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Guide to Services-Day Programs

by Heather Johnson

Typically, the most urgent need families have post-graduation is some kind of safe, supervised and productive activity for their child to engage in since they are no longer attending school. Traditionally, the options for post-school-age day programs were either supported employment in the community, an activities-based day program, or a sheltered workshop. Luckily, the quality and choices offered in day programs has increased in recent years, and there are now excellent programs to choose from. Some definitions: a sheltered workshop (or prevocational program) is intended to help individuals develop skills to work in the community, usually by doing piece or factory work and being paid per completed piece. An adult day program provides supervision and opportunities to participate in cooking, art, music or other types of recreational activities. Job supports, on the other hand, provide individuals with assistance in finding, learning and maintaining employment in the community. Adult day programs are generally located in a large setting, with staff ratios typically between 1:3 to 1:15.



However, the difficulty now lies in the intricacies of the CMS Final Rule. The Centers for Medicare and Medicaid Services (CMS, also known as Medical Assistance), is the national organization that provides services. CMS is changing the way services are provided in order to maximize supports and monitor the programs. The Final Rule refers to the specific mandates the federal government is now imposing on the states. The biggest change with the Final Rule is to get as many people as possible into community jobs and to de-segregate sheltered workshops. One long-term issue within the service system is the lack of genuine employment opportunities for our folks, and the push to get as many people employed in the community as possible has led to new regulations. Basically, this means that everyone must be supported in finding employment before going to a more traditional sheltered workshop or activity-based day program. As of 7/22/2015, anyone 23 years old or younger is going to be required to complete the Office of Vocational Rehabilitation process before they can attend a day program or receive job supports through a waiver. Those over 24 and already in a workshop are “grandfathered” into their placements and do not need to go through OVR unless they want to get a job or add job supports. The OVR process provides funding for an assessment of employability and 90 days of on-the-job supports, at which point the waiver could take over providing services for that person to remain employed.

Some people are not going to be successful in a community job. However, it has also been recognized that most day programs are considered segregated because they offer no opportunities for community integration. Now, day programs and sheltered workshops are required to provide individuals with some kind of community integration, whether this is volunteering in the community, having community members come into or also use the program, or other methods of exposing the individuals to opportunities beyond the facility setting. In order to attend a program like this, though, you must have a letter from OVR stating that employment is not a possibility. The full scope of the changes affecting these programs is still unknown. According to the Pennsylvania Department of Human Services, “at this point, no decisions or definitions have been made regarding adult day program settings. The transition plan states that the Department will review Pennsylvania regulations, waiver service definitions, policies, and provider standards to assure compliance with HCBS final rule.”
Some things to consider: it is usually in the best interests of the individual to complete the OVR process while still in high school. Most, but not all, high schools offer transition services which include this assessment and support, so make sure to specifically request it. Also important: if community employment is appropriate for your child, the money made impacts his or her Social Security benefits (this includes piecework in sheltered workshops!) For more information on any of these topics, feel free to contact your supports coordinator or myself.

Heather Johnson is a Supports Coordinator Supervisor at The Arc Alliance, a nonprofit organization supporting families and individuals of all ages with developmental and other disabilities. In addition to her personal experience as a family member of those with special needs, she has been working for 18 years in all areas of the special needs community. Heather is one of the guest bloggers who will periodically post information for Kokua Network members.

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