Supported Risk Taking
Promoting Dignity Of Risk Through Innovative Practices
APSE 2015
Presented by Community Integrated Services
Angelina Bush
Marcos Rios
Estelle Gilliams
Mission
Community Integrated Services’ mission is
to empower people with disabilities through
individualized employment opportunities that
foster self-sustainability, equality, and
community. Through partnerships with area
businesses and organizations, CIS works to
find jobs that fulfill the employment goals
and desires for the people they serve.
Vision
We believe that all people have the right and
responsibility to be an active part of their
community, regardless of their disability, and
Community Integrated Services helps
people with disabilities Live an Everyday Life
through employment.
Community Integrated Services
• Non-Profit organization 501(c)3
• Established in 1991 in Philadelphia, PA
– 25 individuals/ $250,000 budget
• Supported Employment Agency in Philadelphia,
PA, surrounding counties, and the state of
Delaware
• Employment First Agency
• 25 staff who have obtained CESP
• 47 staff who are ACRE Certified
Community Integrated Services
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Currently serve 756 individuals
248 Job Placements in 2014
Employment for Everyone!
6.2 m (F.Y. 2013) vs. 7.8 m (F.Y. 2014)
Community Integrated Services
• Diversified Funding Sources
– Medicaid Waivers
(Intellectual Disability, Autism, and Office of Long Term Living)
– Vocational Rehabilitation
– School Districts
– Ticket to Work
– Settlements and Trust Agreements
– Private Pay
– SSA Work Incentives
– Grants
• Braided funding approach
Risks People Take in their Lives
We all Take Risks
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Crossing Street
Teaching our sons and daughters to drive
Sending our children to school
Driving
Going out on that big date involving a ring 
Attempting to get that prom date
Are all these risks any different from the people
we work with?
Dignity of Risk
The Dignity of Risk is the right to take
risks when engaging in life experiences,
and the right to fail in taking these.
Financial Risks
Working vs. Not Working
Financial Risks
Not Working
• Expectation to stay on benefits
• No financial gain
– Not able to purchase goods/services
• Not paying taxes, not building for retirement
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Non-complacent in general
Mental health deterioration
Isolation
Lack of daily routine
Financial Risks
Working
• What makes sense financially?
• Will there be a loss in benefits?
– If so, by how much?
• What happens if I stop working?
Elevating Practice & Supporting People
• Realizing individuals have unanswered questions about
working and SSA benefits.
o Misinformation
o Confusing information
o Lack of guidance on application process
• Work Incentive Counseling at CIS
o Currently have 3 Fully Certified Staff, 1 Provisionally
Certified (CWIC)
o Assist individuals across agency (756 people)
Proactive Case Management
• Work Incentive Counseling since 2011
• Upfront and ongoing process
• 100% of individuals offered Benefits Counseling
Services
• 97% of individuals receive Benefits Counseling
Services
• 3% of individuals refuse Benefits Counseling
Services
Proactive Case Management
Individuals receive assistance with
• Applying for benefits (eligibility and appeals)
• Verifying benefits
• Understanding how work impacts benefits
– SSA, Medicaid, Medicare, SNAP, HUD, Childcare
• Help with reporting work to SSA
• Developing and implementing work incentives to SSA
(IRWE, PASS, Subsidy & Special Conditions, BWE, and
SEIE)
• Understanding overpayments
• Rectifying issues on SSA records
Meet Andy
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Receives SSDI & Medicare based on his work history
Receives the Medicaid Adult Autism Waiver
Benefits Counseling while in job development
Started working full time as a Machinist at an
Engineering company
• Benefits Frustration and Nightmare!!!
Current Nationally Supported Model:
Work Incentive Planning and Assistance (WIPA)
• SSA funded program to help individuals receiving SSA
Disability Benefits who are working or thinking about going
to work.
• Individuals are prioritized to get services.
• Promote the Ticket to Work Program and Self Sufficiency.
• Conduct WISE (Work Incentive Seminars) for Beneficiaries
• 93 WIPA programs across the United States (in 2014)
• 11.3 m adults ages 18-64 on SSDI or SSI based on
disability in United States as of 04/2015. Not including
children.
– http://www.ssa.gov/policy/docs/quickfacts/stat_snapshot/index.html?qs
Local Level WIPA- Philadelphia Region
• Philadelphia area WIPA
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Disability Rights Network of PA
Covers Philadelphia County and 3 surrounding Counties.
3 Staff members
184,782 of individuals ages 18-64 on SSA disability based
benefits (SSDI and SSI)
o 61,594 individuals per WIPA Staff
• http://www.ssa.gov/policy/docs/statcomps/ssi_sc/2012/ssi_sc12.pdf
• http://www.ssa.gov/policy/docs/statcomps/oasdi_sc/2012/oasdi_sc12.pdf
Limitations of WIPA
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Sheer Volume
Knowledge of WIPA/ Find WIPA/ Initiate Contact
Not Proactive
Locations of WIPA
Employment team not included
Timeliness of Services
No help with application for benefits
Communication Barriers & Risks
Perceived Risks of Hiring Those With A
Language Barrier
• Unable to train
• Take too much time to
train
• Miscommunication
• Perceived
comprehension
difficulties
Perceived Risk of Working Where No One
Speaks Your Language
• Not fitting in
• Not understanding
People 1ST Language Vs The Deaf Community
PEOPLE 1ST POLICY
• Emphasis on the person
1st and the disability 2nd
o A person who has an
intellectual disAbility
o A person who has
autism
THE DEAF COMMUNITY
• Emphasis on “deaf” or
“hard of hearing” first
before the person
o Deaf person
o Hard of hearing person
DEAF CULTURE
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Straight forward
Conversational storytelling
Home signs
Strong community
Some differences within the community
o Deaf
o Hard of Hearing
o Hearing Aides
o Cochlear Implant
Number Of Deaf Consumers And Staff
Fluent In ASL At CIS
• 33 currently active hearing impaired
consumers
• 7 staff fluent in ASL but not certified
interpreters
Advantages Of Using A Job Coach Fluent In
ASL Rather Than Interpreters
• Relationship w/ the consumer
• Understands what the consumer means and can
explain that rather than doing a straight
interpretation which might not be what is the
intended point
• Understanding supported employment service
• Cost efficient
Other Communication Barriers And
Associated Risks
Consumers who:
• Have limited speech
• Use assistive technology
• Speak another language
• Use augmentative and alternative
communication
23 CIS Staff Who Speak Another Languages
• 13 Spanish
• 7 Staff Fluent in ASL
• 6 others (Croatian,
Laotion, Slovakian
Czech, Brazilian
Portuguese, Norwegian,
and French)
Bilingual Consumers
• 23 individuals CIS supports are bilingual or
speak another language .
• PA Department of Education Grant for 5
students this past school year
o Needed to be bilingual
o Needed to be at risk for dropping out of
school.
o Needed to have an IEP
Meet Eric
• Student from PA Dept of Ed Grant
• Interested in working with his hands
• Working as a Carpenter’s Apprentice
Accommodations and Assistive
Technology
• Used to assist individuals to be as independent
at work as possible
• Make things easier on the individual
o Can be something simple or complex
• What do we use in our lives to be more efficient
and makes things easier?
o Reminders and calendars in cell phone
o Alarm clocks/watches
o Automatic bill pay
Meet Chris
• Is deaf with a cochlear implant, is legally blind,
and is on the spectrum.
• Is currently in Job Development and had some
recent interviews.
• Uses ASL and an iPad to communicate
• Benefits counseling
Meet Esther
• Extensive stroke history
from a young age
• Became a nurse
• Suffered a traumatic brain
injury during surgery
• Caused a speech disability
• Uses voice-over machine
on MacBook
• Currently is a Nurse
Researcher Associate
Accommodations and Assistive
Technology
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Task list checker
Text alerts for breaks
Tip counter (to help report earnings)
Voice over on Apple phone
Point of service
Picture book
Zoom text
Transportation Risks
• Safety Concerns
o Getting lost, following street signals,
safeness of route
o Being lured by a stranger
• Skill level with travel training
o Transfers with public transportation,
walking distance
• Modes of transportation
o Public transportation,
CCT/Paratransit, Rideshare,
walking, taxi, biking, family or
community members
• Reasonable commute
o Travel time, transfers, and cost
• Paying for travel
o Individual, Medicaid waiver, SSA
work incentives, reduced public
transportation fare
Transportation Risks con’t
• Looking for employment
based on reasonable
commute for particular
person
• Travel training consumers to
ensure knowledge and
competence of route.
• Staying safe and teaching
safeness while traveling
• Stakeouts
• Financial assistance with
travel costs initially
Different Models of Employment
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Traditional wage job
Resource ownership
Independent Contractor
Entrepreneurship
Artists and Artisans
Each model has it’s own risks
Risks of Employment Models
• Going through HR
• Interview process
• Fitting in with co-workers
• Being singled out based on disability
• Negotiating with employer
Reducing Risks Of Non-traditional
Employment Models
• Customized employment
o Discovery and determining what makes sense for the individual
• Development of small business advisory council
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Taxes Implications (accounting assistance)
Business Legality (licenses, business structure)
Banking and finances (acquiring loans, profitability)
Benefits Specialist (SSA benefits guidance)
Research and Marketing (business feasibility and guidance)
Meet Christian
Comic Man Comics on CBS news
Connecting With The Community
• To become fully successful at work, other things
in life also need to be addressed:
o Interview and work clothes
o Coordination and help with other services and
benefits received
o Daycare help
o Financial counseling
o Budgeting
o Housing
Community Supportive Partners
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Community Behavioral Health
Client Assistance Program
Social Security Administration
Department of Human Services
Career Wardrobe, Dress for Success, MenzFit, WAY
Child Care Information Services & Emergency Daycare
The Benefits Bank
PA Health Law Project
Financial Empowerment, Clarifi, LIFT, Benephilly
PHASE group, Project HOME, PHA
Broad Street Ministries (food pantry)
Wrapping up
• The individuals that we support have the
same desires in life that we do!
• Dignity of Risk
• We take the same risks!
Any questions or comments?
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