Alaska case study: Pathway to employment for all in the last frontier!

1Introduction

The Alaska Governor’s Council on Disabilities and Special Education (GCDSE), which is the Alaska State Developmental Disabilities Council, has been a major champion and facilitator of Alaska’s employment efforts, having worked over the past two decades to increase employment opportunities for individuals with disabilities. While these efforts have resulted in positive systems change and many promising practices, efforts prior to the Alaska Integrated Employment Initiative (AIEI) did not have a strong focus on employment outcomes for youth and young adults with intellectual and developmental disabilities (I/DD). Following is a brief discussion of the work that set the stage for AIEI’s employment efforts.

2Systems change efforts in Alaska

In 1997, the Alaska Statewide Independent Living Council (SILC), the Governor’s Committee on the Employment and Rehabilitation of People with Disabilities, and the GCDSE held the first-ever Disability Summit which included key individuals from around the state in government, public associations, business, and industry. That year was an important one for Alaska and its residents with disabilities as it was also the same year that Alaska’s only institution, Harborview, was closed. That same year, the Alaska Mental Health Trust Authority, the Rehabilitation Services Administration (in 1998) and the Centers for Medicare and Medicaid Services (in 2000) infused funding into the system to increase the employment rate of Alaskans with severe disabilities. With the award of Department of Labor funds to the Division of Vocational Rehabilitation (DVR), and Social Security Administration funds awarded to Alaska’s University Center for Excellence in Developmental Disabilities (UCEDD) the University of Alaska Anchorage Center for Human Development (UAA CHD), a coalition called the Alaska Works Initiative was formed. The coalition’s advocacy work resulted in the Alaska State Legislature passing a Medicaid Buy-In program in 1998 for working people with disabilities, making Alaska the first state in the country to pass legislation and the second to implement a Medicaid Buy-In program.

In 2000, Alaska was awarded a federal Medicaid Infrastructure Grant (MIG) funding authorized under Section 203 of the Ticket-to-Work and Work Incentives Improvement Act, which lasted until 2009. MIG dollars were used to build on supports to enable individuals with disabilities to become employed and to bolster coalition-building efforts around enhancing employment outcomes for people with disabilities. Significant collaboration occurred in 2003 between the Alaska SILC, the Alaska Mental Health Board, the Alaska Commission on Aging, and the Governor’s Committee on Employment and Rehabilitation of People with Disabilities in planning the second Disability Policy Summit. As a result, agency commitment was secured to work together with the disability community to implement a number of specific recommendations. By 2004, the Alaska Works Initiative coalition, led by the GCDSE, had seen significant changes to the system including: 1) the establishment of a statewide benefit counseling program; 2) changes in DVR’s self-employment policies; 3) identification of local contacts by the Social Security Administration; 4) increased access to one-stop job centers; 5) the piloting of Alaska’s first Individual Development Account program; and 6) inclusion of disability in diversity training offered by the Division of Personnel. By 2005, over 70 Alaskans helped develop a new five-year strategic plan for the Alaska Works Initiative, which focused on achieving the following vision: Alaskans who experience disabilities are employed at a rate as close as possible to that of the general population.

In 2006, The Council was awarded a three-year research and demonstration grant from the Office of Disability Employment Policy to increase the number of Alaskans with disabilities who are self-employed which further solidified the collaboration amongst system partners around employment. This work also helped to propel the 2007 revision of the Medicaid Buy-In program for working people with disabilities allowing participants to save up to $10,000 for an individual (formerly $2,000) and $15,000 for a couple (formerly $3,000) without losing their Medicaid eligibility. A year later, the Disability Employment Policy Summit was held with the Governor’s Office to secure commitments from state agencies to: 1) make the state a model employer of people with disabilities; 2) help people with disabilities build assets; and 3) better integrate services and resources. Alaska’s major funding awards which supported the collaborative foundation with which AIEI conducted its system change work are detailed in Table 1. Table 2 breaks out the major events and initiatives impacting Alaska’s employment system and outcomes.

3Grant beginnings: Status of employment for individuals with I/DD

In 2011, the Alaska GCDSE was awarded a 5-year grant from the federal Administration on Intellectual & Developmental Disabilities (AIDD) to increase the employment of youth and young adults with I/DD and focus the coalition’s efforts towards high school transition. This project, part of the National Partnerships in Employment project, became known as the AIEI. At that time, Indicator 14 Post School Outcome Survey data (Alaska Department of Education, 2012), showed post-school outcomes for individuals with disabilities in 2010 at 182 individuals competitively employed within one year of leaving high school (but not enrolled in higher education) out of a total of 500 individuals who were contacted. Out of this 500 total contacted, 71 were enrolled in higher education within one year of leaving high school, 46 were enrolled in some other post-secondary education or training program, and 47 were engaged in some other employment. Ultimately, 154, a little over 30%, were not engaged in either competitive employment or higher education. Additionally, 2010 data from Senior and Disabilities Services (SDS) showed low utilization of supported employment services compared with day habilitation services for Alaska I/DD waiver recipients. In FY10, there were 356 individuals utilizing supported employment services on the I/DD waiver in Alaska, compared with 1,112 using day habilitation services (A. Horner, Research Analysis III, DSDS, personal communication, January 20, 2017).

Several factors played into these outcomes. First, there was a need to enhance the referral process from school districts to vocational rehabilitation. This was exacerbated by the high turnover rate of special educators, especially in rural Alaska. SDS funded day habilitation services tended to be more commonly utilized than vocational rehabilitation services for this age population. The lower usage of employment services compared with day habilitation services could be attributed to the rate structure, with group day habilitation an easier service to access and being funded at a rate that is higher than individual supported employment rates after adjusting for staff ratio. Finally, there were differences in the understanding of agency roles and the sequencing of funding with respect to SDS, VR, and the school districts for employment services for transition-age youth with disabilities. AIEI sought to tighten the collaborations with partners around employment of individuals with I/DD, putting a specific focus on transition age youth and young adults and assisting in clarifying the roles and responsibilities of state agencies in providing services to them. The core group, tasked with developing sustainable strategies to increase employment outcomes consisted of the GCDSE (State Council on Developmental Disabilities) as the lead entity, the Division of Senior & Disabilities Services (State I/DD agency), the DVR, the Department of Education & Early Development, the Disability Law Center of Alaska (Protection and Advocacy Organization) and the UAA Center for Human Development (UCEDD).

4Project goals

AIEI’s mission was to improve employment outcomes for youth and young adults (ages 16–26) with intellectual and developmental disabilities. Corresponding to this mission were three overarching goals:

AIEI also included specific goals to: 1) ensure meaningful involvement and input from individuals with I/DD and their families; 2) identify and address systemic barriers; 3) develop, implement, and evaluate replicable strategies to remove barriers and improve outcomes; and 4) disseminate information on effective systems change approaches.

Table 3 illustrates AIEI’s core project activities.

To address barriers and develop replicable, sustainable strategies, a three-pronged approach was undertaken: 1) policy development to focus on implementing policy at all levels (legislative, regulatory, day-to-day policies and procedures), including obtaining, allocating, or reallocating resources (people, time, money); 2) capacity building to focus on building knowledge and skills through training, consultation, technical assistance, and peer-to-peer learning; and 3) resource leveraging to include pooling of assets and resources, blending and braiding resources, and integrating AIEI activities with other priorities and initiatives.

5Coalition and roles

AIEI, administered by GCDSE staff, formed a large coalition to serve as an advisory board (see Fig. 1). The coalition encompassed a diverse array of stakeholders, including educators, individuals with disabilities, family members, employers, state agency staff, and provider agency staff. Members were from a variety of different regions across the state, covering both urban and rural perspectives. This advisory board met twice annually to delve into the higher-level systems issues and grant planning efforts. AIEI also developed two teams, which met monthly, to oversee and propel the day-to-day work of the grant. One team, the management team, focused on management related tasks to ensure that work plan items were on target and stakeholder input was integrated into activities. The other team focused on policy and regulation. Staff from Alaska’s UCEDD, Protection and Advocacy agency, Department of Education, and state I/DD agency have been integral to the coalition’s work, both on an advisory board level as well as on a management and policy level. AIEI was fortunate to have members from within the state system who held leadership roles which cultivated success in systems change efforts. Additionally, it was beneficial to have facilitated dialogue around employment services at the monthly team meetings to assist members in addressing issues in collaborative and innovative ways. This ongoing conversation around employment fostered many collaborations outside of AIEI and was beneficial for state agencies to reflect on what other divisions and departments were doing. AIEI served as a means of reducing systems level silos and built its coalition on the strong networks established over the past two decades.

Fig.1

AIEI Grant Partners.

6Work plan elements

AIEI’s work plan over the first four project years included many activities to enhance employment for youth and young adults with disabilities. Some work plan items were narrowly targeted to transition while other activity items had a wider systems impact.

7Project outcomes

7.1Policy outcomes

Several legislative changes occurred resulting from AIEI’s efforts. First, Alaska became an Employment First State, signed into law in June 2014, joining eight other states with cross disability legislation (University of Minnesota RTC on Community Living, 2014). The decision to enact Employment First into legislation instead of simply in regulation was a strategic one. The intent was to ensure long-lasting systems change, and legislation is more likely than regulation to survive administration changes. Additionally, the decision to expand the Alaska law to all Alaskans with disabilities, beyond just intellectual and developmental disabilities, created a stronger advocacy base, which was integral to passage of the legislation.

The second legislative change involved the high school graduation qualifying exam (HSGQE), first implemented in Alaska in 2004, which required all high school students pass a series of tests in order to receive a high school diploma. In 2014, with the passage of House Bill 278, the HSGQE was eliminated after significant advocacy on the part of the coalition and other stakeholders. New legislation allowed for the opportunity to obtain a high school diploma for more students with disabilities. Further, the elimination of the exam gave students, who had completed all credit requirements for graduation while the exit exam was in place, an opportunity to receive a high school diploma retroactively, impacting over 3,000 students (Burke, 2014). Currently, students who do not complete all the credit requirements still receive a certificate of attendance or completion (State of Alaska Department of Education & Early Development, 2015). As many employers require a high school diploma or equivalent, removing this barrier to receiving a diploma, allows youth with disabilities a clearer path to employment.

The last piece of legislation impacted by the work of the coalition was the enactment of the Alaska ABLE Act, signed by the governor in August 2016 (Alaska State Legislature, 2015). Based on federal legislation, the Alaska ABLE Act includes: 1) yearly contributions limited to $14,000, and capped at $400,000; 2) ABLE accounts can be used for a variety of expenses, including, but not limited to: education, health and wellness, housing, transportation, legal fees, financial management, employment training and support, assistive technology, personal support services, oversight and monitoring, and funeral and burial expenses; and 3) an age requirement as a person must have become blind or disabled before the age of 26 (Alaska ABLE Plan, n.d.). All these legislative changes have precipitated state policy changes and are illustrated in Table 4.

Table 4

Major policy outcomes as a result of AIEI

Year	Policy Outcome
2014	Alaska becomes Employment First State
2014	High School Graduation Qualifying Exam repealed
2016	Alaska ABLE Act signed by the Governor

A dedicated policy group, which included representation from the Division of Senior and Disabilities Services (Alaska’s I/DD State agency), Vocational Rehabilitation, Alaska’s University Center for Excellence in Developmental Disabilities (UCEDD), Governor’s Council and Special Education and Disabilities (Alaska’s DD Council), Disability Law Center (Alaska’s Protection and Advocacy Agency), DD Provider Agencies, and other varied stakeholders, developed common employment service definitions and a sequence of employment services leading to competitive integrated employment. Additionally, the policy group worked on supported employment rates, provider conditions of participation (i.e., guidance documents for providers adopted by reference within regulation), and delineation of employment services by different agencies. For example, Division of Vocational Rehabilitation provides time-limited pre-employment services for young adults and supported employment services, while providers under Alaska’s I/DD state agency (DSDS) provide time-limited pre-employment services and long term supported employment services. A lengthy report outlining decision details was created from the work as well as a document appropriate for individuals with I/DD, families, educators, and service providers (State of Alaska Governor’s Council on Disabilities & Special Education, n.d.a).

Infrastructure, which will allow for continuity of the project’s initiatives once federal funding ends, includes: 1) GCDSE (DD Council) facilitating on-going statewide collaboration among state agencies, community partners, and other stakeholders; 2) developing an innovative multi-modal distance education platform and offering regional in-person options in hub communities (see Fig. 2); and 3) creating an APSE Chapter. Additionally, the collaboration will continue to meet under the Employment and Transportation Committee, a standing monthly meeting sponsored by Alaska’s DD council.

Fig.2

AIEI Grant Trainings Years 1–4.

Fig.3

AIEI Grant Goals and Results.

7.2Outcomes

With respect to the three core goals of the project, AIEI has exceeded two of its goals and made significant progress with the third (see Fig. 3). In regards to increasing DVR’s youth caseload percentage, the baseline at the project’s onset was 20% of the caseload being youth with the improvement goal set at 25% by the end of the 5-year project. Grant year four FFY2016 DVR data shows its youth caseload percentage to be 30%, exceeding the project’s goals (B. Oberrecht, Program Coordinator II, Alaska DVR, personal communication, October 14, 2016). It should be noted that out of the 845 youth (age 16–26) who make up this 30% of DVR’s total caseload (2,809), 63% of them are youth with I/DD (530). Both percentages have improved significantly over the life of the project. The other goal related to DVR, increasing the number of hours worked weekly by Alaska DVR’s I/DD youth caseload, was also exceeded. When the project started, the average number of hours worked by youth with I/DD on DVR’s caseload was 13 hours a week, with an improvement goal set at 20 hours a week by 2017. FFY2016 DVR data show youth with I/DD working, on average, 25 hours a week (B. Oberrecht, Program Coordinator II, Alaska DVR, personal communication, October 14, 2016). The third goal was doubling the utilization of Home and Community Based I/DD waiver supported employment services amongst youth and young adults (ages 16–26) with disabilities. When the project began in 2012, there were 84 youth and young adults on the I/DD waiver utilizing supported employment HCBS. By 2016, year four of the project, utilization of supported employment services increased by 33%, to 112 (A. Podunovich, Research Analyst IV, DSDS RA Unit, personal communication, Oct. 17, 2016). Figure 3 is an at-a-glance representation of this journey.

AIEI also noted significant individual outcomes relating to Alaska’s Working Disabled Medicaid Buy-In Program utilization. Figure 4 displays the increase in program use, with numbers rising to 374 by October 2016 (C. Triem, Research Analyst III, Division of Public Assistance, personal communication, Oct. 18, 2016). This is an increase of almost 18%, from March 2014 when numbers were at 317. The increase coincided with extensive AIEI grant efforts towards awareness of this generally underutilized program.

Fig.4

Alaska Medicaid Buy-In Program Utilization.

8Sustainability

Ensuring long lasting impact from the project, far beyond its five budgeted years, has been considered from the beginning. Forming a Policy and Regulations Team, which met monthly, was critical to advancing thorough and outcome oriented policy recommendations to be put forth to the systems for change. Similarly, the legislative advocacy activities undertaken by AIEI provided another path for long-term sustainability. Repealing the high school graduation qualifying exam via legislation represents the elimination of a significant barrier to employment. Alaska is now an Employment First state with competitive and integrated employment being the preferred outcome from services that are publicly funded. Alaska now allows ABLE accounts to be made available to qualifying Alaskans with disabilities. All three will exist once the project ends and further the employment dreams of youth and young adults with disabilities.

Coalition building was the cornerstone of AIEI’s grant work and a facet which members found to be essential in continuing forward because of the many efficiencies created with collaboration and connectedness among state agencies. The members of AIEI’s coalition are now members of the Governor’s Council on Disabilities and Special Education’s Employment and Transportation Committee. This will ensure that the valuable dialogs which have occurred through AIEI will continue into the future. Also, there will be two distinct collaborations which will continue past the life of the project: 1) an interagency employer engagement collaborative – the Business Employment Services Team (BEST), and 2) the Alaska Mental Health Trust Authority’s Beneficiary Employment and Engagement Initiative.

In 2013, work by the Council around employment, including the development of the grant for this project, precipitated conversations with the Alaska Mental Health Trust Authority. There was a request to initiate the Trust Beneficiary Employment and Engagement Initiative that subsequently led to a commitment to five years of funding of $1 million a year for improving beneficiary employment outcomes, including those for Alaskans with developmental disabilities. The Trust has also invested funding for commercials highlighting the Mat-Su Project SEARCH site in Alaska, delivering the message that hiring youth with disabilities had been good for Mat Su Regional Medical Center’s bottom line. AIEI’s work helped set up vital infrastructure for the Trust’s considerable investment in employment and its inclusion of employment as a key strategy as it moves forward with its overall systems work. This work has informed the latest collaborative project, an assessment of the intellectual and developmental disability system, which is bringing together a myriad of stakeholders from state agencies, service providers, individuals with developmental disabilities, family members and others to develop a shared vision in moving forward to meet the evolving system needs. The document, Intellectual and Developmental Disabilities (IDD) Systems Assessment (State of Alaska Governor’s Council on Disabilities and Special Education. n.d.c) was created as a result of this work and displays the tensions on the system by both environmental and reform forces and how employment has become a core facet of the overall outcome goals for Alaskans with disabilities following AIEI’s collaborative work with the Trust and other partners.

Another sustainable collaboration which arose from AIEI’s efforts was that of the Alaska Association for People Supporting Employment First (APSE) Chapter. AIEI facilitated the creation of this chapter in 2014, with fully chartered status achieved in 2015. It is charged with continuing Employment First implementation work in Alaska. Having a fully chartered APSE chapter allowed Alaska to offer the Certified Employment Support Professional (CESP) exam for the first time ever. AIEI worked with DVR to ensure that providers who successfully pass the exam will be considered to meet the requirement to apply to be a vender of DVR services. This Alaska APSE CESP exam will be offered 3-4 times annually in different hub communities and will continue after the project ends with the Alaska APSE Chapter overseeing these efforts.

AIEI utilized Project SEARCH as a best practice model due to its sustainable design which included setting up local partner collaborations for Alaska’s four Project SEARCH sites amongst school districts, host businesses, DVR, and local service provider agencies. True Project SEARCH partner agency collaboration, “leads to seamless transition services and sustainability through braided funding streams” (Project SEARCH, 2012).

AIEI was mindful of sustainability with respect to building training capacity. AIEI obtained approval from DVR for several trainings which would lead to a provider’s ability to be a vender of DVR services. This created a natural pathway and demand to sustain their existence. Trainings that will not continue to be offered in the future will be videotaped and included on resource pages on state and partner websites to allow for continued benefit to the entire transition to employment system.

9Lessons learned

AIEI’s project journey has imparted multiple lessons to the system. First and perhaps most notable, employment services bring potential cost savings to government. This lesson is overwhelmingly positive to a vast array of partners. Alaska was greatly impacted by the worldwide reduction in oil prices. The loss of available revenue for services caused AIEI to be very thoughtful in its message and ultimately resulted in a cost saving theme with employment being a core strategy. This gave AIEI the ability to continue its work, which otherwise would have come to a standstill in harsh economic conditions. Second, an ongoing frequent dialog across agencies is invaluable for partnerships on many other fronts. Monthly collaborations led to statewide issue collaborations and regional event collaborations. State agency collaborations ended up being more efficient and effective which further added to the message of cost savings. Third, AIEI found having leaders with responsibilities for decision-making at the table makes all the difference. Fourth, bringing all necessary parties to the table early in a collaborative process is crucial. AIEI engaged stakeholders from the beginning of the project; however, each year the coalition grew as gaps were identified. Fifth, youth with disabilities and parents value employment. Results from a parent and youth statewide survey relayed that, “having a job in a career they like” is in the top three most important life events for youth and their parents. Lastly, AIEI’s journey has reminded the system that the work undertaken, while dynamic and complex, must be conveyed in accessible terms for individuals with disabilities and their families to truly engage the entirety of the system. AIEI, in collaboration with the UAA CHD (Alaska’s UCEDD), conducted a survey of Alaskan youth with disabilities and their parents. The survey report, while detailed and helpful to state agency staff, was not readily accessible to all individuals and families, so Alaska’s UCEDD distilled the core facets into an infographic to best ensure that the work completed could be understood and utilized by everyone (State of Alaska Governor’s Council on Disabilities & Special Education, n.d.b).

AIEI’s work activity around determining a common definition and sequence of employment services took 3 years of discussion because of the complexity of the topics and how the changes would result in actual practice. While the main document was again helpful for state agency staff who worked in that field every day, it was not in the most usable format for individuals and families. Due to stakeholder feedback, which noted exactly that, AIEI worked with its Alaska UCEDD to develop an infographic that condensed the core concepts and linked individuals with where they can learn more if necessary (State of Alaska Governor’s Council on Disabilities & Special Education, n.d.a). While this seems like a simple lesson, it was profound. If the work that is done is not able to be fully grasped and appreciated by those whom can most benefit, it is not a fully realized work product. This lesson is informing much more than just AIEI’s future work, but also the work of partners as well.

10Promising practices

In AIEI’s first four years, several promising practices were identified and disseminated in the state and nationally: 1) promoting interagency collaboration around employer engagement (i.e. BEST), 2) utilizing multiple distance delivery mediums for innovative capacity building in rural and remote regions; 3) creating state and regional Project SEARCH communities, 3) creating an interagency employment services matrix collaboration to develop common definitions and sequences for employment services (State of Alaska Governor’s Council on Disabilities and Special Education, n.d.a), 4) gathering a broad cross-disability coalition for legislative and policy work and building momentum by increasing the inclusive stakeholder base; 5) utilizing infographics to tell the story to all stakeholders regarding systems change work; 6) linking an employment service enhancement messaging with the potential for cost savings to government; 7) developing a tool for understanding the interplay of benefits and work which allows for a consistent message from state and service system staff to individuals and families (Disability Benefits 101: Working with a disability in Alaska. n.d.); 8) facilitating collaborative work on writing a state transition handbook with broad meaningful stakeholder input, and 9) integrating Discovery techniques and activities into transition classrooms by training teachers on how to use them.

Conflict of interest

None to report.