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j. 1. A. With the most significant disabilities, including their need for supported employment services;

Current Narrative:

It has been two years since ADRS completed its last Comprehensive Statewide Needs assessment. The timeline of the 2020 State Plan did not provide the opportunity for a newly completed comprehensive assessment, however, Local Stakeholder Input Meetings were recently completed within each of Alabama’s seven workforce regions in the fall of 2019.  These public forums were conducted by Governor’s office staff and were well attended by members of Alabama’s disability community.  From these meetings, seven key areas of need emerged:
•    Improved access to public transportation, especially in rural areas, would broaden access to opportunity;
•    Better availability of quality childcare would, for those with young families, remove barriers and disincentives to labor force participation;
•    Greater ADA compliance and disability accommodations would enable more individuals to enter and sustain employment;
•    Greater access to technology including broadband access in rural areas would open doors to participation in training and employment;
•    Enhancements in quality and equity in education and training opportunities;
•    Improved coordination and accountability among Workforce System service providers; and
•    Greater access to health and healthcare benefits.

Findings of the 2017 Comprehensive Statewide Needs Assessment indicate that Alabamian’s with the most significant disabilities (more so than others) need highly individualized employment services, specialized training and equipment, help with auxiliary problems, and an extended duration of support. Within fiscal years 2014 through 2016, among 20,451 individuals that were closed after receiving service, 2,900 had been designated to the agency’s Most Significant Disability (MSD) category. Individuals in the MSD group were more likely to have a disability attributed to Autism Spectrum Disorder, Intellectual Disability, Deaf-Blindness, Traumatic Brain Injury, Serious Mental Illness (especially Schizophrenia and other Psychotic Disorders), Spinal Cord Injury, Congenital Conditions or Birth Injury (such as Cerebral Palsy or Spina Bifida), Neurological Disorders (arising from Epilepsy,
Stroke, or Parkinson’s), Blindness, and Deafness. The average cost of purchased services for individuals in the MSD category was over $1,300 dollars higher per case than non MSD individuals. The higher amount appears due to differences in both the type and intensity of services purchased. With regard to type, individuals in the MSD category had much higher than average expenditures upon Medical Supplies, Wheelchairs, Surgery and Treatment, and Vehicle Modification. With regard to intensity and/or duration, higher than average expenditures for persons in the MSD group were noted for Therapy (Speech, OT, PT, etc.), Job Coaching, Paid Work Experience, Diagnostic Medical Services, and Vocational Evaluation.
For external perspective, RSA funded research has concluded that VR consumers with MSD differed from those with disabilities classified as nonsignificant on the following characteristics: they were twice as likely to be receiving public financial assistance at entry and six times as likely to receive SSI/disabled; they had more often received special education services in high school and had less often completed high school; they more often had no work history, and if they had a work history, had more often been unemployed for at least two years prior to application for VR services; if employed at application, they more often were working in supported or extended employment and worked fewer hours per week; and they had more serious functional limitations and less familiarity with the labor market (Heyward, Schmidt- Davis 2003).

By examining data obtained from respondents to the Alabama State Rehabilitation Council’s 2017 Unmet Needs Survey, we learned that Alabamians with disabilities who have been unemployed for long periods of time were more likely to report employment challenges related to transportation and their maintenance of health. Consistent with the 2014 iteration of this survey, a large number of narrative responses expressed frustration over transportation resources, especially those living in rural areas. Many expressed concerns over the affordability of housing and health care. Several individuals expressed a fear of losing government benefits. Another finding consistent with the 2014 survey (especially among those with the greatest functional limitations) is the expression of a need for more intensive job placement services. Several individuals desired that the agency take more proactive steps aimed at helping them get “a foot in the door” with employers. This year’s narrative responses also included quite a few comments regarding the specific needs of individuals experiencing limitations due to mental illness. Many expressed concerns over limitations experienced due to the cyclical nature of mental illness, unmet treatment and medication needs, and a desire for more individualized services that are sensitive to unique challenges among those with mental health diagnoses. Several individuals expressed interest in VR providing employment services through Certified Peer Support Specialists.

Yet another perspective on the needs of individuals with the most significant disabilities was available by examining the services most often anticipated for MSD individuals by counselors during the eligibility determination process. From 2014 to 2016, 24,122 individuals were determined eligible and assigned an eligibility category using the agency’s Functional Limitations Priority Assessment (FLPA). 5,681 of these individuals were determined to the Most Significant Disability group. More often than those in other eligible categories, persons deemed MSD were anticipated
to require Supported Employment Services, Customized Employment Services, Job Readiness Training, and Rehabilitation Technology and/or Devices. Supported Employment was anticipated for 3,181 of the 5,681 individuals in the MSD category, 56%.

By definition, Supported Employment is a unique employment service for individuals with the most significant disabilities who require ongoing support services to succeed in competitive employment. In one sense, the employment needs of individuals requiring supported employment are the same as would be expected of anyone else; inclusion in the community, opportunity for advancement, competitive pay and benefits. The uniqueness of supported employment is its proactive role in the course of job development, customization of tasks, and the provision of long-term supports. Program data and input from the SRC cited above indicate increasing demand for these services. ADRS recognizes the value of supported employment for individuals with the most significant disabilities and has continued to increase strategic investments in these services despite budget challenges and constraints. Considerable efforts have been made to expand availability, enrollment and the array of providers statewide.