Case Management

Overview

Program/Practice Name: County of Los Angeles Community Assessment Service Center (CASC)

Agency Name: County of Los Angeles, Department of Public Health, Substance Abuse Prevention and Control, Adult Treatment and Recovery Services Division

Contact Information: Linda G. Dyer Health Analyst Adult Treatment and Recovery Services Division Substance Abuse Prevention and Control 1000 S. Fremont Avenue, Bldg. A-9 East, 3rd Floor Alhambra, CA 91803 Phone: (626) 299-4109 Fax: (626) 458-6823 ldyer@ph.lacounty.gov

Type of Program/Practice: CASC serves as an entry point for any Los Angeles County citizen seeking alcohol and other drug treatment and recovery services. CASC connects CalWorks1 clients identified with mental health, substance abuse, and similar issues with treatment, and coordinates other specialized supportive service referrals for clients with Greater Avenues of Independence (GAIN), the initial program point of contact for TANF in the Department of Public Social Service (DPSS).

1 CalWorks is the name used for California programs that include Temporary Assistance for Needy Families (TANF) Welfare to Work programs.

Description

Program/Practice Description: The CASC system is composed of eight contracted community-based organizations located throughout Los Angeles County's eight Service Planning Areas. Twenty service center sites are located throughout Los Angeles County. Some sites are co-located in behavioral health treatment centers and others are free-standing community sites where services are coordinated with the local DPSS GAIN office.

CASC works closely with a network of contracted alcohol and other drug treatment agencies, mental health providers, domestic violence agencies, and other community-based organizations providing substance abuse assessments, information, and referrals to a wide variety of supportive services. CASC ancillary referrals include job development, literacy training, and temporary housing, as well as referrals to food banks, health care, and other needed services.

Background/Program History: CASC began in 1997 prior to the inception of CalWorks (1998). The program was designed by a steering committee composed of DPSS representatives, county-based treatment providers, and advocates. GAIN service workers now also participate on the steering committee. The steering committee continues to be actively involved in the program by meeting quarterly to revise CASC program policies and procedures.

Innovations and Results: CASC serves as the liaison between the GAIN (TANF) client and provider. CASC workers must be able to determine if the provider is licensed and assess the quality of the care provided. A well-trained CASC worker also must be able to create a confidential setting for clients, correctly identify the client's service needs, and connect the client to appropriate mental health or substance abuse services. CASC clients can receive a referral to treatment at their initial intake/assessment before leaving the CASC office, thus "catching" the client at the point of highest motivation for change. CASC staff are trained in motivational interviewing techniques.

Operations: CASC is intended to operate on a large scale, specifically within the context of a large county or State-based social services system. To be implemented successfully, a network of treatment providers (substance abuse, mental health) must be available, licensed and/or certified, and able to comply with the requirements of the CASC model. These providers and their office staff should be culturally and linguistically competent.

Funding: Resources for the program are provided directly from State CalWorks allocations.

Staffing: CASC offices operate in two distinct types of settings: within a behavioral health treatment center, where clients receive both CASC assessments, treatment, and support services; or in an independent community-based site where both assessments are performed and treatment and services are coordinated between the treatment provider and the DPSS GAIN office. In addition to the CASC program director, there are four key staff positions: CASC advocate, CASC assessor, peer advocate, and community specialist.

Additional Information: To ensure standardization and continuity of diagnoses, CASC staff are trained to use the Addiction Severity Index (ASI). CASC employs a database tracking system, which can track clients across the county system and, through a review process, verify client engagement in treatment and match clients to the most appropriate treatment available.

Implementation

Tips to Implementation:The CASC model provides flexibility in a large social service agency setting to address client needs as well as the program implementation needs of a large county-based system. The balance between systems needs and individual client needs is at the heart of this program. Implementation of new program services is facilitated through this model.

Keys to Success: CASC attributes its success to several mechanisms:

• Developing strong relationships of trust among CASC, DPSS, and community providers through cross-agency and provider training.
• Standardization/continuity in diagnosis and treatment through the use of ASI. All CASC staff are certified in using ASI through training provided by the University of California, Los Angeles, which ensures consistency in the application of services across all CASC sites.
• Centralized reporting of aggregate data, providing the capacity to make data-driven decisions and inform program and policy.
• Transparency of the CASC/GAIN system to the client.

Successes: CASC benefits from significant administrative support from DPSS and GAIN staff and community-based providers, thus ensuring clients are able to successfully engage in treatment and fully benefit from the program's employment supports.

Challenges: Challenges include dealing with staff turnover, principally at the DPSS GAIN office, which results in additional need for training, and distributing treatment services equitably across community providers.

Tools

The following tools are associated with County of Los Angeles Community Assessment Service Center. Please send us an email at upitoolkit@blhtech.com for more information about these tools.

Administrative Resources

Includes CalWorks Supportive Services flow chart, job descriptions for key CASC positions, prototypes, new application orientation talking points, sample presentation schedules, and policies/procedures for implementing this type of program

Assessment tool used by CASC staff

Assessment tool used by CASC staff

Overview

Program/Practice Name: Learning Needs Screening Tool, Northwest Center for the Advancement of Learning, Payne & Associates, Inc.

Contact Information: Nancie Payne, Ph.D. Payne & Associates, Inc. 205 Lilly Road NE Building B, Suite A Olympia, WA 98506 Phone: (360) 491-7600 Nancie@payneandassociates.com

Type of Program/Practice: A small, woman-owned business, Payne & Associates, Inc. provides cutting-edge, practical services designed to maximize human potential and create productive environments for individuals with non-apparent disabilities.

Description

Program/Practice Description: Payne & Associates, Inc. provides services to a wide variety of customers and clients, including private businesses; Federal and State government programs; vocational rehabilitation; workforce programs, including welfare-to-work, corrections, and social and human services; and secondary and postsecondary education institutions. The company specializes in research-based methods and services for those who employ and/or provide services to individuals who have learning disabilities, attention deficit hyperactivity disorders, head injuries/trauma, seizure disorders, mental and emotional health disorders, and related cognitive disorders. The diverse customer base requires a sophisticated level of knowledge about employment and management policies, procedures, practices, and industry standards, as well as attentiveness to the specific requests and needs of the customer. For nearly two decades, Payne & Associates, Inc. has provided organizational development, project management, staff development, human resources assistance, consultation, and technical assistance services internationally to many repeat customers in the business, government, service, and education communities. All services are designed specifically for the customer.

Background/Program History: Payne & Associates, Inc. and the Northwest Center for the Advancement of Learning were established in direct response to the significant lack of practical and applicable services within communities that were attempting to address the needs of those adolescents and adults who have learning disabilities and related cognitive disorders. Nancie Payne has a 30-year history of providing direct services to individuals and families who have learning and other cognitive disabilities and are in poverty, come from diverse backgrounds, are under-educated, and are underemployed or unemployed. She has spoken to hundreds of people in 38 States, Puerto Rico, and Canada on subjects addressing learning disabilities, diversity, and poverty and is an international leader in the field of learning disabilities. She has written a number of publications addressing special learning needs, assessment, instruction, accommodations, transition, and work success. Among her numerous publications are chapters entitled "Job Accommodations: What Works and Why" in Learning Disabilities and Employment (Gerber and Brown), and "The Rationale, Components, and Usefulness of Informal Assessment" inBridging the Gap in Adult Education and Literacy Programs (Vogel and Reder). She also was featured as one of 13 adults who have learning disabilities and attention deficit hyperactivity disorder in Arlyn Roffman's book, Meeting the Challenge of Learning Disabilities in Adulthood, in which she shares portions of her personal journey during childhood and adulthood. Her most recent publication is "Adults Who Have Learning Disabilities: Transition from GED to Postsecondary Activities," from 2010.

Innovations and Results: As an Accredited Rehabilitation Service and certified Community Rehabilitation Program, the center is a model full-service operation providing direct services to clients who have cognitive disabilities. The center provides services to approximately 75 to 100 clients annually; service hours range from a few hours to 25 or 30 hours over a period of 1 to 4 months. Each person is treated first as an individual and as such has strengths and can set goals for success. Providing direct services through the center affords a deep base of authentic experience that the majority of consultants and trainers in the field do not possess. Direct services are provided to adolescents, adults, and their families and include:

• Learning disability and cognitive assessment and evaluation
• Vocational assessment
• Counseling, coaching, and support groups
• Employment assistance and support
• Self-employment exploration and development
• Skills assessment, instruction, and tutoring
• Assistive technology and computer skills development

Dr. Payne is the developer and publisher of six versions of the Payne Learning Needs Inventory, which was the instrument used in the research with welfare participants to develop the Learning Needs Screening Tool (validated screening tool used by many States and programs nationwide). Additionally, using a customer-centered approach, she has designed and implemented three models for comprehensive service delivery: intensive interviewing, transition, and training/work accommodations. Payne & Associates, Inc. has a clear vision of improved customer services through research-proven approaches.

Referrals for direct services include Vocational Rehabilitation, Veterans Administration, the Intertribal Agency, Justice, schools, and private organizations/community residents. In ongoing surveys and feedback processes, 90 percent of clients surveyed rated services at above average or excellent and 86 percent reported that their goal was achieved through the services provided.

Implementation

Tips to Implementation: It is important to understand the purpose of screening and diagnosis and to follow through with the critical services and supports that make a difference. The challenge of today's "fix-it" mentality is that while hidden, learning disabilities and many related or co-accompanying disorders are lifelong conditions. They do not go away after discovery or diagnosis. The belief is that if an individual is diagnosed with and informed about a learning disability, it will change and all will be well. However, progress does not occur without a true understanding of self and well developed self-determination skills, which take support and time to develop.

The more the field learns about disability and diversity, the more we see incongruence. While learning disabilities are not isolated to one culture or ethnic group, the meaning and acceptance of the term disability is not consistently embraced. Western culture suggests an operational flow of identification of the weakness or what is wrong together with a plan to correct or remove it. Many cultures and ethnicities uphold the strengths-based model, focusing on the attributes of the individual while minimizing weaknesses. This aspect of diversity is not well understood or addressed within systems.

In the whole of learning disabilities and identification the questions are: What are we striving for? What do we want? There are numerous concerns that must be addressed, including diversity values, alternative testing methods for those whose primary language is not English, transition planning and career development for adults, self-determination development, and accommodations.

The majority of people diagnosed with a learning disability have co-accompanying disorders that also are not addressed. Research has shown that learning disabilities are genetic. Thus, a welfare recipient may have children who also have learning disabilities. The model of service must employ a whole person-whole family approach.

Keys to Success:

• Go beyond talk to taking action.
• Employ a learner-centered approach, always leveraging an individual's strengths, styles, and abilities.
• Have high expectations; people tend to live up to the expectations of someone they respect.
• Adopt an attitude of honoring learners with true acceptance and understanding.
• Recognize that more upfront time and energy in the service delivery model will lead to success at the end with less total time spent.

Tools

The following tools are associated with Learning Needs Screening Tool. Please send us an email at upitoolkit@blhtech.com for more information about these tools.

Job Analysis & Cognitive Mapping

Reference Guide

Learning Disabilities, Attention Deficit/Hyperactivity Disorder & Co-Existing Disorders

Learning Needs Screening Overview

Learning Needs Screening Tool

Learning Needs Screening Tool Student/Client Copy

Overview

Program/Practice Name: North Carolina Work First/Child Protective Services (CPS) Substance Abuse Initiative

Contact Information:

Starleen Scott Robbins North Carolina Department of Health and Human Services Division of Mental Health, Developmental Disabilities and Substance Abuse Services 3005 Mail Service Center Raleigh, NC 27699-3005 Phone: (919) 715-2774 starleen.scott-robbins@dhhs.nc.gov

Kea Alexander North Carolina Department of Health and Human Services Division of Social Services 325 N. Salisbury Street MSC 2408 Raleigh, NC 27699-2408 Phone: (919) 334-1073 kea.alexander@dhhs.nc.gov

Type of Program/Practice: A joint initiative of North Carolina's Division of Social Services (DSS) and the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS), the Work First/CPS Substance Abuse Initiative provides appropriate assessment, treatment referral, and care coordination for Work First (TANF) recipients and eligible Food and Nutrition Services (FNS) recipients.

Description

Program/Practice Description: The goal of the Work First/CPS Substance Abuse Initiative is to provide early identification and connection to treatment of Work First recipients and eligible Food and Nutrition Services recipients who have substance abuse problems severe enough to affect their ability to become self-sufficient. The program also assists parents who have substance abuse problems and who are involved with CPS engage in appropriate treatment. Each county's department of social services has access to a Qualified Professional in Substance Abuse (QPSA), contracted by the Local Management Entity (LME). Generally, QPSAs are located in local county departments of social services and are easily accessible to families and social services staff. All Work First applicants are screened using a standardized verbal screening tool for risk of substance abuse. If the verbal screening tool results are negative, an additional tool, the 'Substance Abuse Behavioral Indicator Checklist II', based on observation, may be utilized. With any of the screening tools, if there are indicators of substance abuse, a referral is made to the QPSA, who completes an assessment. FNS applicants with a Class H or I Controlled Substance Felony meeting eligibility criteria are automatically referred by FNS to the QPSA for an assessment. Based on the assessment, if treatment is indicated a referral is made and the QPSA coordinates the individual's progress through treatment. Working together, the QPSA and DSS develop a plan for the individual to ensure success and self-sufficiency.

Background/Program History: In 1997, the North Carolina General Assembly passed N.C. G.S. 108A-29.1, which prescribed, "Any applicant or current recipient who is determined to be addicted to alcohol or drugs, and in need of substance abuse treatment, to participate in treatment in order to receive Work First benefits " and N.C. G.S 108A-25.2, which stated, "The law requires individuals convicted of Class H or I controlled substance felony offenses are eligible to participate in the Work First and food stamp program." As a result of State legislation, a memo of agreement (MOA) was executed between DSS and DMH/DD/SAS. Responding to concerns from the local departments of social services, the initiative was expanded to Mental Health Services in 2001 with voluntary mental health screenings now part of the initiative. As a result of Child Welfare Cases in 2001, the initiative also was expanded to include child protective services and child welfare.

Innovations and Results: Recognizing that substance abuse and mental health issues are key barriers to employment and self-sufficiency for many Work First and Food and Nutrition Services applicants and participants, North Carolina created the Work First/CPS Substance Abuse Initiative, an interagency effort between DSS and DMH/DD/SAS at the state and local level. The QPSA role is unique as both an accessible substance abuse assessor often offering same day assessments to consumers, and as a knowledgeable consultant for DSS staff. In SFY 2010 a total of 14,080 individuals were assessed statewide through this Initiative, with 2,577 entering treatment.

Operations: Under an MOA between DSS and DMH/DD/SAS:

• Joint responsibilities of DMH/DD/SAS and DSS

  • Develop and provide training for county DSS and LME/provider regarding Work First, FNS, and Substance Abuse.
  • Provide technical assistance to county DSS and LMEs/providers regarding Work First, FNS and Substance Abuse program development.

• DMH/DD/SAS

  • Provide funding to LMEs to assist with hiring QPSAs, and fund non–Medicaid reimbursable expenditures, i.e., costs of tools.
  • Develop consent for release of information in accordance with 42 CFR Part 2: Confidentiality of Alcohol and Drug Patient Records and HIPPA.

• DSS

  • Develop policies and procedures for county DSS to follow in implementing and administering the Work First and Food and Nutrition Services substance abuse requirements.
  • Distribute standardized consent for release.

Each LME establishes a local MOA between county DSS and LME and/or QPSA provider, which is reviewed annually. All Work First adult applicants/recipients are screened for possible substance abuse problems. Currently there is voluntary screening for mental health issues in place. All eligible FNS applicants with a Class H or I Controlled Substance Felony are referred to the QPSA for a substance abuse assessment. The number of QPSAs varies for each LME; there can be one to four QPSAs per LME based on the size of their Work First population and catchment area.

The local MOA will identify who will conduct the screening (QPSA or DSS staff). In general, the DSS conducts the screening and the QPSA provides diagnostic interviews, ensures random toxicology screens are administered as a part of treatment, provides case consultation with DSS staff, provides orientation to the Work First/Substance Abuse Initiative for Work First clients, collects data, provides training for DSS staff, provides care coordination including client advocacy and referral for treatment, assists with transportation and child care, tracks provision of services, follows up with treatment providers, reports to county DSS, and acts as liaison between the LME, treatment providers, and county DSS.

Funding: The initiative was originally funded by discretionary Temporary Assistance for Needy Families funds. However, as of 2002, it is funded by Substance Abuse and Mental Health Services Administration Substance Abuse Prevention and Treatment Block Grant funds, which are allocated to LMEs. The Initiative funds about $40,000 to $160,000 for QPSA salaries.

Staffing: QPs need to be:

• Licensed clinical addictions specialist;
• Certified clinical supervisor;
• Certified substance abuse counselor;
• M.A. in human services plus 1 year substance abuse supervised experience;
• B.A. in human services plus 2 years of substance abuse supervised experience; or
• B.A. in non-human services plus 4 years substance abuse supervised experience.

Implementation

Tips to Implementation: Through the years of implementing the Work First/CPS Substance Abuse Initiative, the North Carolina Department of Health and Human Services has learned that the initiative is always evolving and requires ongoing revisions of policy across the child welfare, substance abuse/mental health, and Work First systems. A consistent message must be conveyed from all parties (DSS, DMH/DD/SAS, LMEs, and QPSAs).

Keys to Success:

• More successful when the QPSA is out-stationed in DSS; easier to provide follow through, be accessible to applicants, create collaborative relationships with DSS, and solve transportation issues.
• Need for confidential space within sites for QPSAs and other treatment providers to serve clients.
• Practical and efficient screening tools, particularly the Substance Abuse Behavioral Indicator Checklist.
• Need to provide accessible and appropriate treatment services.
• Ongoing monitoring needed through reviews of MOAs, performance agreement, and audit.
• Need to provide ongoing support and staff training for QPSAs and DSS staff.

Tools

The following tools are associated with North Carolina Work First/Child Protective Services Substance Abuse Initiative. Please send us an email at upitoolkit@blhtech.com for more information about these tools.

Memorandum of Agreement

Overview

Program/Practice Name:Rapid Employment Attachment Program (REAP)

Agency Name: The Women's Center of Tarrant County and Tarrant County Workforce Development Board (TCWDB), d.b.a. Workforce Solutions for Tarrant County under the auspices of the Texas Workforce Commission

Contact Information:

Kris Kizer Kris.kizer@workforcesolutions.net

Brenda Harrist Brenda.harrist@workforcesolutions.net

Type of Program/Practice: REAP assists Temporary Assistance for Needy Families (TANF) clients who have had 1 month of work participation noncompliance achieve month 2 compliance and avoid the loss of TANF benefits through job search and job readiness training. The program also assists TANF applicants who have received a full-family sanction to demonstrate cooperation in order to regain their benefits.

Description

Program/Practice Description:In Texas, sanctions for noncompliance with work requirements are imposed swiftly and frequently. As of October 2003, the penalty for failure to participate in Choices (the State's TANF work program) is full-family sanction. Full-family sanctions include the loss of all TANF cash assistance and the adult's Medicaid benefits. To reinstate benefits, participants must show 30 days of compliance. Two consecutive months of noncompliance results in the denial of the TANF case and the recipient must reapply for benefits. Recipients are referred to participate in REAP following 1 month of noncompliance. REAP is a 1-month program designed to assist the recipient in demonstrating 30 days of compliance and avoiding the loss of TANF benefits.

Background/Program History: REAP evolved from an Innovative Initiatives RFP issued by TCWDB. The Women's Center has a long history of working with welfare mothers (though this program serves both women and men).

Innovations and Results: REAP was designed to avoid 2 consecutive months of noncompliance with work participation rates that would result in the loss of TANF benefits. REAP is located at all Texas Workforce Commission One-Stop Centers in Tarrant County. A key innovation of this program is the open entry and exit format. Each day of the 30-day program is designed as an individual lesson, allowing noncompliant recipients to enter the program immediately. Immediate program entry enables a TANF recipient to demonstrate 30 days of compliance and prevent the loss of their TANF benefits. TANF recipients that cycle back through the program receive intensive case management.

Operations: The REAP class is operated 4 hours a day, Monday through Friday from 8:30 a.m. to 12:30 p.m. The REAP curriculum covers non-core work activities and job search to achieve 30 hours per week compliance in month 2. The curriculum covers job readiness, business culture training (e.g., appropriate workplace actions, customs, and clothing), interview skills, resume assistance, conflict resolution skills, and budgeting modules. The Women's Center runs REAP as a community-based organization contractor to TCWDB. As a community-based organization, the Women's Center implements TCWDB policies and reports program results to the TCWDB program liaison.

Implementation

Tips to Implementation: A program such as this needs coordination among the Texas Workforce Commission, the Health and Human Services Commission, and community-based organizations to succeed. Face-to-face meetings between contractors and the two State agencies have helped resolve coordination issues in an effective and timely manner. Curriculum design that allows immediate client service and location of the program within the One-Stop system also have increased the program's ability to serve the TANF populations facing sanctions.

Keys to Success:

• Coordination and communication among the Texas Workforce Commission, the Health and Human Services Commission, and community contractors.
• Co-location of REAP within the One-Stop Center; some locations also have TANF eligibility offices located on the same campus.
• Open entry and exit curriculum design of REAP allows the program to serve clients immediately, before they risk losing TANF benefits.

Challenges: The Texas Workforce Commission electronic case management system, The Workforce Information System of Texas (TWIST), was not accessible to all community-based organizations. A new data entry and reporting system had to be developed for community-based organizations. Also, developing paths for people who may appear in REAP more than once was a challenge. REAP now provides those individuals with intensive case management and often offers them mentoring roles for new applicants. Serving as mentors generates a high level of commitment in the original participant.

Tools

"There are no tools associated with this program."

Overview

Agency Name: Stinson & Associates, Inc.

Contact Information: Dr. Jayne Roberts-Stinson President/CEO 189-B Sams Street Decatur, GA 30030

Phone: (404) 209-0665 Fax: (404) 209-0627 jstinson@stinsonassociates.com www.stinsonassociates.com

Type of Program/Practice: Non-attorney representatives that specialize in helping Fulton County TANF recipients with disabilities become work ready or apply for and obtain Social Security benefits.

Description

Program/Practice Description: Stinson & Associates is a small company that offers a variety of services to TANF recipients with disability claims. The ultimate goal is to help people accept their limitations while realizing their capabilities so hard-to-serve TANF customers can participate in meaningful work. This is accomplished by removing major barriers to work and assisting clients with community-based work experiences, job applications, interviews, and searches. Concurrently, for clients with permanent disabilities, Stinson acts as an advocate to help these customers obtain Social Security benefits.

Innovations and Results: The approach is a 24/7 holistic practice. Beyond the traditional activities of job preparation and job searches, Stinson offers an array of services, including assessment, clothing and food assistance, cash assistance in emergencies, and life skills advocacy. A unique practice employed by Stinson involves close collaboration with the Fulton County Division of Family and Children Services. When Stinson begins an intervention, primarily in the case of medically delayed customers, all needs of the customer are addressed. Family members, case managers, and other peopled involved with a customer participate in a meeting, referred to as a staffing, to create buy-in and provide wraparound support for the individual. A staffing takes place once a month for each client, but a special meeting will be called in the event that a client fails to participate properly in the program. The program reports its success is reflected in the resulting increase in the work participation rates in Fulton County.

Operations: The program can enroll up to 20 people per month and the clients are primarily African-American women. Client disabilities include a mix of hindrances to work, from arthritis to worker compensation cases. Stinson reports that about 10 percent of these clients actually have a permanent disability; the others have a temporary disability or a mental health concern. Stinson identifies the extent of the disability, whether the condition is permanent, where the individual will best fit into employment, and whether a different program would better help the client attain employment. If an individual may be eligible for Social Security, Stinson acts as an advocate, unless the person is already working with a lawyer. After a client obtains a job, Stinson continues to support that client for up to one year.

Implementation

Tips to Implementation: For agencies interested in implementing a similar program, Stinson emphasizes that they should choose contractors and professionals carefully to guarantee the providers are effective. They should make sure the organization's resources, style, and staff are well suited to the clientele they intend to serve.

Keys to Success:

• Stinson offers that one key to success is maintaining an open relationship with partners and keeping in constant communication with Division of Family and Children Services offices, which implement supports and penalties as necessary. Stinson emphasizes that having community resource specialists from the county office visit the program regularly helps provide wraparound support for the client and facilitates communication between the two offices.
• Stinson suggests that organizations must make an accurate determination of what disabled clients can and will do. Clients must assess themselves as well before the organization can develop a practical plan to help that client achieve the next step.

Tools

The following tools are associated with Stinson & Associates, Inc. Please send us an email at upitoolkit@blhtech.com for more information about these tools.

Assessments

Stinson & Associates Mission Statement

Participants Manual

Medical Statement

Participants Manual: Making a Difference

Social Security Disability Advocacy Program Assessment

Overview

Program/Practice Name:The New Hope Project

Agency Name: YWCA of Southeast Wisconsin

Contact Information: 1915 N. Dr. Martin Luther King Drive Milwaukee, WI 53212 Phone: (414) 374-1800 communication@ywcasew.org http://www.ywcasew.org/site/c.7oJELQPwFhJWG/b.8083533/k.BDB7/Home.htm

Type of Program/Practice: The New Hope Project provides transitional jobs and support to non–custodial parents.

Description

Program/Practice Description: The New Hope Project began as a demonstration grant in 1994, testing whether a program offering assistance in finding a job, subsidized health and child care, community service jobs when needed, and an earnings supplement could help low–income families enter the workforce and leave poverty. The project showed promising results and in 2003, New Hope began the Supporting Families program, a modification of the original demonstration. Since 2005, New Hope's Supporting Families program has enrolled 300 participants, with 161 obtaining unsubsidized employment. In 2006, New Hope joined a new grant–funded demonstration project focused on easing the transition from prison to work.

In November of 2009, the New Hope Project was acquired by the YWCA of Greater Milwaukee, bringing New Hope Project's staff expertise in subsidized employment and working with re–entry populations to the YWCA's workforce offerings in TANF, Workforce Investment Act and FoodShare Employment and Training programs.

Most recently, the YWCA's New Hope Project was awarded a Department of Labor Enhanced Transitional Jobs Program in the amount of $5.7M. This four year grant opportunity will require the YWCA/NHP to recruit 1,000 non–custodial parents for a random assignment evaluation of transitional employment. 500 participants will be enrolled in the Supporting Families Through Work program to receive subsidized employment, child support remediation assistance, access to training and an earnings supplement once unsubsidized employment has been obtained.

Innovations and Results: Since January 2007, New Hope has provided participants with guaranteed access to employment through time–limited subsidized jobs. Clients are immediately matched to a transitional job based upon their skills, interests, and job availability. The transitional jobs are in local businesses, including construction, manufacturing, auto repair, and baking. The project covers the employee's wages for up to 4 months. In return, employers are required to provide real work and supervision for participants to build their work history and experience. Clients are required to complete weekly timesheets that are signed by their supervisors and forwarded to New Hope for payment.

Participants also receive financial incentives. They are paid a minimum wage for up to 30 hours of work, with no benefits. Additionally, they may receive assistance with transportation costs and purchasing work clothes or equipment. New Hope understands that work is necessary, but not always sufficient, to help individuals get out of poverty, and therefore tries to structure financial and non–financial supports to improve retention and help with advancement. Case managers help clients find employment following the transitional job, including delivering job search assistance and practice interviews. A job developer works with area employers to locate potential opportunities.

Implementation

Keys to Success:

• Developing relationships with area businesses is vital. By highlighting the "free labor" aspect, using letters of support from other employers, and working through community networks, New Hope has a substantial list of potential transitional employers.
• Individual attention is key to New Hope's model. While New Hope offers workshops on job search and advancement, much of the coaching is done one on one, allowing staff members to get to know individuals better, understand their willingness and availability to follow through, and help identify which kinds of help or resources will be most useful.
• Most participants need to improve both their "hard" and "soft" skills. It is not uncommon for participants to lose jobs, so staff must be prepared for that. Helping individuals recognize what is in their control, and what they could do differently, is part of the work and takes a long time. Most participants need to upgrade skills through school or training, but many times they do not have sufficient basic skills in math or reading to qualify to enter training. Finding ways to keep in touch over time is key to helping individuals connect with training when they are motivated to make that move.

Tools

"There are no tools associated with this program."

Overview

Program/Practice Name: VR Reach-Up Program

Agency Name: Vermont Division of Vocational Rehabilitation

Contact Information:

Karen Blake-Orne VR Reach-Up Vocational Rehabilitation 63 Professional Drive Morrisville, VT 05661-9724 (802) 888-1312 Karen.Blake-Orne@ahs.state.vt.us

Type of Program/Practice: VR Reach-Up is a special program that provides vocational counseling, case management, support services, and job search/placement assistance to all TANF participants in Vermont who possess a significant disability-related barrier to employment.

Description

Program/Practice Description: Since 2001, Vocational Rehabilitation (VR) Vermont has worked with the Department for Children and Families (DCF) to help Temporary Assistance for Needy Families (TANF)1 recipients who have been identified as having a disability that is a barrier to employment. These recipients are referred by DCF to VR for services. They are provided with a specialized VR counselor who also serves as the TANF Reach-Up case manager. This means a single counselor provides all services, thus blending the resources of both VR and DCF to provide vocational services and case management.

VR Reach-Up clients are parents who are experiencing a disability that affects their ability to obtain or keep a job. Disabilities, often trauma based, include depression, posttraumatic stress disorder, anxiety disorders, substance abuse, bipolar disorder, and other personality disorders. The current program is the result of multiple years of learning about ways to assist TANF recipients stabilize their lives and obtain meaningful employment.

Innovations and Results: There have been two initiatives in the last two years that have significantly altered the way the VR Reach-Up program is administered. The Teaming initiative was introduced by the DCF Reach-Up Director as a way to provide services to families in a way that appeared seamless for customers and made the best use of an integrate team comprised of five partners including VR. The Creative Workforce Solutions (CWS) initiative was introduced by the VR Director as a vehicle to provide coordinated and collaborative employer outreach across the agency which builds on the Dual Customer approach. The Dual Customers are those seeking employment and the potential employer. In order to assist people who are faced with significant challenges in obtaining employment, both employers and job seekers need to be provided support. The VR Reach-Up program is now more integrated into the overall DCF Reach-Up team at local and statewide levels. The services to DCF customers through the VR Reach-Up grant have increased as a result of Teaming in combination with CWS. The model for progressive employment supported through the CWS initiative is also a good match for the VR Reach-Up program as it allows participants to engage in short, time-limited activities that relate to employment and gradually build and increase over a short period of time to result in competitive employment. Trial work experiences that are time-limited and well organized have resulted in employers who previously stated they had no openings offering employment to a person who has been made visible to them through a work experience.

Individual-level innovations. VR Reach-Up focuses on three concepts that underlie the supported employment model: treatment addressing the identified disability, individualized support, and tailored employment experiences. VR has a wealth of resources that can be provided, including a job developer, job coach, home visits, and various assistive technologies. This results in stability and increased likelihood that VR Reach-Up customers maintain stable employment.

Systems-level innovation. VR Reach-Up uses cross-agency integration to reduce boundaries and facilitate partnering and relationship building with DCF Reach-Up staff. This includes cross-agency training and full participation in the Reach-Up Teaming Initiative as well as the Creative Workforce Solutions initiative which contribute to improved communication and collaboration around staff and customers.

New model. VR Reach-Up is in a developmental phase as the program adjusts to the many changes brought by the Teaming and CWS initiatives. Staff no longer have capped caseloads and exist in their own silo connected only by the referrals they receive. VR Reach-Up Counselors are now expected to participate in multiple levels of the DCF Reach-Up process based on local teaming plans facilitated by the DCF local leadership and a statewide partnership. Depending on the expertise of the counselors, they may offer additional assessments and consultation to other team members who are also serving customers with disabilities. This assists the teams in serving customers with disabilities more adequately as the number who potentially qualify for VR services exceed the VR capacity that exists for the program. Designated employment staff still work directly with VR Reach-Up Counselors customers to facilitate work experiences and training, but are now part of a CWS Employment Team which provides them with additional support in the employment realm by increasing business contacts and relationships that benefit all staff and programs.

Operations: Reach-Up Teams follow a structure of Orientation, Assessment, Assignment, and services through sub-teams, one of which is the VR Team. This VR Team includes the VR Reach-Up Counselor and often 1-2 additional DCF Reach-Up Case Managers. This structure allows customers with disabilities to be flagged early on in the initial assessment process and potentially assigned directly to the VR Team for more assessment and service. Other customers who are initially assigned to the Resource or Employment Teams for service may also be referred to the VR Team when a disability issue comes to the surface. This is done by bringing the case back to the Assignment meeting/Team with medical evidence or anecdotal evidence of the need for assessment or service by the VR Team. When possible, meetings are held to transition the customer from the referring team to the staff on the VR Team. The VR Reach-Up Counselor may take the case based on the extent of the disabling condition, their caseload size, or may not take the case but will be available to the DCF Reach-Up Case Managers for consultation and support. Additionally when a customer transitions from one of the case managers on the VR Team to the VR Reach-Up Counselor, a "hand-off meeting" is held whenever possible with the VR Counselor, the customer, and the Case Manager.

Funding: The DCF Economic Services Division provides $1.7 million per year to VR to provide vocational rehabilitation services to individuals on TANF who have a disability. VR contributes additional funding to support disability-related services. Additional funds from Economic Services Division  to VR for employment services and social security disability application assistance bring this grant to a total of $4 million per year.

Staffing: VR Reach-Up has 10.5 full-time employees working in VR and additional employment training specialists. VR Reach-Up staff can provide mental health/substance abuse referrals plus vocational services. Because the VR Reach-Up counselor is the TANF case manager for their customers with disabilities, counselors have a complete understanding of both the Reach-Up program and VR in its entirety.

Additional Information: Progressive employment, as an approach to obtaining competitive employment through progressive steps, has been very successful for those contemplating employment. The participants who do not believe they can obtain employment may do well with exploring interests, going on informational interviews, attending a company tour, engaging in a one-day job shadow, and then taking part in a part-time placement with an employer. VR Reach-Up offers intensive support to employers and Reach-Up participants during trial work experience. As part of the CWS collaborative, VR Reach-Up employment staff assures employers that they are under no obligation as a result of a work placement, and the employment staff engages in regular monitoring with the employer to ensure a positive work experience for both the VR Reach-Up customer and the employer. The employment staff offer support to employers in cases when participants do not follow through in order to maintain the relationship with the employer for a future placement. Participants are encouraged to follow through with their placements by receiving a small monetary training off-set that defrays the cost of being at work. This incentive has prompted individuals to follow through with their placements and the employer has then offered them competitive employment.

1 Reach-Up is the TANF program in Vermont.

Implementation

Tips to Implementation: VR Reach-Up follows a supported employment model which has its origins in working with developmentally disabled populations. The VR agency is a customer-focused organization using data-driven decision-making. VR Reach-Up employment staff operate with the freedom and flexibility to provide a wide range of resources to their Reach-Up clients. Modification of the work requirement (for TANF clients) is a central concept to the VR approach. Instead of the perception that TANF participants are being deferred (stopping the clock and thus relieving individual responsibility for complying with the TANF timeline for employment), VR Reach-Up describes its process as a modification and/or gradual increase in work participation. The concept of modification has implications for participants (they are still responsible) and for VR Reach-Up staff (they are always looking for a person's highest level of ability versus their disability).

From a more macro standpoint, partnering in a collaborative way with DCF Economic Services Division and other partners both at the State and local levels is valuable and requires effort. The complexity of the Teaming initiative and the CWS initiative have required all of the partners to work toward creation of a shared mission where the greater good of the partnership takes precedence over individual’s holding tightly to their individual program stance. The resulting leadership structure is that of a matrix wherein there exist direct supervisors, local supervisors, and programmatic supervisors. Negotiating these roles and boundaries takes time and development of trust. Shared projects have helped this trust grow to support the matrix model of leadership. While one of the most complex types of management, matrix leadership has the potential to offer the richest and most productive collaboration between multiple partners. Leadership training is essential to ensure all partners can increase their ability to give and receive feedback as well as create agreements that support healthy boundaries for partners and their staff.

Keys to Success: In addition, the success of VR Reach-Up can be attributed to several other factors. VR Reach-Up staff members have master's level training and some have prior experience with TANF, having worked for the Economic Services Division. They are trained to be flexible and customer service oriented by providing individualized services to clients. The wealth of employment resources and access to mental health/substance abuse treatment also contribute to the effectiveness of their work with TANF clients. VR Reach-Up's Management staffs' close relationship with DCF-ESD Management staff has also been a key to an ongoing, healthy partnership that honors the important work we are doing with an underserved population.

Successes: Successes include integrating VR Reach-Up into the Teaming initiative and increasing collaboration of the employment staff dedicated to Reach-Up through the CWS initiative; consistently engaging a hard to serve population in mental health and substance abuse treatment with successful results; continuing to assist between 40 to 65 individuals in obtaining competitive employment per year even during the economic recession; and assisting 100-115 individuals per year to obtain SSI/SSDI benefits so they are served by the appropriate poverty program.

Challenges: Challenges include creating movement with passive clients who can have just enough engagement but no positive accomplishments; supporting individuals who often have deep trauma resulting in fear and depression; operating despite limited resources in a rural State where adequate housing and transportation is difficult to find; and maintaining hopefulness in staff even while they serve a high-needs population that is slow to move toward employment.

Other Lessons Learned: VR Reach-Up Counselors have developed expertise in documenting functional capacity that supports participants' applications for Supplemental Security Income and Social Security Disability Income benefits for eligible Reach-Up clients and their families. Increased assessment up front for more appropriate plan development has also been helpful in reducing long-term reliance on Reach Up.

Tools

The following tools are associated with VR Reach-Up Program. Please send us an email at upitoolkit@blhtech.com for more information about these tools.

Disability Screening Form for Referral to Division of Vocational Rehabilitation

This form is used in some districts to help case managers identify appropriate cross team referrals, i.e., referrals from the Resource Team to the VR Team.

Explaining Services Checklist

A document that offers explanation of the process and obtains a participant's signature so that the VR Reach-Up Counselor can refer to that document when the participant is not complying with the program.

Reach-Up Spending Limits and Support Services Matrix

Overview

Program/Practice Name: Work First New Jersey Substance Abuse Initiative/Behavioral Health Initiative (WFNJ–SAI/BHI)

Agency Name: National Council on Alcoholism and Drug Dependence - New Jersey (NCADD–NJ)

Contact Information: Annette Riordan, Psy.D. Coordinator of Transitional Services Unit New Jersey Department of Human Services, Division of Family Development (NJDHS-DFD) 6 Quakerbridge Plaza, P.O. Box 716 Hamilton, NJ 08619 Fax: 609-631-4541

Type of Program/Practice: The WFNJ–SAI/BHI program is based on managed care principles. SAI/BHI provides independent assessment and case management to augment treatment, a continuum of services, and fee-for-service reimbursement to treatment providers. Care coordinators work to provide coordinated care to TANF participants with substance abuse and/or mental health disorders. The primary goals of the program are to treat substance abuse and/or mental health as barriers to employment, ensure uniform assessment, decrease fragmentation of treatment services among providers offering various levels of care, and maintain and utilize a continuum of treatment services integrated with work activities. Clients unable to work due to severe and persistent mental illness (SPMI) are medically deferred from work activities and assisted in applying for Supplemental Security Income (SSI).

Description

Program/Practice Description: The New Jersey Department of Human Services, Division of Family Development's WFNJ–SAI/BHI program co–locates licensed clinicians (i.e., care coordinators) in the 21 county welfare offices in New Jersey to provide comprehensive co–occurring assessment and case management services to welfare recipients whose substance and/or mental health problems interfere with their ability to get or keep a job. These services include scheduling referrals, conducting assessments, arranging patient placements, developing service plans, conducting clinical service reviews, requesting welfare transportation and childcare supports for clients, and tracking client treatment participation and utilization management. The program adheres to a philosophy of client–centered treatment that informs all clinical service decisions. Specifically, care coordinators assess clients and arrange placement in one or more levels of care according to the client's diagnosis and integrate service planning with social services and work activities. WFNJ–SAI/BHI offers a continuum of treatment options to clients with substance abuse, mental health and co–occurring disorders.

Background/Program History: In 1998, the National Council on Alcoholism and Drug Dependence - New Jersey (NCADD–NJ) was contracted by NJDHS–DFD to provide substance abuse services for welfare clients in all 21 counties. From 1999 through 2003, as part of a randomized research evaluation project, two counties offered both Intensive Case Management (ICM) and Care Coordination services to Temporary Assistance for Needy Families (TANF) clients. The outcomes of the research evaluation indicated that ICM was more effective in reducing substance abuse as a barrier to employment for the hard–to–serve clients. Based on those findings, DFD expanded ICM to 14 counties with the largest TANF and child welfare populations. Lessons learned from the research evaluation include: (a) the importance of community stakeholders' input when designing service delivery systems; (b) the value of cross–systems coordination to develop integrated service plans; (c) establishing a lead agency responsible for overseeing and managing care; and (d) significantly expanding treatment capacity to meet clients' multiple service needs. In 2009, due to the increasing number of clients with co–occurring substance abuse and mental health disorders, WFNJ–SAI implemented the Behavioral Health Initiative. SAI/BHI serves WFNJ (TANF) participants with substance abuse and/or mental health disorders.

Innovations and Results: WFNJ–SAI employs an online case management and care coordination system to track clients from initial referral through successful completion of services, along with any potential future need for follow–up treatment. The state–of–the–art case management system was designed from the ground up with considerable input from frontline workers resulting in minimal operating system changes and extensive quality assurance reporting mechanisms to ensure efficient and responsive quality service delivery. With care coordinators embedded in welfare agencies throughout the counties, along with strong collaboration with Division of Youth and Family Services and the WFNJ–SAI provider network, the program is able to address the multitude of needs that clients present with, integrate treatment services delivery, and coordinate cross–agency networking. Frequent drug screening and the use of a voucher incentive system tied to continued successful substance–free functioning enable care coordinators to better monitor treatment progress and be more responsive to client needs for more or less intensive substance abuse treatment. Additionally, these measures provide feedback to WFNJ about client progress toward employability or maintaining employment.

Implementation

Support Services Available:

• Onsite service delivery at county welfare offices
• Comprehensive substance abuse assessment
• Multi-agency collaborative service planning and treatment

• Child support services
• Intensive case management and care coordination
• Welfare transportation
• Referrals to self-help groups, legal services, and medical services

Tools

The following tools are associated with Works First New Jersey Substance Abuse.

• www.ncaddnjinfo.org/files/sai/ChartForms/ChartForms.htm Care Coordination forms
• www.ncaddnjinfo.org/files/sard/ECCGeneral.htm Intensive Case Management forms
• www.ncaddnjinfo.org/files/sai/Spanish/Spanish.htm Spanish Care Coordination forms
• www.ncaddnjinfo.org/files/sard/Policies.htm Substance Abuse Assessment forms