Common Sense: Beyond Dreams to Ambition

By Robert Morgan, Superintendent of the Delaware County, Ohio, Board of Mental Retardation and Developmental Disabilities

The opportunities available through self-determination are so different from the life that most people with disabilities experience that we need to suspend our current views of reality to begin to see the potential. The early pioneers of self-determination called this dreaming, allowing us to consider possibilities beyond the bounds and restrictions of the current services system; to free both spirit and mind to create the promise of new realities.

This is a joyous and exhilarating experience but it is only a start and must be followed by equally revolutionary thinking, commitment, and hard work. If we do not move beyond dreaming we accomplish little. The definition of dream is “a sequence of thoughts and fancies, or a vision during sleep; a state of abstraction, a reverie; an unrealized ambition; something only imaginary.” A more powerful word, and one seldom used to describe people with disabilities, is “ambition” the desire for power, honor, fame, excellence.

Beyond Dreams

Dreams are private and very personal. Many dreams are fantasies that we enjoy in part because we do not expect them to come true. When we begin to expect that desires can come true we begin to plan and join with partners to act. Ambitions are more likely to be realized when we are in partnership with others who also share similar ambitions. Ambitious people who are successful are not selfish. They have learned that association with other hard working and dedicated people helps them realize their goals and promote a common good.

Nowhere in our lives is ambition more important than in our work. Employment adds the benefit of wages, which helps us to gain wealth. Wealth gives us power and greater choice. People with disabilities have had limited opportunities for meaningful work and rewarding employment. Business opportunities available to people with disabilities have tended to be charitable and associated with other services and supports determined to be needed by people with disabilities. They are seldom described as ambitious especially as related to the career opportunities for people with disabilities. The greatest employment opportunities for people with disabilities are found in the competitive market, where ambitious people work. Getting into the competitive market will require new and ambitious approaches.

System Change

In 1998, Delaware County started a new program for ambitious people called Employment Outcome Support. This is a different way for individuals with disabilities to receive supports and services to help them get into jobs and earn income. The difference is not what kind of job or supports can be acquired, but how the agencies and people helping individuals will be paid. When someone with a disability gets a job and is paid, the agency and people helping that person will be paid. The more the individual is paid, the more the agency is paid.

Traditional rehabilitation and vocational services pay for evaluation, training, career exploration, job coaching, and support. This is known as “fee-for-service.” Fees are based on the cost of each of these services. It is expected that, as a result of these services, an individual will get a job that is well matched to his/her skills so that he/she gains meaningful and successful employment. These services, which are usually provided by agencies with well-trained staff, and who meet high standards, are measured on their success in helping people acquire and keep jobs. However, the fees are paid whether or not the person gets a job and are not based on their salary. These services may be well matched for people with little or no work experience, who have special needs, or a disability that requires accommodations or a great deal of training. It generally takes some time before an individual actually acquires a job and begins earning money.

Employment Outcome Support pays for services only after an individual gets a job and starts earning money. The agency or individual helping will receive 50% of the wages and benefits that the individual receives. This fee will not come from the individual, but will be paid by the Delaware County Board of Developmental Disabilities. If someone receives a raise, works more hours, or gets additional benefits, the fee increases accordingly. The helping agency or individual continues receiving reimbursement for support as long as the person keeps his/her job and wants services. However, the percentage the helping agency or person receives decreasing to 40% the second year of employment, 30% the third year, and 20% for the fourth year and beyond. With Employment Outcome Supports a person with a disability can acquire any type of job he/she wishes.

Choosing Helpers

There are some important differences from the service model fees. Almost any person or organization can assist someone to acquire a job and receive payment for their support. The chosen support will need to have a criminal background check and agree to follow the rules and requirements of the program. Traditional vocational services can also provide Employment Outcome Support and will usually be pre-approved and familiar with all the requirements. In either case, the person with a disability chooses who they want as their Employment Outcome Provider.

Immediate family members of the person receiving Employment Outcome Support or businesses owned or controlled by family members may provide the support services of an Employment Outcome Provider but are not eligible to receive payment. However, family members may re-assign Employment Outcome fees to other community supports and services that may be needed, such as residential services. Family members are not required to complete criminal background checks. The person with a disability has to agree to share information concerning his/her wages and benefits with their Employment Outcome Provider so the provider can bill for services.

An individual can “fire” the provider with at least 30 days notice. The provider will continue to receive their fee for 60 days. If the individual with a disability stays with the same employer, they will not be eligible to select a new provider. If they need help, they can call their case manager.

The fees received for Employment Outcome Support must cover all costs related to employment such as transportation, training, job coaching, special equipment, accommodations, etc. The fees can be used in any way the provider sees fit. This can include, but is not limited to incentives, stipends, or recognition of supervisors or co-workers. The fees may also be used to purchase other community supports for the individual.

Eligibility

Eligibility for Employment Outcome Supports is as follows:
Anyone who is eligible for services from the Delaware County Board of Developmental Disabilities, who will be employed in any position other than in a sheltered workshop and/or government supported employment program, and has made application along with their approved Employment Outcome Provider and has signed an agreement.

Employment Outcome can work for everyone, especially those who really want to work, want to have income, and who can find an provider able to assist them for a fee based on the potential to earn wages adequate to pay fees for their supports. Yes, there may be some whose ability to earn wages compared to their support needs may limit their ability to participate. However, the decision and control of those issues are under the control of the person receiving supports and his or her circle of support. It provides freedom of opportunity and control over choices that are made. It does not eliminate current options of fee-for-service programs.

The Customer, Employment Provider, and Individual Support Administrator sign the agreement.

Employment Outcome Results

The first person to use the Employment Outcome Service was a 38-year-old man, Mark, who had worked at an industrial enclave and wanted a community job where he could make more money. His residential provider assisted him to get a full-time job at McDonalds. The following is a comparison of his old job and his new job based on outcome measures Delaware County used for employment services.

* Note: Under Employment Outcome, transportation costs are included as part of the support service fee.

The income to cost factor compares the wages and benefits earned by the individual to the cost of supporting the employment. A cost factor of 1.00 indicates the cost is the same. Less than 1.00 indicates that they earn less than it costs to provide employment support. By tracking cost factors over time we can determine how well the individual’s earnings are increasing compared to the cost of supports.

The impact of Mark’s increased income also had a positive effect on the cost of other support services. He was able to increase his share of his housing support by $118 a month. With Employment Outcome there is a commitment to decreased costs for future employment support. The plan shows savings of $17,694.19 over the next four years. Mark will also receive an additional $29,000 of income.

Since the Employment Outcomes program started in June 1998, Delaware County has added 15 people. Some people were already employed and started at various years and percentages. The following is a summary for the 15 people currently participating:

Total Wages & Benefits - $208,135.00
Total Cost of Outcome Supports - $73,106.00
Average Wages & benefits - $13,876.00
Average Income to Cost Factor - $2.85
Range of Income - $3,911 to $26,688.00
Average Cost of Traditional Vocational Service - $10,942.00
Projected Cost of Traditional services for 15 - $164,130.00
Projected Savings with Employment Outcomes - $91,024.00

Contact Information

Robert R. Morgan is Superintendent of the Delaware County, Ohio, Board of Mental Retardation and Developmental Disabilities. Delaware County is one of the four Ohio Self-Determination Project counties. You may contact him at morgan@mrdd.net.