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
Effective Rural Vocational Rehabilitation Job Development - A State of the Science Event by RTC:Rural
1. Information for Participants/Attendees:
We will begin the webinar at the top of the hour.
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
submit 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:
Call in: 1-800-832-0736
Passcode: 7785002#
2.
3. Catherine Ipsen, Ph.D.
Director of Employment Research
Research and Training Center on Disability in
Rural Communities (RTC:Rural)
Associate Director
Rural Institute for Inclusive Communities
University of Montana
Catherine.Ipsen@mso.umt.edu
(406) 243-4562
4. Agenda
RTC:Rural Research
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 Disability Disability
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-Core Counties
Employment
Rate
Unemployment
Rate
Not in 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
Met their goals 35% (n = 58)
Personal reasons 30% (n = 49)
Dissatisfied with 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 Goals 28% 72%
Dissatisfied with
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 Services 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)
Delivery Model Blind /
Low Vision
(n = 12)
Combined /
General
(n = 38)
Internal n = 6; 50% n = 7; 18%
Performance-based
benchmarking
n = 4; 33% n = 22; 58%
Fee-for-service or 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 Rural Case Mix
(n = 38; General and Combines Caseloads)
Isolated Rural Small and
Isolated Rural
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”
Alisia McKinlay, 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
32. Susan Foley, Ph.D.
Senior Research Fellow
Institute for Community Inclusion
University of Massachusetts, Boston
Susan.Foley@umb.edu
33. Questions?
Research and Training Center
on Disability in Rural Communities
http://rtc.ruralinstitute.umt.edu
Catherine Ipsen, Ph.D.
University of Montana
Catherine.Ipsen@mso.umt.edu
(406) 243-4562
34. Thank You!
Research and Training Center
on Disability in Rural Communities
http://rtc.ruralinstitute.umt.edu
Catherine Ipsen, Ph.D.
University of Montana
Catherine.Ipsen@mso.umt.edu
(406) 243-4562