Competitive Integrated Employment (CIE)

Employment First Policies come in various forms — legislation, executive orders and state plans. Regardless of the form, an effective Employment First policy defines CIE and describes the roles of various state agencies and partners to achieve CIE for people with disabilities.

• National Framework to Increase CIE through State Policy — The framework identifies barriers to increasing CIE and describes how policy and practice can promote CIE at the state level throughout the nation. The recommendations in the framework are organized according to six core values: collaboration/coordination, consistency, creativity, conviction, communication and celebration/curiosity.
• National Plan To Increase Competitive Integrated Employment — The National Plan was authored by Dr. David Mank and Dr. Rich Luecking in collaboration with the five NEON National Provider Organizations (NPOs): ACCSES, ANCOR, APSE, The Arc of the U.S. and SourceAmerica. The plan provides information and recommendations useful to policy makers, funding entities and in-the-field activities in the overall national effort to increase CIE.
• Employment First Community of Practice (CoP) Webinar Series — This webinar series provides Employment First technical assistance. CoP participants benefit from national subject matter experts (SMEs) presenting information and resources to support Employment First efforts.
• The LEAD Center — The National Center on Leadership for the Employment and Economic Advancement of People with Disabilities (LEAD) brings together a range of organizations, thought leaders and best-practice innovators to expand policy, employment, leadership and economic advancement opportunities and outcomes for all people with disabilities. Funded by ODEP as the WIOA Policy Development Center, it creates numerous webinars and tools that discuss CIE.
• Criteria for Performance Excellence in Employment First State Systems Change & Provider Transformation — The EFSLMP developed a set of criteria to help states and service delivery systems successfully implement systems change within a comprehensive Employment First strategic framework. A blended approach of top-down systems-change strategies, combined with community-based capacity building activities initiated by key stakeholders, is critical to the successful implementation of an Employment First strategic framework.

Rate reimbursement restructuring requires states to determine which employment services they incentivize and which they do not. To increase CIE, rates may need to be revised to promote employment services that result in CIE.

• Medicaid Buy-in Q & A — Created collaboratively by the Administration for Community Living (ACL), Centers for Medicare & Medicaid Services (CMS) and ODEP, this guide answers questions on Medicaid Buy-in programs. Medicaid Buy-in is an optional Medicaid eligibility group that allows workers with disabilities with income above traditional limits to access Medicaid community-based services.
• Value-Based Payment Methodologies to Advance CIE: A Mix of Inspiring Examples from Across the Country — Developed by Dr. Lisa Mill, a Medicaid expert, this guide provides examples of best practices as states determine their Medicaid service rates. The guide tells stories of strategies states used to enact rates that incentivized services leading to CIE. Along with the guide, ODEP hosted a three-part webinar series highlighting key components from the guide with examples from states and state systems.

The ACICIEID final report defines capacity building as creating policy and funding priorities that promote CIE along with community agencies with skilled personnel to deliver supported and customized employment to individuals with disabilities. Building capacity at the state level requires (but is not limited to) funding priorities, use of outcome data, skilled personnel and leadership from federal and state agencies.

• Funding Opportunities to Expand Access to CIE for Individuals with Disabilities — This fact sheet highlights funding opportunities for increasing access to CIE for youth and adults with disabilities in support of their desire to live and work in integrated settings in their communities.
• Staffing to Provide CIE — This webinar, presented by Employment First SME Rick McAllister, discusses the recruitment, development and retention of staff who will effectively promote CIE.
• Most Integrated Employment Setting — State Self-Assessment — This tool helps governors and state administrations understand and voluntarily meet their obligations to provide publicly-funded employment and non-work day services to persons with disabilities.

Interagency coordination means that state agencies and other partners serving people with disabilities work together seamlessly. To increase coordination and collaboration, some states sign formal memorandums of understanding (MOU's), but other states find that a comprehensive state plan to increase CIE (or Employment First) can achieve interagency coordination.

• Blending, Braiding & Sequencing — Blending, Braiding & Sequencing (BBS) are innovative strategies to maximize the efficient and effective use of federal funds across systems for supporting individuals with disabilities to secure and maintain CIE.
• Resource Leveraging & Service Coordination to Increase CIE for Individuals with Disabilities — ODEP and DOL’s Employment and Training Administration (ETA) joined seven other federal agencies in a joint communication that encourages state and local governments throughout the nation to BBS funding to proactively maximize resources and improve CIE outcomes for disabled youth and adults. The joint communication also includes a set of frequently asked questions on leveraging resources.
• Funding Crosswalks: Coordinating and Leveraging Resources to Increase CIE — This report describes how to create and use a funding crosswalk to leverage resources effectively to increase CIE for people with disabilities, including mental health conditions, using Individual Placement and Support (IPS) as an example.
• Guide for Creating Successful MOU's — This guide provides a step-by-step process that walks agencies through MOU development by illustrating who should be at the table, key areas to include in an MOU, strategies for completing the MOU and tips for implementing the MOU effectively.
• Model Cooperative Agreements Between VR Agency and Medicaid, Mental Health and Intellectual and Developmental Disabilities Agencies — The model MOU can serve as a template for vocational rehabilitation (VR) and other agencies to use when discussing and negotiating MOUs with state partners from mental health, intellectual/developmental disabilities and Medicaid agencies.

Provider transformation is the realignment of a disability service provider agency’s business model from providing work opportunities in segregated settings or at subminimum wages to providing CIE for the people with disabilities they serve. Provider transformation is a gradual process that starts with a self-assessment.

• Provider Transformation 1.0 Manual — This manual is intended to help guide and support provider organizations interested in transforming their service delivery models to have an Employment First approach. ODEP also developed webinars on the 1.0 Manual.
• Provider Transformation 2.0 Manual — This Manual supports providers that are in the midst of transformation with modules that offer an in-depth look at specific areas of organizational change central to transformation. ODEP also developed webinars on the 2.0 Manual.
• Transforming Employment Services from Sheltered Work to CIE for all Job Seekers with Disabilities — This brief focuses on how ODEP assists states in achieving provider transformation to increase the number of people with disabilities working in CIE, and reducing states’ reliance on segregated and subminimum wage work.

The ACICIEID final report recommends the phase-out of Section 14(c) of the Fair Labor Standards Act. Section 14(c) allows providers to pay people with disabilities subminimum wages. In order to effectively reduce reliance on Section 14(c) in accordance with the ACICIEID recommendations, state agencies and partners can develop policies and practices that will responsibly phase out its use. Aligning policy and funding in support of strategies that support CIE (such as customized and/or supported employment) can assist providers of employment services to reduce reliance on 14(c).

• Stories of Successful Transformation to CIE —  In this webinar workers from across the country tell their stories of how CIE has transformed their lives. Workers explain the resources, supports and systems that enabled them to achieve success and fulfill their goals of good-paying, community-based employment.
• State Efforts to Phase Out Subminimum Wage — This webinar highlights the efforts in the states of Tennessee, Virginia and Washington to phase out subminimum wage practices before and after the passing of legislation to end 14(c) in each state.
• Section 511 of the Rehabilitation Act — Limitations on Use of Subminimum Wage — The U.S. Departments of Education and Labor have jointly developed a question and answer document to provide information to employers, agencies and individuals with disabilities concerning limitations on the payment of subminimum wages. Other than statutory and regulatory requirements included in the document, the contents of this guidance do not have the force and effect of law and are not meant to bind the public. This document is intended only to provide clarity to the public regarding existing requirements under the law and agency policies.
• Subminimum Wage Program: Factors Influencing the Transition of Individuals with Disabilities to CIE — This Government Accountability Office report identifies 32 factors influencing whether and how people can transition to CIE. This document does not necessarily reflect the views or policies of ODEP and DOL, nor does the mention of trade names, commercial products or organizations imply endorsement by the U.S. Government.

Employer engagement involves engaging with businesses and employers on disability employment, with emphasis on individuals with learning/developmental disabilities and other significant disabilities. It specifically recognizes that effective marketing to promote disability employment includes featuring businesses that successfully recruit, hire and retain employees with disabilities and share their experiences with other businesses.

• People with Disabilities and the Good Jobs Principles — This factsheet gives employers a brief overview of the Good Jobs Initiative, Good Jobs Principles, and how this can impact CIE for People with Disabilities. In addition, it provides useful resources for employers considering hiring disabled people.
• Employer Engagement: Letting the Employer Take the Wheel — This webinar dives into employer engagement and explores creating and maintaining customized employment opportunities.
• Employer Engagement: The Art of Customizing Successful Employer/ Employee Job Matches Inclusive of Individuals with the Most Significant Disabilities — This webinar discusses managing the employer engagement process with examples from North Carolina and Hawaii.
• Customized Employment and Discovery — Customized employment can be a tool that leads to CIE when the relationship between employee and employer is personalized in a way that meets the needs of both. It is a universal strategy that benefits many people, including disabled people who might not have found employment success through other employment strategies. Discovery is the foundation for securing customized employment.

Increasing CIE for people with mental health conditions requires identifying specific applications of Medicaid and other funds and joining  them with services necessary for working-age people who use mental health supports for other life needs that must be addressed to pursue employment. Expanding best practices such as the Individual Placement and Support (IPS) model of supported employment can help streamline the various funding sources. 

• Implementing IPS in Rural Communities: Barriers and Strategies — This issue brief describes barriers that state program leaders face implementing IPS in rural communities and the range of strategies used to eliminate these hurdles.
• IPS for People with Co-Occurring Substance Use Disorder — This issue brief examines challenges and effective strategies for helping job seekers with mental health conditions and co-occurring substance use disorders.
• Extending IPS to Underserved Populations — This issue brief explores how to expand evidence-based employment services for people with mental health conditions in underserved communities and calls for improved access to these practices.
• Cost-Effectiveness of IPS — This issue brief explores whether the benefits of IPS are worth the costs. It provides a nontechnical description of several types of economic analyses, statistics on the direct costs of IPS services, a summary of published economic analyses of IPS and a discussion of key areas of IPS impact on costs.
• Employment and Education Services for Young Adults with Mental Health Conditions — This issue brief summarizes findings from a systematic review of seven randomized controlled trials showing substantially better employment outcomes for young adults with mental health conditions receiving IPS compared to those receiving standard employment services and suggests several specific strategies for IPS teams working with this population.
• Measuring Race and Ethnicity in IPS Programs — Research on IPS for historically underserved groups, including people of color and people of Hispanic heritage, is of particular interest to federal, state and local leaders responsible for planning and implementing evidence-based services. This brief reviews the research on the access to and effectiveness of IPS for historically underserved groups and suggests a standardized template for states to track race and ethnicity in IPS programs.
• State-level Barriers and Facilitators to IPS Implementation — This issue brief uses the findings from a 2019 national survey of state mental health and VR leaders to help state leaders identify common barriers and facilitators to implementing IPS-supported employment and strategies to overcome the barriers, leading to successful implementation, maintenance and growth of IPS programs.

Seamless transition is the transition of youth with disabilities from school to CIE with a clear career path.

• The Implications of WIOA for Seamless Transition for Youth with Significant Disabilities — This webinar dives into employment transition under seamless transition and its application.
• Seamless Transition from School to Competitive Integrated Employment: The Oregon Story — This webinar explores the SME and state perspectives on Oregon’s work through its Employment First State Leadership Mentoring Program to help youth transition to CIE.
• Seamless Transition from School to CIE — State Examples from Michigan and Utah — This webinar explores the process Michigan used to develop an MOU between multiple state agencies to support the transition to employment for students and youth with disabilities, the process Michigan is using to develop pilot sites to demonstrate a single transition design and how to leverage resources and gain buy-in from state partners when developing seamless transition models.

Data and information systems that collect and report a number of important pieces of information about employment and integration outcomes are important in helping states understand where they are and where they need to go.

• Participant Individual Record Layout (PIRL) Data Visualization Tool — There are 10 required disability-related data elements for WIOA Adult, Dislocated Worker and Youth. Explore data by state, county and region, in addition to other variables such as type of participant and services received.
• PIRL Disability Elements: Focus on Data Quality — Access to quality data makes good policy possible and workforce services accessible for everyone. This webinar discusses strategies for improving the quality of the WIOA disability-related reporting elements.
• WIOA Reporting Tips — While voluntary, all participants seeking services from within American Job Centers have the opportunity to indicate whether they have a disability. View tip-sheets that provide descriptions of the 10 disability-related data elements and guidance on how to record them.
• Understanding WIOA Disability-Related Reporting: Tools for Data Visualization — In part one of this two-part webinar series by the LEAD Center, presenters share an online interactive data visualization tool that helps states and local areas better understand the comprehensiveness of their disability-related reporting. It also discusses Wisconsin's workforce system practices and how they benefit programs, employers and participants with disabilities. 
• WIOA Disability-Related Reporting: A Deep Dive into the PIRL — In part two of this two-part webinar series by the LEAD Center, presenters discuss the definitions and coding for each of the 10 disability-related PIRL data elements, why to collect this data and how it benefits participants and programs. Additionally, Wisconsin’s Department of Workforce Development highlights best practices related to their case management system, guidance for their local areas and staff training.