Speaker: Fred Menz

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Employment Conference: -- January 24,2002

Speaker: Fred Menz

Fred Menz: Thank-you very much Peggy. If I start to mumble anywhere along the line, somebody please raise their hand. I am getting deafer and deafer with my progressive age. I seem to talk to myself more and more and it is not only my family that is noticing it now, but it is other people.
Good morning, I am very happy to be here. The title of my presentation is “ The Changing Roles of Community Rehabilitation Programs” and in spite of my credentials I may or may not have something good to say. Good morning, I know I am the only thing that’s between you and lunch [audience laughter], and they have told me that we will eat at 12:25 regardless of whether I am still talking or not. So as they say in Northwest Airlines, sit back, buckle up and wait until we defy the next law of gravity. I am going to talk for about 45 minutes and then hopefully I will have some time for questions; but after Peter’s, or Gary’s, rather Peter’s, I’m thinking Peter Brooks. Gary’s presentation this morning and some of the other people that are going to be talking later on today, I feel a little bit like Whoopi Goldberg at the Golden Globes Awards, you know really sort of cute, but not likely to walk away with anything that has gold and is nice to touch and feel.

As some of you have sat through other presentations I have made at some conferences, or had the misfortune of trying to read my stuff, you will note that I do a pretty good job of dealing with the decades of the future. I am not very good at explaining what and why you all have done what you have done in the past. I always figure that is the responsibility of the RSA Commissioner.[audio cuts out]. We are in Iowa, the rest of you will actually get paid [audio cuts out], who use abuse and deliver quality services to people with disabilities and others. That’s actually the point that I want to maybe step off or launch into my basic presentation today. The point is that what I am seeing as important roles for CRP’s in the coming future is in the leadership and how to address the needs of people with disabilities and others.

All these others including people with disabilities share two common attributes. One they are separated from the mainstream of employment; and secondly they have unpredictable access to resources, economical and political, which will make them or make it possible for them to recognized as a real presence in their own communities. This is the role I see for CRP’s and I am going to come back to that towards the end of my presentation.
Now I have really four simple objectives that I want to go through during the next 45 minutes. One is the lofty task of describing the CRP industry and its clientele; second is to share some finding from a program of research that I am actually directing and somehow have gotten myself deeply involved with; then third, I just want to briefly touch on some of the CRPs and rehabilitation are facing. Then finally I am going to suggest three very, very, important leadership roles for you all. Copies of this presentation of the slides anyway are available down here, but I only brought 49 of them so I did not feel it was my task to pick out the blessed and the cursed.
Let’s maybe start with some facts about Rehab programs. I have data going back to about 1986 that I was actually involved in collecting but my 2001 data I promise you really is very, very sketchy but I think from conversations I have had with people around the country that the trends we see there are probably legitimate even though as Helen talked about with the data that she was working with, do not trust the numbers completely.

First of all, the thing that we have watched and we are seeing in terms of the growth and change of CRP’s around the country is the average daily attendance continues to eek up. The organizations that you are working with, the organizations that are providing services to people with disabilities and other underserved populations, is gradually increasing; and has been for the entire 1980 to 2001 period of time. Again the elevation in terms of volume of people served is [audio cuts out] I believe I’ve taken a look at two [audio cuts out] based on forty-two sites where the others are based on usually several thousand responses. The interesting thing about this though is that this reflects a change in the pattern of how CRP’s are actually providing services to people and where they are actually providing, aiding, and getting their clients from.

Over a period of time the ugly side from my point of view in terms of having spent almost thirty years in the area with CRP’s and vocational rehab program is that vastly declining [audio cuts out] and role that the state/federal dollar plays in serving people with disabilities. In this past two surveys that we did we starting adding in questions about where are peoples dollars coming from that go beyond the traditional of rehabilitation sources in Mental Health, DD, VR and started looking at, and are starting to see significant dollars coming from non-disability populations: TANF, Welfare to Work, in some states General Assistance Services and others, Department of Labor and now Social Security is being another group that is coming in there. This all points to an important thing also another finding that we are coming up with consistently over the period of time is the changing role that fees for services play. More and more of the organizations we work with around the country and as many of you in this state are also reflecting is that there is a decrease in the amount and reliance upon [audio cuts out] for services. CRP’s are more into providing opportunities that are perhaps mainstream employment, that are perhaps into production, that are perhaps into serving underserved populations, that are perhaps into selling products and services directly to the mainstream industries in this country. One of the things that is important about this and is very reflective in many of the questionnaires and the conversations we have with CRP directors around the country, is that there is there is a movement afoot amongst these folks to provide a safety net in terms of their ability [audio cuts out] who have unmet needs. There is an attempt to develop resources and pay for the proportion services that are simply no longer being covered by the public dollar. Enough said on that point.

As we look at the industry then, and one of the big roles that our Research and Training Center has is to do research that has national impact that tries to define where the industry as a total is going. And we have been again, as I said, trying to track down organizations and keep track of where the dollars are going and where the dollars are coming from, who is being served, how people are being served, and what the resources are. And one of the bits of the data that we have been able to gather over a period of time is gross volume of business and gross indicators of volume of business particularly the revenue that comes into CRPs. As we look as these dollars, you can see that the average dollar keeps increasing over this period of time, and even though that yellow bar at the very far end there is based on a small number of sites today. We have other data collection that we are engaged in right now to find out what the actually volume of dollars coming in is, but we are estimating that probably in the [audio cuts out] the typical facility or the typical community [audio cuts out] that provides multiple services and multiple functions within its community is probably at about a 7 1/2 million dollar level today, representing somewhere between a 50 and 60 million dollar industry.

Some basic statistics just to round out this picture of what CRPs are looking like right now at this point in time as we see it and as our data is starting to share with us, we are looking at about 8100 organizations. That is up from our 6,000 organizations we had in 1986. The number is increasing partially because it is becoming a competitive enterprise, there are more private sector units and organizations engaged in providing [audio cuts out] to serve populations then there were back in 1986.
The number is also increasing because one of the characteristics of the CRP today is that it is not simply a single location. The locations range from being walk-in centers to fairly swank and rather sophisticated organizations that provide employment and other services. The number of people that the CRP industry is serving is probably in excess of the 5.3 million people a year. I do not think that is a high estimate. I think it is fairly a good number to work with. And as I have said before, I think the estimate based on some preliminary data we have is that the typical facilities are funded around 7 1/2 million dollars, representing probably maybe 60 million dollars as an industry in total, of which about 30 million, or thirty billion of that [audio cuts out] billion of that is coming from fees for services. I first started playing with data like this about as the slide [audio cuts out] back in 1980 and I made the remarkable conclusion that were over two million people served by rehabilitation organizations and that there average dollar per year was about 500,000 dollars; and oddly enough when I did the math on that and I was first one that actually came out and claimed that this was a billion dollar industry obviously that picture has changed considerably.

So what is a CRP today? It is not a sheltered workshop though it may have some sheltered workshop activity that it is engaged in; it will be having multiple locations; it will serve people with disabilities, and that number is declining in percentage fashion, and other customers, and those range from customers who have other rehabilitation type needs to aging populations to community organizations that are requiring personnel services to organizations throughout the community that [audio cuts out] projects and initiatives which the community organization can engage with; and then they are likely to be in multiple networks; they are likely to be parts of networks; and that may serve one population, that may serve multiple populations, that may represent different trade organizations within the community rehab industry itself.

You are more than likely to have anywhere between two to six partners [audio cuts out] and the community to provide your services to develop your capital and to develop you outlets and resources for people if they are in fact going into vocational employment. You are likely also to be engaged in both vocational and supportive services. Vocational remains a very major part of the organizations that we have [audio cuts out] contact with, yet the things that they are engaged in: hospice care, the development of early childhood programming, childcare and related services a supported person engaged in work are all part of it.
Business operations are perhaps one of the most elaborate areas that we are starting to see community rehab programs engaged in. Back in the 1980’s it was unclear how community rehab programs could stay afloat given the general business practices they followed at that point in time. Today I think many of the business operations compete with the private sector operations in terms of both their fiscal integrity and also their sophistication. Five years ago we saw few organizations using cost accounting software, today it is more than likely the rule and the ability to turn around data for most different funding sources I think as most of you know is a phenomenal growth and puts community organizations in a position they were not before.
The community roots is perhaps, and I think that was one of Gary’s points this morning, was in the thing that I do not think we want to forget in an area where CRPs are particularly strong. They are part of the community; they are integral to it in many regards, and they do in fact provide a very important safety net function. The capital resources I have gone over already, significant dollars to work with, they are also very fragile dollars; they are usually dollars that do not have a long credit line behind them to produce, yet they do have venture capital as well.

So, let me talk now, I want to make a transition here. I want to talk little bit about where our research program is at. As Peggy said, I direct Research and Training Center on Community Based Rehabilitation. We are one of five major employment centers and are funded by the National Institute. We have set up, and are engaged in a research program that is doing, (don’t do that to me, I hate technology when it doesn’t work) looking at five major areas, the first three being the ones that probably consuming all of our resources with the last two trailing along in there. We have three goals: one is to try and figure out what the capacity is, remember that slide back there in terms of the numbers and volume of business that I was trying to get across, well there this is part of a large effort [audio cuts out] now every organization in the United States that provides any sort of vocational services and one of the things obviously we are starting to find is that they are not anywhere near like they were ten, fifteen years ago there are more of them. They may be parts of networks that are dealing directly with people without disabilities as well, I will come back to that point in a little bit; the biggest piece, and one of the most ambitious research activities is our efforts to try and define what are models of quality of employment directed programs. I will talk a little bit about that as well; and then finally to round this whole picture out and to try and better understand and produce models that can be adopted by other organizations around the country in Iowa, Minnesota, Wisconsin, and Illinois where we have developed our own measures of outcome that we are engaged with.

Now, the reason we our doing this research is to come back to the industry with recommendations for actions, to provide guidance to organizations, associations, networks that will allow them to actually improve and expand the variety of organizations that are actually able to be effective in the delivery of services to people with disabilities and other populations. We are after quality practices, and we are after, eventually I would like to see in the next five to eight years, benchmarks and standards that may be applied [audio cuts out] across the industry. That is a dream, whether it is a reality, well wake me in the morning.
Okay, the major part of our research, as I was saying, is really geared around trying to define what is an effective community rehabilitation practice [audio cuts out]. It seems like a no brainer. It seems like the kind of thing that everybody knows. It seems like the kind of thing that why would you need to do this. One of the unfortunate and ugly facts about our rehabilitation field is that we are not data driven. We are driven by small samples; we are driven by a good idea; we are driven by what we believe to be appropriate actions, but are very typically have not gotten around to the part about actually defining what it is that our practices are actually about.
This particular effort is looking at about a hundred organizations across the United States and asking them about what they do well with their clients, and asking them to selectively choose the people based on certain criteria we have so that we have a nice carefully balanced design. To define so that after we finished this research, after we have the data on the 2000 subjects that we have estimated that we will have in this research. That we will be able to talk about and in very solid terms what it is that qualifies and characterizes a really quality and effective delivery scheme of practice.

We are looking at as you can see in the diagram there on the chart, the experiences, activities, times, choice patterns, and a whole host of experiences that people go through as they move from the front door of the organization out into competitive employment. Looking around that picture, we are looking at what the organizations are involved in, where they are located, what kinds of communities they have, their costs, their operational expenses, their staffing and looking into the community in terms of the conditions those organizations are faced with, the unemployment rate, where they are at in terms of competition with other entities, where they are getting their funding from. Then we are also looking at how and where participants, the clients themselves have needs and goals. So again this is a very, very complicated but [audio cuts out] and I will share a little of the results with you in just a couple of minutes.

And then as I mentioned, we are looking at building our own outcomes measures as well. Rather than looking a simple index that says the guy got a job, the guy got $4.00 per hour, the guy got to work twelve hours a week, we are looking at other areas as well in terms of the satisfaction these individuals had with their services and with the outcome they achieved. Eventually as we move out beyond the first nine months of experience and start looking at the [audio cuts out] individuals in a follow-up, we will be then also looking at did they sustain these outcomes and to what extent did they sustain them. All with the idea that what we eventually want to be able to come back to you with, and come back to the people that we are working with is concepts and models, that say that if I am working in Fort Wayne, Indiana. And I have this kind of a client population, and I have these resources to work with. Here is a practice that is known to have some [audio cuts out] method on that population.

In some on my on work with this particular research, I am trying to identify different ways in which we can serve different kinds of client populations. For instance, the Social Security Disability Insurance population is a very significant sub-population with in the community rehabilitation programs. There is a lot of targeted effort going on by the Administration to help people who are Social Security recipients move off and back into employment, and there are a number of approaches that have been modeled and suggested and are being demonstrated. We have a proposal in with Social Security at this point to say that maybe what you ought to look at instead of a model that someone has come up with through congressional debate, the Ticket to Work. Maybe what you ought to look at our models that we know take place in community organizations and do drive towards positive outcomes. There is some attraction to that particular approach, and we are receiving some good vibes so far.

Now in this research that we are working on, and we have at least one of our research cites in the room here. I am going to cite them at the end of this presentation. What we are looking at are a sample of sites and organizations and the data you are seeing up here sort of reflects who these people are that are being served and the programs. Interesting enough this profile is pretty consistent with the composition of organizations and people with one exception, that are served in CRPs nationally. There is a high percentage of them who obviously, that come with a DDMR background, almost equally high percent too are facing mental health issues, there are a fairly substantial proportion, incorrectly spelled, with learning disabilities, and substance abuse and traumatic brain injury trickle in there in various degrees. The one factor in this design that is unusual in terms on the ethnicity of our population here. We forced our subject pools and our site selection to make sure we had a fairly high representation of minorities and adverse ethnic groups because of the way the population in the United States is changing. So in order to make sure that the models had application farther down the line, this is a much higher proportion of people from minority backgrounds on the average than you will typically find in CRPs today.

Here’s some initial findings we came out with from the research. Again this is based on a very, very small number and it is intended to wet you appetite, rather than necessarily provide conclusive information for you. Two things I want to point out there is the high percentage of people who are Social Security recipients. It was interesting, when we had some early discussions with colleagues at Social Security Administration; their concept of a Community Rehab Program was an Independent Living Center or a psychosocial center. That is the only two organizations they had in their mind in terms of when they were developing some of the original legislation. Obviously that does not follow, to be the case, and they anticipated that there was a very small percentage of people who are Social Security recipients being served. Obviously the data here suggests that it is 59 percent, and it is actually 49 percent. Forty-nine percent of the people in CRP’s may be surveyed may be, have been beneficiaries. The disturbing piece about this, and that is something I want to make, attend to and I will comeback to a little bit later, in terms of the before and after; is that even at the end of the program in a grant this is the first three months out of the program they are now employed, they are just starting to get income, the poverty level for this population is pretty significant. We are looking at between 15 and 25 percent who are living above poverty. A rather tragic picture, and I will comeback to that again.

Again, here where we give you a little bit of an idea both what are the kinds of data that we are tracking on these folks and some of the characteristics or kinds of things that they live on, a fairly high percentages of receipt of particular forms of cash and non-cash benefits. In our design we are looking at this from a pre, post, and follow-up standpoint. So we’ll not only look at hours, wages, annual income and so forth, we’ll also then be trying to track the mobility of people on and off the benefits role. I think is an extremely fruitful area.

There’s three slides that are essentially identical. I will just deal with this one. In our research what we are, have, asked people to do in a tedious fashion, and I know Marcia will definitely say this is a tedious activity. Is we presented 47 different of activities that the literature has suggested are kinds of activities that people are provided during the course of their getting to employment, which is sort of a nice way of saying that we worked with a nice little exhaustive list. Out of this, then we have asked our research sites to then indicate for the twenty or so people they selected according to our criteria to track through what the experiences are in terms of whether or not they received any of these kinds, or participated in any kinds of activities, and then also the amount and frequency that they were provided them. Out of this what we are hoping to be able to do is to take the data from the 2,000 individuals and start to use nice terms like factor analysis, clustering analysis, and discriminate function analysis all to build models of what are typical patterns and experiences that people have. Its, I like numbers as well as Helen. It does not go away with age, so I hope Helen is here and appreciates the fact that she has a long career ahead of her if she does like numbers. The important fact about this is that there are some high profile activities that people receive over the period of time they go through your programs, but they are not totally, totally consistent. Our expectation was that we are going to see percents in the 90s and 80s, for a lot of these services because they tend to be the ones VR has typically paid for. There is much, much more variability and as some of the preliminary stuff I did over the weekend starts to show, there seems to be certain patterns of service delivery that get to successful community placements that are somewhat, more than somewhat, very functionally tied to where the money is being, coming from, not perhaps a surprising finding, but there are more roads to roam I guess than one might expect. Again these slides are in the packet of materials there.

These are some of the kinds of data that we will be able to generate from this particular research that talks about where the costs are, where money is being spent, how much it actually takes to get a person from the front door so to speak out into employment. The bottom there, that last portion where it says distribution of services, I think is a rather an important section, and I am hoping and I am really going to be interested in seeing how all it comes out. We took the 47 services and are starting to group them in terms of, you know, sort of functional kinds of things that get paid for in the classic VR model. If you look down there into Job Placement which is one of the, and in our state happens to be one of the most controversial issues that we are dealing with, but your are only paying that much for job placement and where Social Security efforts are going with Ticket to Work, you are only going to pay for this particular outcome, this particular kind of a service really takes up a very, very small percentage of the time and effort that goes into working with clients. I am happy to see that Skills Training starts to play a much higher percentage in our group here than I would have anticipated. Again these are the kinds of information that a national project like this working with this many sites and organizations is actually going to be able to provide some fairly concrete information on.

From my standpoint, again, I, we are just playing with the data, we have been struggling and getting as that map showed you, sites from literally every part of the United States. We have three sites I believe in Iowa, and we have about four sites in Wisconsin, and then it goes just the heck all over the place. We’ve tried, I actually think we have one in Hawaii, and we are really fighting over who is going to get to do a site visit there; but you know when you are the boss, you can, it is the only perk I have got so. Actually I will not end up going there after all. We are finding that there are some are, there is a certain amount of homogeneity in the practices that CRP’s are engaged in. There are models that I think are actually going to come out of this whole picture. There are predictable outcomes. This is the good, good news about this. There are, one can predict based on the kinds of information we are getting, how outcomes are going to be achieved, what those outcomes are going to look like, and in what sector of a person’s life they are likely to be optimized. My goal, and my hope in terms of the rest of this is then to take information like this and start bringing it back into an applications fashion that says I am sitting with you twenty people who are running CRPs, or working in CRPs, here is what we know about organizations like yours with a client population like yours, and this is what we think it means. Now, does it? Does this transfer to your kind of situation, and how can we help you maybe work with that information and make it work?

There is more of this stuff you can get by coming to our website at http://www.uwstout.edu, which is a mouthful, but it is easier for me to say. We are still in the midst of working on this model’s development project. We have 55 sites are now that are aggressively providing us information; we have 45 that we are still beating up on who are gradually providing the data they committed to. And most of the ones that finally finish it report back to us that it really was not all that bad once we beat up on our staff as well, so there is a beating ordered somewhere in the line here that I am not sure about. You will be seeing us come out with several national surveys in the next six to nine months; one to simply get some information like address, phone number, organization, dollars and so forth in terms of what a Community Rehab Program looks like.
About a year from now I will be initiating a study that will look at the impact particular federal legislation as it is trickled down into states on Community Rehab operations [audio cuts out] We may be able to take this back and help in the reauthorization of the Rehabilitation Act. Come September 2002, late in the year, we are going to be holding a conference in Washington D.C., that will be geared towards taking this research the next step. We will be inviting many of our research sites to join us in D.C.. And then as we go through the remainder of this year we are continuing to look for funds to help organizations that like what they are seeing here to either become a part of the research process or perhaps move into a demonstration phase with us so that the research is just not something that ends up on the shelves in my office which are over loaded with stuff already.

Now, lets, I want to move away from what I am doing talk a little bit about where you all are at. It is the bigger picture, and I think that this is where the roles have to start emerging; and, I think this is where maybe you will start seeing where some of the applications of what I have been talking about here from our own research may play out. The pressures that you are faced with in terms of accountability are two-fold: there are more dimensions of accountability now than you can possibly shake a fist at. They not only are simply with getting employment. We are not the only ones that are talking about looking at the quality of life of people, or looking at how employment impacts on peoples lives; we are not the only ones that are looking at the benefits changes that result from your programs. It’s a massive effort nationally to broaden the whole range of areas in which you are typically, honestly, accountable and can be responsive too.

The time frames are really the ones that I get spooked with. The first three there in the short term remind, and this sort of reminds me of a revision, reversal back to a medical model, the time frames that people want are in the short term increasing. Gone is the day of the 30 day closure; gone is the day of the 60 day closure; now it is the era of the 90 day closure and everybody is asking about that. That is the band-aid for the problem of disability for many people and for much public policy. It’s geared towards, can we prove the benefit of what we do based on this particular time frame? The movement, and I think this is where my colleagues from Minnesota Results Council, I knew I would remember you somewhere Jim, where I think you will find our friends in the National Results Council and others looking at, is that we are being required and expected to look much farther out into peoples futures, and I think that is an important piece for Community Rehab Programs to actually become, to develop a leadership function in.

Customers, consumers, these are the five areas that people are concerned about, and I will start at the bottom: Meaningful options: when the economy changes, meaningful options make more difference than the pursuit of a particular social goal, and that is not to denigrate, or suggest the pursuit of other options in a Sheltered Employment setting or employment setting where the predominate number of people happen to have disabilities is not a desirable goal. But the reality is that for people with disabilities and people who in that poverty situation, these become much, much more important. Their status in the community, as I mentioned before, is in pretty tenuous; and their access to resources is the most likely to be threatened. These are the threats that if you talk to any CRP set of executives and you start looking at the data and the literature as well, is there is a sort of a threats kind of a situation; much, much more competition. Much greater likelihood that you are going to be in collaboration with your competitor, much more likely, and that is where some of the numbers are being increases are being [audio cuts out] that you will be faced with a consolidation or a buy out in the next five years. Somebody is going to want your property, your clientele, your budgets, your resources, and your personnel. All of which are the hard things to come up with for an organization that wants to expand. It is sometimes cheaper to buy somebody else out; it is sometimes cheaper to go through the ugly parts of a merger than it is to try and merely keep capitalizing or re-capitalizing or redeveloping your own staff.

De-professionalization is probably the one thing that scares the hell out of me. Excuse me, but due to the lack of graduate programs and continuing education programs, the ability to provide staff, who are qualified to deliver services in community rehab organizations is a very, very serious problem. Figure 8100 organizations, typically between 40 and 60 staff members, typically probably two-thirds of those are in direct services, typically most of them are high school graduates lacking any formal training other than that which they got during the first six weeks of their employment in that organization, and typically about twenty-five percent of them are going to turn over. To me, this is a very, very serious problem when you talk about the kind of services that are actually required and delivered through your organizations.

Changes that we are facing, aging out; everyone in this group, well, I am sorry you are not part of the group, all of us old people have been around a little bit too long. As I look around and go from organization to organization around the country, color hue and culture are factors that are realities. The aging out phenomena, the profile of an organization right now if, for a CRP is mid-fifties white male or upper forties white female in a CEO or an executive position. Mid-management may have a degree in rehab or some related area; mid-management more likely to be women, perhaps minorities, perhaps culturally unique, very few years in service, often times come from outside of rehab, maybe they have a social work degree, maybe they have a rehabilitation degree, at two-thirds people from the community, people with the same backgrounds, people with the characteristics of the populations we are trying to serve, people with who lack training, people who lack experience in serving but have very, very important skills in terms of their knowledge of the community and the people they are working with, obviously two ingredients without unmarked value.

Big problem though, this is where I am starting to get close to wrapping up, and lunch is going to be actually served probably by the time I finish. The core problem that we all face, and I think this is a partially reflected in the fact of why Community Rehab organizations are moving into other populations than disability. The linkage, the data, every piece of evidence that you can possibly put your fingers on points to the fact that disability and poverty and culture are all intermeshed. And, it’s a problem that we have the resources professionally, programmatically to work with. It is a problem much like substance abuse was ten years ago. One that we simply do not want to deal with, or one that we would rather have someone else pay for; but in reality we are paying for it anyway. This is an inextricable combination. It is there. It’s in our populations. It’s in our communities. It is the people that are in the safety nets that we are working to build for our communities. It is out there and until we start facing and dealing with the combination of those and make that perhaps the standard in which, that which we’re trying to have impact through our programs, I think we are going to find the errors of hits and misses in terms of our delivery of outcomes, one that is going to more than just a challenge.
So, I see three important roles for CRPs. They could begin today, it could be tomorrow, it could be next week; and in many organizations, it is already taking place. You are partners and I see a important role in policy, and I see a very, very important role in the leadership area in terms of the quality of rehabilitation services and the quality of the programs that we actually create and provide.

Reasons for partners, and again these came from some conversations I have had with different groups and just talking informally with CEOs over usually beer, but preferred scotch, when the opportunity provides itself. These are the reasons why organizations are starting to partner. It is, part of it is that the money is come down to the community. The money has come down to your neighbors; it has come down to you competitors. There is a diverse [audio cuts out] and as I was talking about the emergence of different populations. It is not just about people with disabilities that were traditionally served, it is about people coming back into the labor force that, who can potentially come back into the labor force, who may have left because the benefits for staying out of the labor force were necessary and appropriate.

Tension over resources obviously is simply not enough, it is not in the right place, and it is not in the right hands. Counter to that is a movement to create more direct control over the resources and one that we probably cannot ignore from among advocates for where the dollars should actually be provided. Rising costs to do business, need to compete, some of my bad humor in terms of waste management is at the reverse end of the pipeline, it is waste management on terms of pencils and paperclips rather than waste management on faulty practices, rising cost of doing business.
And down at the bottom there is, this is almost in some respects today’s political and public policy environment almost reminds me of the 1970’s and for some of you who were back in that era it was really the era of big solutions out of Government. We will come up with the great society by doing a,b, and c; and usually it came down to this is the way we will do it, A B and C and we I think, are looking at our public policy solutions along similar lines. There is a way, and there is a single goal, and if we push towards that way and that single goal we will be much more effective; and we will have solved the big problems of society today. Excuse me I get off on that every once and a while.

But the partnering that is going to take place, I think, and this is based on my own estimations of where things are going, somewhat on data, somewhat on experience, is that the partnerships have to be with the public program; they have to be with the advocates; they have to be with the people who are developing policies; and they have to be with business and industries. Those are essential partnerships if we are really going to move into the next area in which we had, have been rather absent in terms of our presence as an industry. Public policy is being developed largely without the response from CRPs. Oddly enough, I find that a very, very striking phenomenon as I go around the country. It is being developed at the state levels, often times with a lot of political activity on the parts of community rehab programs and their associations, but in a very small voice in terms of the development of the national public policy; and that to me is scary because there are 8100 of you organizations out there and you are serving 5 1/2 million people and you do not have a real strong voice in how decisions are being made.

I will give you a case in point; when the Workforce Development Act was being put together, I happened to be part of a small group of people that were supposed to be CEOs and trade organizations, working to get a small phrase in that legislation; and the phrase was Community Rehabilitation Organizations. There were working to get that phrase in both the Senate and House version of what became the Work Incentives Act. It never made it. They are not identified as a key player in the delivery of Workforce Development services; and that was a major loss I think in terms of CRPs. Yet where are CRP and where are the services that are being drawn upon to meet the problem? Where are the models coming from? They are coming from CRPs. Anyway, small story.
There are, in the handout I put down four particular areas that I think CRPs have to have a very active role in working with the public program, working with policy makers outside the public program, and working with advocates to develop these kinds of areas of impact for people with disabilities; and keep in mind all of my conversation here is about CRPs in relation to affecting the employment outcomes and the quality of life of the people with disabilities. So, I am looking at you all as a vehicle not necessarily the end point; and that is why I am saying that the partnerships that you already have established are as Gary said this morning, really require amplification, really require exaggeration and further development. If a public policy, and some of this comes from the President’s Committee on Employment for People with Disabilities a few years back and it is lynch stone in terms of much of what is being developed right now, while trying to save the government considerable large amounts of money.

First, is the issue of options. Opportunities and alternatives are needed; employment being a very, very important one, and a variety of employment opportunities not a singular form of employment or a singular status of employment. These have to be meaningful, respected and in the community of choice of the individual; supports for people who want to and desire work, very important.

Technology is starting to come about there are significant amounts of money being put into development, application and getting technology into the hands of the people you are working with. But we need to move beyond the simple mechanical and really be thinking in terms of the kinds of supports that people require throughout the life span, in which that disability is played out.
Personal capacities, people have to have skills. Our colleague Helen, I do not know if she is in the room yet, was talking towards why people do not move out of Sheltered Employment. A big piece of that is the presence, or lack of presence of the type of skills that employers need and their ability to access the employment markets where their skill may be able to be applied.
Economic incentives, if you look at the data I have, if you look at Helen’s data, if you look at any of the data that is being collected in the arena of public policy today, the incentives need to be there, and they need to make employment a much more viable option then simply remaining on benefits.
Health care, as every one of you know, and I think Iowa is one of the states that is looking into the vouchering provisions for Medicare and Medicaid. Obviously another arena, and I am not talking [audio cuts out] on these individually, but taking them on as a package, and what you may be able to actually garner some political clout for CRPs and the people you serve.
The last one I added, I do not know why, never even thought about it, is political and economic resources. Your systems are money driven; the people you have, have needs that are related to and require access to resources; and that usually means developing the appropriate public and economic support for work you are after and trying to do.

Then the final role I see, and this I think is one that we are being encouraged by as we start to see the data come in from our sites, is that you can take on an important role in terms of the quality of outcomes and the quality of lives that people actually achieve through your programs. You are doing it in all I am saying is that you need to push at that next stage forward where you are talking about demanding that the model and the services that are provided regardless of what the funding sources may ask you to do, are ones that have demonstrated value and impact. You are at the front line in that regard, and there is, and beginning to be, significant evidence to support that.

Outcomes and expectations. I think we all agree minimum wage, as an average outcome is not an acceptable one. With the level of poverty that exists for people with disabilities even if it is with twenty-five percent of our service delivery population moving more and more towards higher levels of expectations among our staff as well with our clientele is important.
Relevance to more constituencies and continued relevance to ones we have strong histories with. There is a progressive social agenda out there. One of the common things that I find among my colleagues, again as we go around and talk to people in different organizations, is the reluctance to get behind the bandwagon. Part of that is because a lot of us are white, middle-aged, old, white guys but I think that the reality is that there is a progressive agenda out there and like some sectors in the public program, I would be very terrified if we, and the CRP industry, lag behind in moving forward with that agenda that we lost resources that were so hard and well fought for and gained.
The last piece of that whole quality issue is being accountable. Not walking away from it; being publicly and socially responsible for what you do in fact achieve with whatever proportion of the clientele that you are working with were you envision your own success.
So, I have given you a lot of stuff this morning and hopefully it will intrigue you or at least cause you to think a little bit about what it is that this industry can be about. I think the three important, those three roles are not ones that are unattainable by CRPs and, again, they are ones that you will really be playing in partnership with others on. So, thank-you very much.
Some one asks for questions. (There were no questions.)
Peggy Todd: ]Well, thank-you Fred.

Fred Menz: I have one last piece. Would, is Marcia Tope, Brook Loveless, or Donna Albrecht here? Would you come forward please? Yes this is the Golden Globe. Marcia come-on, come-on. We have never met before.

Marcia Tope: No.
Fred Menz: Marcia is with Easter Seals of Iowa and she is one of our research sites that just completed providing the data, and actually I think some of the numbers up there are from . . . excuse me, I wondered why it was so easy to read, you hold it down like that – but, [audio cuts out] take this opportunity while I am here to thank Easter Seals of Iowa for their participation with us. I have a little speech I am going to actually read to you as I present it on behalf of the RTC, and as the immediate past chair of National Easter Seals Professional Advisory Council. I am pleased to present to you this small form of recognition for Easter Seals, Iowa’s participation and contribution to our national research study of quality employment models. Thank you, for each of you, for your commitment, diligence, time, and for the professionalism you brought to this project of major significance. Your participation and work will contribute to the improvement of employment services for people with disabilities well beyond your own community. On behalf of Carl, Deb, Gene, and Sue I add my thanks to you and Easter Seal’s for your assistance in this. Thank-you very much.
Marcia Tope: Thank-you.

Fred Menz: And that means I am done. [Laughter]

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