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Policy Recommendations to Double Employment of Minnesotans with Brain Injury


The Minnesota Employment Policy Initiative*,
 Pathways to Employment, St. Paul, MN, 55101-1351
and the
  Minnesota Brain Injury Alliance, Minneapolis, MN, 55413
 *Corresponding Author: The Minnesota Employment Policy Initiative, Pathways to Employment, email: crydell@kaposia.com 


ABSTRACT

The purpose of the Minnesota Employment Policy Initiative (MEPI) is to facilitate dialogue and develop leadership on disability and employment policy that will result in increased competitive employment of Minnesotans with disabilities.  Partnership is key to the Initiative’s success.  MEPI is enlisting strategic partners from disability advocacy groups, counties, state disability councils, human resources organizations, employment services providers and other service providers, Centers for Independent Living, the University of Minnesota, businesses, business organizations and state agencies.  Together, MEPI and its partners undertake wide-ranging activities to bring together stakeholders to shape and advance public policy.  They are convening “listening sessions” to be used as the basis for policy briefs identifying recommendations that will improve competitive employment outcomes for Minnesotans with disabilities around the core question, “What will it take to double employment of Minnesotans with disabilities by 2015?”  On October 19, 2009 the Brain Injury Association of Minnesota hosted an MEPI listening session on employment of Minnesotans with brain injury.  More than twenty participants worked together to identify strategies to increase employment rates for individuals with brain injury.  Participants represented survivors, residential and employment provider groups, the University of Minnesota, hospitals, state agencies, and the Brain Injury Association of Minnesota. A policy brief based on the listening session was developed with ten recommendations to increase competitive employment of Minnesotans with brain injury.  Many of the recommendations would also be applicable to other disability groups and subsequent listening sessions with other disability groups have identified similar themes.

Keywords: partnership, disabilities, employment, public policy

INTRODUCTION

The purpose of the Minnesota Employment Policy Initiative (MEPI) is to facilitate dialogue and develop leadership on disability and employment policy that will result in increased competitive employment of Minnesotans with disabilities.  Partnership is key to the Initiative’s success.  MEPI is enlisting strategic partners from disability advocacy groups, counties, state disability councils, human resources organizations, employment services providers and other service providers, Centers for Independent Living, the University of Minnesota, businesses and business organizations and state agencies.  MEPI is funded by Pathways to Employment, Minnesota’s Medicaid Infrastructure Grant.  Leadership for MEPI comes from the Association for Persons Supporting Employment First, and from its state chapter, Minnesota APSE.

In September 2009, the Office of Disability Employment Policy (ODEP) reported that only 22% of persons with disabilities were employed.  The employment rate for persons without disabilities was 70%.  That translates into an employment rate in which persons with disabilities are employed at a rate that is less than one third that of persons without disabilities.  The Minnesota Employment Policy Initiative is working across disability groups to close that gap by identifying strategies that will benefit all Minnesotans with disabilities in addition to strengthening and building new alliances to enlarge the circle of employment champions.

METHODS

Together, MEPI and its partners undertake wide-ranging activities to bring together stakeholders to shape and advance public policy.  They are convening “listening sessions” to be used as the basis for policy briefs identifying recommendations that will improve competitive employment outcomes for Minnesotans with disabilities around the core question, “What will it take to double employment of Minnesotans with disabilities by 2015?”

Background on Minnesota Employment Policy Initiative Listening Sessions
The Minnesota Employment Policy Initiative is conducting listening sessions in the following areas: brain injury, deafblindness, development disabilities, transition, mental health, deaf and hard of hearing, autism, physical disabilities and families.


Listening sessions are convened by a host organization which selects participants representing a variety of perspectives.  The listening sessions are facilitated by MEPI using three questions as the framework for the sessions.  The questions are designed to build upon one another creating momentum toward strategies for the final question on doubling employment.

The first question, “Why is work important?”helps a group to focus specifically on employment.  It also reminds the group of the benefits work provides to individuals with disabilities and creates a positive orientation for the subsequent questions.

The second set of questions, “What’s working?  What are Minnesota’s strengths related toemployment?”builds on the first question, reminding participants of the many services, initiatives, and groups that are already in place or in the planning stages to improve employment outcomes.  It identifies strengths on which to build and also opportunities to produce better collaboration between groups and initiatives.  It also creates a shared frame of reference for the group and is usually a learning experience for group members as they share their knowledge base about the strengths and leadership within Minnesota.  The more common focus of identifying barriers often does not lead to creative strategies to address those barriers and the negative focus on barriers can make it more difficult to brainstorm on potential strategies toward better employment outcomes.

The third question, “What will it take to double employment of Minnesotans withdisabilities by 2015?”is the core question for participants.  It is a question originally posed by the Alliance for Full Participation and, with their permission, adopted by MEPI.  It is intended to be provocative by challenging participants to think out of the box and move toward strategies that can have a more dramatic effect on employment outcomes.

Listening Session on Brain Injury
The listening session on “Employment and Minnesotans with Brain Injury,” was hosted by the Brain Injury Association of Minnesota on October 19, 2009.  More than twenty participants worked together to identify strategies to increase employment rates for individuals with brain injury.  Participants represented survivors; residential and employment provider groups; the University of Minnesota; hospitals; state agencies; and the Brain Injury Association of Minnesota.  Their responses to the three questions follow.

Question 1:  Why is work important?

Provides opportunities for social interaction and developing relationships

Creates a sense of self-worth and contributes to self-esteem

  • Provides structure and routines
  • Builds a sense of purpose
  • Provides a social outlet
  • Enables individuals to have more money leading to greater economic freedom
  • Provides a sense of identity important in American culture
  • Creates a sense of confidence
  • Provides greater stability in an individual’s life
  • Enables individuals to use their talents and make a contribution to society

Question 2:  What’s working?  What are Minnesota’s strengths related to employment? 

  • Growing expectation that employment is a normal part of life
  • Better resources and supports specific to individuals with brain injury
  • Working with individuals as they are, rather than expecting them to meet a certain threshold before receiving employment services
  • Opportunities for paid “volunteering” through internships and other incentives to employers
  • Team orientation toward service delivery
  • Outcome-based services and accountability for providers – pay for performance
  • Peer mentoring
  • Greater visibility and presence of people with disabilities in the community
  • Supported employment services
  • Availability of services through workforce centers – resume writing, job-seeking skills, etc.
  • Better infrastructure of supports from a variety of sources
  • Persistence and resilience on the part of individuals with brain injury and those who support them
  • Greater availability of work incentives – Social Security Administration, Ticket to Work, etc.


What will it take to double employment of Minnesotans with disabilities by 2015?

Recommendations from Question 3:

The following recommendations are based on the themes identified from the responses of listening session participants.  The recommendations represent the breadth of the group’s responses and were not prioritized. 

Ensure that work is an expectation of Minnesotans with brain injury and those who support them.  Minnesotans with brain injury and disabilities, in general, are often viewed as “unable to work.”  At times, seemingly artificial criteria of “readiness” become barriers to people and those who support them.  Those readiness criteria are often constructed without an understanding of supported employment and how the concept of individualized support can change perspectives on the potential for employment.  Also, there is very little understanding about customized employment, an emerging set of practices that fundamentally change what it means to be “qualified” to obtain and hold an integrated job in the workforce.[1]  If the expectation that an individual would return to work was part of the medical, therapeutic, and rehabilitation process from the beginning, services should be redesigned in ways that support a return to work or finding a suitable job at the earliest time.  Given the increased fragmentation of the service delivery system for individuals with brain injury, it is especially important to bring together professionals from an array of services to emphasize a focus on employment and to share promising practices across systems. 

Develop measures illustrating the “big picture” by identifying cost savings and the return on investment of Minnesotans with brain injury who work.  Employment services for people with disabilities are often imbedded within the social service system where costs are sky-rocketing.  If employment is viewed as an investment and measures of cost savings are available to policymakers, the return on investment (ROI) for employment services can be better evaluated as a valuable service not only in the gains provided in quality of life measures for the individual but also through measurable cost savings for the larger community. 

Provide individualized employment services and supports specific to individuals with brain injury.  Individuals with brain injury remain a small group with unique needs from other disability groups and within the group there is a diverse array of complex and challenging factors.  Individuals can find themselves included in services designed for individuals with developmental disabilities in which they do not see a “fit” for their situation.  Specialized expertise and a team approach designed to address their medical, behavioral health, cognitive, and employability needs will result in more effective job placement and retention outcomes in the workforce. 

Develop self-employment services as an employment option for Minnesotans with braininjury.  Self-employment is an option that is only recently being fully promoted for individuals with disabilities.  Self-employment can provide an array of accommodations opening up opportunities that might not be available through wage employment.  Self employment needs to be more fully developed to become an accessible and viable opportunity for individuals with brain injury and other disabilities.

Develop a broader range of ongoing supports available to Minnesotans with brain injury responsive to the changing patterns of their needs over time.  Although gains in recovery slow over time, individuals with brain injury can expand their skills through training and compensatory strategies.  The service delivery system available provides a heavy emphasis on medical models early on and is lacking in a consistent array of career and employment supports over time.

Assist Minnesotans with brain injury in developing self-management skills to ensure the greatest possible control over their services and supports.  Self-advocacy is recognized as essential to improving quality of life outcomes and ensuring that individuals with disabilities exercise choice and self-determination in their lives.  The necessity of ongoing supports should not result in the individual being just the “recipient” of services.  The individual should be developing a greater capacity to “direct” supports and services.

Secure a broadening range of champions within the business community to create more employment opportunities for Minnesotans with brain injury.  Employers are key to improving employment outcomes.  Ensuring that employers are knowledgeable about the abilities of individuals with brain injury and also the supports leading to long-term retention is crucial to a successful employment match.  Understanding and meeting the needs of employers is the means to building the support of the business community and to having employers influence other employers as advocates for the employment of individuals with brain injury.

Target small businesses in Minnesota for increasing employment of Minnesotans with brain injury.  Small business is “big business” in workforce development.  Small businesses create the majority of jobs and should not be overlooked when seeking employment.  Small businesses often have flexibility in hiring and customizing optimal employment conditions which can be crucial to job success.

Address concerns about the safety net of benefits available to Minnesotans with brain injury and the perception that employment could negatively impact that safety net.  Many Minnesotans with brain injury are hesitant to work due to fears that they will lose their disability benefits.  Given the complexity of the various benefits and work incentives, it is difficult for individuals and families to access sound advice to enable individuals seeking employment to maximize their income through employment.  The complexity of the system is a major barrier to employment for Minnesotans with brain injury.

The following recommendation was not presented by the listening session group but is added as a promising practice: Explore the Evidenced-Based Practice of Supported Employment - Individualized Placement and Support model (EBP-SE) for individuals with brain injury.  Although originally developed for individuals with serious mental illness, this model of co-locating and integrating employment services with medical services can result in a stronger system of supports and better employment outcomes than other models.  The EBP-SE model for individuals with mental illness co-locates and integrates employment services into mental health centers and into the treatment plans for individuals accessing mental health services.  In applying this model to brain injury, a broader array of medical services might be utilized than for individuals with mental illness given the complex medical and rehabilitation needs of individuals with brain injury.  An integrated approach of medical and employment resources would be particularly valuable in developing adaptations and compensatory strategies for use in the workplace.  The EBP-SE model is currently being explored in Ohio with individuals with brain injury who also experience substance abuse, but it is being recommended here for individuals with brain injury with, or without, the presence of substance abuse.

The fundamental idea with the EBP-SE model is to imbed customized and supported employment practices within a medical and behavioral health milieu to: encourage and increase expectations about possibilities of work; insure access to employment assistance from trained and qualified practitioners; promote job placement and return to work goals through the use of integrated treatment teams supporting individuals with brain injury; and pool available expertise, fiscal resources, and service capacities among all team members to obtain and maintain integrated employment consistent with the interests, goals, and strengths of each individual.

RESULTS

The entire policy brief can be accessed at http://www.mn-epi.org/docs/FinalTBIPolicyBrief.pdf.

DISCUSSION

The Minnesota Employment Policy Initiative will continue to work with the Minnesota Brain Injury Alliance of Minnesota, state agencies, advisory councils and other groups to move toward implementation of the recommendations identified through the listening session.

ACKNOWLEDGEMENT

MEPI is funded with support from a Competitive Employment Systems-Medicaid Infrastructure Grant from the Centers for Medicare and Medicaid Services to Minnesota’s Department of Human Services (Grant #1QACMS030325). The funds for this grant were authorized through the Ticket to Work-Work Incentives Improvement Act of 1999 (Public Law 106-170).  Catalog of Federal Domestic Assistance-93768.

[1] Customized employment (CE) as defined by the Office of Disability and Employment Policy (ODEP) means “individualizing the employment relationship between employees and employers in ways that meet the needs of both.  It is based on an individualized determination of the strengths, needs and interests of the person with a disability, and is also designed to meet the specific needs of the employer.”  Unlike most employment, CE is not driven by the availability of jobs advertized in the market but rather focuses on job creation for the individual jobseeker and negotiated with an employer to meet the needs of the employment situation.  For more information on CE visit http://www.griffinhammis.com/faqce.asp.