Introduction
Balancing the conflicting needs of organizational mandates is a challenge. We are required to achieve the goals of our organizations in the most effective and efficient manner. Unfortunately, when the goals of separate organizations are not compatible, it can create gaps in services for target populations. It can be easy to ignore the problems but true success will only be achieved when creative solutions are pursued. Utah Division of Services for People with Disabilities (DSPD) and the Utah State Office of Rehabilitation (USOR) faced conflicting mandates with Supported Employment. Supported Employment (SE) for individuals with disabilities means competitive work in an integrated work setting, which is paid a competitive wage consistent with co-workers without disabilities performing the same job. The individuals typically need some level of support to maintain the employment. Through collaboration, the organizations created a Supported Employment (SE) pilot which received Legislative funding in 2006. The Pilot was so successful that in 2008 the Legislature passed House Bill 45 providing long term funding for the Support Work Independence Program. The program results in increased service provision, improved outcomes and enhanced consumer satisfaction. Achieving this new program took problem identification and increased awareness of problems by stakeholders, team work, creativity and legislative support.
 
Background
The Supported Employment (SE) program is designed to place individuals with significant disabilities in employment and provide them the training they need to be successful. To be eligible for the program, individuals must need multiple supports over an extended period of time to maintain the employment. The goal of SE is to increase their employment opportunities, improve the quality of life of individuals with disabilities, and provide needed job development supports, on the job training, and services necessary to help individuals maintain employment. Utah’s SE program is administered by two agencies: USOR Vocational Rehabilitation Program (VR) and the Division of Services for People with Disabilities (DSPD).^[1]
 
In 2001, an audit of DSPD was released by the Utah Legislative Auditor General. The Auditor recommended that the Legislature consider providing additional policy guidance on non-Medicaid, non-waiver expenditures. This resulted in a legislated mandate in 2002 to serve those on the critical needs list. Insufficient funding makes it impossible to serve all individuals waiting for services so people on the waiting list who are higher functioning typically do not having their cases funded.
 
The Problem
The goals and funding of DSPD and VR result in gaps of services for individuals that need SE. Given each agency’s goals, it is a structural problem. Depicted graphically in Figure 1, imagine there is a continuum of people with disabilities. Individuals with the most significant disabilities are on the left and individuals with less significant disabilities on the right. The Utah State Legislature has mandated DSPD to serve people with critical needs. They are depicted in Figure 1 on the left of the diagram. VR provides time limited services for individuals that are on the right of continuum. In effect, VR’s definition of most significant disabilities is equal to DSPD’s least significant. So people in the center who are in need of SE and most likely to benefit from the program are the least likely to have their cases funding.
 
The problem arises due to the conflicting mandates of the two agencies. VR’s SE funding is supplied by a federal grant with no state match required. The agency’s mandate is to provide short term services to individuals with the goal of employment. The VR service delivery system provides SE for a maximum of 180 hours or 18 months, whichever is reached first. In addition, VR cannot provide SE without a reasonable expectation of long term supports being available if the person needs them for employment. As a result, if the long term support cannot be reasonably expected to be provided after VR services are used, individuals who could benefit most from SE were placed on the DSPD waiting list.
 
In contrast, DSPD’s mandate is to serve those with the most critical needs and as a result their client base receiving services is generally composed of individuals with more severe disabilities than VR’s. The services are primarily funded by the Individuals with Mental Retardation (MR/ DD) and other Related Conditions waiver (Medicaid). Due to limited funding, there is a waiting list for all DSPD services including SE.

Figure 1: Continuum of Disabilities

 
As is depicted above, the missions and priorities for VR and DSPD are different, resulting in a funding gap of those needing SE. One key population impacted by this gap is youth with disabilities transitioning from school to work. As a result of the wait list, skills they have gained in high school transition programs will atrophy rather than grow.
 
The conflicting mandates also jeopardize VR’s SE federal grant funding. If VR cannot establish a reasonable expectation that long term work supports could or would be available after individuals are employed, they cannot provide the service. Due to the 2002 Legislative mandate and DSPD corresponding rule changes, this expectation often cannot be established. As a result, the number of individuals receiving SE and having their case successfully closed (i.e. the person is employed) has declined over a number of years. In the 14 years from 1991 to 2004, VR’s successful SE closures grew from 46 in 1991 to a maximum of 155 in 1998. By 2004 the successful closures had fallen to only 57 (a 63 percent decline). Table 1 depicts the history of successful VR closures in SE.

Table 1: Successful Closures in USOR Supported Employment
 


Teamwork Achieves Creative Solutions
In the words of Don Uchida, Executive Director of USOR, to overcome these obstacles, “something drastic had to be done to save the program.”^[2]

To be an effective public program, DSPD and VR staff realized they must be unified about the essential need for SE and work together to propose strategies for government to provide this service. It is not necessary for one agency to literally provide all of the SE services in the state, but the need for an articulated approach was critical.
 
SE staff from Vocational Rehabilitation and Division of Services for People with Disabilities analyzed all related data and sponsored a study by the University of Utah and Utah State University^[3] to ensure that all the issues were identified. In addition, the team also studied small efforts of intense SE to see if increased support let to improved outcomes.
 
Based on discussions and analysis, the staff presented concerns to the agency directors: We need to take action on SE or the program will die. If SE services were not available individuals that could be successfully employed would remain unemployed. Realizing the importance of the program, the agency directors took action. The agencies convened a group of stakeholders and developed a concept of intensive services and how they would be unique from traditional SE. In addition, advocates were enlisted to provide grassroots support for the project.
 
The team worked with Representative Ronda Menlove, a member of Utah’s Legislature Health and Human Services Committee. In 2006, she sponsored HB 31 for the SE Pilot project which appropriated $150,000 in state funding for one year and established a pilot program for the provision of SE services to people with disabilities.
 
With the pilot approved, VR and DSPD went to work defining the pilot services and how they would be unique from standard SE services. In addition, the services between the agencies had to be seamless so it was not awkward for the clients. In addition, the services had to meet the SE standards of helping the individual achieve competitive employment in an integrated setting (see box). To accomplish these objectives, the team:

• Developed additional collaborative working relationships
• Created a Management Team to provide support and guidance
• Created an Implementation Team of DSPD Service Brokers, VR Counselors and Community Service Brokers (CSB) and outlined what each person’s role would be

By leveraging state pilot funds with Vocational Rehabilitation funding, Rep. Menlove cited that they “were able to create employment opportunities for about 100 people with disabilities. The data and impact was so impressive to Utah Legislators that the Pilot was funded for second year … Once again the results were seen as so beneficial that permanent funding was extended.”^[4] This occurred in 2008 when the Utah Legislature passed House Bill 45 providing long term funding for the Support Work Independence Program.
 
SE allows people experiencing disabilities, their families, businesses and their communities to experience success in employment. SE also benefits society as a whole. It costs less than other day support options and the average earning power of individuals with disabilities in SE is higher and their need for support is lower than those individuals in day-training workshops. In addition, it builds individual empowerment, self determination and self worth, as well as societal contributions such as payment of taxes and reduced reliance on state services.
 
Conclusion
In Representative Menlove’s words, “This project has been a great example of people coming together utilizing not a huge amount of state funding … and leveraging it with federal dollars to create a program that is meaningful and helpful to people with disabilities … Overall I see this as a very successful program. Through legislative support and collaboration of agencies, we have been able to truly positively touch the lives of people with disabilities.”^[5]
 
Utah’s Pilot project has resulted in over 120 individuals achieving successful employment who would have otherwise not had the supports they needed to succeed. In addition, the success of this program has inspired similar efforts in Colorado.
 
The difference the program makes in people’s lives is much larger than the statistics can measure. The real impact of the program is on an individual’s self worth. One pilot participant, who thought they could never work, went to work part-time earning $8/hour. Now they are earning $10 per hour. Another person now makes $19 per hour. Collaboration and creativity are critical to achieving real innovative results!


 

Sara McCormick, MPA, is a Research Associate at the Center for Public Policy & Administration at the University of Utah. Kathy Daley is the State Coordinator of Supported Employment for the Utah Division of Rehabilitation Services.