basis. So customized self employment is distinct from what we might consider traditional self employment I think in that the conditions of the person who's going to be self employed are really taken account of in detail in terms of matching that to what the needs of the businesses or the community where they live might be. There are a variety of ways that self employment can be customized to address some pretty challenging conditions that people might have and one of them is transportation, which we hear all the time is an extreme barrier to getting people with disability to work, and one of the most obvious solutions to that is for people to work from home or establish an office that is very close to their home and do the work, do work for businesses or for the broader community that they might otherwise, if they went the route of traditional employment, would have to travel much further to actually do the work. And so we are seeing a lot of examples of people who, for whatever reason, have barriers to transportation or have support needs that need to be met at home throughout the day, and who can use self employment that is really customized to what they have to provide to the business other businesses or the community, and when they're able to work and where they're able to work. So that's one of the obvious examples, but another one would be there was a young woman who, in discovery, they spent time at her home, and if you're aware of discovery, one of the key principles and things that differentiate is from other approaches, you go and spend time where people live in order to see what their interests, their strengths, their skills, what conditions really help them be successful, and they found that she had a great interest in preparing and serving coffee and that if you went to her home, that would it was one of the things that happened, is that she created this full spread of coffee and snacks and things and did this all of her own volition, so there's a strong interest and motivation, and she also had great skills. You would never have found that if you had done a voc evaluation on her or observed her in a work trial in an unfamiliar community business or any of the traditional models we use. You would not have seen this, but because they went to her home, they saw it. And so she was assisted to basically start a coffee cart in a local college that had a coffee machine that often broke down and basically just spent very dispensed very poor quality coffee for a high price. When she set up her coffee cart at the local college, she was actually overwhelmed by business and built on something that was very much a discreet interest and a still that she had that met the need of the community. >> Our final question is what do you recommend regarding financial advising for individuals who may be self employed? >> Small business development, as we as the nation really focuses on getting people back to work after the great recession, all the veterans returning home, the new focus on helping with disabilities work is an essential part of life. The effort the supports for people to start small businesses have grown fairly dramatically, particularly in rural areas and in other situations where it makes a lot of sense and there are opportunities. So people with disabilities are no different than anyone else contemplating a small business or self employment and should be assisted to take advantage of those generic resources that can help them evaluate the business. Work incentive benefits counselors also have unique knowledge about self employment and some of the strategies that can be used to hold business assets in a way that doesn't negatively impact eligibility for Medicaid or other services that people would need because that is one of the issues with small businesses that you've typically got to have cash flow, you've got to have an investment account, you've got to have the ability to take in money, buy supplies, cover your expenses. But again, work incentive benefits counselors have that knowledge, expertise, as do providers who have specialized, have chosen to specialize in helping people start businesses. But I do think the generic resources that are out there can also help approach self employment, you know, for people with disabilities in the same way it is approached for others. >> We've provided for all of you in the chat box a couple of free resources for individuals who want to learn more about their personal finances, particularly in relationship to entrepreneurship or small businesses. The money smart for small business is a curriculum that has no copyright. It's something you could use with your local Small Business Development Center or as a supplement to the materials that they provide. We also are going to provide you a link to some work incentive training that you can look at through Cornell University that was sent in by one of the participants on the line. We're out of time for today's question and answer period. Thank you so much, Lisa, for all the information you provided today. If you enjoyed today's webinar, I hope you'll join us next month. We provide a webinar on the last Wednesday of the month from 3:00 to 4:00 eastern time. Our webinars are provided through three mini series. We have completed our mini series on economic advancement and employment. We are currently in our leadership or public policy series, and the next webinar will again focus on that topic. There are webinar archives that you can access at any point in time to learn more about group discovery, customized employment, and self employment, as well as a host of other topics that we've reviewed this year. And we hope you'll join us next month where Lisa Mills will be back with us to discuss effective strategies for integrating employment outcomes and services into managed care models. That webinar will take place September 25 from 3:00 p.m. to 4:30 p.m. eastern. Contact information for Lisa Mills. Again, if you're on the line and one of your questions didn't get answered or you have new questions that pop up, you're also welcome to submit them to myself, Elizabeth Jennings, ejennings@ndi inc.org. Thank you to Lisa Mills for your time and skills. We greatly appreciate you being with us. Thank you, everyone, for joining us. Have a great day.