12/13/2012 Page 1. Welcome to the webinar session on Family Stabilization Services for Employment Services Providers.

Transcription

1 12/13/2012 Page 1 Welcome to the webinar session on Family Stabilization Services for Employment Services Providers.

2 12/13/2012 Page 2 This class is an introduction to Family Stabilization Services (FSS) for MFIP employment services participants. The following information will be covered: Determining FSS eligibility, Conducting assessments, Writing an employment plan for FSS participants, Understanding the use of plan types and identifiers with FSS participants Understanding the interface with WF1, FSS pre-sanction policy, and Returning FSS cases back to regular MFIP-ES services. This training will give attendees the policy knowledge necessary to manage an FSS caseload.

3 12/13/2012 Page 3 You should have a handout with the agenda. Also, have a pen or pencil ready to take notes. Purpose and Goals Stats and Facts FSS Eligibility Categories MAXIS and the WF1 Interface Employment Plans Pre-Sanction process Returning Cases Knowledge Assessment Q & A We will take a couple of quizzes and allow time for breaks. I m going to pass this along to Jennifer Blanchard. She will be presenting most of the content this morning. Thank you so much for presenting, Jennifer, and for sharing your expertise.

4 12/13/2012 Page 4 Good morning, as Sue mentioned, my name is Jennifer Blanchard and I was previously a member of the MFIP Policy Team. I am currently working at DHS in the Health Care Administration working on Health Care Reform. I am happy to be back today to talk with all of you about FSS. I will admit, this is my first webinar so please bare with me. This training is much easier to do when I get to interact with all of you and answer questions as we go. However, I am excited that we are able to connect with so many of you today and I think we will be able to provide you with a good overview of the FSS policy. FSS was developed during the 2007 legislative session to serves families who are not making significant progress in MFIP or DWP due to a variety of barriers to employment. The passage of the federal Deficit Reduction Act allowed states to determine which cases were not making progress in the program and gave them the ability to pull them out of TANF and pay for them with state dollars. When cases are paid for with state dollars the are not in the Work Participation Rate and are not subject to DRA documentation and verification standards This gives counties and tribes more flexibility to work with families in a holistic way. It is important to note though that months on FSS do count towards the 60-month life time limit (with the exception of FVW).

5 12/13/2012 Page 5 The goals for working with families in the FSS service track are no different than traditional MFIP goals. Reduce barriers by identifying them and providing support to mitigating these. Improve family stability by identifying and building on strengths. Reducing poverty by supporting families in building personal assets through income. Reducing reliance on welfare as the primary means of economic support. It s important to note that FSS participants are still MFIP participants. Today we are going to review the policies and procedures that are unique to FSS however, all other MFIP policies apply unless noted otherwise.

6 12/13/2012 Page 6 I think it s helpful to start off by giving you a sense of the make up of the FSS case load As of August 2012 there were 9,744 FSS cases. This is about a third of the MFIP of the MFIP case load. The total number of cases have been steadily increasing over time but who is FSS changes month to month. People do come and go from FSS. About a third of the MFIP case load in any given month (38.1%). State total of MFIP FSS cases as of February 2012: 9,693 out of 25,470.

7 12/13/2012 Page 7 This slide gives you a sense of why cases are identified as FSS, what criteria people are qualifying under. A person could qualify for FSS for more than one reason, for instance, the participant has a FVW and mental illness that impacts their ability to work. However, eligibility is determined in the MAXIS system and there is a hierarchy. I ll talk more about this later but wanted to mention it because this does impact what this data actually means and what it s showing us. An example of this is applying for or appealing an SSI determination is higher on the hierarchy than ill/incap and mental illness. You might be asking yourself why there are 2 other criteria? Although I did not put these slides together I assume the Other that is 19% is the in the country 12 months or less along with the participants 60 and older while the 2% is what we call the DISA algorithm- this is something that is done behind the sense by our reports and forecast folks who can identify cases that will meet FSS eligibility under ill/incap in the following month.

8 12/13/2012 Page 8 I m going to skip this slide because we ll touch on this more when we talk about developing employment plans.

9 12/13/2012 Page 9 As you know, determining FSS eligibility can happen at any point in the life of case. There are situations when, at financial intake, an individual identifies they are applying for SSI so when the case comes to you it is already FSS; there are times when you are doing an intake and a participant reveals to you they are bi-polar and it impacts their ability to work and then there are other times that it isn t until you have had a chance to build trust or some rapport between you and the participant that they reveal they have a medical condition or mental health diagnosis. Then there are times when the participant themselves don t even know that they are grappling with a possible disorder and its only with your help that they meet with a professional to have this assessed.

10 12/13/2012 Page 10 Regardless of when this determination is made it s important to remember these steps. 1. Either the ES worker or the Financial Worker identifies the FSS status. 2. If eligibility is determined by an employment counselor, a paper Status Update must be sent to the financial worker who will update MAXIS with the applicable information. 3. Once the FW has this information, they code it in MAXIS and then it is only when a FW approves a new edibility version of the case that MAXIS is triggered to update the case. 4. The case is then pulled out of TANF funding and into state funding and an interface of the ES status code goes over to WF1, giving you an indication that the case was coded correctly in MAXIS, in order for the case to be removed from the Work Participation Rate calculation. Later on in the training we will go over how you can recognize whether or not MAXIS is coded to reflect FSS eligibility by the ES status code on WF1 Let s take a minute now to turn to page 3 in your handout and put these steps in proper order.

11 12/13/2012 Page 11 Regardless of who is identifying FSS eligibility, communication is key and I know that this is easier for some who sit next to the FW they share cases compared to others who have little communication with a FW. Either way, it is your responsibility to document your attempts to communicate with one another. The data continues to demonstrate that there is room for communication improvement. The case file reviews continue to find cases where the employment counselor had an FSS Employment Plan but the case was not coded FSS in MAXIS. Or on the flip, situations where FSS eligibility has been lost due to, lets say an expired medical opinion form, but the employment counselor still has an FSS employment plan, but this person was back in the work participation rate. Although you roles are different you both impact your participants, the work participation rate, TANF WP Case Reviews, and county funding. The more you can do to enhance this communication, the better.

12 12/13/2012 Page 12 Now we re going to talk about determining eligibility. Take out your handout. There is place for you to take notes while I review these as well as information. There are 12 FSS eligibility categories. The first 5 of the eligibility criteria we re going to review are for those that require documentation from a qualified professional that certifies the illness, injury, incapacity or diagnosis as well as including a statement determining the participant s employability. These criteria include the statement, and severely limits the person s ability to obtain or maintain suitable employment. In law this is defined as A qualified professional has determined that the person s condition prevents the person from working 20 or more hours per week. I am going to use the term qualified professional as I review each of these criteria separately. Your handout, pages 9 and 10, explains who by law can make that determination.

13 12/13/2012 Page 13 The first we ll touch on is Illness or incapacity. This is used when there is a physical injury or incapacitation that impacts a persons ability to work. For example: A participant is in a car accident and has a back injury. They have a doctors statement which says they can t work for 3 months. Or a common example is when a participant is seven months pregnant and is put on bed rest. This is the eligibility criteria that you will use in these situations. This criteria is outlined in further detail in the ES manual in 11.6 All participants ARE REQUIRED to develop an Employment Plan for FSS participants and follow FSS service requirements that you outlined in the plan. See (Ill/Injured/Incapacitated Extensions).

14 12/13/2012 Page 14 The second criteria is Developmentally Disabled. I m not going to go into much detail because this is a vary specific diagnosis. A participant must have a significant cognitive limitation which severely impacts a person s ability to function independently. There are currently only 23 individuals meeting this criteria in the state. The manual goes over this information very specifically. ES 11.6: DEVELOPMENTAL DISABILITY OR MENTALLY ILL

15 12/13/2012 Page 15 The term mentally ill is used because this is what is found in law and in our MAXIS system, however, a more common term to use is mental health disorder. Keep in mind, just because someone has a depression diagnosis doesn t mean they automatically qualify for FSS. One in five of us has a diagnosed mental health disorder but it doesn t necessarily impact our ability to work. That s why you must have documentation that the condition exists and it impacts a persons ability to work 20 or more hours per week. If it s a new mental health diagnosis, once a person chooses a treatment option and becomes stabilized, then they will likely return to work and the regular MFIP service track. But if mitigating factors happen, if there s a very stressful event in their life, this condition may impact their ability to maintain employment, and they might then need to go back into the FSS service track.

16 12/13/2012 Page 16 Having a low IQ alone doesn t make someone FSS. There are many people with low IQ s who, with the right supports, are in a stable employment. More often than not, a participant is going to come to you and tell you they ve been told they have a low IQ but they don t have any documentation. You need to work with them to identify whether or not this condition still exists. Very often these individuals are diagnosed as adolescents and it is necessary that this assessment be done as an adult. See if they still interact with the physician who made the initial diagnosis. If so, see if you can get a copy of the report or the diagnostic summary. Provide the person with a medical opinion form to take to that physician so they can identify whether this condition impacts the individual s ability to work and what limitations it puts on them. However, it s probably more likely that they don t have a relationship with a professional, that they were told this when they are an adolescent and they are going to need to have this assessment done. It s important that you help the participant work with a specialist who can determine how the low IQ impacts their ability to work. If you are having a hard time assisting the participant is setting up a new assessment refer to the manual for tips on how to correctly ask for the tests needed to make this determination. Once it s been determined someone has a low IQ I would suggest making a referral to the county Vocational Rehabilitation Services. Although there may be wait lists, it s worth making the effort because they have staff who are trained specifically to work with these types of participant. Determining if a person has an IQ below 80 may be difficult due to limited English proficiency or lack of cultural assessment tools. Standard methods used to determine IQ may be inappropriate or ineffective. There needs to be a set of culturally appropriate tools to make this determination. I understand that these professional are not always available in outstate Minnesota, however if is it important to help them work with someone who is qualified to work with them. Only accept statements from professionals who are qualified to determine IQ scores AND who have experience assessing functional limitations with non-english speakers should be used to determine eligibility under this category.

17 12/13/2012 Page 17 LD is similar to low IQ in that you may need to have the participant reevaluated if the last time they were assessed was in school, which would not be uncommon. The manual outlines specifically how you need to ask for an assessment to ensure that the participant is screened for LD. If they simply ask for an LD screen they will be told that it is not a covered medical services. The manual talks specifically about the language you can use. It s often very helpful if the individual is sitting with you and you are asking for that appointment together. Something to keep in mind, that we hear often is, how often does an individual need to be re-evaluated? An IQ and LD diagnosis don t necessarily change over time so don t require participants to verify their IQ or LD every year. What does need to be reassessed on an annual basis is how this impacts a person s ability to work. Also like low IQ, determining if a person has a learning disability may be difficult due to limited English proficiency or lack of culturally appropriate assessment tools. Be sure you use the same standards for having this determined as you would for the low IQ. See (Learning Disabled Extension Criteria). This concludes our review of the eligibility criteria which require not only the diagnosis but also the determination that the condition impacts the participants ability to work 20 or more hours per week.

18 12/13/2012 Page 18 Unemployable: One of the things that I might not have mentioned yet, is that when FSS was developed, DHS and lawmakers looked to the MFIP extension criteria to base eligibility on. We had already determined that these conditions often make it difficult for people to succeed in MFIP and thus they should be extended beyond the 60 month limit. These criteria were developed when MN first had to institute a time limit. Unemployable was designed to help ensure that people who had multiple and significant barriers, which impacted their ability to get assessments and proper documentation of the disorders, weren t cut off the program. These were often undocumented mental health and chemical dependency issues. The guidance for this criteria has had to be tightened to ensure it is not used as a catch all. There are currently 264 participants who qualify under unemployable. Not a large number but it is something we monitor. Not having accesses to transportation does not make someone unemployable. Having a felony does not make someone unemployable. It is a combination of conditions that have impacted the participant s ability to get or keep a job that allow for this determination to be made. The law states that a vocational specialist or person designated by the county can make the determination that someone is unemployable. Each county does this differently. Ramsey Co. has a form that the job counselor fills out and then a lead reviews and approves the determination. In other counties a supervisor may determine who is unemployable, and Hennepin County does not allow this eligibility criteria. There is discretion in determining whether someone is to be able to use the unemployable category.

19 12/13/2012 Page 19 (continued) Before determining whether a participant is unemployable for purposes of FSS, counties and Employment Services Providers should assess whether he or she is eligible under a different FSS category. Don t use this while you re waiting to get an assessment. Don t use this while you re assisting somebody in getting an assessment. As I said before there is no single factor or cluster of factors which would indicate un-employability, but take the following into consideration: The participant s work history over the past 5 years. If the person has worked, but has lost job after job, look at why the participant left employment to determine whether any barriers exist which prevent the participant from maintaining a job. If the participant has not worked, review the reason he or she has not been employed to identify any barriers to employment. Is the participant reluctant or refuses to admit to a drug or alcohol problem but it clearly impacts their ability to work, but you know it s going to take some time to build rapport before they re going to want to move forward and get help with this condition? Does someone have a felony record that inhibits employment in positions they ve held in the past. These are all reasons why someone might be determined unemployable. Individuals in this category ARE REQUIRED to develop an Employment Plan for FSS participants and follow an Employment Plan.. Raise your hand if you have a case that has be determined eligible for FSS under this criteria? Send us a quick list of characteristics that you believe meet the threshold for eligibility under this criteria.

20 12/13/2012 Page 20 Needed in the home is used when a participant is needed to care for someone in the HH with an illness or incapacity lasting more than 30 days: Someone who lives in the assistance unit A relative in the HH A foster child in the HH This can t be used, for example, if grandma lives down the street and is going through the final stages of cancer, and the participant wants to be her primary caregiver. That s not appropriate. Participants who are needed in the home MUST provide verification that they are needed to provide care. They are not expected to work but ARE REQUIRED to develop an Employment Plan and follow FSS service requirements. See (Needed In The Home Extension Criteria). With this category we most often get the question, my participant has a medical opinion form stated they are needed in the home but the child with the medical condition is at school part or all of the day. This isn t uncommon and it still meets the eligibility criteria. This is often a situation where the child has a chronic medical condition or a behavioral or cognitive disorder which requires them to be available to come to school on a weekly if not daily basis. These are children who may have weekly medical or therapy appointments and this schedule makes it difficult for the participant to maintain consistent employment. You still have a lot of flexibility in the activities that are put into the Employment Plan, even though they are needed in the home to care for their child. But, what do they want for themselves? What activities can be offered to them that are flexible enough for them to leave if they are needed for their child?

21 12/13/2012 Page 21 Special medical criteria should be used when a participant lives with a child or an adult in the household who meets the special medical criteria. I will go over it very briefly, but the manual provides very specific information about all of the various reasons why a child or adult may meet the criteria. These may include a child who has a physical disability and qualifies for home care services, or they have a home and community-based waiver. This meets the special medical criteria. Or a child has a pretty significant mental illness and this mental illness this mental illness has been determined to meet the severe emotional disturbance criteria. This is outlined in the manual. For an adult in this criteria, it s serious and persistent mental illness (SPMI) criteria that needs to be met for this determination. Those meeting the special medical criteria must be receiving or eligible to receive these services or programs. Verification of the ability of caregivers to obtain or retain employment is not required. What s unique to this eligibility criteria is that when someone qualifies for this they bank months. This means for every month they receive MFIP they are earning another month that is saved and used once the participant hits the 60 month limit and may no longer qualify under this criteria because their child has aged off the system. Something to remember about this, the mistake we often see, is if the participant themselves has an illness that meets the SPMI definition, this criteria is only used for someone other than the participant. If the participant meets the SPMI criteria, then they would be determine eligible under the mental illness criteria, not the special medical criteria.

22 12/13/2012 Page 22 Legal non-citizen residing in the country 12 months or less. This is determined automatically in MAXIS and is based on the dates a person entered the country. That is information that must be in MAXIS. MAXIS determines the 12 month period, and once that 12 month period of time has run, that case is automatically put back into the Work Participation Rate. Participants meet this criteria regardless if they are working full-time or participating in 30 hours a week of activity. You cannot move somebody out of this eligibility criteria until the 12 months has passed. It is only at the point in which the person has been in the country over 12 months will the case flip back to regular MFIP. There are situations when this eligibility criteria can be extended past the twelve months and we ll go over that later in the webinar.

23 12/13/2012 Page 23 Family violence waiver is one of the last eligibility criteria that we ll go into detail about. An individual is FSS once the family violence waiver has been approved. It s important to remember that once an individual tells you that they are dealing with a family violence waiver, there are very specific things that you need to do to assist them, and help them verify the abuse. What constitutes verification is explained in our manual, section See 7.36 (Family Violence Waiver Option) for a list of acceptable forms of verification. The abuse MUST be verified. These participants must work with a job counselor and a person trained in domestic violence (if they are not already working with a domestic violence advocate) to develop an employment plan which focuses on the safety of the caregiver and the children, or if focuses on dealing with any ramifications that might have come from having dealt with family violence. One thing we often hear is, the participant has a family violence waiver but the abuse is now in jail, and their safety is not an issue. Well, we don t know that. We don t know whether this person feels unsafe because the person wants a family member to be bother the participant. We don t know whether this person has become depressed, or whether they are dealing with post traumatic stress disorder. Their safety does not have to be a concern for someone to qualify for a family violence waiver. At the point in which the plan has been developed and signed, you re communicating with the financial worker and they re putting this in the system. Keep in mind with this eligibility criteria, their clock has stopped. The months do not count towards their lifetime limit when they are participating and following their family violence plan.

24 12/13/2012 Page 24 Applying for or appealing SSI or RSDI determination is another eligibility criteria that is automatically determined by MAXIS. Very often participants are applying for assistance, and communicating with the financial worker that they ve applied. The financial worker is putting this into the system and they are coming to you with this eligibility criteria already determined. We often hear that if someone has a physical condition that impacts their ability to work and it s been a year, should I be requiring them to apply for SSI? Simply telling someone to go apply for SSI is not helpful. There are a lot of factors that impact whether someone has a successful application. Everywhere in the state there are places you can refer people to SSI advocates. The manual does have an appendix that lists all of these places, so I would suggest when are you referring someone to apply, refer them to one of these advocates. This is an eligibility criteria that is often frustrating for employment counselors and we ll talk a little more about this as it applies to developing a plan or following a plan.

25 12/13/2012 Page 25 Participants who are 60 or older. This again is automatically determined in MAXIS based on the participants birth date. We do not have a lot of individuals who qualify for this. Very often we do if they are a grandparent who are a caregiver of the child who is on MFIP. You do still want to be developing a plan and having them following a plan. Make it very specific to their unique situation. Very often you ll find that these individuals are complying and working, themselves.

26 12/13/2012 Page 26 I ve talked about a qualified professional and who is a qualified professional. It depends upon the eligibility criteria. These are defined in law, specifically what professionals can make determinations of disabilities. If the participant s health care provider does not provide the information needed to determine whether the participant is eligible for an FSS category, your job is to obtain a release of information from the participant authorizing you to contact the health care provider. Explain to the health care provider why information is necessary, what it s being used for, answer any questions they might have. If at that point they refuse to fill out this material, you can do a few things. Support the client in finding a second opinion, the consumer representative at the health plan. If the health plan does not respond, contact DHS Health Care Purchasing Division at or Indicate which health plan you have contacted or contact the Office of the Ombudsmen for State Managed Health Care Programs at or Physicians cannot refuse to provide an assessment. Physicians cannot refuse to see someone if the participant has failed to show up. Our participants are on Prepaid Medical. They have rights to these services. The definitions of Qualified Professionals is in your handout packet.

27 12/13/2012 Page 27 There are several things that need to be considered when you are working with participants who are trying to get medical opinion forms completed. First, you need to think about if the condition they are trying to get verified would mean they are covered under the Americans with Disability Act or ADA. Many do and so it does require that you assist them in getting the documentation needed to make this determination. We do have a state-developed form, however, counties made it very clear that they wanted to have the discretion to have a form developed in conjunction with their county attorney. So, most of our larger counties have their own form, and many of these are very well developed Anoka County, Ramsey County, Dakota County. They have forms that help guide the physician in making determinations, with questions written in a way that will allow the physician to make the necessary eligibility determination and also have the information necessary to help guide the development of an employment plan. The state form is available on edocs. However, the counties that have well developed plans have given us permission to share a copy of their forms upon request. So, if you come from a county that does not have one of these forms, certainly send an to Sue and she will send you some of these examples. Something else that many of these counties that is very helpful is, a well written cover letter which indicates to the physician the program that the participant is on, the reasons for the questions being asked, how the information is going to be used, and contact information they can use if the medical provider wants to contact the employment counselor. The reality is, there are medical providers who do not want to complete these forms, do not want to communicate with you. Do your due diligence in getting the information. Ultimately, if they re refusing, you need to talk to the client about their options. One of their options is trying to find a physician who will support them in getting this documentation. Before we go on to the next section Sue is going to do a quick knowledge assessment.

28 12/13/2012 Page 28

29 12/13/2012 Page 29 FSS eligibility may be determined by: A. A Financial Worker. B. An Employment Services Counselor. C. Either a Financial Worker or an Employment Services Counselor. D. None of the above.

30 12/13/2012 Page 30 The correct answer is: C. Either a Financial Worker or an Employment Services Counselor.

31 12/13/2012 Page 31 Certain FSS eligibility categories require documentation from a profession that the person s condition prevents them from: A. Working 20 or more hours per week. B. Working for the next 30 days or more. C. Working in suitable employment. D. All of the above.

32 12/13/2012 Page 32 The correct answer is: A. Working 20 or more hours per week.

33 12/13/2012 Page 33 FSS eligibility criteria used for determining Illness or Incapacity, Developmentally Disabled, Mentally Ill, IQ Below 80, or Learning Disabled include this terminology: A. Condition reduces the person s ability to obtain or maintain suitable employment. B. Condition severely limits the person s ability to obtain or maintain employment of any kind. C. Condition severely limits the person s ability to obtain or maintain suitable employment. D. Condition severely limits the person s ability to seek, obtain or maintain employment.

34 12/13/2012 Page 34 The correct answer is: C. Condition severely limits the person s ability to obtain or maintain suitable employment.

35 12/13/2012 Page 35 Now, turn to page 4 in your hand out. We are going to talk very briefly about coding, the WF1 interface, plan types, and identifiers. This table is a quick reference guide which provides the name of the eligibility criteria in FSS, the corresponding panel in MAXIS where this information stored, the definition of eligibility criteria and the corresponding FSS plan type that is associated with the eligibility criteria.

36 12/13/2012 Page 36 This is a screen shot of a MAXIS panel. We show you this so you can better understand why you need to communicate with the FW everything that is happening on a case and why a status update should include specifics, for example, special medical criteria. Your medical opinion form can t just say special medical criteria. This is the EMPS panel. As you can see here, when a FW goes into the case to code this they receive a prompt which requires they further identify why someone qualifies under that specific criteria. As you can see, the FW has to indicate if its home or community based waivers or is it a child with a severe emotional disturbance, or because of an adult with a serious and persistent mental illness. They need to know this information. A question that recently came in on the chat was applicable to this. The question was, a participant has a family violence waiver, or was just approved for a family violence waiver, and they re SSI. Which should I communicate to the financial worker? You need to communicate everything that is applicable to the case. Disregard the hierarchy. That shouldn t be used when you are determining what to communicate. We tell you that so you understand what comes across on the interface. But the financial worker needs to know all of this because there are different things that impact the case. For instance, a financial worker is going to put in that the participant qualifies for the family violence waiver on the MEMI panel, and this stops the participant's clock. The participant is applying for SSI. You might want to ask why are they applying for SSI? Do they have a medical condition? Do you have documentation of that medical condition? Because if you do, you re communicating that to the financial worker as well. They re going to code that the person is applying for SSI, which means they re going to watch to see at the point in which someone s case is approved or denied. That comes across on the MAXIS interface. If they do have a physical illness or injury and there is documentation from a physician that it impacts the participant s ability to work, then the financial worker will code that in the system on the DISA panel. The DISA panel requires that they put in a beginning and an end date, and it s here that triggers someone to not have to pay the $50 housing fee. It s an example of why you need to communicate everything that is applicable with the case when communicating with the financial worker.

37 12/13/2012 Page 37 This is the hierarchy I ve mentioned throughout the training. The example I used before, where the person has a family violence waiver, and they re applying for RSDI or SSI. What will come across on the interface is the SSI application. I ll talk a little more about what this looks like and what this means to you as an employment counselor when determining what kind of employment plan you re developing and the plan types and identifiers that you re choosing.

38 12/13/2012 Page 38 This is a screen shot of the WF1 MAXIS summary page. It is under the DHS-IX tab, under Service Track in the MFIP section. This is the area in which information transfers from MAXIS to WorkForce One. This is the only automated indication to you that the case has been coded on MAXIS, a new version approved, and the case has been pulled from TANF funding and is out of the work participation rate. Depending upon the county you live in, this might take a week, this might take two weeks, this might take three weeks. It could take up to a month. But, you want to be monitoring. If there becomes a point when you believe this might have gotten overlooked, you will want to communicate with the financial worker that the status update was sent but the system has not been coded direclty. You can also see that this is one of the places where the plan type is identified. We ll talk about these in just a bit. A quick here is, you see here: Service Track (highlighted) MAXIS (Emps Code): Mentally Ill (UP) WF1 (Plan Type): FSS hard to employ These 2 things do not need to match. You do not need to reconcile these. Like the example I talked about before with individual with the family violence waiver and is applying for SSI. SSI is what s going to come across, but the family violence waiver is what you will be choosing for a plan type.

39 12/13/2012 Page 39 There is not a different form for FSS. An employment plan is an employment plan is an employment plan. You re using the same document. An employment plan is a contract between you and the participant and when developed well is a tool to help ensure and manage engagement with the individual. An employment plan should be individualized based on the needs of the family, although this is true of all MFIP plans, this is especially so for FSS participants.

40 12/13/2012 Page 40 Plans need to be developed with the full involvement of the participant. You should not be using any pre-developed, cookie-cutter, employment plans.

41 12/13/2012 Page 41 They should include activities that help reduce barriers, focus on strengths to build family stability and identify the most appropriate path to employment.

42 12/13/2012 Page 42 The activities you are including in the plan should steam from information obtained from any formal assessments that have been completed such as the Employability Measure, the medical option form or other documentation used to determine FSS eligibility as well as from information obtained through the informal, ongoing assessments that you are doing when you are talking with the participant, whether that s daily, weekly or monthly.

43 12/13/2012 Page 43 The plan should also include a summary of any support services that are needed in order to successfully participate and follow through with activities in the employment plan. This is includes transportation, whether you are going to provider the participant with gas vouchers or a bus pass, along with the child care that will be provided. A struggle that employment counselors often have is developing a plan that has enough activities to qualify a participant for full or part-time child care. Whatever is in an employment plan, qualifies for child care. However, you might have a participant who is misdiagnosed, who is grappling with some pretty significant health conditions, and the only activities in their plan is going to therapy and following through with any therapy options that the physician is telling them to do. This might equate to a couple of hours of week of child care. A center would not necessarily take a child for only two hours a week. That s what I mean about having enough activities in the plan. If this is an unlicensed provider, then regardless of the hours in the plan, those activities can be covered. However, if the care is provided in a child care center the participant often has to have a certain number of hours of activity to meet the threshold for care. Remember there is flexibility in what activities you are including in an employment plan, doctors appointment, therapy appointments, attending job club. Even if the participant isn t actively looking for employment developing a daily routine and using transportation is often helpful activity. Also remember to build in time for transportation; this counts towards the child care hours.

44 12/13/2012 Page 44 Again, I can t say it enough, you have flexibility in what you include in the employment plan. Don t just think about the standard activities that meet the WPR think outside the box. What resources are available in the community? Does someone need to establish a relationship with a food shelf, for example. Meeting with the person at the food shelf, understanding the policies, going to pick up food. That s something that could be included in the employment plan. It s just one example of what can be in the plan. Use the EM results and the medical opinion form as a guide. But keep in mind these don t dictate what has to be in a plan. For example, you have a participant who has had a steady work history, she has always held down full time jobs doing retail but never earned enough to go off of assistance. She has transferred to your agency and has a medical opinion form indicating she was in a car accident and can only do hours a week of activity and will not be able to do a job that requires extended time on her feet. The employment plan that you and the participant develops can include more than 15 hours a week of activity if the participant feels they can manage it. The medical opinion form is used to determine eligibility. The number of hours in the plan is based on your assessment, it s based on what the participant can realistically do, what the participant wants to do. This individual is going to have to learn a new skill set, it may be appropriate for her to do some training (the occupational research packet, research other industries), while also continuing therapies for her back and attending job club. Her plan might include hours a week of training, attending therapy appointments, it could be a full-time plan with comes with full-time child care.

45 12/13/2012 Page 45 For most professionals in the mental health or disability arena, work is all right. Work is part of a treatment plan. You want to make sure you re doing what you can to support this person so they can ultimately be gainfully employed. Helping people identify what their ultimate employment goals are is a key part of your job. For many people, they don t think steady full-time employment can be part of their future. It s your job to help them see their strengths and identify industries where they could be successful and a plan for how to reduce barriers so getting a job can be a reality. It is their right to work, and accommodations can be put into place, support services can be put in place to help them be successful.

46 12/13/2012 Page 46 Turn to page 14 in your hand out. We re not going to talk about strategies for developing an employment plan. I would suggest attending the EP training the next time it s held. Its during this training that SMART principles and engagement strategies for engagement are taught to help you develop individualized plans and activities that meet the needs of the participant. Raise your hand if you ve ever heard of the SMART principles. In short, when you right a plan don t make it overwhelming. These are tools, and when developed well, they help facilitate engagement. When someone isn t engaging, you have something to go back to review, and if you need to begin looking at non-compliance. It should not be a laundry list of things they have to do. The plan should identify specific activities, how many times they should be completed (attend job club Monday, Tuesday, Wednesday, from 9:00 a.m. to 11:00 a.m.), whether it s a one time activity or something they need to do on a daily basis, include that. Make sure it s something they can achieve and is relevant to their current situation. It s also best to write plans for a shorter period of time, especially if they are in a new situation or in a crisis, or are getting ones and twos on the employability measure. You might not put every one of those things in an employment plan because it overwhelms them to a point where they just can t utilize it as a tool. We hope they look at the EP when they go home and use it as a tool. This helps participants see they have ownership and build on their own momentum to accomplish goals in their employment plan, then revising when necessary.

47 12/13/2012 Page 47 Employment plans need to be open in WF1 and activities opened that correspond with the plan. Although there is more flexibility you are still responsible for documenting the work you and the participant are doing. It s in law and it s your ethical obligation to accurately document what is happening with your participant. Although the DRA standards do not need to be followed there are still guidelines for documentation and verification for FSS cases. The MFIP Work Activity Daily Supervision, Documentation and Verification Guide, found in appendix E of the manual, includes FSS guidelines for each activity. In general though, participants need to complete logs but you can help them fill out their logs, whether that s over the phone or in your office and you decide if you think something needs to be verified. If you have a good rapport with this individual and you trust what they are telling you, then you don t need to verify this information. But, ultimately, the hours to be tracked in WF1. When doing reviews, they are still seeing zero hour cases. Most people are trying to work with and engage these individuals. Robust case notes and materials in the file indicate that the individuals are being worked with but it s not reflected in WF1. It s time consuming, but you need to open a plan, track time and hours, and ultimately have documentation in the plan to support this.

48 12/13/2012 Page 48 We ve already talked about this but it s important to review again, any activity put in the plan must be supported. If those supports aren t available then the plan should be rewritten. Agencies have discretion as to how they re going to utilize that money. What they can do, is determine whether working individuals have more access to car repair money than non-working individuals. There is discretion there for agencies and counties to make that determination

49 12/13/2012 Page 49 Turn to page 12 in your hand out. You are required to choose a plan type in WF1. Plan types are selected on the employment plan page under the Program tab in Workforce One. One and only one plan type should be open at a time (new plan type will close the previous one). Remember that this is the only indication in the system, besides the MAXIS status code, that indicates the case is FSS. The plan type does not need to correspond with the MAXIS ES status code. For example, you are working with a participant who has a FVW and is ill/incap do to a head injury she received as a result of the abuse. Ill/Incap is going to come across however, you will choose the FVW plan type. Identifiers are used to further describe the plan type or a characteristic of the participant. For example, FSS hard to employ, is going to force you to choose an identifier to further describe this. We talked earlier that hard to employ is a learning disability, low IQ, mental health diagnosis, ill/incap. For instance in this case, the plan type is FSS-hard to employ, (MH diagnosis) the reason is because of a mental health diagnosis that impacts their ability to work 20 or more hours per week. The job counselor has then gone ahead and indicated that the participant is current receiving MH treatment and is dealing with a physical illness as well. The EP training goes into great detail with the plan types and identifiers. The handout also gives good detail about choosing a plan type and/or identifier. Section 9.51 of the manual goes over these is greater detail.

50 12/13/2012 Page 50 To wrap up EP s, lets review the timeline that is set out in law. Once eligibility for FSS is determined, the county or employment services (ES) provider must attempt to meet and develop an FSS plan within 30 days. FSS participants must have access to all employment and training services available to other MFIP participants in the agency. You are required to: Establish a schedule for periodic review of the plan includes personal contact with the participant at least once a month, whether over the phone or in a letter. Review the participant s progress every six months if it s a condition that is likely to not change or review progress based on ends dates of the medical opinion form. Check in with the participant once a month and at the six month point to review to the plan to make sure it s still appropriate. Ok, with that wrapped up, Sue is going to do another quick knowledge assessment.

51 12/13/2012 Page 51

52 12/13/2012 Page 52 The MAXIS interface to WF1 will display: A. Only one reason, determined by the MAXIS EMPS code hierarchy. B. All FSS identification codes. C. All ES Status Codes recorded by the Financial worker in MAXIS. D. No FSS indicators.

53 12/13/2012 Page 53 The correct answer is: A. Only one reason, determined by the MAXIS EMPS code hierarchy.

54 12/13/2012 Page 54 Requirements put into the ES plan must be supplemented with necessary supports for the client to comply. If the supports are not available, then: A. The client should be sanctioned. B. The Employment Plan should be rewritten. C. The agency is required to apply client service dollars to support the activities in the Employment Plan. D. None of the above.

55 12/13/2012 Page 55 The correct answer is: B. The Employment Plan should be rewritten.

56 12/13/2012 Page 56 An FSS Employment Plan includes the following: A. Full involvement of the participant. B. Engages the participant in an appropriate number of activity hours per week. C. An assessment of strengths, barriers, and family circumstances that impact goals. D. All of the above.

57 12/13/2012 Page 57 The correct answer is: D. All of the above.

58 12/13/2012 Page 58 Once eligibility for FSS is determined, the county or ES provider must attempt to develop an FSS plan within: A. 24 hours B. 10 workings days C. 30 days D. 6 months

59 12/13/2012 Page 59 The correct answer is: C. 30 days

60 12/13/2012 Page 60 Now what you ve all been waiting for- FSS and pre-sanction activity. We use the term non-compliance when talking about sanctions. This means the person is not following through with one or more activities in the EP or have failed to developed an EP.

61 12/13/2012 Page 61 The first policy that s important to discuss and for you to understand is Good Cause. Good Cause is a situation or circumstance beyond a participant s control which allows the person to be excused from certain Employment Services activities for a certain period of time OR allow for a sanction to be removed retroactively. What can constitute as good cause is specified in law. You can find this list in the ES manual in It is the participant s responsibility to offer good cause reasons for failure to comply. However, you are also responsible for knowing if good cause applies, even if the participant has not claimed good cause, verify and document the reason. Use professional judgment in deciding what circumstances justifies verifying a good cause claim and determining the length of the claim. Bear in mind shorter is better than longer. The job counselor determines whether good cause can be established. Request formal verification if the good cause claim is questionable or if using good cause claims become a pattern (examples of formal verifications could be: medical statements, proof of judicial proceedings, documentation of participation in acceptable activities, obituaries). As it relates to FSS remember one of the good cause criteria is, if the documentation needed to determine if a participant is eligible for FSS is not available, but there is information that the participant may qualify, and the participant is cooperating with the county or employment services provider s efforts to obtain documentation necessary to determine eligibility. You don t want to put someone into the unemployable category the first time you re trying to obtain an assessment and documentation. You re using reduced hours due to good cause, but it s at the point in which you ve tried over and over again to obtain documentation and it s clearly a CD issue or a mental health issue. That s the point at which you might be using unemployable. This means, while you are determining if a participant qualifies for FSS the case would have a Reduced Hours Due to Good Cause EP.

62 12/13/2012 Page 62 I appreciate the FSS pre-sanction policy seems cumbersome and even not logical at times. What you need to remember is FSS law was written by lawmakers and advocates with feedback from DHS. The policies were put in place to ensure every effort was made to identify why a person wasn t participating and to make every effort was made to engage them. As a former employment counselor, I understand your frustration that you aren t able to use a sanction or in all reality, a Notice of Intent to Sanction (NOITS) as a tool to help re-engage a participant. But keep in mind, it s just a tool and as an FSS employment counselor, you are expected to use other tools when working with families. We ll walk through each of the pre-sanction steps that must be followed and talk about how each step can be accomplished. Keep in mind these need to be followed once a participant has been determined eligible for Family Stabilization Services (FSS), or even if the participant hasn t been determined, but there is information known to the agency that the participant may meet eligibility criteria. Either way, you need to follow the pre-sanction policy before you can impose a sanction.

63 12/13/2012 Page 63 The next logical question is what constitutes information. I know you d prefer a more black and white answer but there isn t one. This is an area where you need to rely on your experience and professional judgment when making this determination. What I can talk about are examples of what could constitute information. For instance: Documentation of a previous mental health diagnosis that has impacted their ability to obtain or maintain suitable employment. Maybe the person was employed, lost their job, but in their past case notes, they had previously been eligible for FSS because they had a depression diagnosis and it impacted their ability to work. The first thing you probably want to do is use the steps in the pre-sanction policy to try to determine if this is why they are no longer participating. This would constitute information. Self-reported attempts to get help for a mental health condition that has impacted their ability to obtain or maintain suitable employment. I tried to talk to my doctor about this.. Never really been diagnosed, but If they re bringing it up every time they talk to you, you need to determine if those were signs that indicated that person may be grappling with a mental health disorder or CD issue. If that is the case, follow the pre-sanction policy. The NOITS should not be the first tool you use. Past involvement with other systems such adult or children s mental health, development disability services, waivered services, etc.. as you know there s a pretty high threshold to be able to receive those services. If they have that past history, their lack of compliance is probably based on one of those reasons and you are not going to send a notice of intent to sanction as a way to re-engage them. Follow the pre-sanction checklist. Documentation of a previously diagnosed chronic health condition that has impacted their ability to obtain or maintain suitable employment.

64 12/13/2012 Page 64 The reality is, most of the steps in this process is what you would have already been doing when working to re-engage a participant. The difference here is that you just need to be documenting them as being part of the pre-sanction process. There is a form available in e-docs (DHS-6075) that can be used, in combination with your case notes, to demonstrate the steps you ve taken to engaged the participant. If someone questions whether a sanction was correctly imposed, you can just refer back to this and review all of the dates in which you followed the steps necessary for the process.

65 12/13/2012 Page 65 I m going to go through the steps that you use before you impose sanction an FSS participant. I will use less complicated examples. MFIP is not a homogenous population. Some of these steps work easier depending on the eligibility criteria. There are so many examples that we could use, but because of time purposes and the number of questions we have to answer at the end of the session, I m going to go through these pretty quickly. For the most part, you will use these steps with all participants, not just those who are FSS. First, review the most recent employment plan the case notes, all of the information has anything changed, any red flag, any reason for good cause?

66 12/13/2012 Page 66 Once you ve reviewed for good cause, you are inviting the participant in for a faceto-face meeting. First, leave a voice mail telling them you want to set up a meeting. If you don t hear back from them send them a letter that has a time scheduled for the meeting, letting them know you d like them to come in and meet with you to make sure the employment plan still meets their needs. If they do come in, this is a list of what you would want to review with them to determine if there are reasons for their non-compliance. Determine if non-compliance is explained or mitigated by providing an FSS service Determine whether there is good cause for non-compliance Determine whether plan activities are appropriate Explain consequences of non-compliance Identify other resources that may be available Inform the participant about the right to appeal If they don t respond to your attempts to meet then the next step is scheduling a home visit.

67 12/13/2012 Page 67 When you are scheduling a home visit, send a letter that indicates the time you are going to come out. Be sure to offer to meet them at a central location if that would be more comfortable for them. This letter should also include a summary of the information you would have reviewed during the face-to-face. Remember, this is another tool a way to re-engage them. Now, for most people, they react to this letter just as they would a NOITS. People often don t want you in their home so this will prompt them to reach out and meet with you. Or, they appreciate your willingness to come out and reach out to them, to work with them and understand their situation, and it helps build trust with the participant. Either way, an attempted home visit means an appointment has been scheduled, and someone has gone out and knocked on the door at that time. Simply saying, If you don t respond to my letter, I m going to come out for a home visit does not constitute a home visit. You need to make that attempt for the home visit.

68 12/13/2012 Page 68 If the participant does not respond to you letter or they are not there when you make the home visit, that s when you re going to start looking at trying obtain a review of the plan by a qualified professional to determine if the participant had the ability to comply with the plan but chose not to. So how do you do this? First, do you have a release of information? When you first sit down with a family and you re developing an employment plan, you want to develop a release of information. One that s not too general. If it is, then you need to question whether or not it is written in such a way that gives you the authority to reach out to a primary treating professional? So, at intake, have a medical opinion form, know who the doctor is, have them sign a release of information and review with them at what point you would use it. If you re not complying, I can t get ahold of you, and I need to talk to the specialist. Get a well developed, signed release of information. Send the release of information to the professional, along with a letter explaining why you re communicating with them. State who you are, you work with this individual, they are required to participate, that you ve developed an employment plan. I wouldn t necessarily send them the employment plan because it doesn t mean much to them, but I would provide bullets stating what you re expecting the person to do, and how you re supporting them. Then ask if this plan is appropriate based on the individual s circumstance. There are situations where medical providers respond. More often than not, there may be situations where they don t respond. But, if the professional indicates that the plan was appropriate, send the notice of intent to sanction. If you have a release of information but the professional working with the individual refuses to respond, this is where it stops. They have given you the authority to talk to someone and it is not because of their doing that the profession will not give this review.

69 12/13/2012 Page 69 (continued) If There is a primary treating professional but no release of information or if it too general, send the participant a letter explaining the purpose of contacting the professional and enclose a release of information for the participant to sign and return. (The participant can choose to obtain the needed assessment themselves if they do not want the employment counselor to contact the primary treating professional and use their name). If the participant fails to sign a release of information or fails to obtain the needed assessment themselves, or they will not cooperate with the referral, send a NOITS for failure to comply. The reason the participant has been determined FSS does not always necessitate the involvement of a behavioral or medical specialist, so all you can do is try to involve other professionals For example, if they re in the country 12 months or less and part of their plan is to go to ESL classes. You have no documentation that they re attending and communicating with you. You can send a release of information to say I need to speak with your ESL teacher and know if what I m holding you accountable for is appropriate. If that person fails to sign and return the release of information, that s when it s appropriate to send a notice of intent to sanction.

70 12/13/2012 Page 70 Although the law says to obtain a current assessment, that word is misinterpreted very often. It s not a new IQ or mental health assessment not a formal assessment just a review by the professional who completed the medical opinion form stating that the plan is appropriate. I understand that it seems impossible to sanction someone but in the minds of advocates that s the point. There are just about 100 cases that are FSS and in sanction so it does happen. But overall, your role as an FSS employment counselor is to reach out, to have the tools necessary to re-engage them. benefit of working with you.

71 12/13/2012 Page 71 Once you have gone through the pre-sanction process, the rules are the same as those for a non-fss participant. Following the pre-sanction checklist. Send the notice of intent to sanction. Allow them ample time to respond. Send the Status Update to the Financial Worker. One of the questions that we often get is, we had a successful home visit, and then this fell away after participating for a week or two. Do I have to start the process over again? It s not black and white here. Let s say you did the home visit, it was successful, you obtained a review from the qualified professional saying that the plan was appropriate. It s during that time that the participant reached out to you, came in, redid the plan, and then fell away. I d say, has it been a week, two weeks a month? What could have happened in that period of time that made them stop complying? Questions I would ask myself include, Is a NOITS really the tool I should use to re-engage them in this situation? Is it a potentially crisis situation or unsafe situation? Do I want to decrease a small grant and add to that stress? The cases that are the most frustrating are situations in which someone has come to your agency because they have applied for SSI and they fail to develop an employment plan. You need to follow the steps. At the point in which you need documentation, is when you ll need the release of information. What you would include in a letter is a statement that you haven t had the chance to meet with them, and you don t know what qualified professional they re working with. You need them to fill out this release of information, telling you who that person is, so you can reach out to them. If they don t respond, send a NOITS. A majority of these cases tend to be someone applying for SSI.

72 12/13/2012 Page 72 The exception to this is with a Family Violence Waiver FSS participant, if the participant is not complying with their plan, there are specific steps that need to be followed that are not the pre-sanction steps. The first step is to meet with the participant and their advocate, to review the plan -- ensure their plan continues to be based on their needs and the needs of their family. Ask the advocate if they can help you set up a meeting with them to review the plan. If the advocate believes the plan is appropriate, and the participant continues to not comply with the plan, the participant loses eligibility for the FVW and FSS and this needs to be communicated to the financial worker.. Eligibility for FVW is based on the fact that the participant is following their FVW plan. For some individuals, that s a trigger and re-engage them. Or you may not hear from them. They would then need to be returned to the regular MFIP ES service track. Invite them in to create a regular EP. If they fail to show up to develop a new plan you need to determine if there is information known to the agency that they may qualify for FSS and you need to determine if they meet good cause. If so, engage the advocate, talk to your supervisor, use all tools necessary. The point is, noone with a FVW should be sanctioned. They would lose their eligibility for the family violence waiver, then they would be regular TANF MFIP service track and you invite them in to develop a plan.

73 12/13/2012 Page 73 There are 3 primary reason why a case returns to the regular MFIP service track.

74 12/13/2012 Page 74 First, the participant not longer qualifies for FSS. Maybe the injury has healed, or the person who was needed in the home and the individual needing care has moved out. Or things have stabilized with the 3 rd grader and the parent is not needing to go in and out of school any more. Maybe they have stabilized their mental illness and they re able to work now 20 or more hours per week. Keep in the mind the medical opinion form. If the medical opinion form has expired, or is due to expire, it is your responsibility to know the end date and reach out to the participant to get it renewed. At the point in which the date ends in MAXIS, the person loses the FSS eligibility for a number of these criteria.

75 12/13/2012 Page 75 The participant is able to work 20 or more hours per week and employment is expected to continue, even though a disability continues. Ill/incapacitated more than 30 days Developmentally disabled or mentally ill Learning disabled Unemployable IQ below 80 We are asked all they time, when do you return cases? The general rule is to wait a few months or more (until it looks like the employment will be retained) and then switch the person back to TANF funding. If this is an ill/incap, there was an acute injury and they are back at work now, move them back into the regular MFIP track. Wait a bit of time after mental health issue has improved. Wait a few months to ensure the person doesn t lose the job before moving that person off of the FSS track.

76 12/13/2012 Page 76 The other situation is when the participant has been in the country 12 months or less. Keep in mind, you can make a determination that the person should remain in this category. It is based on whether or not they are testing above an SPL level of 6 in ESL classes and it has to be made before the end of the 11 month, otherwise the eligibility in MAXIS expires and they cannot be put back into this category. (This information is in the manual.) It must be coded in MAXIS during that 11 th month. If they are tested and they are, for example, below the SPL level of 6, they would remain FSS. This has to be determined during that 12 month period of time. How long can they stay? Work with the ESL teacher every 6 months. If it s taking a long time, see if there is more to it a learning disability, maybe finding a different school or services. Take these things into consideration. Don t let people linger here because these months do count towards their 60 month lifetime limit. Regardless if pre- or post-, these FSS policies need to be followed.

77 12/13/2012 Page 77 ASSISTING PARTICIPANTS WITH THE EXTENSION PROCESS Counties and ES Providers must tell families who do not qualify for an extension that they would continue to receive benefits such as SNAP and Health Care when they are eligible, and receive information about other community resources. In all cases, it is important to reach out, follow through, and work with each family as intensively as needed. Families must also follow through on appointments, provide the necessary documentation, complete assessments, and attend scheduled meetings. Expectations need to be clearly communicated.

78 12/13/2012 Page 78 Participants who have reached their 60-month lifetime limit as outlined in 13.3 (60- Month Lifetime Limit) may be eligible for an extension of MFIP if they meet criteria under 1 of the hardship categories. This shows the Hardship Extension categories. The only one that is not FSS is the Employed or Employed with limited hours. ES Manual HARDSHIP EXTENSIONS 13.15: We do get questions like, I have a participant who has been extended for mental illness and is now working 30 hours per week. Should I move them into the employed category. There s some discretion there. Certainly they might count towards the work participation rate if they are in the employed category. But if they are not stable in their employment, don t move them because you don t want them to lose their eligibility if they lose their job.

79 12/13/2012 Page 79 What we ve covered today: Purpose and Goals Stats and Facts Eligibility Employment Plans Pre-Sanction process Returning Cases Knowledge Assessment These are the most challenging and difficult cases to work with. These families have significant and multiple barriers. This is most likely why they are living in poverty. It is your job to make sure they have the necessary supports to try to reduce these barriers and build on their strengths.