The
ultimate impact of this project and the entire demonstration, beyond the
importance to the individuals who became employed, will unfold during the coming
years. As changes are made to
future versions of the Rehab Act, the ADA, SSA initiatives and the Workforce
Improvement Act, the knowledge and perspectives gained during this demonstration
will undoubtedly be considered. At this point, it seems that the ideas of choice and control
of resources by participants will grow rather than wane in the new century.
In fact the changes are already occurring.
This project has had significant impact on a number of initiatives across
the country -- in VR, DD services
and in WIA/One Stop career centers. Three
examples include:
The
Rehabilitation Renaissance Project
This
project, begun in 1996 and continuing currently, represents a replication of the
Choice Access project by Michigan Rehabilitation Services, the state VR agency
in Michigan. Initiated by the state
VR director at that time, Joe Skiba, this project has been conducted through a
contract with UCP of Detroit. Our
local UCP affiliate and VR joined forces to pilot a system implementation of the
Choice Access design initially in six VR regions in 1996 and twelve regions
currently. This project replaces
the Choice Access site coordinator position with a VR counselor and uses almost
all the design components of the original project, with minor modifications to
suit a state-wide VR system.
The
One-Stop to Success Project
This
Department of Labor funded initiative (July 1, 1998 - September 30 2001)
represents the next step in UCPA’s effort to extend the lessons of Choice
Access. We have taken the Choice
Access approach, with necessary modifications, into WIA mandated One-Stop
Centers in Denver and Detroit. We
are recruiting approximately 45 persons with physical disabilities each year to
apply to their local One-Stop center to receive assistance and services similar
to Choice Access. A critically
important difference is that this project allows for participants to
individualize their budgets, which are funded through a blended funding strategy
that combines VR, DD, DOL, SSA and other funding sources held by the local UCP
affiliate as a broker or fiduciary. UCP
of Colorado and UCP of Metro Detroit are cooperating with UCPA in this effort.
Clark
County Washington’s Developmental Disabilities Services
This
is a local effort initiated by a county DD funder to utilize the design of the
Choice Access project to address the needs of students with disabilities
transitioning from local school districts.
Clark County’s plans call for, eventually, the personal budget/ choice
design will be available to all persons served by the county.
At this point the county is negotiating with the regional VR office in
hopes of developing a design that will allow both DD and VR services to be used
in a personal budget, directed by participants.
The county has contracted with a third party entity -- the Washington
Initiative on Supported Employment (WISE) -- to provide third party advice,
planning assistance and brokerage services.
The participant manual and project design strategies used in the Choice
Access and One-Stop to Success projects will be modified to meet the needs of
this local project.
The
final challenge
At
this point, we feel that the report on UCPA’s Choice Access Project speaks for
itself. However, as the disability
field heads into a new era of employment and rehabilitation relationship with
persons with disabilities, we wish to assert the following reasons why choice
and control of resources is such a critically important issue for all persons
with disabilities, especially for persons with the most significant
disabilities.
1.
Because it’s what the people want.
Or many of them it seems. There is increasing advocacy by persons with
disabilities, families on waiting lists, advocates and even legislators to offer
individuals increased choice and control of the resources that society sets
aside for service. This trend is
indicative of a shift from agency-controlled services to individually-determined
services.
2.
Because it’s the law, at least in the Rehab Act.
Since the 1992 and 1998 amendments,
the Rehabilitation Act of 1973 requires counselors to develop individual
plans for employment that affords ”the
opportunity to exercise informed choice in selecting
an employment outcome (what you want), the specific vocational
rehabilitation services (what you need
to accomplish what you want) to be provided under the plan, the
entity (service provider) that will provide the vocation rehabilitation
services and the methods (the way you want it done) used to procure the
services...”(emphasis and parentheses added).
The Rehab Act represents a clear trend in federal legislation that favors
choice and control.
3.
Because it’s the best way out of
the “whose choice is it?” conundrum.
As increasing numbers of people have the chance to become employed in the
community, the idea of “choice” is being used by those who wish to stay in
institutions, workshops, group homes and other congregate settings as a
rationale to continue such programs. Choice
and control of resources offer all customers the opportunity to tailor services
to meet their needs. Of course if
you choose segregation, you would have to find others willing to spend their own
share of public resources to pay the price and you couldn’t rely on public
funds to underwrite or additionally support such programs.
4.
Because it’s the only way to
assure that “one size fits all” managed care rates do not predominate access
to needed employment services.
The base value of managed care is to save money while ostensively
offering a minimum standard of service. Most
managed care systems depend on a capitated rate for payments that is based on
the lowest possible amount of money that will, on average, meet the service
demands for typical individuals in
the system. The human service field
is rapidly moving towards such managed care approaches in the area employment.
Since the rates will be set on historical costs for persons traditionally
served -- persons with less significant disabilities -- people with the most
significant disabilities will be severely under-funded.
Choice allows for individually determined budgets that reflect the needs
of each person.
5.
Because people make better choices
than agencies and employers. Labor-market
and agency-focused perspectives concerning work often do not meet the needs,
preferences and “why work” rationales of individuals with disabilities,
especially persons with the most significant disabilities. When the employment
negotiation is between service agencies and employers, with the outcomes focused
solely on labor market and funding considerations, the needs of the individual
are often overlooked. In fact
when the needs of individuals are
left out of the equation, many persons are simply left out of employment because
they are not considered able to meet the arbitrary conditions negotiated between
agencies and employers.
6.
Because work is becoming a
personalized concept for all of us in our society. As
our society and economy change, we are beginning to understand that our life’s
work must be more about who we are and what we need and less about the arbitrary
shape of job openings. In order for
anyone, and especially for persons with disabilities,
to personalize a job for themselves, it is first necessary to be able to
exercise a degree of choice and control over the resources, the outcomes, the
supports and the methods necessary to achieve that tailored job.
7.
Because what we’re doing now is
not working well enough.
Our traditional agency/system approaches simply are not responding to
persons with complex needs.
Despite efforts that have been made for the past decade and a half to
include persons with significant disabilities, there has been very little
success. People with greater skills
or less significant disabilities always seem to get available employment
opportunities. This is due to a
litany of rationales that range from high employer demands, to insufficient
preparation, to lack of sufficient
funding. It seems likely that if
the traditional approach continues in the future,
employment opportunities for persons with significant disabilities will
remain scarce. However, if these
individuals and their families have choice of outcomes, providers and methods
and control of resources, they stand a real chance to break through into
meaningful employment.
8.
Because choice and control will
re-define the relationship between service organizations and persons with
disabilities. For
decades, persons with disabilities have been at the distant end of a “trickle
down” service system that drained precious resources to pay for arbitrary
administrative costs, cast people into a “client” or service recipient role
and placed them in any open slot in the labor market.
We’ve even adopted “consumer” and “customer” language in an
attempt to remedy this problem. True
choice and control allows participants to direct their services, to choose
providers and to decide whether or not to pay for work performed. This shift is much more representative of the way apartment
hunters, car buyers, grocery shoppers -- everyday “monied” customers
-- do business. Service agencies will have to embrace the kind of true
customer respect, service and satisfaction behaviors of their generic
counterparts or they will go out of business
9.
Because it’s likely to be best
way to access and utilize generic services.
As
the issues surrounding the impact of disability on life become more accepted as
a “natural part of the human experience” (from the preamble to the ADA and
the Rehab Act), the role of the generic service and vendor community has
increased. Its inevitable. When individuals become a part of a generic culture, setting
or organization, they typically want to utilize the same services as everyone
else. However, in the disability
field, people have found it difficult to gain access generic resources due to
the funding relationships held by disability-specific agencies.
Choice and control can allow individuals to shop around and select
service providers and vendors from the generic community.
10.
Because most Americans believe in
choice and control as fundamental ideals -- they represent the ultimate
extension of self-determination and independence.
At the heart of our culture is a belief that we should be able to choose
and have say-so in the fundamental aspects of our lives -- housing, health care,
child care, higher education. Since
work is perhaps the most defining characteristic of citizenship, it is necessary
to include employment in the list of life activities over which we have choice
and control.
And
if the reasons on this list aren’t enough, here’s more:
Why
choice and control?
Because it exposes the “shell game” that the current service system
uses that allows large waiting lists to exist and grow, largely without citizen
response.
Because it opens the door to employment opportunities such as
self-employment and entrepreneurship.
Because it’s consistent with and encourages emerging “sweat-equity”
and personal responsibility strategies such as peer lending, micro-loans and
personal/family investment.
Because it allows funds from a variety of resources to be blended in a
manner not feasible in the traditional system.
Because it requires new, more responsive and respectful, staff roles and
provider/customer, counselor/customer relationships to be developed.
Because it redefines in a customer-focused manner the rationales for
staff and organizations to become certified or qualified.