Service name and California service codes as per rate model

Supported Employment (950, 952)

Conceptual Definition of Supported Employment

Supported Employment Services assist adults with intellectual disabilities and/or developmental disabilities with finding and maintaining a job in competitive, customized or self-employment in the community. Employment must be: 

• in an integrated work setting,
• paid at or above the State or local minimum wage,
• with equivalent wages, benefits and advancement opportunities as people without disabilities in the same position and with similar training, experience and skills.

Employment is developed consistent with the strengths and skills, capabilities, interests, preferences, career goals and informed choice of the individual.

Models/options available under regulations or in the Home and Community Based Services waivers in California

Supported employment - individual.

All activities happen at an individual level - job coach-to-consumer ratio of one-to-one.

Supported employment – group. This is provided at a job coach-to-consumer ratio of not less than one-to-three and not more than one-to-eight with at least three of these consumers being funded by the Regional Center or the Department of Rehabilitation. For consumers receiving group services, ongoing support services are limited to job coaching and is only provided at the worksite. Supported employment can also be accessed through Participant-Directed services (code 458) and the application is similar to Supported Employment Individual.

The Paid Internship Program (PIP) is also a possible option for supported employment and is a particularly important route to long-term Competitive Integrated Employment. In an internship, the person’s salary must be at or above minimum wage and equal to the usual wage paid by the employer for the same or similar work when performed by someone without a disability. The intern’s salary, job coach support and all employer related costs are typically funded by the Paid Internship Program rather than paid by the employer.

Customized Employment is used to refer to an approach to job development where the skills and interests of an individual are assessed and then job developers actively assess and analyze gaps and opportunities with local employers. This enables them to demonstrate how the jobseeker can fill the identified gap and benefit to the company. The job is then customized to the individual and support needs are identified. This approach is recognized in the “Competitive Integrated Employment: Blueprint for Change”.

Eligibility and limitations in California

Who is eligible?

• Adults with developmental disabilities aged 18 years and older.
• All individuals are assumed to benefit from supported employment unless it has been determined by the IPP team that the service is currently not an option.
• Individuals can be living in any setting.

Intensity and duration of support

• DOR Supported Employment Services are usually limited to 24 months. If DOR services are not an appropriate match; funding may be transferred to the individual’s regional center for extended services prior to the 24 month limit.
• No specific limits on the level and intensity of support if when funded by regional centers – the amount and duration of support is determined by a comprehensive assessment of the individual’s employment related strengths and needs and managed through the IPP process.
• Job coaches support employees to learn the necessary skills and behaviors to work independently and the job coaching is faded gradually. If someone continues to need support more than 30% of their working time, this need must be documented in the IPP and approved by the Regional Center.
• An internship cannot exceed 1040 hours per year for each individual placed in an internship.
• People can participate in more than one paid internship, as determined through the IPP process.

Other conditions

• When a person requests or shows an interest in competitive and integrated employment the first access point of call must be the Department of Rehabilitation (DOR), either directly or with the help of their case manager or service provider. DOR may decide they are not able to meet the needs of the individual and must provide evidence that this is the case. If this is the case, the person would connect with their case manager to determine next steps and program options.
• Before determining that an applicant is unable to benefit from vocational rehabilitation services, the DOR must provide trial work experiences with appropriate supports to explore the individual’s abilities, capabilities, and capacity to perform in work situations.
• DOR may waitlist approved individuals and the Regional Center must provide those services in the meantime.

Type of support provided

The main activity of supported employment services is to provide job coaching to individuals while they are working in Competitive and Integrated Employment (CIE). For individuals with more significant needs, supported employment may occur in an integrated but not necessarily fully competitive employment as a short- term strategy to support them into CIE.

• The CA HCBS Waiver (2024 update) lists the following as included in Supported Employment services:
• Training and supervision in addition to the training and supervision the employer normally provides to employees.
• Support services to ensure job adjustment and retention, provided on an individual basis in the community, as defined in California Welfare and Institutions Code §4851(q) and Cal. Code Regs. Tit. 17, § 58830:
• Job development – The process of working with a an individual based on the their interests and abilities to identify potential jobs, meet with the hiring business, and assist the them to apply for and compete for the job.
• Job analysis - Classifying each of the required duties of a job to identify the support needed by the consumer.
• Training in adaptive functional skills
• Social skills training
• Ongoing support services to ensure job retention -Services that are provided, typically off the job, to assist the individual with concerns or issues that could affect his or her ability to maintain employment.
• Family counseling needed to support the individual’s employment.
• Advocacy related to employment, such as assisting individuals in understanding their [employment] benefits.
• Advocacy or intervention to resolve problems affecting the consumer's work adjustment or retention.
• Support following a job loss.

Funding source in California

Department of Rehabilitation (DoR) Regional Centers Through either Vocational Rehabilitation Program or the Habilitation Services Program

There are additional employment-focused services, funded by DoR, that can work alongside supported employment or to assist someone working towards supported employment. These services can be useful for people with developmental disabilities. Providers need to be vendorized for these services separately. They include:

1. Situational Assessment: allows an individual to observe or try out a variety of job opportunities, including the payment of wages, to determine level of eligibility or employability (40 hours) 2. Work Adjustment: allows people to work in a real or simulated environment to develop appropriate work behaviors, attitudes, or personal characteristics that will support them to get and retain CIE. (up to 3 months); and 3. Personal and Social Adjustment: can be used to address barriers to employment – e.g. to to overcome issues that might be impacting their ability to get and keep employment. For more information see: https://www.dor.ca.gov/RRD/Consumer/VocationalRehabilitationServices.as px

Pre-vocational rehabilitation services can support individuals in gaining experience through voluntary work or gaining skills through courses etc. Supported Employment Services can support individuals to develop work related goals and gain similar experience to help them on their route to employment.

How to access Supported Employment Services

The initial request for supported employment can be made to the Regional Center (usually through the case manager/service coordinator) and an IPP meeting requested to discuss the options. The Regional Center may then refer the individual to the DOR. Individuals can also apply directly to their local DOR office or use the DOR website to apply online .

Other terms/names associated with this service type

No other terms used.

Falls under “Habilitation - Residential or Home-based” in the CMS (Centers for Medicare & Medicaid Services) Taxonomy and HCBS Waiver guidance.

Vendor requirements

Programs must initially meet the Department of Rehabilitation Program certification standards and be accredited by CARF within four years of providing services following California Code of Regulations. Title 17 Chapter 3, subchapter 21, Article 2 – specifically § 58810(f)(1)(2).

Key characteristic/Principle

Description of principle/characteristic

Expectations and evidence that a service is providing this service type – what should you see?

Zero exclusion policy

Any individual who wants work is eligible. No one can be excluded due to level of support needs, protected characteristics, poor work history, difficulties with personal hygiene, or failure to comply with treatment or medication regimes.

• No one with a developmental disability would be told that supported employment is not an option.
• Information about supported employment would be made available in different formats that compliment varying communication needs. Information would outline the benefits of supported employment, the type of support available as well as how to find out more information.
• Issues that may impact on people’s success in getting and keeping employment are addressed – for example, training and support related to personal hygiene, assistive technology to assist with medication adherence.
• In developing jobs, employment specialists will be identifying opportunities that fit with the support needs, interests and experience of the individual.

Person-centered support

• Individual preferences of people served provide the foundation for the job search. These can include but are not limited to: 
• Personal skills and interests 
• Preferred type of work 
• Preferred work environment and location 
• Number of work hours
• Type of job support available and provision of reasonable accommodation
• Supported employment professionals work in a way that takes account of the needs, interests, individual/cultural/religious preferences of the person

• When people already have a work goal identified and/or some work experience, and can communicate their preferences verbally or in writing, supported employment services will assist them to identify their skills and interests, preferred type of work, what is important in terms of work environment and location, the number of hours they would like to work. This will include the use of work experience and observation where appropriate, not just through interview or survey-based assessment.
• If the individual has not been able to achieve the milestones above, supported employment services will need to take the lead on collating a personal profile to guide job development for the individual.
• This may involve conversations with the individual and their circle of support along with access to their person-centered profile and plan so that SE staff are aware of people’s skills, preferences, goals, support needs, etc.
• If such a profile does not exist, they would spend some time getting to know the individual and finding out about their interests, skills, preferences, fears, needs, etc. o
• Where needed, work experience opportunities would be identified to give the individual the opportunities to experience different jobs and work settings so that they can make a more informed choice about employment.
• Self-employment should be considered as a valid possibility – interests that can easily give rise to small business include gardening, cleaning, dog walking/pet sitting, window cleaning, cake making/baking for cafes or events, car washing, language translation, YouTube vlogging, computer programing, mechanics.
• If individual preferences, skills, needs etc. are considered in job development, then people are likely to be more satisfied with their job, and find it easier to be motivated to go to work.
• Job coaches and other SE professionals use the language or other form of communication that works best for the individual supported.
• Job coaches and other SE professionals are warm and respectful in their interactions
• They treat people as individuals and with dignity.
• They take a holistic view of the person, understanding that the individual’s ability to work may be affected by many other aspects of their lives.
• They work and advocate with others on the basis that the person CAN work, given the right support and environment.

Rapid job search

The needs and preferences of people served dictate the pace of the job search. The employment professional contacts potential employers in the community and develops relationships with employers and matching employee needs and job interests with employer needs.

• Individuals would not be told that they need to do courses and programs to “get ready” to look for work (e.g. work readiness or adjustment programs) – these have been found to have limited effectiveness in terms of people getting and keeping jobs in the long term.
• Once people’s preferences have been ascertained, employment specialists/job coaches would immediately start to look for opportunities and make connections with potential employers, exploring job match as they do this.
• However, this does not mean that training and development programs are not helpful for increasing people’s attractiveness to employers and to give them the skills they need for the job they have shown an interest in.
• As mentioned above, supporting short term work experience placements or non-competitive but integrated employment opportunities can help people gain experience with different jobs to both improve their competitiveness in applying for jobs and help supported employment services identify the support individuals would need in a competitive employment setting.

A competitive job is the goal

The aim is to find a job in the community that anyone can apply for, pays at least minimum wage and provides the same salary, benefits and opportunities for advancement as people without disabilities in the same position.

• The aim is that employment would be Competitive and Integrated Employment (CIE). That means that it would be:
• in an integrated setting – this is work in the same settings as people without disabilities usually work, where individuals with disabilities interact with individuals without disabilities (not including the person or people providing their support) to the same extent that individuals without disabilities in comparable positions interact with other persons.
• open to anyone to apply for,
• paid at or above the State’s or local minimum wage,
• with equivalent wages, benefits and advancement opportunities as people without disabilities in the same position.
• As noted above, Self-employment and micro-enterprise are a valid form of CIE.
• For individuals with more significant disabilities, supported employment may occur in an integrated but not necessarily fully competitive employment setting as a short- term strategy to support them into CIE. For example, the job may have been developed specifically for them using their skills and abilities and not available to the public. Individuals should be paid at the state or local minimum wage, however sub-minimum wage jobs with reduced task complexity or intensity with the goal of gaining experience and informing future employment choices are in still in existence.

Employment support is integrated with other services

Employment support is coordinated with support from other services to maximize the potential for people to maintain employment

• Many people receiving supported employment services will also be receiving other forms of support. Employment support and other services would be working together to ensure the best possible outcomes.
• An individual’s job coach or another SE representative, ideally chosen by the individual, would participate in person-centered planning and IPP meetings to ensure consistency and that needs are met.
• SE staff would provide advice to families or direct support workers so that they are aware of what they can do to help the person find, adjust to and maintain employment.
• People would be receiving the support they need from other services to help them to keep their job – for example, getting to work on time, maintaining personal hygiene, taking their medications, etc.

Time unlimited support

Even once a job is found, supported employment services have a role in supporting an individual to maintain their employment and make the most of opportunities available to them at work.

• Job development, job analysis and on-the-job coaching are a substantial part of support employment services. The aim is, wherever possible, to fade coaching support and replace this with supports naturally occurring in the employment setting.
• There is no limit to the length of time or intensity of support. A job coach can work with someone for as long as needed and as intensely as needed to maintain CIE.
• Supported employment services can provide support in many other ways to help people find and maintain employment and support career development. Supported employment services would also include, as appropriate, for each individual and employment setting:
• Training in adaptive functional skills.
• Social skills and workforce integration training and support.
• Understanding and responding to feedback from the employer.
• Workplace accommodations/adjustments and assistive technology.
• Work-related skills development, both specific to the job (e.g. to improve productivity, ensure safety in the workplace) and more general development such as problem solving and time management.
• Money management and income reporting skills and support, including where relevant requirements associated with being self-employed and making sure their employment income and benefits are appropriately managed.
• Development of workplace appropriate dress and grooming.
• Training and support for the person to be able to advocate for themselves, report concerns etc.
• Support to access healthcare, physical therapy, occupational therapy, as needed to ensure the person can carry out their job.
• Advice and advocacy related to career development and advancement. o Support to change jobs.
• A range of other ongoing support services -i.e. Services that are provided, typically off the job, to assist an individual with concerns or issues that could affect his or her ability to maintain employment – e.g. interacting on the person’s behalf with the Human Resources or Finance departments of the employer.

Personalized benefits planning

Benefits planning and advice ensures that individuals and, where appropriate, the person’s Circle of Support, have accurate and up-to-date information about the effect of earned income on benefits.

• Supported employment services should provide:
• advocacy related to employment, such as assisting individuals in understanding their benefits.
• Counseling with an individual /family and/or authorized representative to ensure support of the individual in managing benefits and or planning for retirement.