A Comprehensive Strategy

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A Comprehensive Strategy ...






    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




     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


Appendix A: Stakeholder Input List

Appendix B: Summary of Stakeholder Input by Method & Strategy Framework

Comprehensive Strategy: 2

    Stakeholder Input Report


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.

Comprehensive Strategy: 3

    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


    ? 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


    ? 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


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.

Comprehensive Strategy: 5

    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.


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.

Comprehensive Strategy: 6

    Stakeholder Input Report

    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


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

    Comprehensive Strategy: 8

    Stakeholder Input Report

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.”

    Comprehensive Strategy: 9

    Stakeholder Input Report

    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 issuesaround 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

    Comprehensive Strategy: 10

    Stakeholder Input Report

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