INDIVIDUALIZED EMPLOYMENT PLAN (IPE): COUNSELOR-CONSUMER ALLIANCE FOR DEVELOPING AN EFFECTIVE IPE
Event Date: June 18, 2009
Presenter: Samuel Teruel-Velez, M.A, CPM and William S. “Mr. Bill” Harris, M.P.P. CRC
Facilitator: Shelley Kaplan
Overview 
Shelley Kaplan: Good afternoon and good morning, depending where you are in the southeast region. Welcome to the 2009 Southeast TACE Region IV webinar series. You have joined the session today as you know, Individual Plan for Employment (IPE), Counselor-Consumer Alliance for Developing and Effective IPE. My name is Shelley Kaplan and I am a member of the Southeast TACE Region IV team. I want to welcome back many of you who have participated in many of our previous sessions and a big hearty welcome for those of you who are joining us for the first time. 
As most of you already know the mission of the Southeast TACE Region IV Center, along with our other nine counterparts across the country is to work together. And work together to improve the quality and effectiveness of vocational rehabilitation services. And for what purpose? The primary purpose is to enhance employment outcomes for individuals with disabilities. Our TACE works in the eight southeastern states, we have the largest region to serve and we are very proud of that and we are working with some great people. As you know, we serve Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. Our TACE is a collaboration with the DBTAC, the Southeast ADA Center. Both the TACE and the Southeast DBTAC are managed by the Burton Blatt Institute. We are hosting quite a few webinars this year, as many of you know and if you have already signed up for those topics that are of interest of you that is great. But if not, please visit our website and look at the TACE webinar room, hopefully we will have that URL up in the chat box in a moment and see what we are  offering this year when you have a moment to check it out. All of the instructions about how to register are provided on the site and of course if you need any assistance our staff stands ready to assist you. 
Just a quick note about the webinar system, we use a system is that is fully accessible to everybody regardless of their disability and/or the assistive technology that might be used with a computer. This system makes it possible for us to conduct workshops over the internet from just about any computer with an internet connection and web browser. . Please note that sometimes long distance charges may apply. Unfortunately there is there are many computer issues that you have reported to us that are inherent in your systems and are beyond our control, that is  why it is important for you to check your systems prior to the session.. Staff is available upon request to work with you in advance of the session, I want to stress the word "advance" we are unable to trouble shoot technical issues at this point, right before the webinar is scheduled to begin. As in the past, during today's session as our way of cutting down on the problems that people have reported to us you will only to be ask questions by typing them into the chat area. Our speakers will follow-up with these questions as they present themselves. They will also voice the questions for the benefit of participants and the captioner and for the transcript. 
For those joining us on the telephone line, they will not be able it see what is in the chat room, all of that will be voiced so it can be captured. Also, at this time we are advising you to close all other applications you may have running on your computer because they may interfere with your successful experience today. You might also turn off any automatic systems check that your computer does automatically to eliminate any further interference with the session. If you are connected to a network do not forget to periodically tap the space bar once and awhile just to let the webinar system know that you are still there, sometimes if your computer is networked it will shut down if it stays idle for too long. 
Okay. At this point we are ready to begin. We are  so privileged to be joined by our featured speakers, Mr. Samuel Teruel-Velez from North Carolina Division of Vocational Rehabilitation Services, the Independent Living Rehab Program and "Mr. Bill" Harris from the state of Florida with the Department of Education Division of Vocational Rehabilitation. Their bios are up on the TACE website, I won't read them at this point but hopefully you had an opportunity to read them and recognize that we have two outstanding individuals which apparently many of you know based on the conversations that were going on before we started today.  We thank you for your time and at this time, Sam; I will turn the microphone over to you. 
Samuel Teruel-Velez: Thank you very much Shelley. Good afternoon, guys. I want to welcome to you to the webinar. Just very happy to see how many participants we have. Of course, it is changing a little bit between 89 and 91, it looks like many of you have decided to come and spend a few hours this afternoon. Like Shelley said, I am Samuel Teruel-Velez from North Carolina, and I have worked in the field of vocational rehabilitation since 1984, and a member of the North Carolina Division of Vocational Rehabilitation Services since 1988. I want to thank the staff of TACE for their support and assistance in helping us, Bill and myself, prepare for this webinar. I want to thank the staff from East Carolina University who invited me to participate also. I want to voice my great appreciation to my co-presenter, Bill Harris for his dedication, understanding, valuable input and partnership in putting this webinar together. Before we get started I would like to clarify that for the purpose of this webinar I am acting as a private consultant. I am not representing the North Carolina Division of Voc Rehabilitation Services. I will be using and explaining some of the policies and procedures used by the state in order to provide you with different examples for meeting federal requirements of the Rehabilitation Act and for influencing the establishment of the Counselor-Consumer Alliance for development of an Effective IPE. . Before we continue I want to take this opportunity now to have Bill introduce himself, Bill? 
Bill Harris: Howdy everybody, this is Bill Harris out here in the Orlando area. You are correct in that I do recognize a number of the names of the Florida participants. You are also correct in your thanking TACE for their allowing us this opportunity to share with you some thoughts that might be of value to you. Unlike Sam's status this afternoon, I will be representing the state of Florida Department of Education Division of Vocational Rehabilitation. Much to their dismay, yet I do appreciate this opportunity and the faith and guidance and assistance they have provided me in putting together some of the materials to share with you today. Like Sam, I have been in this business for quite a while, I have indeed enjoyed it. I recognize many old friends out there. I hope that you benefit from this webinar, without further adieu, back to you, Sam. 
Slide 2: Counselor-Consumer Alliance 
Samuel Teruel-Velez: Thank you, Bill. We will start our webinar. Please move to slide 2. We will start the presentation by providing you a very simple definition of what is the Counselor-Client Alliance. It is a partnership of the counselor and consumer that is characterized by the sharing of responsibilities, sharing of information, mutual respect, mutual input, mutual decisions, it is goal-oriented, it is flexible, it is full of communication and it should begin with trust. Next slide please, slide 3. 
Slide 3: When does the Counselor-Consumer Alliance start? 
When does the Counselor-Consumer Alliance start? Bill and I with our experience in working with other counselors know that this alliance has to start at application. The counselor must immediately encourage and foster an atmosphere that is conducive to communication, mutual respect, sharing of information and is goal oriented. There are elements that must be present in the alliance and also at application. There has to be an exchange of expectations, an explanation of the VR process, and most important discussion and understanding of informed choice, and a very clear establishment that employment is the purpose and the goal of the alliance. Bill, would you like to make some comments? 
Bill Harris: Yes, Sam. In researching for this presentation I found some common themes running through the literature. I would like to share them with you and with the other participants periodically through the course of the webinar. As we presume we are preaching to the choir, if you will, we are all professionals and we all understand some of the basic tenants of these processes and philosophies. The Counselor-Client working Alliance is considered to be a central factor in all successful counseling processes, especially the VR counseling process. This must include an effective working alliance. Researchers estimate that as much as 30% of the variance in counseling outcomes can be attributed to the Counselor-Client working Alliance. This is a positive collaboration between the counselor and the client. The working alliance can be most beneficial and an excellent predictor for outcomes for consumers with disabilities when the counselor and consumers agree on the goals and preferred outcomes. The counselors collaborate with consumers on tasks to accomplish those goals and preferred outcomes. And the counselors have a favorable view of the counselor-consumer relationship. This likens itself to an empowerment approach, in forming an effective counselor-consumer working alliance which must include elements that the consumers and counselors bring to the relationship. Primary elements for consumers include, taking responsibility for their own decision making and for their own actions and consequences of their actions. Key elements for counselors include the following, knowing and admitting their limitations, for example admitting their lack of knowledge of a specific disability or condition and its impacts vocationally, and displaying an unconditional positive regard for the consumers they serve. Next slide, slide 4. 
Slide 4: Exchange of Expectations 
Exchange of expectations. The consumer shares and identifies reasons for contact, goals, needs, services, and desired outcomes. The counselor shares and clarifies roles, explains the rights and responsibilities, initiates guidance and counseling, emphasizing above all employment as the desired outcome. Next slide, slide 5. 
Slide 5: The Vocational Rehabilitation Process and Informed Choice
The Vocational Rehabilitation process and informed choice. The counselor thoroughly explains the VR process, including some sub-processes that we wanted to dwell on briefly today including the order of selection, financial participation and utilization of similar benefits. Program eligibility needs to be thoroughly explained, including the preliminary assessment, the possibility of the need of provision of diagnostic services and information on the 60-day per of determination of eligibility. IPE information should be introduced, the importance of consumer active participation and development of the plan, the selection of services, vocational goal identification, selection of vendor services and providers as well as venues and formats are strongly emphasized. Within the context of the order of selection our associates in Florida have really done a fabulous job as both on this slide you see A is order of selection, B is financial participation. In April of 2008 overnight we implemented financial participation for the first time to my knowledge in the state Vocational Rehabilitation program in Florida. Approximately five months later, in August, we implemented the order of selection. We are continuing to work under the order of selection and I presume that at this juncture most of you, at least the Florida participants, are well aware of these circumstances. I will be happy to discuss specific questions relating to the order of selection and the financial participation deployment in Florida at greater length given questions from the participants. Let me go back for just a moment however, to the concept of the working alliance. As this concept has an overlay upon everything that we do. It is been said that the working alliance has consisted of three interdependent components of goals, tasks and bonds. Goals can be identified as the targets for interventions, behaviors, outcomes and are of course generally recognized by us in the rehab community as outcomes. Tasks are the behaviors, cognitions that are engaged in by both the counselor and the client while in counseling. What have you accomplished today? The idea of bonds is the level of the compartment compatibility between the counselor and the client. Bonding develops form the interaction between the counselor and client during a shared activity. This bond can be expressed as liking, trusting, or a feeling of common purpose and understanding between the counselor and the client. I see that there is a question here from someone, let me see, of the states represented which ones are in the order of selection? Thanks for the question, Rebecca. I see Georgia and Kentucky are in order of selection and we already know that Florida in under order of selection. I would encourage other participants to let us know about your particular states. Frankly, I do not know. Within the order of selection in Florida, I see Tennessee is as well, thank you. The order of selection, as you all know, is a process by which each state agency can provide a fair and orderly way of determining the order in which individuals with disabilities are served. This is inherent when the VR agency cannot serve 20:07all the individuals with disabilities that apply for our services. As you know, we established categories in which individuals are assigned rankings, if you will, based upon the significance of their disability. In Florida and I presume in other states working under order of selection, we have three categories. We are mandated legislatively to serve the most significantly impaired individuals. For us in Florida, that is known as a category 1, or most significant disability. We have a second category, which is the second tier, or middle category of a significant disability. Lastly, we have the category 3, which is an eligible individual with a disability, yet we do not presume that the services would be expected to last more than six months and disabilities and impairments can often be corrected through surgical and medical treatment of modalities. Remember earlier I said how proud I was of my Florida cohorts. In April 2008 we were hit with the financial participation piece and in August again. The financial participation piece was sort of a paradigm shift for us. The financial participation assessment is a rationale process and it actually requires individuals to participate in the cost of VR services. However, if individuals are receiving for instance SSI or SSDI or both they are exempt from the financial participation. Financial participation in Florida applies to all services accepting assessment for vocational rehabilitation needs, the guidance and counseling which we perform daily, interpreters or other aids, on the job training, personal assistance services, job-related services, job serve and placement. I'll be happy to go into greater length into these concepts and application in Florida as needed in the future. I would like to ask Sam now give us insight into how things are shaking out in North Carolina on these subjects.
Samuel Teruel-Velez: Thank you, Bill. I wanted to mention that what we are presenting to you are elements that we believe are important that you discuss and work together with your applicant at that very first interview. You want to provide as much information to the consumer in reference to the VR process itself, where you are discussing your expectations and the consumer is going to be also discussing what their expectations are. You have to start having good communication and good understanding in order to be able to plan for what needs to be done before you get to the point of writing your IPE. Let me mention in North Carolina there is not an order of selection implemented. However, we do have lines for the establishment for order of the selection and the division director will make a determination prior to the start of each fiscal year whether or not we will implement the order of selection. Clients will be placed on a pre-service list that is done after eligibility has been determined and a category has been assigned by the counselor based on the significance of the disability and the number of limitations and functional capacities. In North Carolina we have six categories. The first two categories address most significant disabilities. The second two categories address significant disabilities. Having a fifth category that addresses the need for multiple vocational rehabilitation services. And our sixth category addresses eligible individuals that do not qualify for a higher category. In reference to financial participation, in North Carolina we have been using financial participation as part of the process for many years. It is not something new for us, especially for counselors that have been within the system for 15, 20, 25 years. We do have the exception for those consumers that receive SSI and/or SSDI. However, if they have any kind of any other similar benefits, we will take later about that, they have to be provided and brought up at that time when the counselor is working with them in explaining what is the financial participation. We require that this financial participation will be clearly understood and that it is kept in mind at all times so that, what we call cost services are provided in the IPE the consumer clearly understands there will be requirement to use the similar benefit or if they have some additional income that they will have to pay for part or for the services that are identified. Let me also mention that in cases that we have when consumers are receiving SSI and SSDI would we look at is the numbers of individuals in the family. We look at it as a complete family unit. If the person that is requesting or applying for services is married or has a family member that works or has other sources of income we consider that income as part of the family unit, and thus it is considered for the consumer to participate in their plan. Let me address a little bit about utilization of similar benefits. In North Carolina we provide rehabilitation services only when services are not available through some other source. Similar benefits are to be investigated and used for all rehabilitation services; they must be recorded on the IPE, and must also be added to the IPE whenever new services are added. Example of the similar benefits,  we have Medicaid, Medicare, health insurance, if they have workers compensation claim, or if they are suing someone and it is considered that the person will receive financial assistance of compensation that also is considered as part of their income. Educational grants, again, for those pursuing some kind of training of education, especially when it is at the university level. Next slide, slide 6.
Slide 6: VR Process and Informed Choice
The VR process and informed choice. Emphasis is placed on the explanation of the comprehensive assessment and what it entails and its purpose. The consumer identifies their needs, strengths and challenges meeting requirements for completion of the comprehensive assessment. The counselor and consumer discuss and plan for taking advantages of the strengths and for overcoming challenges. Next slide please, Bill, slide7. 
Slide 7: Informed Choice
Bill Harris: Thanks, Sam. We are now on slide number 7. I see a number of questions in the chat area. This is very heartening. It shows that we are paying attention. One particular question was asking about our processes for individuals that might come into the state as a recent transfer, which happens with some alarming frequency here in Florida. Their only immediate expectation besides being put in a wait list or order of selection would be job placement. I see that a number of individuals have responded similarly, as we would here in Florida. There are projects with industry grants that have been sought and awarded to a number of our centers for independent living here in Florida that do provide job placement services for individuals that are on the wait list. And we have a very strong partnership with our workforce boards and one-stops to assist us in the placement of individuals with disabilities when there are other rehab services that are placed on hold due to the wait list. Thank you for the questions. I can see, Sean, in southwest Florida, I guess that is Naples area, they also got a PWI grant, good for you. We appreciate that opportunity. 
Slide 7. Informed choice. Informed choice is a shared responsibility. Identifying options and considering the advantages and disadvantages of each. It is a partnership. As Sam stated, it begins with the first meeting. It is continuous, throughout the entire rehab process. We must be mindful that accommodations should be identified and provided as needed. For instance, if you have a new referral coming in, your first encounter with a consumer in your office, and you have information suggesting they are a wheelchair user; rearrange your furniture if necessary. Make them feel comfortable. Make them feel as though they are less threatened. This is very important. This is basic human interaction and civil behavior. Let us face it, we sit in our offices, we know the drill, we are in charge. These folks are coming to us for help; they are wary and weary, skeptical and scared. Let us put them at ease and get on with the program. Next slide, number 8. 
Slide 8: Key Elements of Informed Choice
Sam and I have identified key elements of informed choice. It is an ongoing process, a joint effort, consumer driven, it is counselor supported, individualized, and the involvement is documented. As we all know, if it is not documented it did not happen. I have some further comments and thoughts on this element of informed choice; you know this is really not a new concept. After all free will was mentioned in Genesis. Socrates was known for saying "know thy self." And Shakespeare’s Hamlet encouraged us ages ago “to thy own self be true.” Intuitively the VR professional must examine their own acceptance and encouragement of free will and informed choice to facilitate and encourage our customers' acceptance and deployment of informed choice. The counselor's philosophy of human nature, that people have free will, or their lives are determined, or predetermined, could greatly influence how he or she thinks about and encourages informed choice. There are times being a parent when I am as guilty as the next, I realize this, and I regret it. Sometimes we have this paternalistic attitude towards some of our lower functioning or less of the consumers. I guess given recent staffing patterns at voc rehab, it would be more of a maternalistic attitude for some, but I think you understand the concept. Informed choice and free will pervades most societies. The Koran has said that God intended to give humans free will. Most clerics in the research that I have done suggest that the concepts of free will is applied to most great religions. Therefore, let us remember what Will Shakespeare had to say so many years ago regarding knowing ourselves and acting accordingly. Next, it is back to you, Sam, and slide number 9, I believe.
Slide 9: Counselor-Consumer Alliance
Samuel Teruel-Velez: Thank you, Bill. I was calling attention to the participants; they asked a question about the order of selection in Florida. Pamela answered; I wanted to thank her for giving that information out. Counselor-Consumer Alliance, now we move from the application aspect of it, we will move to the process of eligibility. The counselor must directly communicate with the consumer. In this slide we are addressing after we have made the eligibility decision. The counselor must directly communicate with the consumer to answer any questions the consumer may have in reference to the process involved in the eligibility determination. I want to again to have the counselors remember to address or reiterate to the consumer if there is an order of selection in place what category they have been placed in, what their eligibility determination means. Also, provide the consumer with the information about the possible utilization of similar benefits. The counselor should specify what it means to be eligible. We find ourselves with two statements that are usually brought about by the consumer, I will get everything from VR, or I am entitled to everything from VR. You have to communicate with the consumer about what has happened through the process of determining their eligibility. The consumer in some instances wants to have -- what they want has absolutely nothing to do with the employment goal. They will ask about some services that will not take them over, to what is their vocational goal that was identified in the plan. Next slide, slide 10. 
Slide 10: Preliminary Assessment
All right. Prior to doing that eligibility decision you have the preliminary assessment. Prior to making a final decision of eligibility a counselor may question an applicant's ability to benefit from VR services. In many instances the counselor is not too sure with the information they have gathered, by the conversations, the guidance and counseling sessions they have gone through with the consumer, if they would truly benefit from VR services. In those instances a Trial Work or an Extended Evaluation period may be used before a determination or eligibility or ineligibility is made. The counselor and consumer must meet to discuss and agree to the provision of that Trial Work experience and/or Extended Evaluation. This process involves just about the same process of developing the regular IPE. Because you are required to have a plan, you have to identify objectives and goals in the plan. The work plan and Extended Evaluation IPE together have to come from the input of counselor and the consumer. Bill you have some addition information?
Bill Harris: I would like to thank Pam and a few others out there who are assisting with the chat aspect of explaining some of the impacts here while I am trying to make sure I do not lose my place in the presentation. I know -- we can tell, we understand intuitively that a lot of angst has occurred because of the order of selection. This has been a change on how we do services in Florida. Yet in these difficult times have demonstrated to me the strength of the program. We applied the standards for order of selection. We have done extremely well in movement of this category 1, or most significantly impaired people, through our system. I was informed earlier this morning that an associate who determined eligibility for a most significantly impaired individual in the last week of March of 2009 was able to invite the person to develop an IPE this morning. That is less than three months. We are making progress indeed. I share the pain of many who have had to deal with confrontational aspect of explaining to their consumers, their families and others. We have had many queries about our changes in processes. We must respond to them civilly, gracefully and honestly with the understanding that we are doing what we should have been doing all along, that is to serve the most significantly impaired yet employable citizens in our communities. Now, I am supposed to be talking about preliminary assessment. We all have guides. We all have lists. We all have our favorite questions. We all have our preferred way of doing business. And I do not intend to belabor the point by reading through an exhaustive list of issues that may impact employability. In the event that any of you would like to see the list that we use in Florida just go to the bio area, you will find my email address and I will send them to you. Nevertheless, there is a particular twist here with regard to the order of selection. As we understand it, even though my associate counselor last saw the customer invited from the wait list this morning only three months ago, we all know the mayhem and misjudgment, misfortune that we befalls our customers. For heaven’s sake, stuff happens, it happens to all of us. These occurrences impact our customers, it is for that reason that I would like to remind everyone out there laboring under and with the order of selection model that if we forget to go back and revisit many of the questions and issues that we addressed a month, two, three, four, five, or six months prior we may be missing the boat. I know we have all had these cases, yet sometimes in our haired and hurried work day we forget that circumstances may have changed for that customer during the time that they are on the wait list. We forget this at our peril. Many of the questions that I think need to be readdressed are you employed? Is your condition stable? Have you been employed since you have been on the wait list? For who? How long? Why did you leave? Do you understand the type of work that you are seeking? Have you changed your mind about the type of work that you are seeking? Have there been any intervening legal, social, marital problems? Can you pass a drug test? Have you recently applied for or been approved for Social Security? Are you ready for job training and placement? Can you work or study any shift? Are you getting treatment for your illness or condition? We need to revisit every issue that was addressed earlier because we all know that stuff happens. Sam?
Sam, did I put you to sleep, good buddy? 
Samuel Teruel-Velez: No, I was just waiting for you to let the microphone off, Bill. [ Laughter ] Let me make a comment that is very important, I am glad that you took care of it very, very well. That is the point where you have the order of selection and as a counselor periodically -- we will leave that, we know how many consumers we have to come over to the offices to apply, we know that many of our counselors have very, very large case loads. However, the point is once we place a consumer in a particular category it is prudent and realistic that category -- that consumer will be reevaluated again whenever it is possible to make sure that if their condition has changed we may need to make an adjustment of that category. Let me take the question from Susan, what is the average case load for VR counselors? I would say in North Carolina we are talking about 65 to about 75 or 80 consumers. In many cases you have consumers that their case files have gone for a few years, they are in school, the counselor does not revisit them as often. I hope that answers your question, Susan. Let me also mention that we do have to communicate to the consumer the reason for establishing this order of selection so it is very clear to them this is not a decision that was made based on some kind of crazy argument that somebody brought up. But that most importantly this order of selection was established because of the availability of resources. We have to comply with federal mandates, but we also have state mandates. In these hard times the consumer has to be aware that we have to make some tough choices and they are not made because we want to put them aside or we want to postpone them. Contrary to that, many times the order of selection is established because we want to clearly assure that the quality of the services of the VR agencies continues to be of high quality. We have to be very careful that we do not run into a situation where the services that we are delivering to consumers are greatly affected because we do not have the resources. Let me ask now to come back to the presentation, slide number 11, please. 
Slide 11: Comprehensive Assessment
All right. Coming back to our presentation. I will talk a little but about comprehensive assessment. The counselor and consumer will review the VR process and comprehensive assessment. They will share information on tools and options that will be used during the comprehensive assessment. Examples of the tools may include the VR assessment evaluation. The counselor should include questions that should be addressed by the evaluator.  We also have the extend extent of the evaluation and the outcomes that are decided, community based assessment, supported employment, and situational assessment. I want to make a comment about the community based assessment, remember this is a technique that allows an individual with a disability to perform competitive job-related duties in the public or private sector. We have to be careful that when we use the tools and options we do not make the error of placing a consumer in active employment. That is not the objective of using these tools. Bill? 
Slide 12: Comprehensive Assessment (CA)
Bill Harris: Slide 12, please. Comprehensive assessment. Comprehensive assessment staffing is the consumer, counselor, and other individuals involved in the generation of reports and information during the comprehensive assessment period. Getting together is strongly recommended. It reminds somewhat of the person centered planning concept that we hear of often in the supported employment tier of services. This gives us an opportunity or purpose to share and clarification information on the data gathered, testing performance and recommendations made. It provides the consumer with evidence-based information in selecting a realistic vocational goal and start identifying goals and services that will not only assist with reaching the goal but that are directly related with the achievement of the goal. One further comment, often times in sharing and clarifying evidence based information and data, we must remind ourselves that quite often in our conversations with employers we learn that it is emotional and behavioral-related issues that most greatly impact their staffing needs. Let us just not forget that you have to get along to go along irrespective of the evidence-based information and your performance. Next slide please, slide 13. 
Slide 13: Individual Plan for Employment
Individual Plan for Employment. The IPE represents the culmination of the assessment by documenting the job choice and the nature and scope of services and the benchmarks. The counselor provides the consumer information necessary to make decisions regarding alternative goals, objectives, services, service providers and methods to procure the services and/or assist in the acquisition of the information necessary to make these informed decisions. Information will include cost. It will always include information about costs when the customer is not excluded from the financial participation formula and is expected to pay a portion of the costs related to the rehabilitation. We also must address accessibility, the duration of potential services, the qualifications of service providers, and the degree to which the services are provided in the most integrated setting possible. Another brief comment on Florida's take on IPE development feasibility, in Florida we demand that VR explore the individual's abilities, capabilities and capacity to perform in work situations using as Sam mention a few slides ago, Trial Work experiences. Under limited circumstances if an individual cannot take advantage of Trial Work experiences or if options for Trial Work have been exhausted before eligibility decision is made, DVR will conduct an extended evaluation to assist in making the determination. In Florida our director, Bill Palmer, has decided to use some recently streamlined ARRA monies to develop a model for on the job training within the state of Florida for our consumers. Which will to a greater degree provide us with situational assessments of individuals' vocational capacities and provide valuable work experience for those consumers. I am very happy that we are looking into that new initiative. Back to you, Sam, for slide 14.
Slide 14: Individual Plan for Employment Continued
Samuel Teruel-Velez: Individual Plan for Employment. Services will be provided consistent with the full input of the consumer. Remember we have to keep in mind that this plan is for the consumer. We have to have input from the consumer. The employment outcome will be consistent with the consumer's informed choice. All services identified must be directly related to the achievement of the vocational goal. And the IPE must be agreed to and signed by the consumer, and approved and signed by the counselor. This part is very important. I have always told the counselors that I work with that signature, the signature of the consumer and the signature of the counselor is what gives the ownership to the IPE. It makes it successful. The counselor and the consumer at that point are saying that they will work together, they identified the services, they worked together on the timetables for accomplishment of the vocational goals, and the plan is something that is for both of them to work together on. Slide 15 please. 
Slide 15: Essential Components of the IPE
Essential components of the IPE. Make sure to identify the employment outcomes. We have to make sure that goal of employability is always present, that the consumer understands that from the very beginning of the application that the objective and the goal of obtaining services and the overall VR process is for them to become employed. Select VR services, make sure you identify the services that are to be provided, that they are identified in the plan. And the consumer is part of the selection of the services. Choose service providers so that the consumer understands who are the other participants, who are the contractors, who are the vendors that will be present in assisting them in achieving their employment outcome? Again, establish the timelines, identify responsibilities for the consumer and counselor and in many cases the overall organization responsibilities, and that you have identified those similar benefits. Make sure that the consumer understands that some of the services are not going to be completely directly provided or purchased by your organization, but they will be coming from other benefits, other community organizations or other vendors around that they have been already identified as being part of that plan. Next slide, slide 16. 
Slide 16: Measuring the Consumer Progress and the Flexibility of the IPE
Measuring consumer progress and flexibility of the IPE. The consumer and counselor must communicate and meet periodically to share information about the consumer’s progress toward the vocational goal and other goals that were identified on the IPE. This is very important. You want to use these periodic meetings so that the consumer understands how they are moving along into achieving that vocational goal. Also you will use the meetings to start determining if there have been changes in the condition of the consumer, I am talking if they have some kind of impairments but also in their family relationships, their income. Like I said earlier, in North Carolina we apply the financial participation; we have to make sure that their income has not changed. We review basically this financial participation every year, all right. There should be at least an annual review of the IPE with the consumer, the case is active for one year, in many cases those consumers who are receiving training. You have to make sure they are progressing at school as they should be doing. Also any changes with their condition, their relationships, or if there are medical needs that need to be tended to that might affect the progression of the IPE. Amendments are required when there are substantive changes in the vocational goal, services to be provided, or service providers. In Florida, unless a similar certified provider is substituted for a similar service. And Bill will give you a little bit more explanation on that part. 
Bill Harris: What is meant by that statement of "unless a similar certified provider is substituted for a similar identical service"? For instance, if a deaf customer required interpreter services during an on the job training exercise with a specific employer and the contracted interpreter that was identified in the IPE was no longer available through circumstance to continue with the required ongoing services, Florida vocational rehab acknowledges the fact there is  no need for an amendment to the IPE to change the IPE in order to identify another certified interpreter who might be able to be brought in the very next day to provide the very similar or identical service. Slide 17 please. 
Slide 17: Empowerment of VR Consumers
Empowerment of VR consumers. We keep going back to the beginning. We keep talking about the expectation that we establish consumer engagement, self-determination, and activity from the very first meeting. We need to focus on the relationship of customer and VR as allies, not as adversaries. That goes back to that bonding piece in the alliance. We need to make people feel comfortable. We need to foster the relationships. And at times, admittedly, we need to work on it. We also should challenge our customers to deploy self determination through research and informed choice. It seems to me through my career that the number one sticking point, if you will, often within alliances in an IPE process relates to the vocational objective itself. In Florida VR we must provide a description of a specific employment outcome that is chosen by the eligible individual. Of course, we know that it must be consistent with their unique strengths, resources, priorities, concerns, abilities, capabilities and interests. While documenting their informed choice in reaching these conclusions we must also remember to look at challenging our customers to perform a job analysis, job shadowing to really understand how deep the water may be that they wish to dive into. Labor market information has been rather gloomy as of late. I would like to congratulate not only my Florida associates, but all of the TACE professionals within the southeastern United States, that continue to labor strongly in a rather dismal labor market as we try to place often marginally employable individuals into  integrated employment. I notice there are a couple of questions coming up on the board. I do not intend to address them now, I will address them later as I would like to move on to Sam, and slide number 18, please.
Slide 18: Customer Empowerment and Informed Choice in Successful Rehabilitations
Samuel Teruel-Velez: Thank you, Bill. I have been trying to answer the questions as fast as I can. If any of the participants have put a question up, please keep scrolling down, you will see I have done my best to address the questions asked. Customer empowerment and informed choice. In successful rehabilitations research suggests that the development of an effective Counselor-Consumer working Alliance is paramount for facilitating consumer informed choice and self-determination. You have to establish that alliance you have to communicate with the consumer. The central factor in all successful VR IPEs is an effective working alliance between the consumer and the representative. I was called attention in reference to one of the questions that I answered. This one was asked by Emily; let me see if I can get to it. Emily had a question in reference, how often should we,  when attempting to identify similar benefits how often do the state VR counselor reach out directly to other rehab counselors with the private insurance when client is receiving those benefits? I have addressed the question as follows, because this is a really good question -- I am telling Emily that the VR counselor should always reach to a similar benefit provider, always. This is something that needs to be done because, remember, for many reasons, especially now that some of our funds are somewhat limited, we have the order of selection established in some of the states, we have to make sure that if a consumer already has a service that is going to be provided by a similar benefit provider we have to make sure that the consumer understands they have to reach it, we have to make sure that the consumer has tapped that resource before we use VR funds to provide the service. We cannot provide a service that can be provided or has been identified to be provided by a different source. What we are doing -- it is basically, we are duplicating a service. I hope that helps in answering the question. I want to go -- mention again in reference to the slide that we have up now; we have to continue to remember that we have to establish that working alliance with the consumer and the IPE is a result of the partnership. Bill, slide 19. 
Slide 19: Essential Ingredients of an Effective Working Alliance between VR Staff and Consumers
Bill Harris: Thanks, Sam. Before we address slide 19, which appears to be the last slide of the presentation, I would like to address an issue in the chat area. The statement is as follows: Usually VR services are a provision in most long-term disability policies. We try to coordinate with state VR. No rate increases would be applicable. That is Emily's response to Holly's earlier statement of, as my experience as a VR Counselor consumers are at times very hesitate to involve insurance companies because they fear that their insurance rates may increase. It was an ethical dilemma for me regarding do no harm.   You have seen Emily's statement from the aspect from a private insurance rehab specialist. I would like to share with you my perception as a generalist in the state program. I think the concept of do no harm applies directly to the individual. Yet to a certain degree I think there is a greater good aspect here. This is a public trust. Most of us are public employees. Tax dollars support our efforts. Sam and I have gone to some length trying to explain similar benefits, the concept that VR services must be required and inaccessible from any other source before VR provides the services, as well as the rule that VR is of last resort. The responsibility we have been given by the taxpayers to oversee the use of the funds and resources they have provided us. I would never decide to not require a client to alert their insurance company of an issue where in there might be a sizable award returned to the state of Florida and the taxpayers. That said, slide 19 talks about essential ingredients of an effective working alliance between VR staff and consumers. We need to treat all customers as adults; we know this, regardless of the severity of their disabilities. We should not use our jargon and vernacular, use age appropriate language and technologies. Client comes in, you start talking about the IPE, to them I do not know what it would mean to them, and we should explain our terms when we have to use terms that are unfamiliar to them. We should always place emphasis on consumer strengths while respecting consumer values and strengths. I believe that is the last specific PowerPoint slide that we have prepared for your consideration. Now I would like to it up to further questions. Celestia or anybody can you help me locate questions we have not addressed yet?
Questions and Answers 
Samuel Teruel-Velez:  All right. Let me address the question from Trish. The question is, any suggestions for dealing with an entitlement mentality? I want to bring us back for a moment to the slide where I talked about eligibility. That is a part that I always put a lot of emphasis on to the consumer. There is a belief that once you are eligible for VR services you will receive the whole array of vocational rehabilitation services. It is hopefully a good skill that our counselors will acquire, develop or already have, to make sure that the consumers understand that the provision of the services is directly related with their vocational goal. The overall services they will receive is going to carry them to that employment aspect and that if something happened in between because of the flexible the counselor should be part of the partnership, the counselor can work with the client to address it. But it has to be very important that the counselor develop that skill where they can communicate to the consumer -- look, what we are moving towards is this vocational goal, we are not some type of organization that will be providing for you to resolve some other aspects that you are facing because of your disability. Bill you got the next one?
Bill Harris: Yeah, Sam as soon as I can find it. I just communicating with an old friend, Patty, I have not seen in years. She's rather shocked I am still here. I'll be retiring in three or four months, but let us not push it, it could be any day now. The previous question was an entitlement mentality. I try to remind counselors who I have trained over the years that we do not give people what they want; we give them what they need. Mediation is often included in the discrimination between people's wants and needs. I do not have a magic bullet, I am not sure that anyone does. This is a very difficult issue for all of us. I have certainly wrestled with that for many years. There was another question. Was this from Patty, about client going to CAP.CAP does not always have to be the enemy. That is not to say that over the years I have not been battered a bit. But they are performing a legislatively required very important function within the rehabilitation paradigm. They are going to advocate. Some of these clients cannot advocate for themselves. Some of the issues that they want to advocate too often seem rather extreme yet by and large we must remember that CAP, the Client Assistant Program does not have the power to write IPEs. CAP, the Client Assistance Program does not have the power to write certificates of eligibility, you do. We do. There is a very specific role for each within this industry. I hope that answers the question on the CAP issue, if not just let me know. 
Samuel Teruel-Velez: Yes, I would like to add a little bit more about CAP based on Elizabeth's question. Is it still client's choice with the option of going to CAP? I believe that CAP is a resource and it is part of those options and information we provide to the consumer. It is an advocacy organization or agency and it is also part of the rehab act. I always provide information to the consumer hoping that -- that I can also use CAP as a resource for the client. I have been very much lucky, I guess. My experience with CAP has always been very positive, both as a counselor and a few years ago I was the IL program specialist for the state of North Carolina, I had very good experiences with them. The counselor that work for CAP would come to me and we would sit down and discuss cases, contact counselors directly and make them part of the conversation, and develop good ways to have the CAP representative and the counselor work together with the consumer on resolving issues they had. 
I want to go ahead and address the question from Amanda. For VR programming requiring that clients pay for a portion of their services how does this work? How do you decide how much the person is to required to pay? Holly made a comment as well, I am glad you asked that question, I would like some input as well. In North Carolina, I will talk generally; I am not going to talk about the exception of SSI/SSDI to kind of give you a clearer presentation of how it is done. We take the income of the family, every member of the family. In many cases we have a family of one. In situations where there is a spouse or children, or somebody else in the family that contributes to the unit we take that income information. We also have some deductions that are allowed that the consumer is paying directly, for example, even if they do have some medical insurance but they are responsible to pay out of pocket we use some of the deductions as part, if the consumer for some reason has modified their vehicle, they are paying for the vehicle that has been modified we also take a deduction for that, so on. We have some thresholds that have been established by the legislature here in North Carolina that tell us the minimum income that is allowed for each family unit. Once we have subtracted the deductions we compare it with the threshold that is given by the legislature. Where the consumer has what we call additional money then we make an estimate of the rehabilitation plan. Once we make that estimate we say the cost of your plan is this amount of money, you are required to contribute, let us find out where do you want to contribute. We have a case where a consumer needs a ramp in their home, but at the same time needs to go to the community college for classes and he or she has not qualified for any grants or any kind of assistance then what we'll do is say to the consumer we will pay for your college education, you will use this additional money to go ahead and construct the ramp in your home. That is how we kind of work it out with the consumer. I hope that answered the question. Bill you get the next one.
Bill Harris: Okay. Yeah. Good explanation, Sam. You have had a financial participation formula process in place for quite some time. As I stated previously, the issue in Florida is relative new, it happened -- April, I believe. We developed a process by which -- as I stated earlier, we had exemptions. A person on SSI or SSDI is exempt from participation, meaning that an individual does not have to participate financially in the services required to obtain and maintain employment. . Now, if you are not receiving SSI or SSDI and your earnings are based on a formula of 185% of federal health and human services poverty guidelines we apply a formula. For instance, when it comes time for IPE development here in Florida we want to see their tax returns for the prior year. We want to see their W2s, we want to see information that relates to the resources they have to bring to the party. Let me give you a brief example. A single individual not receiving SSI or SSDI comes into one of our offices and is requesting a nonexempt service, in other words, anything other than assessment for eligibility, referral, job search, personal assistance, aid, interpreters, support to employment, on the job training, school to work services, community-based work, Trial Work, et cetera. Anyone coming in requesting any other service which would include physical and mental restoration, transportation, rehab technology, self-employment, technical assistance, occupational licenses, vocational training, academic training, if that is their expectation then we are going to ask them for information to determine their financial participation. If that individual is a single individual and if the formula for 185% of the health and human services poverty guidelines for a single individual is roughly $29,000, if the individual brings in to the counselor the financial information regarding their presumed capacity to participate and we find that the individual presumably should have $20,000 to contribute towards the cost of their participation we would expect them to assist us with 60% to 70% of the cost of those nonexempt services. I am hoping that is clear. Now, if the individual, however, comes in and has $20,000 to contribute and they provide us with documentation of impairment-related work experiences then we would deduct the IRWEIs from their presumed surplus capacity to participate. This happens with some frequency here in Florida. I was in an associate's office with an individual with a quadriplegic condition just yesterday. His specific request was for a new wheelchair, as his power chair is getting rather long in the tooth. Once we look add at his income, the mid 30s, and his wife's, in the mid 60s, we had over $100,000 of income presumably available for a family of two with the poverty guidelines being roughly $40,000. Presumably this individual would pay for 100% of those services. Now that I have gone on and on Florida’s take on financial participation, I have forgotten if there is another question. If so, Sam, you want to jump on it?
Samuel Teruel-Velez: All right, Bill. Let us see. I see two questions here. Let me see if I can get to them pretty fast. We have Rebecca, do we not -- we do not have a financial participation policy here in Tennessee, we are looking at starting one for training purposes, but nothing else that I know of. So my question is, what happens when a person says they cannot or do not want to participate? All right. This is what we usually do here in North Carolina, let me mention from the information that Bill provided, as we are completing the financial eligibility form, when we prepare the financial eligibility form we require the consumer to provide two clear documentations of those expenses that they have and then we make the analysis if they fall into the allowable deductions. If the consumer does not want to participate, or says that he or she cannot afford it then we work with the consumer in providing those services that are considered and this is the language we use here in North Carolina, are those no coast services.  An example of them, you have the counseling and guidance, information and referral, job skills training, the one providing classes on how to complete applications, how to search for jobs and so on. Making it very clear that the consumer understands that any other service that does in fact require their financial participation will not be provided. We also do not leave it closed like that, we work with the consumer to try and facilitate how to access any other service that might provide that particular service that they are pursuing without having to spend their money. 
There is a question from Mark. Anybody ever hear clients discuss a master degree after four years of sponsorship and the regional plan states the goal as the undergrad degree how open an option should that be? Mark, remember we are dealing with an Individual Plan for Employment. And that is what Bill and I, we emphasize that partnership has to be established from the very, very beginning. In sharing information with the consumer then you will want to address the vocational goals and try to be as specific and try to share as much information as possible. Try to make it simple. You do not want to get into a lot of verbiage here. For example we have had a vocation for a consumer that it is a realistic vocational goal to pursue that field of counseling. Well most likely is that a consumer pursuing this field will be able to obtain employment if he or she obtains a masters degree. In that very first IPE that is prepared we explore the possibility of providing the training all the way to the master’s degree. Giving us much information, sharing as much as we can. Again, the IPE will address an undergraduate degree for some, we just have to work out with the consumer and explore the options, may be in some situations where the VR does not have to be involved with them. But in situations where VR is involved then we have to obtain more information of why the person is not able to obtain employment in the field of study for the undergraduate degree, what is the market analysis to find out what is going on that the person is not able to secure that employment on that original degree without going on for their undergrad degree. In many situations we do not pay for the master’s degree level because hopefully we have already provided the training for the person to have the skills to find employment. Bill I am leaving you with the next one. 
Bill Harris: Okay. Can someone identify the next one for me, please?
Shelley Kaplan: We did have a question a ways back in terms of whom other than the counselor and the consumer would serve on the team when conducting a comprehensive assessment?
Bill Harris: That is a really good question, I am sorry I missed that one earlier. We need to look at it on a case by case basis. Person centered planning suggests that any individual who can impact rehabilitation services by way of the input regarding feasibility of employment and likelihood of employment should be included in the assessment piece. This takes on a whole different direction when looking at supported employment-related cases. The add vent of natural supports and our understanding of the need to develop natural supports within the communities. We need to be open to allowing the customer to invite others to these planning meetings. We all have our legal departments. We all understand issues of confidentiality. There have been times when I have had to run into my office from the conference room and crank out about six waivers of confidentiality for unexpected and unanticipated participants invited to an IPE conference by the customer. Yet we are talking about alliance and empowerment here. Our consumers are hopefully going out and working in the community. Anyone who can help us help them support those goals is welcome in my planning conference. A specific reference was made before about the need for support coordinators in certain cases to be involved in our planning conferences. I would strongly recommend that be a normal occurrence. The support coordinators and often times’ social workers and independent living counselors and others may have greater insight into the client than we have gained. I would say the more the merrier; I hope that answers the question.
Samuel Teruel-Velez: Alright Bill, you have a question from Mark. . How do you decide who continues in school and who doesn't? In Mike's world, the probation officer does. In your world who decides? 
Bill Harris: Mike, I am with you, buddy. Remember the mayhem piece about readdressing and revisiting preliminary assessment issues when folks come off of the wait list. I can see you are wallowing in that reality, my friend. To Mark's question about graduate school, in Florida graduate school is a service that requires prior approval. That is an approval process that goes oftentimes to the state office. Our list of prior approval-related services is rather lengthy and is a different process. And might be an interesting concept for a future webinar, but would be too lengthy for us to discuss today. Nevertheless, in Florida prior approvals for graduate school training must be obtained. The presumption for the need for graduate school training, which must be approved at the district office level, is that the individual would be unable to obtain and maintain services -- I am sorry obtain and maintain employment with merely a bachelors. An example -- remember I spoke of IRWEs earlier, if we have someone with a disability that requires a significant amount of expense on their part merely to get ready for, get to, and access the world of employment we would take that under consideration. Because an individual that needed attended care that needed additional medical care that needed assistance with ADL issues would need to earn a higher income than an individual without those expenses. Therefore, we often look at these issues as a level playing field concept, Mark. Would an individual need to earn a higher salary, or income, in order to offset the additional expenses related to their disability? I certainly hope this answers your question. 
Closing Remarks
Shelley Kaplan: Great. This is Shelley. I do hope that answers the question. We are coming up on the last five or six minutes here. We have some important information to share with you all. I want to thank both of you, Sam and William, for giving just so much information to our participants today. It is a lot to think about certainly. You have up on your screen the contact information for both of our presenters today. Who have graciously given us their contact information. You can follow up with your questions. I am left with two take away messages from my state point, many of the concepts that you presented are very familiar to us, and to the work I do in particular, in helping people understand their rights and responsibilities under the Americans with Disabilities Act. The concepts that you talk about in fostering and effective alliance concepts such as good communication, respect, flexibility, trust, case by case process, that it is an ongoing process, that you need to document these are terms that are very, very similar to what the ADA and its amendments is asking of employers and employees to engage in when they talk about the interactive process needed to determine a effective and reasonable accommodation to enable somebody that you might placing into a particular job to do the essential functions of that job. It strikes me that the counselors and those who are teaching counselors play another pivotal role here in the process you engage in and model at this early stage of discovery can really help your customer achieve a more successful employment outcome in the long run. That just struck me in particular. 
Also, it is wonderful to see some much chat in the chat room among the participants. I encourage you if you have some other needs that you would like to see addressed we have on the TACE website a needs assessment form. You are welcomed and encouraged to complete that needs assessment, or send a note to the project and let us know what other kinds of topics we could provide you with to enhance your ability to do your job better. 
The next slide we have up is the contact information. If we could move on to slide 22. 23 excuse me. You have the contact information for our TACE center before you. We encourage you to keep an alliance going with us and communicate with us your needs. That would be very, very helpful. Thank you to our presenters. We appreciate the time you have taken to present your expertise today. I want to remind participants that a transcript of the session, along with all of the handouts will be posted and available on our TACE website within approximately two weeks of the session. You can find that at the website, tacesoutheast.org. Also, this particular session has been approved for CEU credits. As well as CRCC credits, those right now are pending. We are hoping we will have that in place very, very soon. But you have a slide before you in terms of how you go about getting those credits. Please note that once this session is approved for CRCC credits, we have every reason to believe it will be, you must reside in one of the eight states served by our TACE in order to receive the credits. Anybody wishing to get CEUs, those can be given to anybody whether you are in our region or not. 
As all presentations that offer so much information, if there is  other questions that bubble up that you did not think about at the time, if your questions were not answered please feel to contact the TACE center by giving us a call toll-free at 866-518-7750, . Or you can send an email to the TACE project, which is posted before you at tacesoutheast@law.syr.edu. With that I will -- bring this session to a close. We thank you very, very much. We look forward to your participation in future sessions. Have a great day. Bye-bye. 
 [Event Concluded, June 18, 2009]