UNITED STATES DEPARTMENT OF EDUCATION

OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES

REHABILITATION SERVICES ADMINISTRATION

WASHINGTON, DC 20202

INFORMATION MEMORANDUM

RSA-IM-97-08

DATE	:	June 23, 1997

ADDRESSEES	:	STATE VOCATIONAL REHABILITATION AGENCIES (GENERAL)

STATE VOCATIONAL REHABILITATION AGENCIES (BLIND)

STATE REHABILITATION ADVISORY COUNCILS

CLIENT ASSISTANCE PROGRAMS

REGIONAL REHABILITATION CONTINUING EDUCATION PROGRAMS

RSA SENIOR MANAGEMENT TEAM

SUBJECT	:	RSA Demonstration Projects to Increase Client Choice

CONTENT	:	In October of 1993, RSA awarded seven grants to demonstrate ways to increase client choice in the rehabilitation process. Grants were awarded to:

-	Arkansas Rehabilitation Services

-	Berkeley Center for Independent Living

-	Southwest Business, Industry, and Rehabilitation Association

-	The Development Team, Inc.

-	United Cerebral Palsy Association

-	Vermont Division of Vocational Rehabilitation

-	Washington Division of Vocational Rehabilitation.

These projects have explored a variety of methods for increasing informed choice throughout the vocational rehabilitation process and have developed tools and training for providing technical assistance to others interested in exploring their methods. The attached descriptions, prepared by the project directors, highlight the methods used by each project and the types of technical assistance that are available.

INQUIRIES	:	Each project description includes contact information. Within the Rehabilitation Services Administration, the contact person for matters related to informed choice is Suzanne Tillman at 202-205-8303.

______________________

Fredric K. Schroeder, Ph.D.

Commissioner

Vermont Division of Vocational Rehabilitation

Consumer Choice Project

Vermont's Vocational Rehabilitation Undergoes Major Systems-Change

Using the Consumer Choice Project as its learning laboratory, the Vermont Division of Vocational Rehabilitation (DVR) has begun the implementation of Vision 2000. This statewide systems change initiative is designed to create a consumer-directed organization by 1999. The Choice Project is responsible for operationalizing the language of the Rehabilitation Act Amendments of 1992 that relate to consumer choice and for developing strategies to more fully ensure the consumer's full participation and choice in rehabilitation efforts.

This initiative is totally replicable as a state-wide systems change effort because the project is housed within the regular DVR program and serves the same cross-disability clientele. The intent of this initiative is to remove barriers within the DVR system that inhibit consumer choice while promoting consumer ownership and personal responsibility.

Based on the experiences of the Choice Project, many of the unique features described below have already been incorporated into the regular DVR program. All VR personnel have received extensive education about project initiatives and experiences and have begun to incorporate these changes into their unique office protocol.

Unique Program Features

-	Eighty-nine percent of consumers report satisfaction with the amount of choice and control in determining their vocational goal and 74% of individuals report an increase in their ability to make decisions: The counselor role has shifted from the traditional clinical approach to a more educational method. Decision making skills, problem solving, and accessing resources within the community become a focus for education. The consumer takes on more responsibility for choosing vendors, comparative shopping, and making the important decisions. The counselor must have a high level of skills to constantly assess the consumer's ability to assume increasing amounts of responsibility to accomplish their vocational goal. The overall project goal is to provide an approach that encourages personal responsibility while teaching and ensuring the necessary skills and supports for the consumer to assume that responsibility.

-	Individuals are certified as eligible for services in one day on average as opposed to 54 days in the traditional VR program. In addition, they are developing their employment goals 31% faster as a result of expedited eligibility and other streamlined procedures: Counselor judgement and individual reporting form the basis for determining eligibility, often saving individuals several weeks of waiting for services. In many instances, services can begin on the person's first visit to a DVR office. By changing other intake procedures, individuals coming to DVR for services can expect faster response time and less paperwork prior to seeing a counselor.

-	Choice of vendors and service providers contributes to cost savings: To date the average successful closure in the Choice Project is being accomplished with 21% less funds for purchased services, as compared to Vermont's regular DVR program. Individuals may choose where to purchase services and goods as well as where to receive assistance in making better choices. Often individuals can negotiate a better price for goods than can the State and can shop for items that better suit their unique needs. This method also fosters ownership in the outcome of the purchase or service and therefore, greater ownership of the outcome.

-	Direct cash payments contribute to more timely services and consumer control: Consumers can purchase goods and services anonymously, with greater dignity by receiving cash. By using a cash system, they also experience no unnecessary delays due to the inability of the purchasing system to process payments quickly.

-	Consumer input drives program improvement and staff evaluations: Every program participant is interviewed at 6 month intervals to gain insight into consumer satisfaction with the quality and timeliness of services as well as their degree of involvement in the process. This data is used to direct Vermont's systems change initiative at both the systems and program level as well as for evaluating individual counselor performance. For dissatisfied consumers, a peer review process has been developed to resolve issues and ensure a prompt return to the pursuit of vocational goals.

-	Self-employment goals increase job opportunities: When given a wide range of employment options, 24% of project participants have chosen to pursue self-employment goals. This compares to 2% in Vermont's regular VR program. This process has increased opportunities for individuals who have disability-related barriers that can better be accommodated in self-employment settings. It is also an indicator that all employment options are truly being explored.

At the end of three years, the project has served 454 individuals. These include 173 people who are currently employed, 155 who are enrolled in career education or training programs, and 126 individuals who are still exploring their possibilities. An additional 48 people have left services without achieving their vocational goal.

For Additional Information or Assistance:

Division Director	:	Diane Dalmasse

Project Coordinator	: Michael Collins

Address	:	Division of Vocational Rehabilitation

103 South Main Street

Waterbury, VT 05671-2303

Phone/TTY	:	(802) 241-2186

Fax	: (802) 241-3359

E-mail	:	diane@dad.state.vt

michael@dad.state.vt

CAREER CHOICE

An RSA Funded Choice Demonstration Project

Award No. H235D30034

Career Choice is an easily replicable, stand-alone small group program: it is efficient, effective and choice-enhancing. The Development Team, Inc. has implemented it in collaboration with Centers for Independent Living and disability-specific community services organizations in Washington, D.C./Northern Virginia, San Francisco/Oakland/Berkeley, California and Jacksonville, Florida. Fifteen group programs focused on specific types of disabilities were completed between March 1994 and June 1996: three physical; four chronic; three learning disabilities; three deafness; and two HIV+. Three HIV+ programs are now in process. During fiscal year 97 the Career Choice cross-disability model will be tested at three sites as an additional program option within the Vermont Division of Vocational Rehabilitation.

HIGHLIGHTS/INNOVATIVE PRACTICES

*	Direct outreach to persons with disabilities including culturally diverse populations and those currently considered underserved by VR. Limited but important outreach roles for community groups.

*	A quick self-assessment process effective for presumptive eligibility; first-come, first-served.

*	Participant decision to participate and commitment to complete the work.

*	A highly structured small group training program as the core service: a comprehensive and tightly scheduled process. (12 weekly 3 hour sessions, maximum of 12 persons)

*	Consumer-controlled process of peer review of all purchase requests; group decisions on a group budget of $15,600 for additional services/products for 12 participants.

*	Participants manage purchase of additional services/products with two-party checks and enhanced mainstream consumer techniques to achieve quality and satisfaction. No vendor lists.

*	A Plan to Achieve Career Choice (P.A.C.C.) assembled as participants go through the processes of self-assessment and group training prepared by the participant. It is also the (only) paper data file. Participants retain copies.

*	Guest presenters and volunteer mentors from the business community.

*	A self-directed Career Club to provide support; continued learning and networking opportunities while participants conclude receipt of products/services and pursue vocational plan.

*	A follow-up process that involves contact four times over two years to identify any additional needs and for data collection.

WHAT HAPPENS IN THE GROUP TRAINING

Participants help each other: examine and strengthen personal and job readiness including skills to manage their disabilities during the job search and on the job; identify transferable skills, and choose employment objectives; identify potential barriers to achieving their objectives; research and identify needed additional services/products, and providers of those services/products; prepare purchase requests and justifications; participate in a structured process of peer review of requests and allocations to individuals within group budget (amounts have varied from $0 to $4,800); increase their confidence as consumers and their knowledge of how to manage their purchases; develop or improve job seeking skills; develop a job search, career advancement or business development plan; and are prepared to support each other in a 3-month career club while they conclude receipt of products/services and pursue their vocational plans.

MANAGEMENT OF GROUP PROGRAMS

Leadership teams (2-5 persons including staff and volunteers with disabilities) are organized and trained for each group, to implement the program and facilitate the group training. The team collectively performs the functions of program management, group facilitation, recruitment of volunteers/guest presenters, data management and collection, and clerical tasks. The program manager/lead facilitator is usually a staff person: in Vermont, VR counselors will have this role. Initially, a program manager/lead facilitator will use the equivalent of one month's time over a period of six months, plus two days of leadership training. Total time commitment is reduced by 1/3 in subsequent groups.

The Leadership Manual, a comprehensive and structured tool for program implementation, is the basis for the intensive leadership training and for replication of the program. All phases of the program are addressed in detail including session plans for the 12 group sessions and management tools such as schedules, tracking forms, record forms. The Participant Manual contains information, exercises, interactive tasks, homework assignments and selected supplemental materials which together constitute the substance of the group training program. Together with the leadership training these manuals provide program consistency, quality control and replicability from site to site and group to group.

Separate editions of the Manuals have been developed with variations to address the needs of 6 types of disabilities plus cross-disability groups, a model which meets the needs of small or rural areas, statewide CILs and other cross-disability agencies.

Collaboration with community service organizations and CILs provides:

*	broadened direct access to persons with disabilities for the outreach process

*	increased access to peer support and coordination of community services for participants

*	expanded access to the business community for recruitment of guest presenters and mentors matched to individual participants employment objectives, for resume review, job search or business plan review and networking.

Career Choice is purposely a relatively low-cost, limited management approach. Total costs per participant are $2,400 for the core program plus $1,300 for additional services/products. For the first group at a new site, core program costs are about $500 per participant higher.

DATA AND OUTCOMES:

March 1994-June 1996

Program Statistics and Demographics (First 15 Groups)

Avg . Per Group

Brochures Mailed/Distributed	1,456	-	Average Age = 41.3 years

Inquiries/Return Postcards	49	-	Ethnicity = White-68%, Black-22%, Hispanic and Other-10%

Telephone Interviews	35	-	Education = 8-22 years, avg. 15.2 yrs.

In-person Interviews	16	-	Benefit Status = SSDI 24%, SSI 16% (unduplicated count receiving either = 37%)

Registration	10	-	Prior VR Experience = 30%

Completed Group Training (92%)	9+	-	Employed at Program Entry = 43%

Verified Employment Outcomes as of 01/97

(Sufficient data not yet available for groups which started after June 1996.)

Verification of employment outcome requires two consecutive months of employment whether a new or retained job. Outcomes will increase when data is complete at two years of follow-up. These outcome percentages are based on persons for whom we have data for at least nine months after completing group training.

Overall:	Verified Employment Outcomes	73%

Persons with No Prior VR Experience:	Outcomes	70%

Persons Receiving SSDI or SSI:	Outcomes	62%

While initial job retention was achieved by 70% of those employed at entry, only 43% retained their original job through the periods for which data is available. But 50% got new jobs in those same periods, including some who first retained jobs.

Almost all jobs are mainstream and permanent. 22% started businesses or are self-employed. Average hourly wage is $10.43. Job titles cover a broad spectrum.

With the exception of persons who receive SSI or SSDI, there seemed to be no indicators which would predict a lessened expectation of Career Choice participants achieving their employment objective; outcome expectations for Social Security recipients are reduced by about 16%.

The only demographic difference or significant outcome difference between those Career Choice participants who had prior VR experience and those who did not, is that 19% more of those without prior VR experience were receiving SSDI or SSI at program entry.

TECHNICAL ASSISTANCE

The Development Team, Inc. is prepared to provide technical assistance to any state vocational rehabilitation agency or other employment related agency regarding:

*	Development of a fast track, low-cost, choice-enhanced group model.

*	Effective and limited collaboration with CILs and other community groups, including outreach to under-served populations.

*	Uses of the Career Choice Manuals/ other materials.

*	Informed choice of expanded VR program options.

*	Self-assessment and presumptive eligibility.

Technical assistance arrangements can be negotiated for services beyond what can be provided by the very limited resources of the Career Choice project.

PRODUCTS

Career Choice Leadership Manual.©

A comprehensive and structured tool with all details necessary for implementation and replication. (150+ pages)

Career Choice Participant Manual.©

Loose-leaf manual with supplements used by participant to reinforce and supplement group discussion and guest presenters. (400+ pages)

Plan to Achieve Career Choice (P.A.C.C.).

A file folder of documents, which constitutes both, a comprehensive plan and an individual data file. (70+ pages)

Career Choice Program Descriptions of Practices: Implications for VR Services.

(6 page article)

Recruiting Business and Professional Volunteers.

(brochure)

Exploring Products and Services.

Brief self-help guide for the participant/consumer. (brochure)

FOR ADDITIONAL INFORMATION

Harry L. Hall, President

The Development Team, Inc.

Oceanside Office Center

300 North 2nd St., Suite 10-C

Jacksonville Beach, FL 32250

Voice/TTY: (904) 247-4640

Fax: (904) 247-4113

E-mail: TDTI1ESD@AOL.COM

The Development Team, Inc. (TDTI) is a not-for-profit corporation created in 1983 to develop and manage programs to assist people with disabilities to obtain/retain employment. Persons with disabilities are substantially involved in both the policy direction and staffing of TDTI.

Arkansas Rehabilitation Services

COMMITMENT TO CLIENT CHOICE PROJECT

CONTACT:

Sterling Hughes, Project Director

Commitment to Client Choice Project

2703 W. 28th Street, Pine Bluff, AR 72603

Telephone: (501) 534-1372

Fax: (501) 534-1067

PROJECT DESCRIPTION AND GOALS

The Commitment to Client Choice (CCC) Project is a federally-funded pilot project to promote client choice within rehabilitation services. With a design based upon consumer input, the project is the product of a public/private partnership between Arkansas Rehabilitation Services (ARS) with vast experience in rehabilitation and job development and Empowerment Network Unlimited, Inc., a national private, non-profit corporation with expertise in choice, consumer-driven practices, inclusion and empowerment. Expanding the partnership, ARS networks with the University of Arkansas Research and Training Center in Vocational Rehabilitation (ARTCVR) and the Arkansas Regional Rehabilitation Continuing Education Program (ARRCEP) for evaluation and replication activities respectively.

The project is being implemented in a ten-county area in Southeast Arkansas. Known as the "Delta," this primarily rural area is high in cultural diversity, poverty, unemployment and underemployment. This is also an area in which all types of services are quite limited, at times nonexistent. With a goal of serving 300 individuals within the 5 year scope of the project, the project initially focused on students transitioning from public schools and later broadened to individuals from 16 to 65 interested in employment and meeting the criteria for rehabilitation services.

The goals of the Commitment to Client Choice project are:

*	Create an environment within ARS that promotes informed client choice;

*	Increase opportunities for informed client choice and empowerment during the selection of vocational goals and objectives, the type and scope of services needed, and providers of those services,

*	Expand opportunities for people with severe disabilities to achieve positive employment outcomes;

*	Increase the cultural diversity of individuals with severe disabilities in vocational services, and

*	Support the replication of project models throughout the state, region, and nation.

PROJECT COMPONENTS

Empowering consumers to identify and achieve success in their chosen career and life goals is the ultimate challenge for the grant, a challenge that is tackled through several innovative strategies to enhance traditional vocational rehabilitation services:

*	CONSUMER CONNECTORS are private vendors who contract directly with individual clients to assist them in linking to various community resources, such as housing, food stamps, counseling, etc.; facilitating the person-centered career planning process; fulfilling consumer responsibilities in the implementation of the career plan; developing creative options to meet consumer-directed career goals (e.g., new vendors); challenging the system to move beyond previous traditions in providing supports; and developing job possibilities.

*	A PERSON-DRIVEN CAREER PLANNING PROCESS allows the individual to invite friends, family and others to take part in the planning process, is facilitated by the Consumer Connector to assure that the rehabilitation system is really listening to consumer choices, explores individual preferences and dreams, focuses on enhancing capabilities instead of "treating" limitations and on developing a career rather than just getting a job, and addresses factors that influence successful employment, such as shelter, health and safety.

Respect for choice is reflected in the diversity of occupations individuals are seeking, such as these: assembly line, cosmetologist, welder, early childhood teacher, florist, security officer, mechanical technician, child psychologist, home health worker, auto-body repairman, professor of political science, radiologist, data entry clerk and criminal justice social worker. One of the most exciting arenas of creation of new jobs has bee the number of people who are seeking self-employment. Entrepreneurs have chosen to develop diverse businesses, such as shoeing horses, cosmetology, ceramics, accounting, housecleaning and photography.

*	"GO FOR THE GOLD" EMPOWERMENT TRAINING provides consumers an intensive one- day training session packed full of tips and strategies that lead to success--building positive attitudes, increasing confidence and self-esteem, enhancing image, attaining good communication skills, making informed choices, developing assertive behaviors, and understanding rights and responsibilities. The presentation is humorous and motivational. Individuals who experience the training indicate that they feel more empowered to gain control of their lives and pursue their goals as a result of the training. A summary of training highlights is provided to participants for their continuing reference.

*	CREATING NEW VENDORS is a critical strategy for providing choice in these poor Southeast Arkansas counties where very few traditional service options exist. The Choice project responds by identifying and creating new vendors -- 161 to date. Most of these new vendors exist because consumers identified and chose to do business with them.

*	CONSUMER DIRECTED VOUCHERS Since state accounting practices precluded that actual distribution of funds to individuals to purchase services, ARS modified its existing purchase order to give Choice consumers greater control of the voucher process. All purchase orders for evaluation, connector or vocational services must be authorized by the concerned individual. The voucher is issued to the desired vendor who has completed the process to become a vendor for the state.

Beyond these important strategies, project staff get ongoing consumer input from a Consumer Advisory Committee, advice from community resource people on ways to target diverse populations involved in a Cultural Diversity Task Force and consultation from area business leaders and employers serving on one of three business councils. The project's evaluation quantitative strategies are heavily based on consumer satisfaction with the planning process, empowerment training, counselor services and connector services. Qualitative strategies also reflect consumer interests through interviews that are videotaped and audio taped. Slides documenting the stories of individuals are also secured and vignettes developed.

CURRENT STATUS

To date, 277 applications have been taken for the Choice project from April of 1994 through January 1997. Eighteen percent of the those indicating an initial interest in the Choice project dropped out prior to being determined eligible for the program. In a number of cases, high school students initially targeted changed their minds or their choices were not supported by their parents. Other reasons included moving, not responding to numerous attempts to schedule evaluations or other meetings with the Choice counselor or changing their minds about the program once they understood the investment of considerable time and effort required to receive financial assistance. Of the 226 individuals determined eligible for program services to date, just over 5% of those reaching the service implementation phase of their Choice experience dropped out for reasons such as moving, not responding to repeated attempts to establish contact, changing career interests, changing life circumstances, not completing training programs and similar reasons.

Of the 195 individuals who have been actively involved in the project:

*	38 have been closed as successfully employed, with 7 in self employment.

*	Of those with successfully employment outcomes, 25 were on SSI and 6 on SSDI.

*	The number of successful closures is reduced because of the choices of many entering the program initially meant 4 years of college, delaying successful employment outcomes.

*	Since most of these individuals have achieved success only recently, follow-up to gauge length of ongoing employment after the project has not yet been accomplished.

Of the 157 currently remaining in the program:

*	26 are currently receiving vocational training of some type.

*	8 individuals are currently at the Hot Springs Rehabilitation Center which is a short-term residential training center.

*	23 individuals are currently in on-the-job training situations.

*	41 are attending college programs from 1-½ years to 4 years.

*	6 are working to become self-employed.

*	30 of those currently active receive SSI and 10 receive SSDI.

*	59% of individuals served by the program are from culturally diverse backgrounds contrasted with approximately 21% in the regular rehabilitation program.

Originally, we anticipated an average cost per person of $10,000. Of the 38 who have reached successful employment outcomes, the overall average cost is $5,121. The average cost for regular rehabilitation clients who were successfully closed in 1995 is $3,287. Three factors work to skew this figure to the high side for the Choice project:

*	Several individuals have required expensive technology to increase their employment potential, such as a speech device purchased for one individual at a cost of nearly $8,000.

*	This figure is also heightened because it contains those self-employed as well as regular rehabilitation cases. The average cost for individuals in self-employment is $ 7,6731 and $4,545 for individuals in more typical rehabilitation situations.

*	Sending individuals to the Hot Springs Rehabilitation Center also skews the cost per person. Typically, this training costs around $2,500 per month, with some cases reaching totals of $20,000 or more. While only part of these costs are reflected in cost per client in the regular rehabilitation program, the full cost of this residential training is figured into the Choice cost per client.

*	Finally, the cost of Consumer Connectors is included in the average cost per person. These costs are not incurred for individuals in the regular rehabilitation program because such services are not available. These services range between $500 - $1,200 per person who stay in the project.

REPLICATION

Each of these strategies is based heavily on respect for the individual to make choices regarding career and what is needed to achieve success. The values underscoring these concepts are profoundly important, even more so than the operational parameters that make them work. So, replication demands a rejuvenation of leadership and revitalization of values held by counselors and others. Since it is the approach of rehabilitation services toward the individuals they support that is targeted for change, the salient factors of implementing these strategies are not impacted significantly by geographic location or cultural diversity factors. These strategies are currently being accomplished with success in a ten county area of extreme poverty, few services, high unemployment, low income, high cultural diversity and massively rural. While valuable for any participant, the person-centered planning process appears to be most valuable for those individuals who experience the most complicated disabilities.

Administrative costs of replication are limited. The planning process and empowerment training can be provided with little additional cost to programs beyond expanded or redirected staff time. The curriculum for training is currently being developed for publication. Alternative funding sources may be possible to provide consumer connector services. National consultants experienced in the design, implementation and evaluation of these concepts are available to assist those interested in replication particularly through staff training, conference presentations, program review, and evaluation. Reasonable consultant time and expenses must be covered by interested parties. Materials are also available.

Southwest Business, Industry and Rehabilitation Association (SWBIRA)

CLIENT CHOICE PROJECT

PROJECT OVERVIEW

SWBIRA's Client Choice Project is a new initiative designed to demonstrate ways to increase client choice in the rehabilitation process, including enabling clients to have choice in the development of a "client-driven" written vocational plan, and choice in the manner that providers are selected, thereby improving the quality of the rehabilitation process. It is a case management-based system that will give clients access to the entire range of services necessary for a work attempt.

The objectives of this project are to:

provide self-directed rehabilitation services to 643 eligible disabled persons over 5 years;

establish a primary collaboration with the State Vocational Rehabilitation agency. Secondary collaborations will also be established with other organizations such as the local mental health services coordinating entity (COMCARE) for the purpose of identifying eligible disabled persons;

conduct other outreach activities as necessary to recruit a sufficient number of participants;

set up a network of approximately 50 service providers which will address a comprehensive variety of rehabilitation needs;

devise a payment system for the purchase of cost-effective services utilizing both vouchers and purchase orders;

place 80% of project participants in successful employment with 45% retaining employment for 60 days.

Services will be provided at no cost to the participants and may include one or more of the following:

Job placement and post-placement assistance;

Job readiness training;

Job coaching/on-the-job training;

Financial counseling;

Worksite accommodation;

Physical rehabilitation and restoration services;

Therapy/family counseling;

Transportation and other support; and/or

Special training.

Eligibility

Residents of Maricopa County, Arizona, who have any documentable physical or mental impairment to employment, who are unemployed and not currently receiving services under an individualized written rehabilitation program established through a designated State unit, and who can benefit from vocational rehabilitation services in terms of an employment outcome are eligible participants. Sources of participants will primarily be through collaborative arrangements with the State Vocational Rehabilitation agency and the local mental health services coordinating agency, COMCARE. General community recruitment will also be conducted.

UNIQUE FEATURES/INNOVATIVE PRACTICES

The two major elements of the project are:

1)	The Written Vocational Plan (WVP)

The client, as well as family members, guardians, advocates, or other authorized representatives, will fully participate in the development of a "client-driven" written vocational plan. The WVP will include the client's vocational rehabilitation goals, case manager objectives, the services to be provided, projected dates for initiation and anticipated duration, and an evaluation procedure and schedule for determining whether the goals are being achieved.

2)	Purchase Power

Clients will be educated regarding possible providers and will be given the option of using vouchers to provide them with "purchase power" to arrange and purchase services from the providers of their choice. The education of clients will be accomplished by providing clients with "service provider handbooks."

The project will feature several innovative activities:

an advisory board of case management specialists, State VR, COMCARE, rehabilitation professionals, disabled clients, community representatives and Advocacy Groups; this committee will be involved in the development and implementation of the project in an advisory capacity; specific attention will be given to recruitment of handicapped persons

full participation by the client in the development of the WVP to empower the client as s/he becomes involved in the rehabilitation process

service provider handbooks and educational materials for clients that include agency and service descriptions

established agreements with a variety of service providers offering services at pre-negotiated cost- effective rates

complete vocational assessments for clients not tied into existing service systems when appropriate

comprehensive team vocational planning meetings

availability of voucher system for direct service purchasing by client, or second option of case manager arranging services (client's choice)

biannual evaluation of quality of services provided including client input

case management monitoring system for client progress and service provision

an evaluation component for project progress and success

a form will be developed and provided to clients to advise them of the Client Assistance Program (CAP) and how to access it; this will be augmented by a question and answer session with each client and advocate when appropriate specific to corporate appeals procedures (internal) as well as CAP appeal (external).

AREAS OF TECHNICAL ASSISTANCE

SWBIRA's project has provided technical assistance regarding the use of vouchers in purchasing services for clients. It has produced an Operating Procedures Manual for the purpose of training project staff, and a Service Provider Manual which is used by participants to choose vendors.

DEMOGRAPHIC DATA

Between January 24, 1994, through December 31, 1996, SWBIRA's project has:

contacted 1,693 individuals.

enrolled 673 participants.

provided assessments to 469 participants (this is the base group).

provided additional services to 318 participants.

placed 218 participants, 182 of which have achieved 60 day job retention and thus have become "successful closures." This is a placement rate of 46% of the base group, and an 83% 60-day retention rate.

218 were closed as "unsuccessful closures" or did not maintain employment for 60 days and were terminated from the project.

196 individuals receive SSI and/or SSDI benefits.

approximately 25% of participants have prior VR experience.

currently, 51 participants are in active ("training") status, and 18 are in employment status working towards their 60 day retention (our project does not follow participants after 60 days on the job).

self-employment is not a goal of SWBIRA's project.

average hourly wage is $6.94, or $14,435.20 annualized. The range is minimum wage to $16.83 per hour.

Contact Information:

Lee Lanning,

Project Director SWBIRA

2222 North 24th Street

Phoenix, AZ 85008

(602) 275-0180/ 275-0390 FAX

Center for Independent Living

Client Enhancement and Empowerment Project

The Center for Independent Living (CIL) in Berkeley, CA, has one of the seven choice Demonstration Projects in the nation. CIL is the only Independent Living Center operating one of the five year "Choice Demonstration" grants. The project's focus is to enhance choices and provide empowerment opportunities for persons with disabilities.

Highlights of the Project

Interest in small business, home-based business and self employment have been at high demand in the CIL project, stretching the traditional views of vocational rehabilitation services. The CEEP project has been instrumental in assisting over 70 consumers to be self-employed and/or operating a small business. The project has become known as "experts in small business development" for individuals with disabilities by many of the vocational programs and rehabilitation counselors in the San Francisco Bay Area.

The Rest of the Story

The Project works with people who experience various types of disabilities, economic and environmental issues. The CEEP has worked with 370 consumers in the first three and a half years. The project has been successful in identifying several trends leading to the success of persons with disabilities in achieving their vocational goals.

Services provided include, but are not limited to, small business/self-employment, continuing education, certificate training programs, education in blue collar trades, employment readiness skills, placement assistance, access to technology, transportation and regular empowerment seminars and workshops.

Self-direction is the key to the success of the Client enhancement and empowerment Project. The following represents the key components of the CEEP:

a)	Consumers are given fiscal boundaries from the very beginning. During the group orientation to the CEEP attendees are clearly told that all vocational plans must average $3,800. Consumers have responded well to knowing what funds are available to them and how those funds can be used. While many plans developed in the CEEP project cost more than $3800 the project's goal is to keep the average of the 100 persons served per year to $3800. Consumers needing adaptive technology, specialized training, personal assistance, sign language interpreting, and other services develop plans that may significantly exceed the $3800 average. When the consumer knows the limits of their "budget" they look for more affordable services, technology, training, and education.

b)	Consumers are empowered to arrange and receive services with any qualified provider, business, accredited school, or any other vocational services provider that will enable them to achieve their vocational goals. Having an open vendor system has empowered the project's consumers to search out the provider who best matches with their specific needs and skill level. This freedom in choosing providers also holds the consumer accountable to follow through on their vocational plan's various objectives and tasks; And even to terminate services if they are not satisfied with the vendor or services received.

c)	Consumers have all the necessary resources available to them for advocacy. The project staff is trained to teach and assist consumers in understanding their rights and advocating for themselves. The CEEP project continues to provide workshops on the ADA, self-empowerment, self-advocacy, numerous employment issues and topics related to small business development and operation.

d)	Consumers are encouraged to pursue vocational goals not readily supported by traditional vocational rehabilitation systems. The dignity of risk is in itself empowering for the consumers. Providing freedom to choose the vocational goal, the project makes an investment in the person's desire and fortitude to achieve goals which may at first sight appear to be unreasonable and /or unrealistic. Few consumers have failed due to choosing an "unrealistic" vocational goal. Rather, the opportunity to achieve is so empowering that often the consumer achieves the unachievable.

e)	Persons interested in establishing small businesses are required to submit a complete business plan similar to what the Small Business Administration (SBA) requires. Each consumer is expected to learn basics in small business development and operation, to understand budgeting, realistic income projections, licensing requirements and implement meaningful marketing strategies. Consumers choosing this vocational goal have achieved significant levels of success in their home-based small business and/or self-employment.

The following are examples of the types of employment outcomes achieved by consumers of the CEEP.

Word-processing Service-

Ms. B is a low vision consumer who had been a registered nurse for 25+ years. Due to the exacerbation of her disability she felt it was time for a career change. The project assisted Ms. B in writing a business plan which included equipment, reference materials, f-ax machine and with guidance from project staff a CCTV. Today Ms. B is successfully operating her home-business and doing what she likes best.

Therapist-Body Talk -

Ms. M experiences chronic pain to the point that she is not able to be active in any physical capacity. Ms. M now uses her only her voice to help other chronic pain sufferers control their pain through visualization therapy. This type of therapy, although very alternative, is in high demand in the Bay Area from those choosing treatment in the emerging holistic health field. Ms. M. was provided voice coaching, a voice activated computer, support services and assisted with her small business development activities. The service is provided on a sliding fee scale of $30 to $80 per session. Ms. M is well on her way to eliminating her dependence on public assistance.

Building Contractor-

Mr. T experiences a severe learning disability and needed assistance in reading/mathematics in order to complete and pass the contractors licensing examination. Under the direction of Mr. T a tutor was hired and Mr. T obtained the reaming materials necessary to prepare for the licensing exam. He passed the examination and today is a very proud licensed building contractor.

Computer Programmer-

Ms. R. has been on SSI for more than 20 years and been sick with Environmental Illness and episodes of mental illness. Ms. R. came into the project looking for training and upgrades for home computer to practice C++ programming and several other programming software packages. Ms. R. was hired by a local company to work as an intern (less than $20K per year). During her internship she was recruited by another company at $35K per year. Ms. R was able to work with Choice Project staff in interviewing skills, how to request reasonable accommodation, equipment upgrades, computer classes, medication and moral support. Ms. R. continues to work as a computer programmer and is extremely happy!

Demographics and Outcomes (October 1993 through March 1997)

Total number consumers qualified:	367

Current Open Cases:	209

Closed Cases:	158

Successful closure:	69

Unsuccessful closures:	10

Did Not Complete:	79

Female:	203

Male:	164

Ethnicity:	367	records available

African American:	102	(28%)

Asian:	32	(8%)

Latino:	20	(5.%)

Native American:	5	(.01%)

White:	173	(47%)

Other:	35	(9%)

Previous State Vocational Rehabilitation Experience(within past 36 months)

Previously Rehabilitated closed with 26	30

Closed as not Rehabilitated	137

No previous history with VR	182

Not accepted for services from VR*	18

*	Reasons individuals were not accepted for services from the state VR agency varies, including but not limited to, "unrealistic vocational goals".

At Entry to the Project:

Receiving Public Assistance	267	consumers:	73%

Small Business/Self-Employment Interest	154	consumers:	42%

Clear Goal	297	consumers:	87%

Please contact the Project Manager to obtain information on the CEEP or any of the following:	Year-end reports; Sample flyers on empowerment seminars/workshop; Orientation packets; Choice Video (To be completed 8/97); In person Seminars/Workshop on Choice by Project Staff, Explanation of protecting choice mi the process of authorizing vocational plans; Telephone consultation; And copies of the CEEP Small Business Directory.

Michael Donnelly, Executive Director

Terry "Herk" Herkimer, Project Manager

Center for Independent Living

2539 Telegraph Avenue Berkeley, CA 94704

510-841-4776

510-848-3101 TDD

510-841-6168 FAX

Washington State

DIVISION OF VOCATIONAL REHABILITATION'S CHOICE PROJECT

Washington Division of Vocational Rehabilitation (DVR) has implemented their Choice Demonstration grant, the Participant Empowerment Project (PEP), to develop and design approaches that ensure the rehabilitation process is participant-driven. Strategies that are proven to be successful will and are being implemented statewide to assure rehabilitation services in Washington State are participant-driven.

PEP has been responsible for developing strategies and approaches that encourage and call for participants to direct and guide their rehabilitation process. PEP has worked with the DVR training coordinator to design and implement a training that all DVR personnel have attended on participant choice. Counselors around the state of Washington have incorporated PEP's approaches and concepts into their caseloads. PEP's results to date are:

*	PEP has accepted 260 into the project. At acceptance into PEP, participants were unemployed, 156 were on public support.

*	110 of PEP's participants obtained employment in their chosen fields. Eighty-eight percent of those participants have maintained their employment for over sixty days.

*	50 participants have or are attending school or training programs.

*	The sixty-five participants who have closed their cases employed earn an average of $11.00 per hour and work an average of 32 hours per week. Thirteen of those participants closed their cases self- employed. One hundred participants have closed their cases.

REHABILITATION TEAMS

The rationale behind the Rehabilitation Team is the belief that holistic, effective vocational planning results when the participant chooses who is involved in their vocational planning. The Rehabilitation Team process has removed vocational planning from a more medical, problem-solving approach (with the counselor gathering the information and providing the solution), to a team approach that allows participants to define their strengths and have those strengths determine their vocational directions. Ninety-one percent of PEP's participants support the concept of the Rehabilitation Team. This data is from participant evaluations and focus groups that are in place to assure PEP is participant-driven.

*	PEP participants are asked to invite supportive individuals-friends, family or other professionals- to be involved in their vocational planning process as team members. The first team meeting is facilitated by PEP staff using a modified version of Futures Planning. Teams take approximately fifteen to twenty percent of staff's time.

*	The role of the team is to help a participant establish a solid vocational plan, and to provide support and encouragement while the participant is implementing the plan. Rehabilitation teams help participants set obtainable goals for themselves and establish natural networking.

*	Each team meeting ends with an action plan that lists the steps to be accomplished in the next four to six weeks toward the individual's goal. These short-term plans allow participants to have success that they can build upon. The short duration of plans allows participants to easily change or correct the plan if it is not working. The action plans form the foundation for the IWRP and assure that it is participant directed.

CONTROL OF CASE SERVICE DOLLARS

PEP has found that in order for participants to direct their services, they must have influence over how their vocational dollars are spent. Participants in PEP have joint control over their money and services. They share this control with their rehabilitation team. The project attempts to give participants control and choice by several different methods. These methods have resulted in eighty percent of PEP participants feeling that they were provided choices in their rehabilitation.

*	Participants have the ability to directly choose and contract with providers of their choice for vocational or related services. Participants negotiate for the services they want directly with community providers. Participants are helped by staff and the team to have a clear idea of what they need from a provider prior to the negotiation. PEP also offers participants training on, How To Chose A Service Provider and How To Negotiate. Participants usually attend one of these trainings or work with staff this information prior to hiring a vendor. A participant can choose whether or not to have PEP involved in the actual negotiations. At the end of the negotiation, a contract is written between the participant and the provider. PEP receives a copy of that contract. This contract is written and honored as a contract, but is not a legal document. It is an agreement that delineates each person's responsibilities, how services will be provided, the expected outcome and reimbursement rate.

*	All bills and reports from the provider go directly to the participant. All reports that are written belong to participants. This includes diagnostic, assessment and placement information. PEP pays for services only after receiving authorization from the participant.

*	Each Participant has an account of $3,300 to draw on in order to pay for their rehabilitation needs. Participants have spent more due to their vocational needs but in most cases have spent less. The average cost of a case at closure is $2,500. The participant and his or her team determines how vocational dollars will be spent. Each month every participant receives a monthly accounting from PEP on expenditures. Participants decide when their cases are closed.

INFORMATION

Providing information in a format that makes sense to the individual is critical in implementing a structure that facilitates participant choice. PEP provides information in a variety of formats through each stage of the rehabilitation process. Participants also provide feedback on the effectiveness of PEP's approaches. This information loop allows PEP to provide a structure that facilitates participant-directed services.

Classes

PEP offers its participants a wide menu of informational classes taught by community resource providers, past participants and project staff. A few examples of the topics offered are:

*	Labor Trends, Needed Skills for the Changing Job Market

*	Job Accommodations, Working With A Disability, Employer Panels

*	Negotiating Skills, Self-Advocacy in Employment

*	How To Determine A Good Job Match For Your-self,

*	Interviewing Skills, How to Chose A Service Provider,

*	How To Run A Rehabilitation Team, Setting Goals and Objectives.

*	Peer Support Group

PEP offers peer support groups. These groups allow participants to obtain information and perspective from their peer. An Independent Living Specialist and/or a participant co-facilitates the support groups.

Evaluation

Participants are asked to complete an evaluation form on the usefulness of each training or group they attend. This information allows PEP to add or modify the type of classes they offer. All trainings are voluntary. Participants and their team members complete evaluations after each team meeting. PEP holds focus groups at six month intervals to solicit participant feedback. Participants are asked by PEP to evaluate the services they are receiving every quarter either by phone interview or in writing.

TECHNICAL ASSISTANCE

•	Participant Training Curriculum, Evaluation Materials

•	How to Form and Run a Rehabilitation Team

•	Structuring a Payment Reporting System for Participants

For Additional Information

Contact Person(s):	Abby Cooper	Jeanne Munro

Phone:	206-587-4444	360-438-8010

TTD:	206-587-4439	360-438-8000

FAX:	206-587-4447	360-438-8007

UNITED CEREBRAL PALSY ASSOCIATIONS

UCPA Choice Access Project

Overview

United Cerebral Palsy Associations (UCPA) is one of the seven organizations awarded a grant by the Rehabilitation Services Administration as a part of the Jefferson Amendment to the Rehabilitation Act of 1973, as amended in 1992. The amendment authorized a demonstration to examine ways to increase choice in employment by persons with disabilities. As a result of years of strong advocacy in securing state and federal funding legislation for supported employment and in implementing innovative employment services, UCPA feels that employment vouchers represent the next step to increase choice and in assuring access to jobs for persons with severe disabilities.

The UCPA project is based in three sites across the eastern U.S.: Detroit, New Orleans and Pittsburgh. Each site identifies 15 persons per year for service for a total of 225 participants over the five year demonstration.

Unique Features of the Project

A.	The project's design is based on a lineage of previous successful national employment demonstrations.

UCPA has recognized that in order for persons with severe physical disabilities to become successfully employed, effective and individualized strategies must be available to service providers. We have made a long-term commitment to develop such approaches and we have embedded them in the design of the Choice Access project. This project individualizes employment services by suggesting that participants purchase services which result in:

a.	The development of a descriptive and optimistic narrative profile of an applicant to be used as the basis of planning,

b.	Implementation of an individualized employment planning process which creates a personalized blueprint for job development,

c.	Tailored job development representation which negotiates, carves or creates individualized jobs and entrepreneurial businesses,

d.	An analysis of the job sites developed for applicants, and

e.	Facilitation and assistance of successful job performance using natural supports and quality instruction.

B.	The project targets persons with severe physical disabilities, for whom traditional rehabilitation services have not typically been successful.

The project is focused on the employment needs of persons who experience a life impact of their disability in the areas of communication, manipulation and mobility. This group of persons are traditionally the most under-represented in achieving successful employment outcomes from both vocational rehabilitation and developmental disabilities services. Currently approximately 40% of the participants in the project also experience an intellectual disability, although it is neither a factor which is considered for acceptance or one which excludes persons from participation.

C.	The "qualified provider" requirement of regulation is resolved by offering a qualified process to participants and providers based on a "building code " concept developed from the UCPA Self- Directed Staff Training Curriculum.

The federal regulations require that all choice projects assure that participants select "qualified" providers for service delivery. Rather than requiring certification or licensure to assure qualified providers, UCPA uses a "building code" strategy, which describes the quality components of effective employment assistance. This approach utilizes the UCPA Self-Directed Staff Training Curriculum for Supported Employment, which was developed through a project funded by RSA. General components and indicators of quality employment services are identified in this document which are much the same as the components for house construction used by communities to assure that quality housing results for home buyers. By using a qualified process rather than qualified individuals or agencies, participants have a much broader range of choices for service providers.

D.	Choice Coordinators fulfill a redefined role of traditional rehabilitation counselors and Employment Advisors provide independent advice to participants on a paid retainer basis.

Each project site is managed by a part-time Choice Coordinator (.75 FTE) whose job is to provide outreach and recruitment, to develop a pool of providers and advisors, to liaise with the Local Referral Committee (see below), to assist participants to develop a Futures Plan for Employment and to handle all local project data and financial forms. A UCPA employment staff person is assigned to each site to provide technical assistance and training of providers and advisors.

In order to assure informed choice, the project recommends that participants hire an Employment Advisor on either an outcome or retainer basis to provide perspective in navigating the treacherous human service system. The advisors then assist participants in negotiating with service providers to obtain their employment outcomes. Participants may select from a variety of service providers -- traditional agencies, individual providers, friends, generic services, anyone except a family member who currently lives in the same residence.

A pool of advisors is maintained by each Choice Coordinator to assist participants to identify individuals. Advisors chosen by participants fall into three categories: a) persons with disabilities who know how the system works (about 65%); b) local advocates who wish to assist participants part-time (about 25%); and, c) parents or family members (about 10%).

E.	Acceptance into the project is made by a volunteer citizen committee, comprised of stakeholders, who offer participation based on the severity of life impact of disability rather than on performance. Employability is assumed for all applicants and persons with more significant disabilities are considered first for selection.

Applicants to the project apply through the Choice Coordinator and all names are forwarded to a Local Referral Committee. This committee is comprised of local volunteers who are stakeholders in the employment of persons with severe physical disabilities. Minimally, each committee has a person with a disability, a family member of a person with a disability, a UCP agency representative, a local VR counselor and a local school representative. Additional members may be added to achieve a maximum size of nine members. The LRC is charged with the difficult task of selecting the fifteen participants each year for each site. No tests or evaluations may be used and the committee assumes employability for all applicants. Additionally, the committee has an affirmative action mandate to include persons with the most severe disabilities as well as persons who are minorities.

F.	Each participant receives a targeted amount of funds, which are held in individual accounts, with UCPA acting as a fiscal agent.

Upon selection by the Local Referral Committee, each participant receives $9,466 which is drawn down from the federal government by UCPA and held in individual accounts. These funds are under the sole control of the participant. Payments are made through the use of Requests for Payments initiated by the service provider and approved by the participant.

G.	Each project site is assigned a technical assistance consultant who provides the Choice Coordinator and Local Referral Committee members with support and who provides training to employment advisors and service providers.

Consultants provide a minimum of three, multi-day training and technical assistance visits each year as well as on-going telephone assistance to Choice Coordinators. Training is provided to providers, advisors and local referral committee members as well as to participants and family members on the indicators of quality, individualized employment, on contracting and invoicing for services and payments, on consumer empowerment and responsibilities and on overall project design and outcomes.

Examples of Employment Outcomes Achieved by Project Participants

Employment outcomes of the sixty-five persons who have gotten jobs through the Choice Access project vary with the wishes of each individual and reflect the needs of persons with severe physical disabilities. Since a personalized blueprint is developed for each participant, describing their conditions, preferences and expected contributions, the types of jobs are extremely varied. A few examples of employment, for persons who have a life impact of their disabilities in communication, mobility and manipulation, follow:

Ms. A.R. from Pittsburgh:

Does quality assurance by scanning film products for a film processing company. Before Choice Access, she had a few part-time employment experiences which were not satisfactory to her.

Ms. L.L. from Pittsburg:

Owns her own company which provides a service scanning typed materials into a scanner and computer on a contract basis. She was assisted in this business by a former teacher and friend who provides her with office space. She has plans to diversify her business to include management of services for persons who need independent living supports.

Mr. E.L. from Detroit:

Works for a national automobile rental firm, detailing newly purchased cars prior to rental. Although he has always loved cars, he was never able to afford one. In this job, the company allows him to take a car home and back to work, anytime sufficient cars are available.

Ms C.D. from Detroit:

Works as a child care worker in a day care center. She loves children and always wanted to work in a child care center. However, she lacked the education and skills to meet the state requirements for a certified day care worker. Through negotiation with a local center, her job developer was able to tailor a job which fell outside the arbitrary requirements and yet met the center's needs for assistance to a day care teacher.

Mr. O.M. and Mr. E. M. from New Orleans:

Are two brothers who wished to share a job. They hired a common job developer and a position was found in a local human service agency in which they do data entry using a mouth stick. One brother works the morning hours and the other works during the afternoon. They share a common ½ hour around noon and they also share transportation to and from work in the middle of the day.

Dissemination and Products

The project director, site consultants and choice coordinators actively provide dissemination of project design and findings, on a national basis. Staff have provided extensive dissemination throughout the duration of the project to national conferences and to states and agencies which have requested information. In addition, two states have replicated the project's design -- the Michigan Rehabilitation Services in the Renaissance Project and the Minnesota Governor's Planning Council on Developmental Disabilities in a state demonstration. A sampling of dissemination efforts follows:

TASH (The Association for Persons with Severe Handicaps)	3 national presentations

APSE (The Association for Persons in Supported Employment)	3 national presentations

NAPAS (National Protection and Advocacy)	1 national presentation

UCPA (United Cerebral Palsy Assns.)	2 national presentations

SETNET (a VCU video presentation)	1 national presentation

Numerous state and regional presentations

Products

1.	Choice Project Participant's Manual

This manual is given to all project participants. It contains information on participant responsibilities, opportunities and contract forms.

2.	Choice Project Form Set

These materials are given to all providers and advisors. The booklet contains voucher forms, request for payment forms and other project documents.

3.	UCPA's Choice Access Proposal

This proposal is offered to sites wishing to duplicate the Choice access model.

4.	UCPA's Self-Directed Staff Training Curriculum

This curriculum is the basis for the "building code" approach to ensuring quality services.

5.	SETNET Video Tape on the Choice Access Project

This tape was produced as a result of a national presentation.

6.	Project Renaissance Video Tape and Proposal

These materials were generated by the Michigan Rehabilitation Services and UCP of Detroit as a part of their ongoing replication of the Choice Access project.

Project Findings

Persons currently served	169

Jobs developed	65

Avg. hours worked/week	18

Avg. hourly wage	$5.95/hr

Range of hours worked	6 - 40

SSI recipients	83%

SSDI recipients	14%

Males	52%

Females	48%

White	60%

African-American	40%

Average age	32 years

Range of ages	16 - 60 years

How to contact us:

Michael Callahan, Project Director	Michael Morris, Executive Director

UCPA Choice Access Project	United Cerebral Palsy Assns.

4101 Gautier - Vancleave Rd. #102	1760 "L" Street, NW, Suite 700

Gautier, MS 39553	Washington, DC 20036

(601) 497-6999	800-872-5827

(601) 497-6966 Fax	202-776-0414

MiCallahan@AOL.com