Home and community-based services (HCBS) provide opportunities for individuals with disabilities and older adults to receive services in their own home or community. On January 16, 2014, the Centers for Medicare & Medicaid Services published a final rule that sets forth new requirements for states using Medicaid funds to pay for HCBS, supports enhanced quality in HCBS programs, and adds protections for individuals receiving these services. In addition, the rule reflects the intent of CMS to ensure that individuals receiving services and supports through Medicaid’s HCBS programs have full access to the benefits of community living and are able to receive services in the most integrated setting. The Administration for Community Living (ACL) is highlighting an example of a promising practice for employment benefits designed to meet the needs of individuals, promote integrated employment, and comply with requirements of the HCBS settings rule and the Supreme Court’s Olmstead v. L.C. ruling. With regard to Medicaid-funded employment services it is the state’s responsibility to ensure that 1915(c) HCBS supported employment waiver services are furnished to a waiver participant to the extent that they are not available as vocational rehabilitation services funded under section 110 of the Rehabilitation Act of 1973.
SRVS (pronounced “serves”) ran the only sheltered workshop in Shelby County, Tennessee. The workshop had been operating since 1962 and served 110 adults in 2012. “Our workshop was our face in the community,” said Tyler Hampton, SRVS’ Executive Director. “Everybody loved us. People were happy. When you walked through people would hug you.”
So when Tennessee state leaders asked him to apply for technical assistance funded through the U.S. Department of Labor, Office of Disability Employment Policy (ODEP) Employment First State Leadership Mentoring Program (EFSLMP), Hampton said “no” because he knew it would mean closing the workshop.
After a second call from the Tennessee Department of Intellectual and Developmental Disabilities, SRVS committed to assisting 20 beneficiaries transition to integrated employment in the fall of 2012.
SRVS began receiving technical assistance from subject matter experts in early 2013. During a presentation at SRVS on customized employment, a technical expert described the benefits of working in the community for people with disabilities, including the opportunity to develop friendships and natural supports in ways that would be more realistic than in workshops. Another technical expert with experience in transforming sheltered workshops led a walk-through of the SRVS workshop.
These experiences opened Hampton’s eyes to what he characterized as “the inequities that were happening within our workshop.” “I didn’t realize it,” he added, “I knew we had to close.”
In 1962, youth with disabilities and their families didn’t have many options, according to Hampton, sheltered workshops were created because families wanted their kids to work. “Internally we thought we were doing great things,” Hampton said.
Today, he believes the workshop model has “lived its purpose.” It took a while to convince other staff that they needed to close. Hampton also knew he would get “push back” from SRVS’ Board of Directors, so he proposed a steering committee to look at ways to transition the workshop. The committee met weekly to identify strategies for the workshop transition and reported to the board every month. The steering committee included several influential board members, including one man whose son had formerly worked in the workshop and had successfully transitioned to competitive employment.
SRVS started by implementing a curriculum focusing on “soft skills” including: resume writing, handling conflict with a boss, dressing appropriately, and navigating a professional environment.
Beneficiaries had participated in the SRVS workshops from 12 to 40 years. People were assessed and placed in three categories: those ready for employment, individuals who needed some skills development and those resistant to change or lacking in many necessary skills. SRVS adapted their services to meet each person’s specific needs. Individuals who transitioned to integrated employment were welcomed back as motivation for their peers. SRVS created a “wall of fame” featuring pictures and success stories and displayed it in the main hallway.
In August 2013 the SRVS board formally agreed to close the sheltered workshop and on June 30, 2015, after more than 50 years, the workshop closed.
Of the 110 beneficiaries who had participated in the workshop, 42 are now successfully employed and 62 are receiving supports as they seek employment. A few of the older beneficiaries were interested in work but their families wanted them home to support aging parents. Six transitioned home or to other facility-based providers.
Working directly with beneficiaries, Troy Allen, Director of Community-Based Services, said “people started seeking me out saying ‘I want to go out’,” with interest in more community integration as their peers achieved successful employment.
Today, SRVS’ community-integrated model provides supports to 200 people in the community including just shy of 100 people in community employment, according to Allen. With the change in business model came a shift in their approach to hiring and training staff. The job function and focus of the sales staff member shifted from securing workshop contracts to exclusively seeking and developing community employment opportunities and business partnerships. They cross-trained all their job development staff so anyone could do intake, discovery, and placement if needed. Finally, they hired stabilization coaches to support individuals once they are employed.
SRVS also implemented a customized and supported employment model through a collaborative Letter of Agreement with Tennessee’s Vocational Rehabilitation agency.
SRVS also credits $950,000 in grants over two years from local foundations and corporations for assisting with infrastructure changes including purchasing equipment and supporting hiring additional staff to help transform their model.
Hampton believes that “the Employment First initiative had a broad appeal to funders” for three reasons: “it deals with increasing employment opportunities, is in line with current best practices for people 
with intellectual and developmental disabilities, and includes a business model change to allow people better access and involvement in their community.”
This is ACL’s fifth profile of a local program promoting integrated employment for people with disabilities; read the full series. ACL is interested in hearing from states, providers, and advocates working on integrated employment. Share your successes, challenges, and questions by sending an email to aclinfo@acl.gov.