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Peoria Workforce Action Grant:
Policy and Systemic Influence
Grant number, name, and location: Workforce Action Grant, Peoria IL, #E-9-4-2-0115
Grant recipient: Human Service Center
Project lead: Human Service Center
Subcontractors: City of Peoria Workforce Network and Northwestern Center for Psychiatric Rehabilitation
- The project created a formal joint initiative ("A Brand New Day") between the Division of Mental Health and Division of Rehabilitation Services that includes the expansion of the IPS model across Illinois. Coordinated efforts to try to identify funding for more employment-related services for individuals with mental illness are under way.
- In order to achieve systems change in employment services for individuals with significant mental health needs, it is necessary to focus on employment as the expected outcome, have clear outcomes across systems, and build funding systems that support these outcomes.
- Grant-funded initiatives have provided seed money to replicate the Individual Placement and Support model in other parts of the state based on the collaborative model developed in Peoria.
- State policies regarding Medicaid rules, which limit earned income to residents of long-term facilities and efforts to try to bill employment services under Medicaid, continue to be barriers to employment for some individuals.
Individual Placement and Support Model
The Peoria project was used as a model for a new joint initiative of the Illinois Division of Mental Health (DMH) and the Illinois Division of Rehabilitation Services (DRS) termed "A Brand New Day." Historically there was a significant gap between the services of these two divisions, particularly at the local level. The initiative was a new effort to collaborate in serving individuals with mental illness. On May 21, 2004, a statewide videoconference was held for DRS, DMH, and providers. The Peoria Supported Employment project (SEP) was featured as an example of what can be accomplished when multiple agencies collaborate to assist an individual with serious mental illness.
After this videoconference, DRS committed to funding a series of four trainings (with related consultation) on the Individual Placement and Support (IPS) model to expand those practices in Illinois. The Human Service Center and the Center for Psychiatric Rehabilitation worked with DRS to develop and provide components of the training. DMH identified the need to find funding to continue the project when Department of Labor funds end. The state was interested in expanding the model to other communities.
The National Center on Workforce and Disability/Adult (NCWD/A) provided consultation to DMH and DRS around funding strategies to increase employment outcomes for individuals with mental illness. The recommendations (click here for more information) included:
- Clearly define outcome expectations and create funding patterns that support those outcome goals for individuals and providers.
- The supported employment financing processes should be made less complex and easier to navigate for all involved.
- DMH and providers in its system should reinforce the principle of employment as a desired and expected outcome for the total mental health system.
The state began replicating this project. Trying to influence the state provider system, the project hosted three different mental health centers at their site to learn the IPS model and how to implement it in their own agency. The project trainers and researchers with Northwestern University Healthcare (moved from University of Chicago Center for Psychiatric Rehabilitation) implemented their own IPS model. In May 2005 Illinois was awarded the Johnson and Johnson Foundation grant to expand the IPS model across the state. The new grant proposed to look at a cost model to help identify state money for funding supportive employment services. The goal was to provide a funding stream for the IPS model. The cost model had to be developed by July 2006, at which point three new mental health centers would be selected to develop the model across the state.
A second grant to assist the state in implementing the IPS model was approved by the National Institute of Mental Health and Substance Abuse and Mental Health Services Administration. This was a one-year grant to develop a plan for further dissemination of the IPS model. The Human Service Center was a subcontractor on this grant, with the role of developing an instrument to measure the implementation of IPS within other mental health centers. They planned to write a subsequent proposal for a multi-year implementation project.
Information-Sharing with Policy Makers
David Leitch, a local state representative from Peoria, was the lead mental health expert for the House Human Services Appropriation Committee. The project director and the National Alliance on Mental Illness project advisory committee participants met with him on numerous occasions to discuss local mental health planning, SEP activities, and benefits of employment for individuals with serious mental illness.
The U.S. House representative Ray LaHood was kept informed about the project via his chief of staff, who was on the Human Service Center board of directors and received reports regarding the initiative.
Addressing Systemic Disincentives to Work
Approximately 250 individuals with serious mental illness resided in long-term care facilities in the Peoria area. One focus of the Peoria SEP project was to assist these individuals in obtaining competitive employment. Within months of its start, the project discovered that Illinois had a Medicaid rule that limited earned income to $55/month for residents of long-term care facilities. Any excess income must be turned over to the long-term care facility to offset the state's Medicaid payments. This was a major barrier to motivating individuals in these settings to work.
The project worked with the administrators from the Illinois mental health and public aid departments to identify a solution, but did not have any real success. In conjunction with the local Center for Independent Living, a strategy was developed to move persons who find work from the care facility to one of the Human Service Center's residential programs. This constituted a transitional residential placement, which allowed the person to develop savings and then obtain independent living. The project also connected with the National Conference of State Legislatures to explore the rules and policies in other states, which could help educate policy makers in Illinois. The Illinois House passed a resolution in June 2003 requiring a study of the income limits for nursing home residents. Unfortunately, to date no action has been taken by the Illinois Dept. of Public Aid towards this study. In addition, the project director met with a staff member in charge of disability issues for the Illinois Attorney General to discuss Olmstead and the impact of the Medicaid earned income policy.
Initially, Medicaid funds were used to pay for some employment support services for individuals. However, concerns from the state Medicaid authority resulted in a discontinuation of this policy. In Illinois, historically Medicaid did not fund employment services as they did not meet the "medically necessary" criterion. For a period of time, the grant functioned as the catalyst and testing site for potential revisions in the Illinois Medicaid program under the rehabilitation option. The grant aimed to demonstrate how IPS vocational services provided to individuals with serious mental illness were critical to an individual's recovery process. They hoped that revisions to the Medicaid service descriptions under the rehabilitation option would be considered. This would allow services necessary for recovery to be incorporated into the mix of Medicaid allowable services.
Due to continued confusion over what constituted billable services, and clear understanding from the state that they would examine any bills for services such as assessment and case management more closely, the project decided to discontinue billing any services under the Medicaid Rehabilitation option. The project planned to resume billing some services when there was a clear definition from the state on what constitutes a billable service.
In the beginning of the grant, the Human Services Center accessed the DRS Benefits Planning, Assistance and Outreach (BPAO) project to train project staff. The BPAO provided in-depth information on the impact of earned income and assets on SSI/SSDI benefits and Medicare and Medicaid health insurance. SEP staff were also taught how to complete the necessary Social Security intake forms and releases, including the Benefits Planning Query. This process captured all necessary information to complete an individual analysis of planned employment income benefits. The project had an agreement with the BPAO project to fax the forms directly to them, whose staff promptly conducted the analysis for rapid turnaround time. The information was then provided to the individual and the supported employment job coach who could explain the results on an ongoing basis and use the information as part of the motivational interviewing process with individuals. This interviewing process helped consumers explore their vocational goals based on a stages-of-change theory.
In April 2004, the Human Services Center contracted with the DRS BPAO project to house a half-time benefits specialist to provide benefits analyses locally to individuals. This individual spent mornings in the One-Stop Career Center, accessible to all that needed the service. The closest full-time benefits specialist was located in Springfield IL, 75 miles from Peoria. This distance made it extremely difficult to coordinate services and schedule appointments. To date, the Human Service Center is the only entity known to have entered into such an agreement with the BPAO projects in the country. The partnership was featured in a Best Practice Report from Cornell University in February 2005.
There continued to be a mutual relationship between the project and the Local Workforce Investment Board and One-Stop. The board's division manager belonged to the project advisory committee. The project ran two job clubs on-site at the One-Stop and provided mental health awareness training and orientation to supported employment for all One-Stop staff. The Peoria Workforce Development Network added some additional services at the One-Stop specifically to increase services to individuals with serious mental illness. They included a mutual support and problem-solving group for individuals who have obtained employment, mock interviews with One-Stop staff, and software packages that assisted individuals with reading, writing, and basic computer software skills. The SEP project identified this need for individuals they served.
Project staff also attended the Workforce Network Committee, a monthly meeting of the board and One-Stop directors and partner organizations. As noted above, the part-time benefits specialist contracted between DRS and the Human Service Center spent mornings at the One-Stop conducting analyses for individuals with disabilities from the local community, including those served by the SEP project.