Lessons Learned From the Provision and Funding of Employment Services for the MR/DD Population

Abstract

The goal of Ticket to Work is to support job acquisition and job retention among Social Security Administration (SSA) disability beneficiaries in job situations where earnings are sufficient to move these individuals off SSA disability cash benefits. This article considers the adequacy of provider payment incentives through the Ticket to Work for helping persons with mental retardation/developmental disabilities (MR/DD) achieve employment outcomes. It examines the work support strategies that have demonstrated their effectiveness in assisting persons with MR/DD acquire and retain employment, particularly with SSI and SSDI recipients. It analyzes the experience to date in using performance-based funding to purchase job acquisition and retention services, and the implications of this experience for the implementation of the Ticket to Work reforms. Specific areas related to the Ticket to Work addressed in the article include: the ceilings on current proposed milestone-outcome and outcome payments in the Ticket compared to what is known about providers' cost structures in other performance-based funding systems; and the factors likely to influence the decision-making of Employment Networks in accepting or rejecting Tickets. The article concludes with recommendations for restructuring the Ticket to Work to improve the adequacy of access to the Ticket program for SSI/SSDI recipients who are potentially viewed by Employment Networks as highly challenged in achieving an employment outcome.

Vocational rehabilitation services and employment outcomes for adults with cerebral palsy in the United States

“…According to Shrey et al., fewer than one per cent of SSDI beneficiaries stopped receiving SSDI when provided with vocational rehabilitation services. Legislative efforts such as the Ticket to Work and Work Incentive Improvement Act of 1999, which provide social security beneficiaries incentives and supports, are needed to prepare for, attach to, or advance in work . At present, SSI and/or SSDI recipients are now permitted to work for longer periods of time with less reduction of financial and medical benefits .…”

Security versus instability in special work centers in Spain

“…The author attributes this to the fact that, in most countries, training and social support are provided to improve the skills and safety of workers in sheltered workshops, not as a preparation for ordinary employment. Wehman and Revell (2005) note that although the Americans with Disabilities Act (ADA) has fostered the competitive employment of people with disabilities, including people with mental retardation/developmental disabilities, the real impact of this growth in employment outcomes is relatively small compared to the total number of people with disabilities in non-integrated work or sheltered employment. Migliore et al (2008) find a preference for integrated employment.…”

Evaluation of an employment program for people with mental illness using the Supported Employment Fidelity Scale

“…The supported employment (SE) model, referred to in Australia as ‘open’ and ‘competitive’ employment, has a long history in the disability field, with over 20 years of development in many countries, particularly the US (Cain, 2005; Wehman & Bricout, 1999; Wehman & Revell, 2005). In Australia, the Commonwealth Disability Services Act (1986) established the legislative foundation for the funding of this model.…”