Effective Rural Vocational Rehabilitation Job Development - A State of the Science Event by RTC:Rural

On July 22, 2017, State Vocational Rehabilitation staff and administrators, researchers and job development providers from across the country participated in RTC:Rural’s State of the Science webinar exploring how Vocational Rehabilitation (VR) payment models influence the availability of job development services in rural areas. The event aimed to help participants understand which models may facilitate better VR outcomes in rural areas, and encourage conversation between VR and providers about how payment models impact job development services.

While VR agencies use a variety of models to deliver job development services, the majority contract with third-party providers to deliver services such as resume development, job coaching, and job placement. There is evidence, however, that different payment models (such as hourly, fee-for-service, or performance-based benchmarks) influence the availability and quality of job development services in rural communities.

This Rural VR Job Development webinar explored the relationship between VR payment models, geography, and VR outcomes. The webinar was designed to provide current and pertinent information to stimulate a rich discussion among participants. Strategies to address VR outcomes were discussed such as hybrid models that draw upon the strengths of different delivery models and the use of incentives to serve rural areas and “hard cases.”

The webinar featured a review of current research from the Research and Training Center on Disability in Rural Communities (RTC:Rural), followed by reactions from a panel of experts representing a variety of perspectives within the field of VR service delivery:

--Betsy Hopkins, Director of Maine’s Division of Vocational Rehabilitation, spoke about Maine’s efforts to implement a hybrid payment model.
--Jessica Adams, a job development service provider in rural Idaho, shared insights from her experience participating in Idaho’s piloted (and then abandoned) performance-based system.
--Mimi Shafer, Rehabilitation Area Manager in southwestern Minnesota, spoke to challenges in serving rural areas due to CARF accreditation requirements, and new challenges introduced by WIOA.
--Joe Xavier, Director of the California Department of Rehabilitation, shared his perspectives on what makes a successful VR program in rural areas.
--Susan Foley, Ph.D., Senior Research Fellow at the Institute for Community Inclusion at University of Massachusetts, Boston, shared perspectives based on her experiences directing multiple national centers focused on research, training, and technical assistance for VR agencies.

A video recording of the webinar is available for viewing here: https://www.youtube.com/watch?v=XhBHn50LdH8

1. Information for Participants/Attendees:
We will begin the webinar a .
All webinar participants will be muted except for
the presenters.
Participants, please use the text chat box to
communicate with the moderator, as well as to
s
ubmit questions and comments during the Q &
A periods at the end of the webinar.
This webinar will be recorded and the archive
made available on the RTC: Rural website.
How to join the audio portion of this webinar:
Use your computer speakers (this is most likely
the best option)
OR
Call into the teleconference bridge:
C
all in: 1-800-832-0736
Passcode: 7785002#

3. Catherine Ipsen, Ph.D.
Director of Employment Research
Researchand Training Center on Disability in
Rural Communities (RTC:Rural)
Associate Director
Rural Institute for Inclusive Communities
University of Montana
[email protected]
[phone]

4. Agenda
RTC:RuralResearch
Rural Disparities
Premature Exit
Job Development Contracted Services
Panelists
Betsy Hopkins, Director of the Maine Division of Vocational Rehabilitation
Mimi Shafer, Rehabilitation Area Manager of Minnesota VR Services
Jessica Adams, Provider, Community Connections, Idaho
Joe Xavier, Director of California Department of Rehabilitation
Susan Foley – Director of the RRTC on VR, RTAC on VR Program Management, and SGA
project
Participant Input

5. Rural Demographics -Disability
As counties become
more rural, the
percentage of people
with disabilities
increases.
This trend is true for all
disability types and age
groups.
12.4 %
11.7 %
15.5 %
17.7%
NATION METRO MICRO NONCORE
Disability Rate by Metro Status

6. Rural Demographics -Poverty
14.7 %
17.1 % 17.1 %
22.4 %
24.4 %
25.0 %
METRO MICRO NONCORE
Poverty Rate by Disability Status
and County Type
No DisabilityDisability
Poverty rates increase as counties
become more rural for people with
and without disabilities.
One quarter of people with a
disability living in non-core counties
experience poverty.

7. Rural Demographics -Employment
Non-CoreCounties
Employment
Rate
Unemployment
Rate
Notin the
Labor Force
People w/out
disability
72.3% 6.6% 21.2%
People with
disability
29.4 % 5.9% 64.6%Employment and unemployment rates are
slightly lower in non-core counties for
people with and without disabilities
Discrepancies between groups, however,
are very large and accounted for by
individuals with disabilities who are not in
the labor force

8. Explaining Rural Disparities
Limited economic opportunity and
choice
Lack of infrastructure (i.e. public
transportation, accessible buildings,
etc.)
Limited access to programs,
specialists, or experts

9. Vocational Rehabilitation
VR can help overcome rural barriers
Access point for rural consumers
Funding stream for obtaining services
Higher employment outcomes in
rural (RSA 911, 2015)
33% of all cases in urban
34% of cases in large rural city
37% of cases in rural
38% of cases in isolated rural
Context
Similar rates of competitive closures
Nominal differences in wage rates across
locations
Higher rates of self-employment closures as
cases become more rural

10. Exploring Reasons for VR Dropout
Nearly half of all eligible consumers drop out before completing the
program.
VR spends approximately $365 million annually to serve consumers who
disengage from services.
Premature exits include cases classified as:
Unable to locate
No longer interested in receiving services or further services
Premature exit is associated with worse economic outcomes
82.9% of consumers with cases closed to competitive employment were still
employed one year later compared to 33.4% of consumers who chose to forgo
VR services (Hayward & Schmit, 2003)

11. Exploring Reasons for VR Dropout
Prospective study with VR clients to better understand factors leading to
premature exit.
T1 = 355, T2 = 262, T3 = 212, and T4 = 188
Overall satisfaction with VR services across time points was associated with:
Pace of service delivery
Rates of contact between the counselor and consumer -both in-person and
via phone/email.
Satisfaction ratings with the counselor

12. Exploring Reasons for VR Dropout
162 participants left the VR system over the 24 month study period
Reasons for Exit
Mettheir goals 35%(n = 58)
Personalreasons 30%(n = 49)
Dissatisfiedwith services 34%(n = 55)

13. Exploring Reasons for VR Dropout
Almost half of respondents at
each wave of data collection felt
that progression through VR
services was too slow
Reason for exit, however, was
strongly associated with delivery
pacing
Reason for Exit Service too slow About right
Met Their Goals28% 72%
Dissatisfiedwith
Services
71% 29%
Personal Reasons 50% 50%

14. Possible Strategies to Reduce Exit
Increase counselor-consumer
communication
Telecommunications (rural strategy)
Deliver services more quickly
Reduce the time for determining eligibility
SGA project
Reduce the time to IPE development
Get people working and faster
Job Development Contracted S ervices project

15. Job Development & Contracted Services
Receipt of job placement and development activities are important predictors
of VR employment outcomes
Bradley, Ebener& Geyer, 2013; Timmons & Smith, 2010
Agencies generally deliver services using one of three models
Internal service delivery
Performance-based benchmarks (vendors, contractors, CRPs, etc.)
Fee-for-service or hourly (vendors, contractors, CRPs, etc.)
Research
Qualitative interviews –40 agencies, 35 states
RSA 911 quantitative analyses (and model indicators) – 50 agencies, 42 states

16. Internal Delivery Models
In some agencies, counselors provide job development services
As part of normal work load
In cases when vendors (or CRPs) are not available
Business consultants, business outreach specialists, employment consultants
Provide job development and placement services
Network with employers about DVR services generally –dual customer approach
Provide a different skill set than counselors –background in business, human resources, etc.
Can share cases with vendors (vendors work with client; employment consultant works with
business)
Some agencies serving blind and low vision consumers use internal job developers
(versus vendors) because they are educated about blindness
They have more success working with businesses and developing opportunities
Vendors are reluctant to serve clients who are blind

17. Performance-Based Funding / Milestones
Payments are provided for measureable outcomes
Most include 3- 5 milestones with payouts increasing for employment outcomes
Job readiness assessment, Job placement plan, Placement, 30 days, 90 days
Some states offer a tiered payment system, with higher payout rates for severity of disability
or quality of placement
Agencies vary on whether they will pay for a milestone more than once
i.e. if a person loses their job placement

18. Fee-for-Service and Hourly Funding
Counselor authorizes payments for services to an outside vendor
Some services are paid a flat rate
Some services are delivered on an hourly basis or package of hours that can be
reauthorized
The agency pays for services delivered, regardless of employment outcome

19. Job Development Service Delivery
Funding models vary by agency type (n = 50)
DeliveryModel Blind /
LowVision
(n = 12)
Combined /
General
(n = 38)
Internal n = 6; 50% n = 7; 18%
Performance- based
benchmarking
n = 4; 33% n = 22; 58%
Fee-for-serviceor Hourly n= 2; 17% n= 9; 24%

20. Internal Delivery Models
ADVANTAGES
Allows the agency to be more responsive to
the business sector
Staff are more skilled at talking with
businesses and selling VR
Provides in-house communication
opportunities between the counselor and
business consultant
DISADVANTAGES
Employment consultants are often a single
point of contact with businesses
Good for employers, but makes if hard for
counselors to facilitate job development
Limited number of staff so geographic gaps in
services
Some potential conflicts about shared cases
between the employment specialist and
vendors

21. Performance-Based Funding / Milestones
ADVANTAGES
Emphasizes employment outcomes
A clear way to set expectations and track
outcomes without paperwork
Defined payment structure
Risk is incurred by the provider
If providers are not effective, they will
likely go out of business
Reduces “over-serving” consumers
Cost effective
DISADVANTAGES
Potential for case creaming
Emphasis on placement does not
necessarily result in good jobs
Unpredictable income, which can be
difficult for small providers
Lost capacity in rural areas
Less communication about cases
between the counselor and provider
Less ability to change providers mid-
stream

22. Fee-for-Service & Hourly Funding
ADVANTAGES
Counselors and providers communicate
about case progress
Counselors retain control of the types of
services delivered
Services may result in better employment
fit
Consumers can easily change vendors if
needs are not met
Funding is more predictable
May entice providers to serve more rural
locations
DISADVANTAGES
Too much time is spent negotiating services
Counselors have to sign off on every hour
Cases can slow down or stall out while
approvals for additional funds are being
negotiated
Cases may languish since the funding model
does not reward case closure
Cases require monitoring to motivate
progress towards outcomes –placement and
closure

23. Implications from the data
Rate of RuralCase Mix
(n = 38; General and Combines Caseloads)
IsolatedRural Small and
IsolatedRural
Performance-Based 3.8% 8.8%
Fee-for-Service 8.3% 15.4%
Internal 7.2% 16.9%
Sig. .084 .120

24. Rapid Research Results (n = 31)
Of agencies primarily using vendors or CRPs (n = 22)
86% (n = 19) say there are gaps in services in rural locations
50% use rural incentives to increase service availability
Among all respondents (n = 31)
74% agree or strongly agree that incentives are necessary for
increasing services rural areas

25. Incentives
Rural incentives
Drive time
Mileage reimbursements
Higher rates
Outcome incentives
Bonuses for wage thresholds or
benefits
Bonuses for pacing
Case incentives
Tiered payment schedules or higher
wages for “harder-to-serve” cases
“We do not currently use benchmark differentials
related to the severity of the disability (and we’re on
an OOS), location, or job factors, such as higher
salaries or benefits obtained. This is frankly not
working out too well, and hasn’t for years. We’re in
the process of revamping the system to take in just
that sort of variable”
AlisiaMcKinlay, Division Director, Florida DVR

26. Combined models
To address shortcomings of different models,
some agencies have moved to hybrid models
Fee-for-service with bonuses for placements, pacing, and job quality
Contracted services housed within the VR office (VT)
Increased opportunities for case communication; reduced need for documentation
Fee-for-service payments developed on a monthly fixed rate (HI)
Overcomes variations in number of referrals
Helps keep smaller operations afloat
May be a good rural strategy

27. Panel of VR Experts
Betsy Hopkins
Director, Maine Division of VR
Jessica Adams
Community Connections, Inc., Idaho
Mimi Shafer
Rehabilitation Area Manager in Minnesota
Joe Xavier
Director, California Department of
Rehabilitation
Susan Foley, Ph.D.
Researcher, Institute for Community
Inclusion, University of Massachusetts

28. Betsy Hopkins, M.S.
Director
Maine Department of Labor
Division of Vocational [email protected]

29. Mimi Schafer, M.S., C.R.C.
Rehabilitation Area Manager
Minnesota Vocational Rehabilitation Services
[email protected]

30. Jessica Adams
Program Manager
Community Connections, Inc.
Coeur d’Alene, [email protected]

31. Joe Xavier
Director
California Department of Rehabilitation
[email protected]

32. Susan Foley, Ph.D.
Senior Research Fellow
Institute for Community Inclusion
University of Massachusetts, [email protected]

33. Questions?
Research and Training Center
on Disability in Rural Communities
http://rtc.ruralinstitute.umt.edu
Catherine Ipsen, Ph.D.
University of Montana
[email protected]
[phone]

34. Thank You!
Research and Training Center
on Disability in Rural Communities
http://rtc.ruralinstitute.umt.edu
Catherine Ipsen, Ph.D.
University of Montana
[email protected]
[phone]