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2010 Feature: A Job PERC

Rehab Psych Team Promotes The Wisconsin Idea for Adults with Disabilities

Sheltered employment has often become the default for many Wisconsin adults with disabilities who have a right to integrated, community-based employment.

Care managers who lack training in job development or access to job developers often refer clients to sheltered workshops as the only apparent option in their community.

Across the state, service providers lack access to common evidence-based practices and other information that has kept them from increasing integrated employment opportunities for their adult clients.

“We want to give clients with disabilities true choice for employment outcomes… They have not historically been provided with choice,” said Professor and Chair David Rosenthal.

Rosenthal, Professor Fong Chan and a team of students are leading the research arm of a new project designed to deliver training, technical assistance and other resources to Wisconsin’s long-term managed care and other service providers. The project was conceived and developed from a concept paper that Chan wrote.

With a three-year, multi-million dollar Medicaid Infrastructure Grant, the UW-Madison RPSE Department, UW-Stout Vocational Rehabilitation Institute, Employment Resources, Inc. and the Wisconsin Department of Health Services have been working to develop the Paths to Employment Resource Center (PERC).

PERC is designed to be a web-based platform to facilitate communication and resource sharing among stakeholders and to offer professional development for the state’s service providers. Project leaders aim to roll out PERC as a sustainable entity with external funding by late 2011, when the MIG grant cycle ends.

The project is an extension of DHS’s Pathways Projects – an initiative with a history of promoting innovative, person-centered employment opportunities for clients of Wisconsin’s long-term managed care system.

PERC aims to support integrated employment in community-based, minimally minimum wage positions that meet individuals’ needs and interests, and provide achievable alternatives to sheltered employment.

Project leaders want to equip more service providers with the knowledge necessary to make community employment the default option for their clients. At the same time, they want to offer evidence that supports customized employment options as the next step in improving the lives of people with disabilities.

“This is a systems-change initiative with two long-term goals – sustainability beyond MIG funds and actually having enduring system change in vocational outcomes for people with significant disabilities,” Rosenthal said.

Rehab Psych TeamDHS leaders invited Rosenthal and Chan to join the project. Their research team includes Ellie Hartman of UW-Stout, graduate students Cayte Anderson, Chia-Chiang Wang, Connie Sung, Emma Hiatt and administrative student assistant Jason Brooks. (All are seen here except Brooks)

“I felt we needed to be the face of the project,” said Rosenthal, explaining that, in addition to enhancing the Department’s research mission, it provides both graduate student funding and a valuable community service. “We are helping facilitate research that pertains to best practice evidence, which informs the training module.”

The research included 20 focus groups involving school transition specialists, representatives from the state departments of Public Instruction and Workforce Development, managed-care organizations, community rehabilitation programs, Aging and Rehabilitation Resource Centers and other stakeholders.

Participants reported they had difficulty navigating between organizations in the current service delivery system and the organizations had difficulty communicating among themselves due to inconsistent information, Rosenthal said.

Based on the findings, the project team identified two main areas for improvement – providing practitioners with job development and placement training with emphasis on employer needs and perceptions, and integrating systems to enable providers and consumers to better navigate among agencies.

“What we’re hearing from focus groups… is that the need is overwhelming,” said Anderson, a graduate student who has worked for Pathways since 2002 and co-facilitated the PERC focus groups. “(Participants said) that there aren’t enough job developers or people they can bring into the team process – people who specialize in helping people find jobs – there aren’t enough of those folks out there to meet the need.”

Case managers without job development training do what they can, but large case loads and a lack of networking hinder their ability to offer clients a variety of employment options, Anderson said.

“There’s a lot of people who want to work and sometimes the case managers aren’t quite sure where to start,” she said. “But they are resourceful… (if a client wants to work), they will really go to the Nth degree to try to hook them up.”

Many focus group participants reported a general lack of understanding among providers about what other system partners do, Anderson said.

For example, care managers might not be familiar with the roles of information and assistance staff, who in turn might not understand what the Division of Vocational Rehabilitation does.

“We did hear from a number of people who are out there in the trenches day in and day out who said it would be really helpful to have a place to go to get consistent, reliable, trustworthy information,” she said.

Agencies and organizations compile a lot of data locally – reports on what works and what doesn’t – but the information isn’t necessarily collected into a system-wide clearinghouse, Anderson said.

PERC developers want to address that by building in resources for service providers and other stakeholders and by incorporating online courses for continuing education credits, which providers also requested.

“The challenge was that we had a hodge-podge approach, so what we’re trying to do is create a streamlined, responsive, proactive training and educational learning environment … so we don’t have a wild disparity between one county and another,” Anderson said.

Before PERC, people working on Pathways Projects lacked a central research engine to evaluate the system, to measure stakeholders’ knowledge about employment services and opportunities, and to provide access to research findings.

As the UW-Stout team works on PERC’s professional development and distance-learning components, the UW-Madison team is compiling best practices based on research applied to practice, as well as practices validated by research.

An important part of the PERC research program is to scaffold supported employment and compile evidence that supports the expansion of customized employment.

Sung, a graduate student who has been reviewing the literature and analyzing focus group data, said that the team found an information gap between clinicians and researchers.

“We have to see what ways we can translate the research to the clinician and vice versa,” Sung said. “What we are trying to do is close the gap.”

Previous research that hadn’t been aggregated produced findings that were controversial and weren’t necessarily applicable across environments, she said.

The research team needs to make associations among various studies to identify which services and treatments are valid for similar communities, people with similar disabilities, and so on, Sung said.

The team plans to produce summaries that clinicians can use in daily practice, meta-analyses for rehabilitation scholars and other leaders in the field, and ongoing program evaluation reports.

“We want to build ourselves up as role model in this state so other states can reference us,” Sung said. “We want to create a reference model for our field… it’s really a challenge.”

Project members agree that PERC’s greatest value will be its comprehensive offerings that allow users – regardless of role or location – access to relevant, useful information that supports successful, community-based employment for people with disabilities.

“If you just read from books, you can’t really know the full picture,” Sung said. “With on-the-ground project work like PERC, you get to see the bigger picture.”