The following is a guest post from Tom Nerney of the Center for Self-Determination. The report in question – Federal Financing of Supported Employment and Customized Employment for People with Mental Illness – can be found here.
The recently published report, “Federal Financing of Supported Employment and Customized Employment for People with Mental Illness,” holds significant value and important insights for those whose work is primarily with persons with cognitive, intellectual and developmental disabilities. This report’s significance emanates primarily from its concentration on the financing of supported employment. This is a topic too rarely covered because of its complexity and lack of clear accountability for developing supported employment let alone responsibility for identifying and sharing best practice. The authors of this report have identified both Individual Placement and Support (IPS) and Customized Employment (CE) as two of the best strategies for employment based on at least minimal evidence based criteria. The general acceptance of both strategies and similar developments in the field of intellectual, cognitive and developmental disabilities adds strength to their choices. But this is not a report on the effectiveness of these two approaches to employment; rather, this report concerns itself with accessing federal dollars to implement this kind of supported employment for those with serious mental illness.
Here is where things get interesting. One could easily substitute any other disability for mental illness when federal financing issues are under consideration. The authors of this report identify the following federal agencies as having some responsibility here: The Social Security Administration (SSA), the Center for Medicare and Medicaid services (CMS), The Substance Abuse and Mental Health Services Administration (SAMHSA), the U.S. Department of Education (ED) Rehabilitation services Administration (RSA), U.S. Department of Veteran Affairs, and the U.S. Department of Labor (DOL). The authors of this report claim that better shared responsibility among these agencies will result in “more effective support” and that case studies of current state and local practices will be a major strategy. My experience is that with so much diffused federal responsibility no agency will ultimately be responsible. In addition it is my experience that individuals to be served have better outcomes when they control the planning and the purchasing of supports necessary to be successful as in self-determination.
But the authors courageously identify so many current efforts from VR to Ticket to Work to One-Stop Career Centers that their examination found wanting. Ultimately all of the disability groups end up identifying Medicaid and Medicaid reform as central to a fair and equitable system for funding these programs (not the best time to be proposing changes). The elephant in the mental health room, Medicaid, must be very nimble. It is the same elephant in virtually all of the disability rooms. Any deep reflection on financing leads to the inevitable conclusion that we are all in this together. Perhaps it is time that we mapped a cross-disability plan to reform the financing not just of supported employment but all supports needed by individuals with disabilities.
So many of us have worked for so long to take the Medicaid program and twist and tweak it to obtain some desired result. We are the alchemists of the 21st Century. We are attempting to turn the crude oil of Medicaid law and regulation into the gold accoutrements suitable for work. When reading this report, remember our new slogan: Alchemists of the 21st Century unite!
Tom Nerney
Center for Self-Determination