Introduction: It is the mission of the Intergovernmental Agreement (IGA) between Arizona Department of Health Services/Department of Behavioral Health Services (ADHS/DBHS) and Arizona Department of Economic Security/Rehabilitation Services Administration (ADES/RSA) Vocational Rehabilitation (VR) to increase the number of Arizonans with serious mental illness who are successfully employed and satisfied with their vocational roles and environments. Community Partnership of Southern Arizona (CPSA) and RSA share a commitment to recoveryoriented services and the foundational values of self-sufficiency, independence, system collaboration, and the provision of a full array of vocational services and options. The partnership between CPSA and RSA remains one of critical importance to individuals receiving services who desire to obtain and maintain employment and pursue a career path as part of their recovery journey. Purpose: This document serves to provide RSA and CPSA staff and their subcontractors with specific administrative and procedural guidelines as members of the two systems work collaboratively under the IGA. In addition, this protocol functions as a framework to bring together the resources of the two systems, build upon existing efforts and facilitate a broad spectrum of joint State and local initiatives. Region II/GSA 5 lead contacts for the Regional Collaborative Protocol include: Employment Specialist, Community Partnership of Southern Arizona (CPSA): 520-325- 4268, 4575 E. Broadway, Tucson, Arizona 85711 Region II Program Manager, Rehabilitation Services Administration (RSA) or designee: 520-628-6810, 400 W. Congress, Suite 440, Tucson, Arizona 85701 Comprehensive Services Provider (CSP) Vocational Liaisons The vocational community will be educated on the Regional Collaborative Protocol and have the opportunity to update and revise it through the following means: Vocational meetings CPSA Technical Assistance meetings with CSPs RSA Supervisor s monthly meetings Feedback solicited from CPSA members, groups and agencies (e.g., Adult and Children s Behavioral Health Community Councils, Recovery Support Specialists, etc.) Coordination of Treatment and Planning Services: VR Referrals for all Members: The following outlines the process for making referrals for VR services, collaboration and coordination of services in developing the Individual Service Plan (ISP) or the Individualized Page 1
Plan for Employment (IPE) and service delivery as outlined in the ADHS/DBHS Covered Behavioral Health Services Guide. 1. Referral process: a. Informal communications between RSA staff and clinical staff are encouraged prior to referral, when key changes occur with the member s situation and prior to closure of the member s services by either party. b. Group orientations will be held at the CSP site a minimum of once per month. Additional orientations are available at the local RSA office. If the member cannot attend the group orientation or a group setting is not appropriate for the member, an individual 1:1 orientation will be scheduled. c. Upon attending orientation, the member will be assigned to a VR Counselor. The VR Counselor will then request a referral packet. The Vocational Liaison will insure that the referral packet is delivered within 7 business days. d. After the orientation, the VR Counselor has 7 business days to schedule an intake appointment. At the intake appointment, the VR application will be completed and signed. Members may complete the body of the application prior to the Intake appointment, but the application must be signed at the Intake appointment. e. VR eligibility should be determined within 30 days and the individual will receive a letter confirming the eligibility decision. 2. Members are to be encouraged to invite both the VR Counselor and the Behavioral Health Representative (in addition to other members of the Adult Recovery Team and natural supports) to meetings in which their IPE or ISP is being discussed. The CSP Behavioral Health Representative is expected to include the VR Counselor in writing the ISP. The VR Counselor will provide input/recommendations for the ISP in writing upon receipt of the ISP Recommendation Form. The VR Counselor is expected to include the CSP Behavioral Health Representative in writing the IPE. The Behavioral Health Representative will also provide input/recommendations for the IPE either in person, over the phone or through email communication. 3. All members shall be offered Extended Supported Employment (ESE) throughout the rehabilitation process by both RSA and CSP staff. RSA staff will complete the VR Coordination of Extended Supported Employment form Part I and obtain a signature from the CSP Vocational Liaison to ensure funding for ESE prior to implementing an Individualized Plan for Employment. Once an individual has been working in a job, is considered to be stable in the job, and needs ongoing support to maintain employment, a Status 22 meeting is called by the VR Counselor in order to transfer the responsibility of funding the supported employment from RSA to the CSP. Status 22 meetings are to include: a. The member b. The clinical staff person c. The CSP Vocational Liaison d. The VR Counselor e. Other parties invited by the member Page 2
CSPs are expected to fund ESE services on an ongoing basis if the individual and team deem it necessary, and ensure that those services take place at the member s provider of choice. 4. Services provided by the CSPs include: a. Referral Services b. Treatment Services c. Rehabilitation Services (see Important Note below for guidelines and limitations) d. Medical services e. Support services (including personal assistance services and peer support) f. Crisis Intervention Services g. Inpatient Services h. Residential Services i. Day Programs IMPORTANT NOTE: The Regional Behavioral Health Authority (RBHA) will provide Rehabilitation Services (see the ADHS/DBHS Covered Behavioral Health Services Guide www.azdhs.gov/bhs/covserv.htm for a detailed description of services and billing limitations) to assist individuals on their path to recovery through meaningful work or community activities, education and opportunities for community participation. These rehabilitation services will assist the individual in preparing for employment before making a referral to RSA or to complement vocational services being concurrently provided through RSA. Rehabilitation services include the provision of education, coaching, training, demonstration and other services including securing and maintaining employment. Services are broken down into the following categories: a. Skills Training and Development and Independent Living Skills Training. b. Behavioral Health Prevention/Promotion Education and Medication Training and Support. c. Psychoeducational Services, i.e. pre-job training RBHAs may provide this service only when not available through RSA). d. Ongoing Support to Maintain Employment, i.e. job coaching and ESE (RBHAs may provide this service only when not available through RSA). Due to the billing limitations in place for these services, the following outlines situations in which Psychoeducational Services and Ongoing Support to Maintain Employment can be provided through the CSP with appropriate documentation in the clinical chart: a. The member is ineligible for RSA services. b. The member chooses not to use RSA services. c. The member is placed on a wait list by RSA. d. The member is awaiting eligibility determination by RSA. Page 3
e. The member has needs that require immediate action, i.e. member is at risk of losing employment and needs assistance with job retention. 5. Vocational Rehabilitation services provided by RSA include: a. Vocational Counseling/Guidance. b. Career exploration, vocational assessment, job planning. c. Work exploration. d. Planning, purchase and coordination of services needed to secure a specific employment goal (including training, work adjustment activities, on-the-job training, other skill building activities, individual job development and placement, supported employment, job coaching, tools and assistive technology services). e. VR post-employment services. Certain services, based on the individual s vocational goals, are only available through RSA, such as: a. Restoration tools and appliances (such as glasses, hearing aids, etc). b. Vocational counseling services. c. College/university tuition (including books and supplies). d. Occupational/vocational training and supplies. e. Employment-related goods and supplies (such as tools, computer, fees for licensure or certification, etc). f. Self-employment services and funding. g. Financial assistance to overcome barriers to work, which may include car repairs, meals at school, funds to purchase uniforms or professional interview attire. Problem Solving: Staff will strive to resolve issues and barriers at the Adult Recovery Team level, involving the member, family, CSP staff, VR Counselor and others as appropriate. If consensus cannot be reached within the Team, CSP and VR staff will involve the support of their supervisors. Supervisors will aid in finding a resolution within appropriate time frames. For CSP vocational service issues not resolved by the above resources, CPSA s Member Services staff is available to assist in problem resolution. For RSA issues not resolved by the above resources, the client will be given a Request for Review of Counselor Determination form, a Client Assistance Program (CAP) brochure, and appeal information. The CPSA Employment Specialist, as well as the RSA Region II Program Manager, are available to troubleshoot and resolve cross-system issues that arise. Each CSP is to identify a contact person(s) for CSP-related vocational system issues. In addition, data and anecdotal information (from any source) is communicated to the lead contacts through quarterly meetings, email and phone conversations, and will be used to identify service delivery and CSP issues. Page 4
In the event that issues are unable to be resolved in the above mentioned manners, the following shall be forwarded in writing to both the ADES/RSA and ADHS/DBHS Statewide Coordinators: Issue that is unresolved. Actions that have been taken that have not resulted in resolution of the issue. Recommendations for resolution of the issue. Information Sharing: The following outlines the how and when information is to be shared and gives details about the types of information to be shared. 1. Once the member attends the orientation and decides a referral to RSA is in place, the Behavioral Health Representative will provide the assigned VR Counselor with the following information within 7 business days: a. SMI Determination / 2nd Level Review, b. Annual Assessment (Part E), c. Individual Service Plan, d. Individual Service Plan Review/Update, e. Progress Notes, f. Crisis Plan g. Medication Flow Sheet, h. Psychiatric Evaluation, i. Any relevant Vocational Assessment, j. Copy of driver's license / State issued I.D. / Social Security Card, k. SSA Award Letter, and l. Other information to the extent required to meet the purposes of this agreement It is the understanding that NTXIX members, or TXIX members who were recently NTXIX, may not have everything listed above in their case files, so with those members, it is extremely important to at least include the SMI Determination, any Psychiatric Progress notes, and any other information that may help expedite the eligibility process. 2. RSA and CPSA shall communicate changes in client status in a timely matter (e.g., participation, progress/lack of progress, medication changes) preferably by phone or in person, or during on-site CSP visits by VR Counselors. 3. RSA staff s on-site and off-site schedule(s) of orientations, as well as any contact information, are updated and shared at Vocational meetings. Page 5
4. CSPs are to have processes in place to ensure that information on progress, service goals, changes in ADES/RSA status and other key information is included in the behavioral health record. The VR Counselor is to give a copy of the Eligibility Determination, IPE and completed Coordination sheet to the Employment Liaison to be filed in the member s medical chart. Any major change in IPE or ISP information needs to be exchanged on a timely basis. 5. RSA Programmatic Data (when available) and updates on coordination of ESE services are shared at various meetings: a. RSA/DBHS IGA Advisory Committee Meeting b. Quarterly Vocational Task Force Meeting c. CPSA/CSP Technical Assistance Meeting d. RBHA Administrator Technical Assistance Meeting 6. CSPs, RSA, and CPSA shall participate in IGA Technical Support and Monitoring Annual Site Visits to examine service coordination via review of the behavioral health record, member interviews, CSP staff focus groups, and VR Counselor interviews. In addition, CSP utilization data compiled by CPSA is shared with CSP staff at technical assistance meetings and reported to ADHS/DBHS in the Quarterly Rehabilitation Progress Report. This information is reviewed and shared at the Quarterly IGA Core Group Meeting. Resource Sharing: CPSA, RSA and the CSPs agree to coordinate resources to support members mutually served under the IGA. Services are delivered with the explicit goal of members successfully achieving or maintaining competitive employment as part of their recovery process. Services will be continually evaluated and modified to most effectively meet this goal. Arrangement for Co-location: In order to increase VR visibility and further embed vocational/employment services at the CSPs, VR Supervisors distribute information to the sites individually. Materials may consist of RSA brochures, posters about employment, or an RSA DVD playing in CSP site lobbies. CSPs are responsible for providing space for orientations and client contact to facilitate members easy access to VR services and foster collaboration between staff. The assigned CSP provides VR staff with the necessary equipment to do their job effectively: group meeting room, private meeting space, desk, computer connectivity, telephone and optimally, internet access. On-site orientations and meetings with members are dependent on availability of space, staff time and distance from RSA office. Joint Training In addition to coordinating resources in service delivery, jointly available training topics are identified through assessments at both the local/regional and state IGA levels. Training opportunities include: Page 6
IGA training with different topics jointly agreed upon by RSA, CPSA and other RBHAs each year. The training is made available to members and CSP, RSA, vocational provider and consumer-run provider staff. Monthly trainings through CPSA are available to any interested party and are communicated through the Community Training Calendar posted on the CPSA website. An overview of vocational services training is offered quarterly by CPSA Employment Specialist. Summary: CPSA and RSA will work to ensure that VR Counselors and CSP staff receive adequate training on the provision of vocational services and are familiar with and adhere to the procedures outlined in this Protocol in service delivery. This Protocol will be reviewed on a yearly basis or more often as needed and revised as necessary. For a list of agencies and clinics in GSA 5, please visit the Links Page on the CPSA Website. For a list of ADES/RSA locations, please visit the Rehabilitation Services Page on the ADES Website. Page 7