CALIFORNIA’S
COMPREHENSIVE STRATEGY
TO IMPROVE THE EMPLOYMENT RATE OF
PEOPLE WITH DISABILITIES:
STAKEHOLDER PERSPECTIVES
A Report for:
the California Health Incentives Improvement Project
Prepared by:
Curtis Richards
The Center for Disability Issues
& the Health Professions,
February 2006
This report was developed for the California Health Incentives Improvement Project through funding from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, grant number P-92399-9/02
TABLE OF CONTENTS
I. BACKGROUND
II. STAKEHOLDER INPUT: EMERGENT THEMES
A. Expectations & Attitudes
B. Disability Awareness & Sensitivity Training
C. Education & Training
D. Career Preparation & Development
E. Connecting Activities
F. Addressing Employer Needs
G. Leave No Youth Behind
H. Working With Veterans
I. Injured Workers
J. Aligning Systems
III. CONCLUSION & RECOMMENDATIONSS
Appendix A: Stakeholder Input List
Appendix B: Summary of Stakeholder Input by Method & Strategy Framework
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Stakeholder Input Report
I. BACKGROUND
In early 2005, the Governor‟s Committee on the Employment of People with
Disabilities issued the first draft of a Comprehensive Strategy, as called for under
Assembly Bill 925. In conjunction with the California Health Incentives
Improvement Project (CHIIP), the Governor‟s Committee launched an aggressive
effort to solicit public input into the Comprehensive Strategy by advertising that it
was posted to a public website and asking stakeholders to review it and offer
comments. It also took testimony at its Spring and Summer public meetings.
Both organizations were committed to building a Comprehensive Strategy around
evidence-based practices and extensive input from people with disabilities, their
families, employers, service providers, and other stakeholders during the 2005
calendar year. The comment solicitation recognized that the “complexity of
coordinating programs administered at State and local levels by government,
education, and community-based organizations requires a comprehensive
strategy that is clearly and universally articulated. California must use a
comprehensive strategy across multiple employment, healthcare and support
services to impact employment outcomes for people with disabilities, especially
as we acknowledge the continuum and diversity of disability in our society.”
The input solicitation went on to declare that the Comprehensive Strategy will:
? Support the goals of equality of opportunity, full participation,
independent living and economic self-sufficiency for people
with disabilities that will bring adults with disabilities into
gainful employment at a rate that is as close as possible to
that of the general adult population;
? Ensure that State government is a model employer of
persons with disabilities; and
? Support State coordination with, and participation in, benefits
planning training and information dissemination projects
supported by private and federal grants.
In March of 2005, the CHIIP leadership, in consultation with the Governor‟s
Committee staff, decided to augment the public comment on the Comprehensive
Strategy by launching three additional sets of stakeholder input collection
activities. The CHIIP wanted to organize a series of informal, non-scientifically-
based focus groups, host an online discussion group with people with disabilities,
and conduct key informant interviews of human resource professionals
knowledgeable in Return to Work strategies for injured workers. To assist in
these additional stakeholder input sessions, CHIIP also engaged Western
University‟s Center on Disability Issues and the Health Professions (CDIHP) to
handle the logistics of the focus groups, conduct the key informant interviews,
and complete this stakeholder input report.
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Stakeholder Input Report
This report does not reflect, or in any way include, any comments on the
Comprehensive Strategy received directly by the Governor‟s Committee at public
hearings or through its website. That data was not available, and would have
been well beyond the scope of this project. Rather, this report addresses the
three additional stakeholder input groupings supported directly by the CHIIP, at
times in concert with the Governor‟s Committee.
It should be noted that the Comprehensive Strategy that was “on the street”
during the bulk of this stakeholder input process was the initial Strategy released
in April of 2005 and revised that November. By the time of the third, more
substantive draft Strategy released in mid-December, all stakeholder input
sessions had come to a close.
Initially, CDIHP developed an interview protocol that could be used for the key
informant interviews, and was adapted for use in most of the informal focus
groups. The Governor‟s Committee had a shorter set of questions that it began
using in informal focus groups it began to host as well. Both sets of questions
were geared toward soliciting opinions about barriers and successes around
employment of people with disabilities. They were not geared directly to the draft
Comprehensive Strategy.
Human Resource Key Contact Interviews: Beginning with a list from an
experienced human resource disability management specialist, CDIHP attempted
to contact employers, businesses and business consultants to be key contacts,
representing the business/employer segment for input into the Comprehensive
Strategy. These first contacts led to others and those led to more. Some of the
original interviewees also recommended other individuals that were contacted,
screened and a few interviewed. Gaps in representation were noted and other
contacts from both past Governor‟s Committee members, local and state boards
and contacts of contractor and/or CHIIP staff were contacted for interviews
and/or recommendations.
Over 100 contacts were made or attempted to identify and screen for the final 10
individuals to be interviewed. Brenda Premo, director of CDIHP and former
director of the California Department of Rehabilitation, conducted all 10
interviews, each of which was a 1.5 hour telephone phone interviews. Each
interview was taped with permission; tapes were then transcribed and used for
this report. Interviews were conducted with:
? a small business owner and CA Small Business Network
Coordinator;
? a consultant and mediator with health care businesses and
occupational health (WC) issues with other businesses;
? a consultant with large companies and medium size
companies (e.g. HP, Levi etc)
? a consultant with insurance companies;
? a consultant with large companies; Comprehensive Strategy: 4
Stakeholder Input Report
? a director of a small business resource center;
? a chief of occupational health at a major hospital;
? a chief financial officer at a large disability agency with prior
experience with one of the big four accounting/consulting
firms;
? a senior counselor with the Department of Rehabilitation who
has a high job placement record; and,
? an human resources director for large to medium software
and hardware companies.
A complete list of interviewees and affiliations appears in Appendix A. All
interviewees were promised confidentiality, so no names are used in this report.
Two Virtual Classroom Sessions The California Foundation for Independent
Living Centers (CFILC) offered to host some stakeholder input sessions using its
online “virtual classroom” as a means of efficiently collecting input directly from
people with disabilities and CFILC members. This new technology provided for
live interactive web based electronic classroom sessions for up to 17 sites per
session, in addition to a line for the presenter and another one or two sites for
accommodations like interpreters for the deaf or hard of hearing and/or
descriptive listening narrative for blind or low vision participants. Each site was
able to have between two and five participants viewing the computer screen and
listening via phone conference lines to the presenters. Both on line chat
functions and phone conversations via the conference line were available to each
site.
The first virtual classroom session was held on Thursday, July 28, 2005 with 12
sites connected and 24 participants registered. The second session was held on
Wednesday, August 3, 2005 with 15 sites connected and 33 participants
registered. Participants for sites were primarily advocacy and disability service
agencies, including many independent living centers, the World Institute on
Disability‟s California Work Incentives Work Group members, and the
Department of Rehabilitation‟s Bridges Transition Project sites.
Informal Focus Groups: In addition to these two groupings of stakeholders,
the CHIIP and Governor‟s Committee staff wanted to reach out to other targeted
groups for input into the Comprehensive Strategy. In all, 12 informal focus
groups were conducted, with participants either being selectively recruited to
participate or being a captive audience of an existing program or site. Some of
the targeted groups recruited into these informal focus groups included
employers, labor union and apprenticeship programs, veterans and youth and
family members. There were, however, two open-ended forums---one held at a
regional disability employment conference sponsored by the Department of
Labor and the other a consumer-organized conference known as Respectability--
--that also offered opportunities for input using this methodology.
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Stakeholder Input Report
Finally, this report is intended to be used as an independent reference by the
Governor‟s Committee, the CHIIP, or any other parties interested in
understanding how the collection of individuals queried feel about the
Comprehensive Strategy and the employment of youth and adults with
disabilities more generally. It is also intended to be folded into a comprehensive
report as supporting documentation that CHIIP needs to submit to its funder, the
Centers for Medicare and Medicaid Services. There are two helpful appendices
to this report, one that lists the individuals and groups participating in this data
collection process, and the other a much more detailed list of summarized
comments organized by the categories of the Comprehensive Strategy outline.
II. STAKEHOLDER INPUT: EMERGENT THEMES
Across the three stakeholder input categories, certain themes emerged. This
section will report on those major themes, oftentimes in the words of the
stakeholders themselves.
A. Expectations & Attitudes
One of the major themes that emerged from all three types of stakeholder input
sessions revolves around expectations and attitudes. While on its face, this
theme may seem simple, stakeholders raised issues and concerns about
expectations and attitudes in ways that demonstrate a great deal of complexity.
Low expectations; for example, was identified as a significant issue for employers,
for service providers, for family members, and for people with disabilities
themselves. In other words, it is insufficient to think that people with disabilities
are not being hired because employers alone have low expectations when, as
the stakeholders point out, nearly everyone someone with a disability comes into
contact with has low expectations of them, and the person with a disability has
low self-esteem and internalizes all of these negative reinforcements.
In one open forum, a participant said that “we need to have high expectations for
people with disabilities,” while another in the same forum said people with
disabilities “should not settle for „whatever.‟” One consumer advocate went so far
as to refer to “the soft bigotry of low expectations of employers” when asked what
obstacles people with disabilities face in the workplace.
“People with disabilities should be prepared to fail,” stated a consumer advocate
in the same forum, while another declared that “we need higher expectations of
ourselves.” These comments parallel years of research and advocacy around disability public policy, especially in education and employment.
The issue of attitudes elicited a great deal of emotion, conjecture and hypotheses
from many of the stakeholder participants.
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People with disabilities “need to get out of their own way; they need to help themselves,” one employer stated in a focus group while another in the same
setting confirmed that “people with disabilities come with attitudes.” Some people with disabilities have the attitude that “they are going to take care of us
and I don‟t have to worry about (anything). They‟ll do it for me,” said one
employer interviewed, “if you coddle people then you are taking away their ability
to help themselves.”
“Attitude is a very big barrier, a very costly barrier,” said another employer. “But the person‟s own anxiety, fears, anger can be a barrier to success.” And, for injured workers, “fear and sensitivity to losing contact with the workplace is a
huge factor,” said one worker‟s compensation consultant. “People‟s feelings are
really, really hurt when they don‟t hear from their employer.”
“Unfortunately a good number of employers have negative experiences because there are so many people that take advantage” of them, explained a human
resources manager. “People that truly may not be disabled and what we‟re
talking about now is maybe worker‟s comp. So unfortunately some employers
will have a hard time with, they are very suspicious I guess that‟s probably it.”
But in the cases where someone is “coming in already with an established
disability that they‟ve overcome, I notice that employers and managers tend to be
more accepting and open.”
Yet, several consumer advocates or people with disabilities who participated in
focus groups said that “we need to change employer attitudes,” when asked
about barriers to employment. “Information about hiring the disabled must be
brought to their attention so they are aware of the kind of good and loyal
employees people with disabilities can make,” another focus group participant
said.
As some stakeholders pointed out, issues about one‟s disability are very
personal and deep-rooted. One employer explained that the obstacle of attitudes
about disability “is sort of a cultural problem.” In American society, “we don‟t like to be impaired ourselves. We don‟t like contending with our own losses of capacities and we don‟t like it in other people either.”
Similarly, one disability employment specialist reinforced the point, “when we have shortcomings we find it very uncomfortable and we don‟t like everything that
ensues from even those temporary shortcomings. There is a kind of an
undercurrent of negativity that I don‟t think the most stellar commission on the
planet could really overhaul this human nature problem.” She went on to say that “I think that leadership can help influence it so that it is not such a big factor.”
In response to how these attitudinal issues should be addressed, several
participants in all three stakeholder groupings said that people should “focus on ability” or “recognize abilities rather than disabilities” or “we need to look for Comprehensive Strategy: 7 Stakeholder Input Report
abilities and be open-minded.” One participant summed it up by saying that “I wish we could just use common sense, courtesy, and sensitivity with everyone!”
B. Disability Awareness & Sensitivity Training
Stakeholders seemed to believe that a lot of the negative attitudes and low
expectations could be addressed by individual, group and very broad disability
education and awareness training. Many stakeholders even called for a state-
sponsored public relations campaign, through Public Service Announcements, to
help educate the general public and create a different societal view of people
with disabilities.
One employer pointed out that businesses “need employees to hire” as another
in a different setting said that he needed “qualified employees” to fill positions.
“Companies can‟t discriminate in this job market,” an employer said, speaking positively of the economic necessities of finding good employees.
One independent living center director said that “employers need education
about disability issues so they don‟t discriminate when people with disabilities disclose their disabilities.” Employers need to be sure that they “don‟t make
assumptions, such as understanding that Cerebral Palsy does not equate to
mental retardation” said another disability community advocate.
“Our people don‟t know disability etiquette,” said one mid-level manager in the private sector. “We don‟t want to hurt anyone‟s feelings by asking the wrong
questions,” expressed another employer. “We need to better understand the
ranges of disability,” said another manager.
Training for managers was an issue that surfaced several times in each of the
stakeholder input groupings. “Training for managers is really lacking,” one
employer said. Another employer in the same focus group felt that “hiring managers need to learn how to work with people with disabilities.” There are “a
lot of legal issues that cause trepidation for managers.”
An employment specialist felt that employers “need training to ease fear of
litigation” while a disability rights advocate proposed that “employers receive
education to correct misconceptions about people with disabilities.” One
advocate suggested there was a strong need for “global awareness training for
both sides – employers and people with disabilities.” And, another advocate
proposed “public service announcements regarding people with disabilities to be
run in primetime to help change perceptions” of the general public. The state needs to “conduct a major public relations campaign to educate employers about
people with disabilities, including by using some of the more successful people
with disabilities and by operationalizing it through employers and employer-based
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associations” such as the Society for Human Resource Managers (SHRM) and
Chambers of Commerce.
“It is important to remember that if they don‟t know what to do, they are going to run,” said a disability employment specialist. “If they do know what to do, if they
have been given some support from an HR person or someone like me, then
they‟re usually pretty happy to continue the process and honestly and sincerely evaluate the person‟s ability to do the work. Most recruiters and frontline
supervisors I don‟t think have a big problem with disability as long as they
understand what the impairment is and how it is going to match up with the
productivity requirements.”
“I think the average person, and I honestly believe even HR, thinks about people
who can‟t use their limbs” when thinking about people with disabilities in the
workplace, explained a human resources manager for a high technology
company. “We all know that there is just a lot more to it than that, a lot more
different degrees of disability… Because I‟ve worked with people who have had
sight and hearing problems and as a certified credit card industry we had blind
people working as customer service people.”
“I think people are becoming more educated,” said a human resources manager,
recounting a story about having to fire a woman with mental health needs after
four or five serious episodes. “But I still think there are a lot of people that don‟t
know there are people out there that have some mild cases of bipolar and they
probably have no idea” about other types of hidden disabilities.
“Our managers don‟t know the definition of „reasonable‟ for accommodations”
said one employer, while another in the same dialogue admitted that his
“managers don‟t typically know unless someone asks for an accommodation.”
The “costs of accommodations are just unknowns to businesses,” said an
employment specialist. “If we can help them become better known, it may
alleviate some of the concerns of smaller employers.” One employer said that he “started affinity groups, including with people with disabilities, to help identify and
address accessibility issues.”
One employer very directly said that he believed the “definition of disability is vague.” One hospital employer cited Carpal Tunnel syndrome as an example of
a condition that is used too loosely. “Most people who come in with arm
symptoms actually do not have Carpal Tunnel syndrome,” she said. “It is really a
sub categorization of what they may present with. Most of what we see is more
soft tissue in nature. We see a fair amount of Carpal Tunnel syndrome referrals,
but it‟s not the automatic diagnosis. Carpal Tunnel specifically relates to damage
of a specific nerve in the upper extremity, called the media nerve and some
people have it but many people who present with problems don't have it. So we
deal primarily with people who have acute, and I would say subacute, work
related musculoskeletal injury.”
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Offering another perspective, one consumer advocate said that “we need to infuse humanity into human resources.”
“Smaller companies are more nervous about cost of accommodations” than larger companies, said one employer, “especially those companies without a
human resources person or department.” Another employer said that
“companies with fewer resources may be less knowledgeable about disability
laws,” as a colleague from the same business explained that “companies need
information on legal requirements, resources and human resources issues” around working with people with disabilities.
“There is a lot of misinformation about the costs of accommodations,” one employer expressed, citing examples such as people with disabilities missing
work, health care costs, etc.”
“From a building perspective, I don‟t think I‟ve ever been in a building that doesn‟t
have access, if it‟s at least two stories,” said the human resources manager. “So
if a person comes in, you believe the business is now pretty much set up with
their processes and procedures to provide the request.” In the cases “where
there are really unique things, you know those are going to be typically in the
beginning of your hiring process,” she continued. “I haven‟t had anything that has
required a lot of money where we couldn‟t do it and so I haven‟t been faced with
that. I‟ve put in access ramps; I‟ve done things like that for years.”
“Education and outreach, it‟s almost like it has to be ongoing, that just has to be
continuous, so resources for those types of leads I think would be very, very
important,” explained one disability employment specialist. “Speaking very
candidly, we are in a society where small business, I mean they‟ve got it coming
at them in every direction and you know they‟re worried they are going to get
sued because they are not complying and they don‟t know.”
In one of the employer focus groups, it was suggested that “on-line training needs to be offered for employers in short increments” because “every time you
pull a manager off line, it costs the company money.”
“If I were Governor, I would want to get out more education and understanding
about people, more visibility with people with disabilities because I think once
people are sensitized more to it and understand it better, a lot of their fears drop
off and they realize that this isn‟t really rocket science to try and work with people
with disabilities,” explained a human resources manager for a large corporation.
“Its really a matter of understanding and being a little bit more open-minded, just
like we have gotten at least in this state with minorities and women and whatever
interest groups that have either been discriminated against, or been given the
shaft through the years. If I had a budget I think I would put some toward
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