SERVICE INTEGRATION: TRENDS, PRACTICES AND CHALLENGES FROM A SYSTEMIC PERSPECTIVE by William E. Kiernan This presentation will examine employment options from a systemic and practice perspective. Employment for individuals with disabilities has and remains a high priority for policy makers, agency administrators, practitioners, employers, family members and most importantly individuals with disabilities. It should be noted that this chapter will focus upon those individuals who have had mixed or no success in employment. There are those individuals with disabilities who have and continue to be successful in seeking and maintaining employment. Introduction The concept of employment for persons with disabilities is one that is emerging. The evolution in perceptions, practices and views of individuals with significant disabilities has changed dramatically from one of limited expectations to a recognition of the capacities of such individuals to engage in real work for real pay. This chapter will examine the national trends that are shaping the employment agenda, present some of the data that shows the current status of employment for individuals with disabilities, consider some of the issues that these trends have raised at the service delivery level, present some of the recommendations for change that have emerged from providers of employment and training services, consider some of the needs that persist for systemic redesign and finally offer some challenges that must be addressed if we are to see an integrated and effective employment and training system for individuals with disabilities that leads to real work for real pay. The efforts of a diverse community of interested individuals; those having disabilities, family members, professionals with considerable experience and expertise in supporting individuals with disabilities, policy makers who are on the cutting edge of innovation and managers who have not only seen the light but lit the light to change, are leading the way to innovation and change for adults with significant disabilities. Some of the recommendations and observations included in this report reflect changes that have been initiated, plans for new initiatives at the legislative and practice levels and finally changing perspectives on the overall role of individuals with significant disabilities in guiding and managing those resources available to respond to personal dreams and aspirations. A. National Trends Less than four decades ago it was felt that individuals with significant disabilities needed a caring and protecting environment, one that would assure safety but not expect participation in major life activities such as work. Over time this expectation has evolved to one of recognizing that people with significant disabilities can and want to live in typical community settings, have friends, be able to travel about and have a meaningful job. For all, work provides not just an avenue to economic self sufficiency but a gateway to friendships and relationships, a means of establishing an identity in society, and a way of making a contribution that is perceived as valued by others. Work offers a chance for economic stability, social networking and community identity. For individuals with significant disabilities, while there has been an increasing awareness of their capacity of work, the rate of participation in the workforce remains very low (about one third the rate of individuals without disabilities). With more than two thirds of all adults having a disability not working, a main pathway to the American dream is closed. Indeed the expectation of many is that persons with significant disabilities should not be expected to work nor is it a desirable activity. The early perceptions of having specialized settings for both work and non-work activities persist for adults with significant disabilities. Even given the very compelling demonstrations that have emerged where, through approaches such as supported employment, individuals with significant disabilities are and have continued to work, we continue to hear calls for segregated and specialized work places by some and from others the belief that employment is not a realistic goal. Within the last decade a number of federal initiatives have called into question the perception of individuals with significant disabilities not being able or expected to engage in real work for real pay. The passage of the Americans with Disabilities Act (Public Law 101-336) some ten years ago raised the bar of expectation noting that all individuals with disabilities must be provided the opportunity to participate in all facets of our society, including work. This landmark legislation calls into question the concepts of specialized and segregated settings. The ADA opens the door to community involvement, community membership and full citizenship for all individuals with disabilities. The Rehabilitation Act Amendments of 1992 (Public Law 102-569) confirmed that persons with disabilities must be viewed as having the potential to benefit from vocational rehabilitation services leading to employment. With the passage of this legislation, the assumption would be that individuals with disabilities are able to be employed and that it is the responsibility of the agency to either place them in employment or verify that this is not a possible option for certain individuals with disabilities. Additionally, the Rehabilitation Act Amendments of 1992, as in the case of The Education of All Handicapped Children Act (Public Law 94-142), placed a strong emphasis upon the interests and preferences of the individual and the role of the person in the planning and implementation of any rehabilitation goals or educational services. Education legislation nationally has championed the cause for inclusion of students with disabilities in all educational settings. With the passage of the Individual with Disabilities Education Act in 1991 (IDEA: Public Law 101-476), the growing emphasis upon preparation of students with disabilities to move from school into adult life has served as a common thread between rehabilitation, education, and developmental disabilities legislation nationally. The Developmental Disabilities Assistance and Bill of Rights Act of 1975 (Public Law 94-103) established the civil rights base for persons with disabilities. The Developmental Disabilities Legislation along with the ADA clearly document that persons with disabilities have rights and that these rights must guarantee equal access and opportunity. The Development Disabilities legislation, like IDEA and the Rehabilitation Act, places an emphasis on transition from school to adult life and, like other federal legislation, recognizes the need for a focus on the individual rather than on a diagnostic group or label that may be used to describe an individual. The School to Work Opportunities Act of 1994 (Public Law 103-239) recognized that all students must be prepared to move from school into adult life. This legislation, while not focused specifically on students with disabilities, clearly indicated the need for all students, both disabled and non- disabled, to have the opportunity to develop skills leading to employment. The emphasis on transition emerged as a shared priority area in both IDEA and the School to Work Opportunities Act. These legislative initiatives recognized that planning for the future is a critical element in the educational process. With IDEA calling for transition planing to begin at age 16 (preferably age 14) and the recognition that transition planning was essential for all students, there was a growing interest in having programs and services be more generic and serve all students. In the past four years there has been an increase in the interest on the part of the federal government to streamline the range of employment programs. With the passage of the Workforce Investment Act of 1998 (Public Law 105-220) and the establishment of the One Stop Career System, the emphasis on a less complex and more customer focused employment and training system has emerged. This legislation provides states with an opportunity to develop a consolidated workforce investment plan that will respond to the needs of job seekers as well as employers. WIA is designed to create a single access system, no wrong door strategy, such that any individual who is interested in seeking employment can be served. The level of services will vary depending upon both the needs of the individual and the capacity of the job seeker to self direct his or her job search efforts. The potential for developing a uniquely focused employment plan through the use of an Individual Training Account (ITA) reflects the strong role that individuals with disabilities may play in the job preparation and job seeking processes. As a strategy for integrating all of the employment and training efforts at the federal level, the reauthorization of the Rehabilitation Act was included as Title IV of the Workforce Investment Act (Silverstein, 1999). The passage of the Workforce Investment Act was a clear statement by Congress to simplify the employment and training activities at the federal level. The major focus of WIA is the establishment of a state workforce development plan. Depending upon the interest of the Governor and other state authorities, the state may choose to submit a comprehensive employment plan that will include services for all job seekers, individuals with and without disabilities. The actual implementation of the plans that are developed will be accomplished at the local level through a One Stop Career Center system. The Ticket to Work and Work Incentives Improvement Act (P.L. 106-170) is a significant effort to reduce a key barrier to employment by providing options for states to support persons with disabilities through extended health care coverage should they return to work. The Ticket to Work portion of this legislation allows the SSA beneficiary to have a ticket that will redirect a percentage of the cash savings once the individual is off the cash benefits role and employed for nine months. This ticket can be used as a voucher of sorts by the individual securing the supports needed to remain working for up to five years provided that he or she remains employed and off SSA cash benefits. A key aspect of this initiative is the placing of the resources into the hands of the individual and allowing these resources to be used over an extended period of time. While not a legislative initiative, the Olmstead decision rendered in 1999 interpreted Title II of the ADA and its implementing regulation, which obliges states to administer their service, programs and activities ‘in the most integrated setting appropriate to the needs of qualified individual with disabilities (28 CFR 35.130 (d)). This ruling, while initially directed at the provision of community living services, also calls into question the use of non-work or sheltered work settings when integrated employment options could be accessed. In ruling in the case of Olmstead v L.C., the Supreme Court affirmed the right of individuals with disabilities to receive public benefit and services in the most integrated setting appropriate to their needs. In addition to the call for inclusive settings, Olmstead also affords individuals with disabilities and their families (when appropriate) the opportunity to make informed choices regarding how their needs can best be met in community settings. These federal statutes serve to reinforce the need to focus upon individual preferences, involve individuals at all stages in the planning and implementation of education and rehabilitation programs, assure that persons with disabilities have equal access and opportunity in work, community living, and recreation and look to the integration of the various resources such that persons with disabilities are served by the generic system. B. Current status on Employment of Individuals with Disabilities a. General Workforce Trends: National data on employment of adults with disabilities remain very troubling. In 1997, while males without disabilities were reported to have a labor force participation rate of 95.2%, men with disabilities reported a rate of 35.5%. For women with and without disabilities similar disparities are noted, with a labor force participation rate 80.7% for women without disabilities and 31.9% for women with disabilities. Using a broad definition of disability, the 2000 U.S. Census incidence of disability is reported to be 19.2% of the overall population between the ages of 21 and 64. This percentage rises to 41.9% for those over 65 years of age. This same report notes 56.6% of those reporting having a disability are in employment, this in comparison to the 77.2% employment rate for those not reporting a disability. It is clear that from whatever perspective (or definitional set utilized) those individuals who report a disability regardless of severity are more often unemployed (Houtenville, 2001) Poor labor force participation is, of course, only part of the story. Individuals with disabilities experience both underemployment and high rates of poverty. The median annual earned income for individuals with disabilities is as much as one third lower than their non-disabled peers, and individuals who are working are disproportionately participating in entry level and service industry jobs offering few if any benefits. These general trends are echoed in the employment outcomes for individuals with the most significant disabilities. An ongoing data collection effort of the Institute for Community Inclusion reports that only 25% of adults supported by state Mental Retardation and Developmental Disabilities agencies are in real work settings with the remainder split between sheltered employment and non-work programs (Butterworth, Gilmore, Kiernan & Schalock, 1999). The investment in employment opportunities by state Mental Health agencies is even more limited. In FY93 only 25/38 state Mental Health agencies could identify or estimate the number of individuals receiving vocational services. Those agencies that could identify such data reported that less than 1% of individuals supported were in integrated employment (Whitney-Thomas, Thomas, Gilmore, McNally & Fesko, 1993). More recently, a 1999 NASMHPD survey found that most states could not specify their expenditures on employment supports, indicating that employment remains a low priority. Wages are paid to individuals with disabilities in both segregated and integrated settings. In the sheltered workshops (segregated setting) the wage payment is typically determined on a rate of productivity with the average wage payment when viewed as an hourly wage quite low. Individuals in sheltered employment earn minimal wages, averaging only $2.46/hour for individuals recently closed by state VR agencies. The lowest sheltered wages were earned by individuals with mental retardation ($52/week), with an average wage of $64/week across all disability groups. Overall, wages in sheltered employment are one third to one quarter those in competitive employment, even after accounting for severity of disability (Gilmore, 2001). Even in integrated employment the wage rates for individuals with disabilities are low when compared to poverty rates. Some of this is a reflection of the position level held, while some may be reflective of the typical part time nature of the jobs obtained. For competitive jobs limited wages and benefits contribute to the high level of poverty among individuals with significant disabilities. Individuals who recently completed services from the VR system are representative of individuals in the workforce. In FY1998 individuals with mental retardation averaged only $152/week in wages, and worked only 28 hours per week. Across all disability groups, weekly wages at closure averaged $272/week, compared to mean annual earnings in the general labor market of $657/week (Butterworth, Gilmore, Kiernan & Schalock, 2000) b. Segregated Work and Non-work Settings: Sheltered employment and non-work services continue to be the dominant model for day and employment services. There are an estimated 7,000 community rehabilitation providers (CRPs) in the United States supporting over 1,000,000 individuals with significant disabilities (McGaughey, Kiernan, McNally, Gilmore & Keith, 1996). The state and federal Departments of Labor provide certificates to many of these programs such that wages are based on rates of productivity with most individual in these settings earning considerably less than the minimum wage. One third of individuals supported by Mental Retardation and Developmental Disabilities agencies work in sheltered employment, and some 42% participate in non-work services. Despite the continuing investment in these service models by certain funding agencies, state Vocational Rehabilitation agencies have been successful in reducing their use of sheltered employment. There has been a steady decrease in new entries from the VR system referred to sheltered employment over the past 10 years. The percent of individuals with developmental disabilities who enter competitive employment rather than sheltered workshops with Vocational Rehabilitation support increased from 74% in FY85 to 86% in 1998, with the greatest increases for individuals with moderate, severe, or profound levels of mental retardation. Despite this positive progress, the total number of individuals in sheltered employment and non-work services in the United States continues to grow each year, including 7,634 new entries into sheltered employment from the Vocational Rehabilitation service system in FY1998. Many more individuals enter or are supported in sheltered employment or non-work setting through the state Mental Retardation and Developmental Disability agencies. In part, this is reinforced by the reimbursement practices of the federal government where the Health Care Financing Agency (now Centers for Medicare and Medicaid Services; CMS) policies have been less progressive and more beneficial to the states where non-work services are provided (Butterworth et. Al, 2000). c. Related Foci on Inclusion: Even given the somewhat low earnings in work settings, there is a clear movement towards community settings highlighted by a strong emphasis in the education world on the inclusion of students with disabilities in regular school settings. This was closely paralleled by the movement of individuals from institutions into community living alternatives and more recently the growing emphasis upon home ownership for persons with disabilities. Large scale institutions, over the past 20 years, have come under continuous assault from civil rights groups and researchers regarding their inability to provide adequate and humane services and supports for persons with disabilities. Alternative community living arrangements, such as group homes and cooperative apartments, emerged in the past 20 years and have demonstrated the capacity of persons with disabilities to live successfully in community settings. More recently, there is growing recognition that group homes are limiting in their basic design with cooperative apartments, shared living arrangements, and home ownership providing a much wider range of flexible options for persons with disabilities. The movement from large, segregated, and isolated residential arrangements, such as the institution, into integrated community settings and home ownership is a movement that is well underway. Similar to the community living movement, the movement of individuals from segregated day and employment services to real work settings reflects a significant paradigm shift highlighted by the advent of supported employment and the growing recognition that with specific job training strategies onsite, job modification, and job accommodation there can be an increased match between individual skills and job requirements. The use of onsite training through the role of the job coach has further supported the movement of persons with disabilities into regular jobs. The growing recognition of the need to move people with disabilities from segregated to integrated employment settings has been highlighted by supported employment efforts as well as research demonstrating that individualized and tailored employment settings can accommodate persons with even the most significant disabilities. Strong emphasis has been placed on a conversion of segregated work and non-work settings to integrated employment settings and the redirection of resources to support more aggressive integrated employment options for persons with disabilities Current Issues While there are clearly some trends toward increased consumer direction and consumer control of services and supports and the recognition that there needs to be a more effective and efficient employment and training effort for individuals with disabilities, there are a number of issues that emerge as we seek to move more toward the tenants of the Workforce Investment Act and its call for universal access, streamlined services, increased accountability, employment and increased state and local flexibility. The legislation of a more seamless service system does not necessarily mean that such a system will be immediately initiated but rather that this will be the goal for any reorganization of employment and training services in the coming years. As the effort to reconfigure services and supports gains momentum there are some issues that are emerging including those that reflect a lack of clear goals and a resurgence of territorial behaviors within various service systems. Some of the key issues include; (1) a need for job ad role clarification (not my job syndrome), (2) a concern about agency budgets and limited resources (debates as to which dollar will be the first dollar in), (3) a concern about accountability to the administration and legislative branches that allocate resources (who gets the credit) and finally (4) a lack of clarity as to how ongoing assistance can be made available to those who may need such assistance (if not on a permanent basis, on an episodic basis). a. Not my job: With any reorganization there is bound to be some confusion about roles. One has to only consider the major shift in the Nation’s perspectives on welfare and the calls for reform of the cash supports of the welfare system. There was a clear shift in the focus on dependence to independence and work as the major welfare reform initiative at the state and federal levels rolled out. The concept of getting people off the rolls meant that the welfare system and its employees, experienced in dispensing money and resources, would now be involved in employment supports and life supports. The staff were not experienced in this area and thus were not sure what their new functions were to be, many feeling that this was not the role that they had initially signed up to perform. As in the case of the welfare staff who were now being asked to do another type of job, so also has there been a shift in the role of the One Stop Career Center staff. For these staff there was a knowledge base in employment and training but a lack of experience in serving all job seekers, including those who have a disability. This lack of skills tended to be played out in the scenario where, when a potential job seekers would appear at the One Stop, if there was an apparent disability or the reporting of a disability there was an immediate referral to the public Vocational Rehabilitation agency. In this instances as well as with the welfare worker many of the One Stop staff may feel that employment of individuals with disabilities is not their job but that there are ‘specialists’ trained to do this work. The intent of the WIA legislation was not to set up a parallel system of employment and training but rather to set up a comprehensive system that would be able to address the needs of all job seekers. If such a system is to be successful, then there must be a concerted effort to retrain existing staff, clarify roles of staff, expand on key duties of soon to be hired staff and develop technical resources that can assist these staff in responding to all job seekers. Similar to the movement in education to have dual certification where an educator is prepared to educate all children so also is there a need to increase the skills of all employees so that the call ‘not in my job description’ moves to the call ‘can some one give me some advise on this situation’. b. First dollar in; As resources become more scares, the recognition of the need for greater coordination becomes more apparent. In times of ample resources, often the solution to a problem is the identification of new money or new positions. In more limited resource times this is not an option and thus there has to be serious rethinking of how limited resources are allocated. It is in these times that we see more of a call for role clarification and reduction in duplication of effort. It is also in limited fiscal times that there is more of a tendency to be reluctant to allocate resources first but rather to hope that there is another pool of money that might be available to support the individual. With the adoption of a ‘no first dollar in’ strategy, the focus on the individual and the need for more flexibility often disappears. The concept of shared resources and the use of resource mapping strategies can assist agencies in stretching their resources toward a shared goal. The retrenchment to a ‘no first dollar in’ strategy is one that leads to greater segregation of resources and less collaboration around individual consumer needs. c. Who gets the count: Coupled with the dilemma of first dollar in is also the debate as to who gets the credit for the success of the service. In some instances there is an overlap in service delivery particularly for those who have more significant disabilities. It is not uncommon for individuals with disabilities to be known and served by three or more agencies at the state level. Often each of these agencies has a different mandate and thus while there my not be a direct overlap in the actual service delivery, there may be an overlap in the role or assignment of case managers or clinical program staff. The concerns about who gets the count is a reflection of the movement of the system from process to outcome and the documentation of the impact of the money spent upon the obtaining of a true outcome. In the area of employment the simplified measures of job obtained, earnings realized and benefits awarded are easy to measure. Measures of consumer satisfaction, increased levels of independence and changes in social networks are more difficult to document. The debate about over counting and duplicate counting would not be a debate if the systems were able to agree upon shared outcomes measures to be collected and reported. While a relatively easy concept to articulate, it is much more difficult to implement. Many agencies have varying legislative mandates for eligibility determination, range and scope of services to be offered and types of resources that can be purchased. Some states are moving toward a shared data reporting system that will clarify overall outcomes but may not link the obtaining of the outcome directly to a single agency. The need to develop a more uniform data collection and reporting effort is obvious. The long term impact of all human services must be linked to the individual, his or her preferences, interests and support needs. Measures of quality of life and service outcomes are now emerging but have generally not been applied statewide and across agencies. If such a measurement system is to be developed, then the debate about who gets the credit will be secondary with levels of satisfaction and independence being more accurate measures of impact at a system as well as an individual level. d. What about the long haul: Many agencies and programs, particularly as it relates to employment, are there for the initial effort but not for the long haul. Often the period of service delivery is in the initial phases of employment identification and job development as well as the job training but is terminated once the individual masters the skills of a specific job. While this approach works in the early stages of job development, it offers little support for the individual who is interested in changing jobs and may need some assistance as well as for those who have recently been separated from a job and need replacement assistance. Often issues of reapplication or redetermination of eligibility arise and the time between jobs can become significant. The long haul investment also recognizes the need to support the individual in other than the job. For some the need for ongoing assistance in the areas of community living, social and recreational options and transportation are essential to managing a level of independence. The more recent concept expressed in the Ticket to Work with the strategy of easy on and easy off may be important here. A more viable concept is one of ongoing eligibility where success is not defined as closure but increasing levels of independence and economic self sufficiency. An individual may remain eligible indefinitely but only need services at times of change or crisis. If those services were available immediately, it is quite possible that long term unemployment can be averted and there can be a better argument made to the individual with disabilities that entry into work does not mean the end but rather the beginning of supports and services. While the above four issues can reflect some of the concerns from a systemic perspective, they also reflect some of the concerns that an individual may have as he or she attempts to navigate the complex adult human service system. The following section outlines some of the strategies for change that have been raised by those charged with supporting individuals with disabilities in seeking and obtaining employment. Strategies for Change Given all of the national trends and the concerns at the local or practitioner levels are there any clear messages that are emerging that could facilitate the needed systemic change. A series of focus groups with federal and state representatives was conducted by the Institute for Community Inclusion as a part of the work scope that the ICI with the Presidential Task Force for the Employment of Individuals with Disabilities. It was the intent of this effort to see if there were some common threads across a series of state agencies that could emerge as we go toward a more streamlined and efficient system for supporting the employment of individuals with disabilities. A series of recommendations emerged as a result of this research effort. These recommendations were organized into 8 themes that emerged during the interviews: 1. Expand Individual Control of Resources and Planning (Use a Person-Centered Approach): ‘People should be funded, not slots’ (Community rehabilitation provider). This theme captured a consistent concern that there needs to be increased focus on individual preferences and priorities. Recommendations included providing individuals with more direct control over the resources, improving planning processes, and emphasizing long term career development. 2. Improve opportunities for creativity and flexibility: Informants talked about a need to increase creativity and flexibility throughout the entire system for policy setting at the national, state, and local levels. The overall emphasis was on thinking outside the box including supports for flexible work schedules, entrepreneurial and small business opportunities, and creatively merging employment and residential supports. 3. Simplify system: ‘So, instead of states spending a lot of time, energy, and trouble with waivers, Medicaid should adopt changes that we know improve employment programs’ (VR Commissioner). ‘[You should not be] forced to prove that you cannot work at all in order to receive benefits’ (family member), Much of the discussion focused on the complexity of the social security system. There is broad agreement that there is a continuing perception that it is too risky or not cost-effective to work for SSI/SSDI recipients. Service providers, state agency staff, and people with disabilities have difficulty wading through the work incentive options and the implications of work on benefits. Key informants stated that people with disabilities were too fearful of venturing into work incentive options not only due to fear of health insurance loss but due to confusion and misinformation. 4. Advance the use of technology, accommodations, and modifications: ‘The system is going to have to figure out how to get people transportation’ (VR Commissioner). The issue of access to technology was a major theme. Individuals have limited access to assistive technology, durable medical equipment, and communication devices that are essential for their jobs. Informants also expressed routine concern for accessible transportation as a major barrier to employment. 5. Align resource distribution with priorities: Federal policies need to actively encourage states to expand employment options (MR/DD Agency Administrator). ‘Sheltered work should not be an option for anyone’ (Community rehabilitation provider). Informants discussed a variety of ways that state and federal policy provide inconsistent messages to individuals and service providers about service priorities. These include the expanding role of Medicaid funding, varying funding rates and structures across services, and the ways that states collect and share data about service outcomes. Concern was also expressed across the stakeholder groups about system investment in sheltered employment services. 6. Expand public and private partnerships: ‘How can the federal government influence businesses to open up to people with disabilities?’ (VR Commissioner). ‘There is a need for proactive development of employment opportunities on a systems level’ (MR/DD Administrator). Some informants discussed the need to expand outreach to and partnerships with the business and labor community. One informant expanded on this theme by addressing the need to change broader community attitudes through national outreach and marketing strategies in partnership with generic resources such as national media. 7. Improve services to unserved and under-served populations: Key informants were concerned about several populations that they felt were under-served or unserved. These included people with traumatic brain injury (TBI), transition aged youth with emotional and behavioral disabilities, people with persistent and severe psychiatric disabilities, and transition aged youth that graduate at age 18. 8. Improve collaboration at the federal, state, and local levels: ‘Access to the VR system, labor, and one-stop centers is negligible for people with the most severe disabilities’ (MR/DD Agency Administrator). ‘I can’t get follow-along funding for someone who has been in (Medicaid Funded) day habilitation’ (Community rehabilitation provider). Collaboration as a theme emerged across several policy issues. Respondents expressed considerable frustration that the federal entities writing reforms, such as welfare, workforce improvement, and work incentives were inconsistent about mission, the role of employment in the lives of people with disabilities, and programmatic requirements for serving people with disabilities. Similar concerns were echoed at the state level. Collaboration between state agencies including Vocational Rehabilitation, Mental Retardation and Developmental Disabilities, and Mental Health agencies was identified as a strategy for developing more individualized and holistic services. Systems Redirection The redirection of the adult service system will require a concerted effort by administrators, policy makers and local providers and investment by family members, advocates and individuals with disabilities to assure that this new system does in fact serve all individuals. Some of the elements of system redirection include: a. Special to Generic; As there is an increased interest in assisting individuals with disabilities in accessing typical community services and settings there must also be an effort to increase the effectiveness and access to the generic support systems addressing employment, community living and recreation. The trends are clearly to move away from the sole reliance on the ‘specialist’ to provide services to individuals with disabilities. In local schools there is a return to full inclusion where educators are educating all students and the special resources serve as a technical resource to the classroom teacher. This same trend is happening in the adult service system with the passage of WIA and the recognition that the generic employment and training services, the One Stop Career Center, can offer services to all job seekers. Just as in the case of the full inclusion in schools, the specialist is a resource to the staff of the One Stops and supports the staff in serving and addressing the needs of job seekers with disabilities. The model of specialist as resource to other generic employment and training staff has been at the core of those One Stop Career Centers that have been able to expand their scope of service to all job seekers. This transition from special to generic will not happen suddenly but over time when there is significant efforts at training of staff and the redefinition of roles of professionals and other support staff in the employment and training system, the public Vocational Rehabilitation system and the local school systems. b. Group to Individual: The determination of eligibility in many agencies is based upon the presence of a diagnostic label rather than a functional need. The use of these diagnostic labels serves to reinforce the concept of separate and different. For some individuals who have certain conditions it is possible that selected approaches may be more effective but for many individual with disabilities the supports offered to individuals with and without disabilities may be more similar than different. The lessons learned through the countless supported employment demonstration projects have shown that approaches that offer training in a relevant context, use of multi-stimulus input and foster involvement of typical colleagues in the work setting have all shown that the focus on the individual is more effective. The adoption of strategies such as person centered planning and consumer directed services mandates that the focus be upon the individual and not the collection of persons who may have a similar diagnosis or condition. The emphasis on the individual is supported through the use of planning processes that focus on the person, his or her preferences and the skills that the individual has rather than the limitations. c. Focused to Broad: The recognition of the need to focus upon the whole person has been reinforced with the many experience of the welfare reform activities at the individual state levels. The need for a job while essential to increasing the level of economic self sufficiency must be coupled with the need for living, transportation, family supports and health care. To address employment solely will not be sufficient to facilitate the entry and maintenance in a job for most individuals. The recognition of the needs of the whole person are apparent through the activities of such planning efforts as person centered planning and wraparound services and supports. The development of a structure that offers resource management and brokerage functions for individuals with disabilities is emerging. The approaches appear to offer some considerable opportunity to develop a true wraparound supports structure for the individual with a disability. The approach calls for shared responsibility, collaborative funding and joint program development. d. Targeted to Continuous: Historically the employment and training services of both the generic and disability focused services were targeted toward job access and initial placement. More recently there is a growing interest in developing services and supports that are continuous and ongoing. Continuous services are not meant to be at the same level day in and day out but rather to be available, so that when the need arises the services and supports are available. The concept of continuous can be viewed by some as entitlement rather than eligibility. The concept of continuous should be view rather as the ultimate easy on off scenario where the individual is supported to reach a high level of economic self sufficiency but not necessarily required to exit a program or service. e. Process to Outcome: The collection of data on employment outcomes has been sketchy at best. The public Vocational Rehabilitation System has for many years collected information through their RSA 911 annual data collection activities. State Mental Retardation agencies collect data on employment outcomes but this is only aggregated through the activities of the Institute for Community Inclusion through an every other year data collection effort with state MR/DD agencies. For the state Mental Health agencies most continue to feel that employment outcomes are not their responsibility but rather that of VR or the One Stops. In most cases the data that are collected outside of the RSA 911 and the ICI data collection are process data. Many states can tell how many individuals are being served in a program option or prototype but few can tell you the outcomes realized by either the individual or the program. There is a move to establish outcome based data collection efforts that will document individual achievement as well as increased levels of consumer satisfaction. While these effort are early in their development, they offer some promise to moving away from process measures (how many are where) to outcomes (earnings, satisfaction and levels of independence) Challenges If the adult service system is to live up to its promise of universal access, seamless service delivery, increased flexibility and consumer focused supports, then there are a number of challenges that will need to be addressed. Many of these are not new but have existed for many years. These include but are not limited to the following: a. Shared Mission and Focus: There is clearly a need to have agencies and programs have at least a sense of shared mission if not a common mission with a recognition that employment and service integration are critical elements. As it presently stands there is no national policy on employment. There are mandates from the Presidential Task Force on Employment of Adults with Disabilities that call for a clear and unambiguous message that employment is the outcome of preference for all individuals with disabilities. Unfortunately, there is yet to be concurrence on this issue. The passage of several pieces of national legislation and the development of systems such and the One Stop Career Centers all call for a consistent message that employment is the goal for all. Employment was at the crux of the welfare reform effort nationally. We need to have not only our mandates but our perceptions embrace employment as both a realistic and desirable goal for individual with disabilities. b. Coordination of Resources: In this time of shrinking resources there is a more significant need to reduce duplication and streamline services. The recognition of multiple enrollment into state programs by individuals with disabilities mandates the need to revise the current case management system. Overlapping case managers often serve to complicate rather than to streamline the execution of person centered plans for individuals with disabilities. The coordination of resource requires that a more integrated service system that has fewer hoops to jump through, is clearer to the consumer and leads to better outcomes be developed. Simply merging agencies or entities will not be the answer. There must be a clear rethinking of agency missions and a redesign of the core goals and objectives if we are to see a more efficient and effective service system emerge. The call for reform for reform's sake will not lead to better services. The call for reform that provides universal access, streamlined services, more flexible in use of resources and more individually designed supports will lead to real change. c. Uniform Data Reporting: As we design a new system of services and supports we must also consider a new way of documenting outcomes and impacts. The need for uniform data collection and a way of reporting outcomes linked to program practices is not new. The time has come for a clear way of measuring outcomes across agencies. With a lack of coherence in agency missions the development of shared data sets is considerably more challenging and some may say impossible. This challenge is not one of eliminating all the various data collection efforts underway but rather a call to develop some simple data elements that can be tracked at the local, state an national level that will offer policy makers, program managers and researchers some way of evaluating effectiveness and replicating practices that work. d. Continuous Supports Eligibility: Short of entitlement to services, there is a need to have some way of assuring that individuals with disabilities who enter employment can, when necessary, receive assistance in times of crisis or change. The concepts of continuous supports implies immediate and ongoing. This should be viewed not as a guaranteed level of support but rather a form of insurance, or a guarantee that the necessary supports will be available immediate and will be of such a level to be able to assist the individual in addressing a problem or issue. Summary The challenge of developing a seamless, integrated service system for adults with disabilities in the employment and training arena is significant. The mandates of the Workforce Investment Act and the tenants of Olmstead have defined both the nature of the relationship, accessing the generic employment and training service as well as the setting, real and not segregated or sub-minimum wage jobs for all job seekers with disabilities. The call for a more inclusive and integrated system also calls for a new way of doing business one that supports flexibility in the allocation of resources, focuses on the individual and links services and resources around accomplishment of the goals and objectives of a persons centered plan. References Butterworth, J, Gilmore, D, Kiernan WE & Schalock RL (1999). State trends in employment services for people with developmental disabilities. Boston: Institute for Community Inclusion (UAP), Children’s Hospital. Whitney-Thomas, J., Thomas D.M., Gilmore, D.S. McNally, L.C., Fesko, S.L. (1993). National study of day and vocational services for adults with developmental disabilities in state Mental Health Agencies: Report of data from 1993. Boston: Institute for Community Inclusion (UAP), Children’s Hospital. Butterworth, J, Gilmore, D, Kiernan WE & Schalock RL (2000). State trends in employment services for people with developmental disabilities: Preliminary Findings. Boston: Institute for Community Inclusion (UAP), Children’s Hospital. McGaughey, M., Kiernan, W. E., McNally, L., Gilmore, D., & Keith, G. (1996). Beyond the workshop: National trends in integrated and segregated day and employment services. Journal of the Association for Persons with Severe Handicaps, 20(4), 270-285 Burkhauser, R.V., Daly, M.C., & Houtenville, A.J.C. (1999). How working age people with disabilities fared over the 1990’s business cycle. Ithica, NY: Cornell University, Rehabilitation Research and Training Center for Economic Research on Employment Policy for Persons with Disabilities Houtenville, A.J.C. (2001). Disability and employment in the USA: National overview based on 2000 Census. Ithica, NY: Cornell University, Rehabilitation Research and Training Center for Economic Research on Employment Policy for Persons with Disabilities