Manager Minute-brought to you by the VR Technical Assistance Center for Quality Management

In this episode of Manager Minute, host Carol Pankow sits down with Cora McNabb, Executive Director of Kentucky Combined, for an honest, in-depth conversation about how her agency is responding to the rising fiscal pressures in vocational rehabilitation.

Facing skyrocketing service costs in the wake of the pandemic, McNabb shares how Kentucky made the tough but necessary decision to implement an Order of Selection. She walks through the agency’s strategic approach, including cost containment measures like staffing freezes, policy changes, and clear, consistent communication.

Listeners will gain valuable insights into:

·       Using data to drive timely and effective decisions

·       Building transparency and trust through fiscal openness

·       The power of collaborative leadership in times of change

·       Why engaging RSA early and assembling diverse internal teams makes a difference

This episode offers practical advice and real-world examples for VR leaders and decision-makers working to maintain service delivery in a rapidly evolving landscape.

Tune in and be inspired to lead with clarity, collaboration, and a commitment to sustainability.

Listen Here

Full Transcript:

Cora: How quickly things can accelerate, because you can be okay one month and then a lot of case service costs hit in the next month. Oh, you're not looking so good.

Carol: Having that bigger group. Looking at the situation, I think more minds make for better observations about what's happening in perspective. You can't do this by yourself

Cora: moving forward, I think that we're going to have deeper dives into the programmatic and fiscal data at our meetings than what we were having.

{Music}

^{Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.}

Carol: Joining me in the studio today is Cora McNabb, director of Kentucky Combined. Cora, it's so great to see you. Thanks for being here.

Cora: Thanks for having me.

Carol: Well, so over the last five years, the fiscal landscape for the VR program has been shifting, and the pandemic had led to a slowdown in spending as customer demand decreased. But now things are ramping up again, including inflation. In March, I recorded a podcast featuring RSA in Indiana, combined director Theresa Kolezar on this very topic. CSAVR also highlighted it in a general session, and the VRTAC-QM released a tool to help state VR agencies navigate order of selection. Today, I want to have a real time discussion with Cora about how she and her team are navigating the order of selection process in Kentucky. As one of our more seasoned state directors, she's in the midst of working through these challenges, and I think it's important to hear firsthand what that looks like. So let's dig in. So, Cora, can you tell our listeners a bit about yourself and your journey into VR?

Cora: Sure. I started out in the early 90s in a nonprofit organization. I never finished college. And so about that time, my mom died and I decided to go back to college and finish. And I did a practicum in the nonprofit, and from there on, I was hooked. And it was actually a sheltered workshop at that time. And I started out in vocational evaluation. That was around the time, if you remember, supported employment started to grow. And so I had the privilege of starting that and taking over the oversight of the supported employment program. And I was there for about 14 years, and then we moved from Indiana to Kentucky. And I really didn't even want a job right away. But there was an opportunity to be an administrator for the blind agency. And I took that job. And so 20 years later, here I am and I've been the executive director. This is my sixth year.

Carol: Wow. You have a very similar background to me because I started out in that world too, of sheltered work, and then when supported employment came around, ended up leading actually in our state hospital, one of the programs to get our folks out into the community working in supported employment. It was so crazy. I look back at that and how far we've all come. That's pretty cool. So how big is the VR program in Kentucky? Like how many staff and customers do you serve and what's your budget look like to give people kind of a sense of scope?

Cora: Our budget is probably around 90 million. That includes everything. Last year we served about 40,000, and that would be also including pre-employment transition services in there. And so currently we have about 480 staff, of which around 140 of them are VR counseling staff.

Carol: Wow, you are not a small program. I didn't realize you were quite as big as you are. So how has the fiscal landscape changed for your agency over the last five years.

Cora: Our consumer services has really seen an unprecedented increase in cost after Covid 19. The pandemic and in the last several years since 2021, we have seen increases in all areas, applications, eligibilities, cases, employment outcomes as well as the numbers served. And obviously if you've got increases there, you've got increases in expenditures and you have to take into account how the cost of services have increased. Our applications from 2021 till 2024 increased 95%. Our eligibility is 102% and our expenditures increased 72%. Of course, that also meant our employment outcomes increased as well. So we've increased a lot.

Carol: Holy smokes I haven't heard numbers that big? That is huge. You know, I wonder too. Some people have been telling me that the customers that they're seeing now coming in the door are also different than kind of pre-pandemic that they said, folks that they're serving when they're looking at case characteristics are tending to be more complex. And so in addition to kind of everything going up, the individuals needing service need more things. And so the cost per case has also gone up. Has that been the case for you all?

Cora: Yes. The cost per case has also gone up.

Carol: Interesting. So, you know, during the times of plenty when the message was spend, spend, spend. What kind of strategies did you implement at that time? Because I remember you back then going like, oh my gosh, we gotta, we have to spend all this money.

Cora: Yes we did. We had a lot. We had like a full year of carryover. We increased tuition costs. You know what we paid for tuition. We suspended cost sharing or the financial needs testing. We suspended that we gave raises and we hired additional staff because the demand and, you know, we had long wait times in some of our more urban areas. And so we added additional staff to handle the caseloads.

Carol: Yeah. I remember you saying way back when, I think you had a region where you couldn't get counselors for quite some time. It was way over a year, and you were just dying to get those salary increases to see if you could get folks in. So are you now covered statewide with staff?

Cora: Yes. Since we have implemented the wages and then staff got additional wages as well, you know, annually through the state fiscal year, our turnover went from around 44% to about 2 to 3%. So we have a very stable workforce, which I think also contributed to how many people we were serving in cases that we were seeing.

Carol: So that's pretty amazing. So you can see all the, how the strategies are playing out. You know you are keeping your staff. That's been good. But then all the other pieces that you put into play, like suspending, cost sharing and all of that. What are you finding is happening today?

Cora: Well, we know that agencies rising costs against the estimated expenditures that we have in the available funding has what has pressed us to look at entering order of selection, because we know that at the end of the year, we will have spent more than what we have if we don't.

Carol: So what steps have you been taking to implement the order of selection?

Cora: A lot. We looked at both fiscal and programmatic. We did fiscal forecasting from 2021 through 2024. We looked at four years and we analyzed that data for all areas, referrals for applications. We looked at attrition costs. We looked at the applicants in each priority category by their status. We looked at our assessment cost for that time period. We looked at our attrition cost. We have consulted with our state rehab council. We've held public hearings. We're currently waiting for approval from RSA through the process for the state plan amendment. Through that process, RSA identified that we had duplicative language in our priority categories. For category one and two. We use the word most in both of those categories, but we defined it out by functional capacity. And they had not noticed that before. So they came back and told us we would have to either close one and two, or leave one and two open. And leaving two open is not an option for us. We have to close category two, so we are going to have to close all four categories while we work on addressing the issue with those priority definitions. So that's going to require obviously additional public hearings and a policy and regulatory change. So that has kind of complicated the process for us. But we need to correct that. And we started that process with our state rehab council. On Monday, we had a session where we're beginning to look at those priority categories. We also held training of staff. We've held one training and we have another one scheduled for next week. We've worked collaboratively with our cabinet leadership and the governor's office. They both have been very supportive, developed communication plan. So it's a lot. It's a long process really.

Carol: Well, it is a lot. I was thinking about that kind of the political piece of it because sometimes folks forget, you know, there's the mechanics of it. Do you have your policy in place, you know, and how's that all rolling in training of staff and doing your amendment. But politically, sometimes you will get pushback from the higher ups going, we don't want you to do this. We don't want you to go on an order, but you're not experiencing that. You are getting support.

Cora: No. And of course, we don't want to go into order selection either. So we're going to work as quickly as possible to get those definition changes done. And our policy changed, you know, the regs. But we want to make sure we do that in a quality manner because how you define those priority categories is important.

Carol: Yeah absolutely. So where are you at then in the process with getting your state plan amendment approved by RSA?

Cora: We're just waiting on it. We have sent it back and now we're waiting. We're hoping to implement by May 1st. So we're just waiting to get that back.

Carol: Yeah. So you're coming on kind of quick, too. There's, uh. Well, I shouldn't say quick. You've been working on this for a while. There's a number of states that are in the throes of various stages of working it through. One thing you said is this takes a lot of time. And I know people have called as of late, like, even in the last week or two, and they're like, we need to implement an order right away. Like, we need to go on by May 1st. And this is like an April 1st timeframe. And I'm like, that's not even possible.

Cora: No. And it is a cumbersome process. But when you think about how important the decisions are that you make, I guess it would be hard not to have a process that takes time and a lot of thought, and you need to look at everything thoroughly.

Carol: I know one of the big pieces that folks from the feds, you know, RSA will talk about is cost containment strategies, trying to look at any kind of cost containment strategies you can put in place first, or kind of alongside as you're looking at implementing an order to help, kind of rein in the expenditures. So what kind of cost containment strategies have you put into place, or are you guys looking at putting into place?

Cora: Yeah, back in I guess probably September in the fall was a telling month. We looked at that and went, whoa, our costs were way up. And of course we knew there was tuition in there. But even in spite of that, they were way up. And we saw that trend beginning to be there. And so we started to look at more data. And so in January, we stopped all out of state travel. That was, you know, funded through the VR grant. All personnel actions were put on hold. We are now in the process of looking at our contractual agreements and reducing them where we can. We also, here in Central Office, are going to consolidate some of our space, give up some of the vacant cubes that we have. And another thing that we've been looking at off and on for the last several months, our hearing aid costs, and we did release some temporary staff and some initial probation staff, which was very hard.

Carol: That is hard. None of these things are easy to do for sure. It's very painful. I've been hearing from people all over where they're having to do very similar types of things, and you've had a little bit longer on ramp because you've been noticing this since last fall. It isn't like, hello, today you just got this notice, like, say from Jake going, Cora, you don't have any money, which is happening. Other people, they're not having access to any financial information about the program. And it's really super troublesome because you can't be in control of the allocation and expenditure of your funds as the VR director, when you don't even get a financial report.

Cora: Right. That would be very concerning.

Carol: And you've really had to navigate that because you've had many different structural changes in Kentucky with where that fiscal folks land. I mean, they used to be with you, and then now you've got them way at the cabinet level. So it's a whole different picture.

Cora: Yeah. Through looking at those, we get a weekly report, we get a lot of reports. And it was looking at that where we begin to see the percentage of differences start to change. And I think, you know, if you get regular reports controlling your administrative costs are not that difficult. It's those case services costs because plans are written and money is obligated. And once that starts, unless you're running that data and really looking at it ongoing, in which this is something that we've learned, we will be looking at more data and different data going forward as we maneuver through this. You know, how many plans are in place implemented. All of that is really important to look at ahead of time, because you can see what's coming, because once they're implemented and those services are on the plan, the trains on the track and it's going.

Carol: That's right. You're talking about this and looking at this, who's the we? So I know it's you and Susie, but who's the we that's looking at the data? Do you have an expanded team looking at it? Who do you include in that?

Cora: Our leadership team, my division directors. And then also the cabinet fiscal staff.

Carol: This is sage advice because I think some leaders have had a tendency to want to keep this close to the vest, like they know there's a problem, but they're not wanting to include a bigger group. And I just need to, like, make a pitch right here. Having that group involved, like your leadership team and the fiscal people in the cabinet and having that bigger group looking at the situation, I think more minds make for better, you know, observations about what's happening in perspective.

Cora: Right.

Carol: You know, you can't do this by yourself.

Cora: No you can't.

Carol: Yeah. I'm really glad that you're doing that. So what kind of advice would you have for your colleagues across the country who are wrestling with these similar issues? What are things that you found that have been helpful for you working through this?

Cora: Well, I think to know that you're not alone in it, and it is a very difficult decision. Once you make the decision, I think it's important to act quickly and be confident, because it's really easy to blame yourself that you know you didn't do a good job, or that you have let the disability community down in your state. The grants very complicated and all the processes surrounding it, I think are complicated and challenging. I think the more people that you surround yourself with and making all those decisions, the better. It's very important. It's kind of like we ran a data set today and sent it to Jake, and I didn't think about did it have pre edits in it? And Jake came back and said, does this have presets in it? Because the data can be deceiving in itself too. And then know that how quickly things can accelerate, because you can be okay one month and then a lot of case service costs hit in the next month. Oh you're not looking so good. And the fiscal forecasting group has been great to be a part of all of those groups. The new fiscal forecasting tool. There's all kinds of tools that are out there. And then I know I always say this for those states where they don't have those relationships somehow be working on them, because without them you're not going to be successful.

Carol: Yeah, that's all very good advice. I do want to dig in for a minute on the data, because I know folks like to look at different things. What have you found to be most helpful to you and the leadership team when you're talking about the data? What are the kinds of things you guys are looking at that have been really impactful? And is there any way that they're displayed or something that has been more helpful to you?

Cora: Well, I think the annual cost of services over time, looking at that historical data, how many referrals that you have, how many applications that are currently in the hopper, the attrition cost, looking at those help. Because if you know about 38% of your cost, that is going to you know, those authorizations are not going to go to payment. That helps just all kinds of data, really. And looking at it by priority category. And one of the things Susie and I have talked a lot about is, and RSA mentioned to us is, are we too top heavy in one priority category over another one? Because then that makes it difficult as you are looking at closing. And that's kind of what happened to us, by the way, that we define those functional limitations. Now we're kind of stuck until we get our definitions changed. We have to close both one and two, and that's not what we wanted to do. We wanted to leave one open and just close two.

Carol: How many categories do you have?

Cora: We have four.

Carol: Okay. Because I know I've seen people have even like 5 or 6. And I feel like the more you finely slice and dice those, they end up almost becoming irrelevant in a way, because you might have a half a percent of people in a category. So you go, you're closing this. And it's confusing to the counselors, like, how am I finally finding this? It makes it harder to implement and it's causing you more grief really.

Cora: Yes. I think that we're going to try to simplify ours as we move forward.

Carol: Yeah, that sounds really good. Have you had to do anything in particular to help people get comfortable, like in understanding and interpreting the data? Because I know sometimes folks, you know, everybody's minds just work differently. And so you could have a report. And for some people it's super obvious. Oh yeah. Like you can interpret that and it says x, y, z. Other folks are like it just looks like Greek on a page. Have you had to do anything to help kind of with like data literacy?

Cora: Well, it's interesting that you say that because informing the public and the public hearings, I think that was difficult for individuals because and part of that is probably they just don't simply want to see it because they don't want us to close the categories. You know, because it's not it's not a good thing to do. But I think once we presented the data and would show what large percentages of increase that we had, that people would go, oh yeah, and our state rehab council, they were very supportive and could see that. But I think just the general public, it's more difficult, probably because it's their child or their, you know, grandchild and it's just more difficult. So that has been difficult getting everyone to understand it. That's a good point, though. The data sometimes is difficult to accept.

Carol: Well, it definitely lends to that whole when you have a communication plan, you're really talking differently to different groups because you've got obviously kind of your higher ups in the politicals and you've got your own staff and the consumers and then the other stakeholders. So the messaging may look different just because you're trying to communicate in a way that people can understand what's going on. Right? Absolutely. Yeah. So what are you projecting for the future? Now we've gotten the, you know, continuing resolution came, the money came, which is good. What are you looking at when you look out a year or two? What are you thinking.

Cora: In my crystal ball? I don't know really what to expect. So hoping that our funding stays stable. The cola was great. That was a great surprise for all of us. And getting that and you know, moving forward, I think that we're going to have deeper dives into the programmatic and fiscal data at our meetings than what we were having, making sure that we're marrying those two together. Because if you just look at one and goodness, if you're not looking at it at all, then you really are having difficulty. I feel like we have some hope knowing that the rest of the award did come, and we need to build that carry forward money back up, not to the point where we had it, but we have to have that.

Carol: Yeah, I know RSA said recently about, you know, building that money up, but they were like, you really should in this time of continuing resolutions, their rule of thumb is you should have at least two months of kind of cash available so that you're not scrambling when we're waiting to see what's happening with the CR or whatever. And I know some of the agencies have been closer to the vest, like they're kind of right on the penny with every dollar that's come in is getting spent. So it is good to have a little bit of a reserve.

Cora: I think this is the first time in six years that we've gotten to the, you know, and I imagine there are other states that have really expended almost all their money because we were, what, six months in?

Carol: Yeah.

Cora: Yeah.

Carol: People cried. People cried. When the new GAN came out. I talked to over a dozen directors. People were yelling and had tears of joy. People were just overwhelmed because it has been so stressful. And folks, not sleeping at night. You know, it's it's been tough, very tough. So I definitely think you have great advice for folks. So if you're not looking at your data, you need to. And if you're only looking at it one way, and I know a couple folks were caught off guard that way, they really weren't kind of marrying up what was happening programmatically with the fiscal data. They weren't looking at both sides of the picture. And like you said, you had that just Ginormous increase of applications and eligibilities and all these folks coming in the door and the people have changed. If you aren't looking at all of that through that lens and then looking at what's happening over here financially, you're kind of missing a really critical piece. And it does bring your fiscal side of the house together with the program people, which is so important.

Cora: Right.

Carol: Yeah.

Cora: When you see those increases, then you should mentally note right away you're going to see expenditures increase.

Carol: Yeah. Well, and I like that you said to Jake was able you weren't sure on the one data. You know, did it include the Pre-ETS or not. And Jake, at the cabinet level, RSA knew enough because he's gotten so involved in the program, knows enough to call you and go, hey, Cora, does this data include the Pre-ETS? That's what we want across the country. We want fiscal staff to understand enough about the program that they can have that realization to ask a darn question like, what is this inclusive of? Above, right? Yeah, that is great.

Cora: And care.

Carol: And care. Absolutely. Like that leads to a lot. Oh my gosh. Well, Cora, I just I think the world of you, you've been one of our longer term standing directors, even at the amount of years you've had in now doing this. We've just had such a turnover, and I continue to see that, we had two more directors leaving last week. It just does not stop. So I think one great piece of advice from you, though, is including that leadership team. You can't just have one person in the agency that understands everything going on because that person walks out the door. It is tough to recover because everybody else left behind has no clue what's going on.

Cora: Right.

Carol: Well, thank you, Cora, I really appreciate you having this conversation. And for folks that are listening, definitely remember, you can always reach out to us at the QM. You can also reach out to your RSA state team. They are super helpful as you're facing these really tough decisions you're making. And if you're considering going on an order of selection, I say involve RSA early. Early in the process. Cora knows it's a long road to hoe. There's a lot of things that have to be covered, but it's important because you're making a very important decision, so you don't want to leave any stone unturned for sure.

Cora: No. They've been a great support for us. We have a great team at RSA that we work with.

Carol: I love that. Well, thanks, Cora, I hope you have a great day.

Cora: Appreciate it. Bye bye.

{Music}

^{Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!}

We’re celebrating a major milestone with the return of our very first guests: Kristen Mackey, Director of Arizona Combined, and Natasha Jerde, Director of Minnesota Blind.

As Vocational Rehabilitation leaders navigate rising demands, shifting funding, and major structural change, Kristen and Natasha join us again to reflect on the post-pandemic landscape—and how it’s testing directors like never before.

From managing centralized services to sustaining staffing under fiscal strain, they share the real-world challenges that keep them up at night—and the strategies they’re using to adapt.

With transparency, persistence, and a mission-first mindset, these leaders dive into:

·       Navigating state and federal priorities

·       Responding to workforce volatility

·       Staying connected to data and purpose

Their insights are a must-listen for anyone leading in today’s VR environment. Tune in and be inspired to lead with clarity and resilience.

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Full Transcript:

Natasha: Our program income is significantly dropping. The inflation, the cost of services. We've had four and a half and 5.5% salary increases with no additional state appropriations. So all of these things together keep me up every single night.

Kristen: We want job placements, we want employment, we want independence. If somebody's saying increase your job placements, fine, we can do that. It's how do we then take what they're giving us and make it not be a distraction, and we can mold to the thing that they want, but still do it at the base level.

{Music}

^{Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.}

Carol: Well, welcome to the manager minute. Joining me in the studio today is Kristen Mackey, director of Arizona Combined, and Natasha Jurdi, director of Minnesota Blinds. So how are things going in Minnesota, Natasha?

Natasha: I think the Minnesota word for today is going to be interesting. It's interesting. How about I leave it at that and I'll talk a little bit more as we dive into the questions.

Carol: Awesome. That is interesting. I want to know about that. How about you Kristen? How's it going in Arizona?

Kristen: You know what? I think I might steal Natasha's word. There's so much happening. We're trying to keep managing and keep abreast of all of the changes that come out on the news and everywhere, trying to keep centered and just keep doing what we do to get the work done. It's been a lot of fun.

Carol: Well, I couldn't think of two better people to bring on because this is super exciting. This is actually our 50th episode of The Manager Minute, and I couldn't think of a better way to celebrate the milestone than by bringing back my two incredible guests from episode number one in May four years ago. It's so crazy. And back then I just laughed. We were diving into the world of post-pandemic VR. What's it gonna look like? How are we going to navigate all these changes? You guys were working on things like electronic signatures and how you equipped your staff, you know, to work remotely and all of that. So a lot has changed since those early days, and I'm excited to catch up with you both to see how far that you've all come. So just reflecting back to my time as a director, I remember many a sleepless night and Natasha can attest to that. I remember coming to a meeting like, I don't sleep at night and I keep a pad of paper by my bed. And it was so funny. I heard a director tell me they did the same thing.

This was a month or so ago. They were like, you know, I keep this pad of paper by my bed because, you know, we were worried about so many things. There was WIOA implementation back then, and we had a less than stellar monitoring report and a financial picture that was super tough and it just wasn't very pretty. And so I kept that notepad because in the middle of the night was always my best thinking I'd wake up, I'm like, oh, I gotta write this down. And so I can remember in the morning. So I know now, four years later, from talking to you all last on the podcast, the pendulum has certainly swung in a new direction, and I'm really eager to see how things have evolved for the both of you. You know, like what's changed, what's stayed the same, and what lessons have you learned? So let's dive in. So, Natasha, will you kick us off and just give our listeners a little snapshot about yourself and the agency that you lead?

Natasha: Sure. So I have worked at State services for the blind since I was a baby intern 2008. I have been a deaf blind counselor, a supervisor, the director of our policy and program administration, and I became the director in August 2019. Our agency, we have about 140 staff across the state. We have a Voc Rehab program, an older blind program, our Randolph-sheppard program. But we also have a communication center where we do braille audio transcription and have a radio reading service. So we have a little bit of everything at State Services for the blind. We've grown a bit since 2019. Yeah, there's a lot of fun.

Carol: It is a lot of fun. Blind agencies are always near and dear to my heart. And since I came from Minnesota blind, Natasha knows that I just love that whole variety and all of the work. It's so fun. Kristen, how about you give our listeners a little snapshot about yourself and the agency that you lead?

Kristen: Sure. Similar to Natasha, I started as a VR counselor in the field transition. That was my first job in first entrance into VR. I moved into policy manager policy and then became the director of the Arizona Combined Unit in 2016. Arizona is combined and we are also under a safety net agency. All of the VR, IL OIB, BEP is in a division. That division is in a department. So our DSA is really rather large and we are kind of shuffled 3 or 4 deep down. So we have enterprise services, shared services, which makes things a little bit more difficult to manage than it was when I started the job, when we didn't have some of those other items. So it's been a learning lesson and trying to figure out how do we get done what we need to get done with all these people involved now.

Carol: Yeah, your structure makes me nuts. I'm just saying, full disclosure, but having gone on site with you and your team several times, I'm like, what? You have to always explain. We had DIRs and we have this other thing and all these different levels. I'm like, oh my Lord, I just don't even know how you do it. So I know there's been a lot of big changes since we spoke last, so I'm going to kick it to you first. Natasha, what are some of the biggest changes you've seen in your program since we last spoke?

Natasha: I was actually talking to one of my outreach coordinators, Lisa Larges, and she's like, I think you brought some bad juju because the timing when I started and then everything that happened since I started has just been wild. So since we last met, I've experienced a global pandemic, a civil rights movement that essentially started literally down the street and around the corner from our headquarters. A roller coaster ride of funding at both the federal and state level. We went from having too much to now we don't have enough. We have a new federal administration with very different priorities than we have seen before. We have settled into this new hybrid work, which isn't new anymore. It's kind of our new normal. It's just been, I think you name it, it has changed or it's different or it feels different or it looks different. I think the biggest question right now that we're all faced with is, in light of all of these changes and challenges and opportunities, how do we maintain the integrity of the program, continue to provide high quality services that get people into competitive careers and retain the staff that we have worked so hard to get. While these past few years that's been a focus of a lot of our agencies is how do we recruit? And now with everything happening, is all of that recruitment efforts going to go to waste?

Carol: You know what's kind of funny when you talk about that? Because I look back to when I started at SSB, you know, and so in 2013 I become director. You go at the very end of the year, I was the interim and then made permanent in 14. And you just go, okay, I thought I brought bad juju with me to because WIOA went into play and then we had all this wacky stuff going on. We owed all this money for the case management system. So now, you know, just hearing you, it's like, well, maybe it's just the cycle of the program. Like there is no spot in time where everything is ever just copacetic and all smooth sailing. I think it just continues on.

Kristen: I think that I really feel like that's so good to remember because I think you can in this position, you can take a lot of things like, oh my gosh, am I not doing this right? What skills don't I have? How am I not doing this, that or the other. And it just is a constant. Like it just changes constant. And you have to constantly readjust your focus and your priorities and your strategy. And so it's helpful to remember that our environment is constantly changing at state and federal level. And we just have to be able to manage and navigate and not beat ourselves up over it.

Carol: Oh, that's a super good point. Natasha's going to laugh at this, but I'm actually going to hold up so our listeners won't see it. But I still have my Strengths Finder. So we used to always do strengths Finder at SSB. I still have my top five strengths. And staff used to ask me one of them is adaptability. So my fifth strength was adaptability because people would be like, how can you just roll with the flow? Like you need to just tell like Central Office, we're not going to do that thing that they want for the legislative session. And I'd be like, okay, we're going to pick our battles. That is not the battle we're going to pick right now. We're going to answer the question they need, because the sooner you do that, you get that off your back and then you get back to your business and do your things. And so for me, it's easier because in me is adaptability. I've always been able to kind of go with the flow, whether administration changes or, you know, any of that, where that is more difficult for other people when you want things to be very set and it's hard for you to pivot and make that move. So, Kristen, what are some of the biggest changes you've seen in your program in the last four years?

Kristen: Wow. Well, as I indicated, the state was kind of in that move and shift to centralized services, you know, some of those shared service models. So, you know, it started with our training department and, you know, but we got to keep our policy and we got to keep our contracts and procurement. And the next thing you know, like air moves out and then, oh, we're going to move out all of your facilities management. And so slowly, piece by piece, the staff that you had working with. You have been now pulled to a different reporting structure and a different requirements to do their job. And so when, you know, we used to have a staff of like 500 people that were fully dedicated on board, directly connected with me, I had direct relationships with them. I was able to really work with them. And over the last five years, I've seen that direct connection and relationship with people fade out because those folks are no longer in those positions. They've graduated or moved to other things. They didn't stay within the agency. So, you know, within our VR program, IOB program, BEP, those program staff super dedicated and want to really fulfill the mission of the work in serving individuals with disabilities. And then we have all of our shared service team dedicated to their job to don't necessarily have the same focus on the mission and the outcome of serving individuals with disabilities. It's been very difficult to try to figure out how to play nice with them, because they got to do stuff for you, right? I need you to manage my budgets. I need you to manage my contract. But I also, you know, don't quite like the way you're doing it or you're not doing it fast enough or you're not following my vision for how that would work. So it's just been a real challenge to see how to grow and manage the different structures that are in play now.

Carol: I think you hit the nail on the head on that with that centralization, because it's happening across the country. I mean, we see it everywhere. Every director like just struggling as your people move out from under you, whether it's the IT, the HR, the whoever you had. And now they're centralized, which Congress allows. It was written in the rehab Act, like you can structure that way. But they lose that connection to the mission and what you're trying to do. So when you're doing that work sort of in isolation of what's the end game and how you impact, you know, the staff person having their computer so they can do the work with the customer. You don't see that urgency in it. So it's like, yeah, so we get to you in two weeks, you know, really need your computer or whatever. It's just hard. It makes the job so much harder. So I know not only those changes have happened, the financial landscape is shifting drastically for the VR program. How has this impacted your ability to serve individuals? And Kristen, I'll send it your way first.

Kristen: We've been fortunate in that Arizona with the formula grant. You know, we still receive a little increases every year. So the not getting the cost of living this last year was not as impactful as it had been to some other agencies. So I do, you know, knock on wood for that a bit. Now if that continues we're going to have another, you know, constantly evolving story there. We have had to take a look at for our cases. How do we spend more money faster. And that's been again the challenge of working with shared service opportunities is, well, they don't have capacity to put these contracts in place that I need in order to be able to spend the money that we have, right? We have been successful in keeping it in the VR bucket, but now we need to spend it on our consumers and our clients. But I need a contract to do that and don't have the resources or the capacity from that team to be able to put that out the door. So it's super challenging to know that you're sitting on money that you could spend and do a lot of good things with, but there's then that external factor of not having the capacity to put all of that together to get that money spent.

Carol: So you're in actually a pretty lucky position. You know, other people listening to this podcast are going, What? Kristen Mackey, you've got all this, you've got all this money. Because almost all the calls I get on a daily basis with my list of people all going on the order of selection, I keep a little sticky note, you know, and everybody calling and just frantic. They are literally like tapped out. There is no money, but yet you're trying to spend your money and you don't have the resources to really help you get some of the plans in place.

Kristen: It is challenging, but I feel fortunate that I'm challenged on that end of the spectrum versus the end, where there's not enough money or capacity or staff resources. One of the other pieces, too, is, you know, in this current landscape, budget wise, can't bring on as many people as we would like to, you know. Can't do all of the support services that we or support staff that we would like to. So downsizing your footprint, right? All of that, those are our major expenditures. And we're asked to shrink that. It creates a really kind of a nightmare for projection and and budgets all of that.

Carol: Oh, 100%. How about you, Natasha? How's the finances looking at SSB?

Natasha: It's getting tight. It's getting tight. We were on the other side of that a few years ago. We had more money than we could spend, and we used that as an opportunity to do things that we've always wanted to do or needed to do, and we never had the funding to do it, but we always did things that we could course correct quickly on them or aren't forever. So we didn't make a lot of permanent decisions with that money because the writing was on the wall. We knew that once the pandemic shifted, we were going to see an influx in applications. Inflation was already on the wall that prices were increasing. So we made some, I think, pretty strategic and smart decisions with the money we had and how we spent it. However, it's still tight because we are getting an increase in applications. The cost of services is increasing. We ended our order of selection September 2021. I have no desire to go back there for me. I don't even want to speak it out loud. I know it's an option. I know I may need to use it one day. I can't say never, but I don't think that is the best direction for us because people need our services just as much as before, if not more. And for individuals who are blind or low vision or deaf blind, there really aren't any comparable options available, at least in Minnesota. And we're here for a very specific reason. And so I have always said it's my responsibility to ensure that we can continue doing what we are here for. That may mean that services are going to take a little bit longer to get started.

We are increasing our supervisory oversight. We have a ton of financial reports, which I'll talk about in another question that have helped us get ahead of sudden spikes that we're seeing so we can do those course corrections. This also may mean that we're not backfilling or we're freezing some of those positions for a little bit that aren't essential. I'm using the term we're going to freeze, flick or fill, and every position that's our litmus test will freeze it, meaning we don't need it right now. It's not essential for service delivery. We'll revisit this.

Flick means you know what? This position really isn't serving its purpose anymore. Let's figure out a different way of doing the work or fill. And we've prioritized counselors and VR techs and anyone doing direct service provision. But it's also all of this is going to force us and continues to force us to find new ways of doing things, which I don't think is a bad thing. One of the goals I've put in place this year is that all of the extra noise. You know, that can happen when you're working in a state government agency. Things that pretty much distract you from what you're supposed to be doing. My goal is we don't do those things if it doesn't stem back to our mission and actually help people get jobs or live independently, we're not going to do it. And I told that to the commissioner's office. You can ask me all day long to do all of this extra stuff, but it's not serving a purpose for us. I'm sorry. I'm not going to do it. And they've been okay with it so far.

Carol: That's awesome. Until you get a legislative request that they need you to answer in ten minutes and analyze.

Natasha: Yeah, I can't say no to those. Yeah, all these extra work groups and task forces and let's do this and that. We got other things we gotta do.

Carol: So what's the biggest thing, Natasha, that's keeping you up at night right now? Because I know there's always something, something is niggling somewhere. What would you say is the biggest thing keeping you up at night?

Natasha: Well, I have a few, but the biggest one is that. So we're not a combined agency. We have a separate general agency and that separate general agency is an incredibly tight budgetary situation. I would go so far as to say they're in a budgetary crisis, and because match maintenance of effort and carry forward determinations are at the state level, not agency, it is very possible that their constraints will impact our funding. And specifically I am very worried are Carryforward is in jeopardy. And we had a scare where we had a very high chance of losing all of our carryforward this last end of the federal fiscal year. Because of those budgetary constraints, the general agency is doing workforce reductions and doing layoffs, and they have the same type of staff classifications that we do. And we are a union state, which means bumping, which means my staff are in jeopardy. And so I'm up every night between 2 and 3 a.m. thinking of ways that we can help in any way possible. Our program income is significantly dropping. I think I've heard other states experience something similar. The inflation, the cost of services. We've had four and a half and 5.5% salary increases with no additional state appropriations. So all of these things together keep me up every single night trying to figure out how do we sustain.

Carol: Now they're going to keep me up at night, too, because of course, I worry about you all. And of course, I really worry about SSB. So I always hold that near and dear to my heart. But oh man, that is a lot. But I know you instituted some things, though, between you and the general agency, just to make sure you guys were communicating better about those financial reports and such, didn't you? Like, what did you do?

Natasha: We have an amazing relationship. We review our federal reports together. I sat closely with the VA's fiscal team, walking through what I know about the fiscal processes, the federal regulations. That's something that Carol taught me very well. I understand it quite well. So we worked hand in hand. We've been doing that since October.

Carol: That's good. Good stuff. How about you, Kristen? What's keeping you up at night?

Kristen: We had a recent monitoring that monitoring. We get through it, Right? And, you know, you haven't always have an inkling of things that need to be fixed and things that we should address, right? And sometimes those get shuffled because priority is whatever. So we had the monitoring very much highlighted certain areas that we need to address and take care of. And one of those was our fiscal management and continue as managed outside of my direct staff and even two and three layers above me. So it's one of those concerns of like, I wonder what's going to happen next. I never quite know what the fiscal situation is going to be. Emails flying around, you know, I'll get an email at the end of the day and it's I need more information. What is this about? How did you come to this conclusion? Who was involved in making this decision? It's kind of just a plethora of items that, you know, any given night, and mine is usually between 3 and 4. Like, oh, wake up and go like, oh, shoot, that sticky note fell off the roster somewhere. I need to go and send that email or this project. We started it, but now it's like kind of hanging, languishing. I need to poke somebody about getting that back on the roll again. I don't know that it's one specific thing, but it's just kind of just the size of the job is not a 40 hour a week job. It is a all encompassing. I dream about work. I it wakes me up at night, you know.

Carol: Well, my newest trick with not having my notepad beside my bed, but I actually been waking up more just because I've had so many more phone calls. Things have been really crazy lately with our fiscal team and people just reaching out. And so maybe end of the day or, you know, people's time change, you could get a call from Guam. You know, it's a way different time. So people are calling all the time. So now at night when I wake up, I text myself, you know, a note like, just so I remember, like remember to get back to so and so tomorrow. So now I just am picking up my phone. I don't have the pad there anymore, but I had two messages from last night for today that I didn't want to forget.

Kristen: I sent texts because I don't put my work phone by my side, but I have my personal. So my work cell phone is embedded in my personal and I just send text to myself.

Carol: Yeah, my work and my personal are all together, so it makes it a little challenging.

So I know we're going through an administration change on the federal level right now. And a lot of state administration, you know, that changes every four years to with governors, sometimes you keep a governor twice in a row, but a lot of times not. And it will bring these shifts in priorities and just all of this change. How do you guys navigate and adapt to those changes, whether it's on the state level or federal level, when you're approaching your work? And I'm going to kick that to you, Natasha, first.

Natasha: I think the biggest thing, at least for us, has been a lot of communication and transparency, not only with our staff, but our customers, our community partners and stakeholders in the face of unknowns. People look to steadiness and information even if you don't have a lot to share. The absence of information often speaks very loudly, and people will fill in the blanks, sometimes not in a way you want them to. So we are communicating frequently, even if we don't have information. People look to me, am I panicked or am I calm? And know if I am panicked, it will not be good. People feed off of that and so I am always calm. I am always just. I can't guarantee or promise anything, but I can say we're in this together and I remind everyone why we're here. We have a mission. As Carol knows, the mission is on the wall. We look at it frequently and nothing has changed. No matter what happens federally or at the state level, that mission has not changed. We have proved that during a global pandemic. VR agencies are adaptable, creative for us in Minnesota, SSB was one of the first agencies, if not the first, allowed to go back into people's homes and provide services. That's because we know how to do things quickly and strategically to respond to whatever comes our way. We don't wait for people to tell us what to do or how to do it. We take charge and we lead the way. And I feel that is how VR is across the country. We tend to be leaders in faces of crisis and urgency. We tend to step up when others don't.

Carol: Yeah, good advice. That's all good advice. Kristen, how about you? Because you've had major shifts. I mean, you've already alluded to this, this whole like take away your people. And that's been all shifts in the structure within the state government and such. You know we've got the federal different priorities. So how do you navigate and adapt to those changes in your work and for yourself, even, like how are you taking care of yourself through all this.

Kristen: Being able to adapt the work that we do? Natasha says that we have a mission. We have a very clear outcome that we have whatever side, whoever's telling you what they want to do or how they want to do it. You need to be able to mold what that strategy looks like so you can speak to it. And I always talk about it. It's a spin. I don't like the terminology of spinning, you know, for the sake of trying to hoodwink anybody or not be transparent. But at the end of the day, we want job placements, we want employment, we want independence. So if somebody's saying increase your job placements, fine, that we can do that. It's how do we then take what they're giving us and make it not be a distraction and we can mold, you know, whatever we're measuring to the thing that they want, but still do what we are doing at the base level. And so I do feel like that's really part of our job as leaders is to and Natasha spoke to this earlier is take that noise and then see how we can like get it to stop with us and push it back in a way that still supports the work we're doing, whatever comes to us in terms of work group where you need to measure this, or we want some kind of change in X, Y, or Z. Okay. I can give you this back that will meet your needs. And it doesn't change or distract from what I'm doing in our department or in our programs. I think it's just being flexible in your thinking, being able to not have to have a certain way of approaching things, because you got to understand what that landscape is. You got to speak the words that they're speaking in order to get them to listen to you and kind of play with you so that we can all get to the same end goal.

Carol: One thing I've seen from you, Kristen, just working with you these past years in my TA capacity is I'm like, I love your persistence because you've had to navigate this really tough, internal, weird structure. It just is weird. And you are super persistent in messaging. Okay. Like you send a message to this person, oh, I'm not the person. Okay, then who is the person? Okay, I'm going to go to this person and you will not let it go till you find till the end the little trail of crumbs you get to and you're like, all right, I'm finally getting to the person because I have to get this thing answered. Some people just give up. They're like, oh, I don't know. And then staff ask and you're like, well, I don't know. We don't know who's doing what. Oh not you, you. You don't let that happen.

Kristen: That is one piece of advice I give to people when they come on. This is a state government, federal government, there are all sorts of red tape, barriers, hoops. Everything will get in your way if you let it. You're going to have to be persistent. Don't get jaded with it. Don't give up. Just know that you're going to have to be persistent with getting to the thing that you want to get done.

Carol: So switching a little bit. There's a lot of different structures in hiring VR agency leaders. I mean, you can be a political appointee. You can be more of a career professional where maybe you have some protections, maybe it's not a full blown union, but you got something. And we've had 14 new directors in the last less than ten months. Again, 14 new directors in VR. You know, people don't always realize like, how does that and each of you represents a different bucket here. How does that distinction, whether you're a political appointee or you have a little more protection influence your agency. Kind of how you approach the operations and your decision making. And I'll ask you first, Natasha.

Natasha: I am a career professional. I'm the highest level you can go before you start hitting the politically appointed positions. So that means I get the privilege of bringing some stability to the agency. Granted, that doesn't mean I can't get fired or laid off, but I am not politically appointed. So when the administration changes, I don't change with it. So that means staff can expect some consistency, and they don't have to wonder who's going to be coming in now to shake things up with their own ideas and views. They know what my priorities and goals are. They know how I work and they know what to expect. And so I have the luxury of time to create a culture that will sustain anything that comes our way. I have the time to develop that succession plan, offer professional development and mentorship opportunities. But when I was thinking of this, I can see the value of Having fresh new faces, coming in with different perspectives and experiences, and that they may have a better idea for how we do things. You know, we talk about people who have been in the position for 30, 40 years. Is there some value to having that new life coming into an agency? So I recognize that being a career professional could also be a limitation of mine, which means that I really need to surround myself with people who think differently from me, and I can't get stagnant.

Carol: Yeah, that's a really good point. Although there are very few 30 year or 40 year career leaders in the VR program anymore, I think we got Diane Delmas out in Vermont and Greg Trapp, those are the two I always think of. Otherwise, boy, people have been coming and going pretty fast, but that is good advice because you can get a little stuck.

Now, Kristen, you're on the other end of the spectrum because you are a political appointee.

Kristen: I am not a political appointee, but I am an at will employee.

Carol: Oh, you're an at will though.

Kristen: Yeah,.

Carol: So it's very similar. So you're an at will person, does that impact you at all, like in decision making or as you go about doing your job?

Kristen: Well, certainly. You think, you know, is this decision going to make me the scapegoat for something that goes south, right? So, you know, it does impact my thinking. I don't let it impact whether it's right or wrong. To do that is just my base. You know, you just have to have that gut kind of commitment to. This is what I said. It's the truth. I don't have any qualms about how I do the work or the transparency that I have in the work that I do. So keeping it all above board, hope that that serves you in the end. Natasha, you had a very positive outlook on new people coming in. In my tenure, I've experienced a lot of changes in different people at different levels coming in and not having any idea about the rehabilitation programs that we run. And so it is a kind of a continuing education of individuals who are coming and going to have them see the value of the programs and the way that they need to operate.

Carol: Yeah, I appreciate that. So let's look a little bit at kind of leveraging both of you like this leveraging your data. And we're kind of skipping around a little bit here. But how do you guys like to leverage data to inform your financial and programmatic decisions? Now remember we've got a lot of new directors. We have listeners out there that are they don't know we I get this question all the time. You know, we talk about data informed decision making. People are like, yeah, we talk about it, but what does that mean? And how do you really do it in practicality? So Kristen, what would you say do you have like an example or how do you like to best leverage data when you're looking at making decisions, whether programmatically or financially?

Kristen: Just because I have a little bit more programmatic data that I have access to and ability to manipulate, we really look at that in terms of, you know, when we're setting our annual strategic goals, what is our five year goal? Take a look at what have the last three years look like. You know what the percentage of increase or decrease is? How are we adjusting those things? Use the data to understand where are the gaps, what's not working, and something we expected the needle to move and it didn't. What's not working in that process. And so you know, what lever do we pull to say this is going to be quote unquote a countermeasure for that thing, and then measure that data over the next three, six months. And if there's a change, then we can kind of understand then did that work or didn't it work? I think far too often in our workforce we say, well, this is a problem, but we don't really have any data around it. Should we gather a ton of data for the program to being able to use that data to help inform what decisions or what changes to processes should we be making and how should we make those. And then we can track it to see did it make a difference or what difference did it make? And is it something we should replicate? Is it something we should pull back. So I really like to use our data from our program, you know, participant program data to inform our strategy on what we're going to be doing in the next 1 to 5 years.

Carol: I know before you have presented at CSAVR and showed like you had some really cool ways you were able to look at data and you did a lot of it by your region so you could start narrowing in, because you can have this tendency to go, oh, you look at the data broadly and then you're like, oh, we must have this problem everywhere. Well, you realized you had regions, you know, in your state you're like, well, why am I like spanking everybody? What we write, we need to focus over here.

Kristen: Yeah, we have those metrics. And it's a metric per counselor, per rehab tech, per purchasing specialist. That unit of counselors rolls up to the supervisor. The supervisor rolls up to the program manager. So I can drill down from a state level perspective to a region perspective. Is it a supervisor office problem? Is it a person problem? And that has really helped us understand. Also, where do we need to direct the energies and efforts in terms of making changes.

Carol: Yeah, I really like that. That was really good stuff. How about you, Natasha? What are you doing with leveraging data? Because I know that's in your wheelhouse, too.

Natasha: We actually hired within, like, the last year or so, a data analyst who is skilled in data visualization and being able to take a bunch of raw numbers and tell a story. And we have been working with her to develop not only the programmatic data, which we now have a ton of that we can look at, but also our fiscal forecasting and what's happening on a budgetary level. It is because of those reports which I am getting weekly, monthly and quarterly reports, depending on the nature that we were able to suddenly see this huge, unexpected spike in case services authorizations. Within just a month of it happening, we were able to drill in. What exactly is going on? What are the bucket items that are the red flags we were able to look at by staff member by region, and we found that our interpreters have gone up over 300%, which then led us down to, okay, what's going on with that? What's the story behind the data? We also are every week meeting as a fiscal team. So the three fiscal staff that I have and myself, we meet every single week. I am intimately involved in our federal reporting. I look at every single report that they put together before we submit our 17. We walk through it. I know where we're at with match. I know where we're at with maintenance of effort. I know exactly where our 15% set aside is, and I can tell you that every single month how we're doing and what issues we're going to be facing. And that's because we have the data. If a director never looks at data and doesn't know what's happening in their programs, they're not going to be able to spot issues. You have to know whether you're doing good or you're not doing good. You need to be able to catch those things.

Carol: Yeah. And unfortunately, you have many colleagues across the country. And I will come in and they're being told by like the DSA fiscal staff, hey, don't worry about it. We got it. And so there have been directors of programs of 150 plus million dollars, have never seen a budget report. Zero idea. So literally anything they want to do. Hey, can we send a staff to training? They're asking this group of fiscal people sitting over here because they don't even know what's in the budget. It is the most insane thing I've ever seen. So you really hit the nail on the head. Like, you have to have access and it is required in the law, in the act, in setting up the agency org structure, you have the sole responsibility over the allocation and expenditure of your funds. And how can you have that sole responsibility and not have any data that goes with it? So I preach.

Natasha: I will say, data is if you have a legislative ask and you are requesting more funding, the stories are important, but they also want to see the data behind it.

Carol: 100%. And it can't be data that's changing by the day. Oops, we forgot this because I've seen people get burned on that as well. And then the legislators are going, okay, well, this data now is suspect, and I think they need a legislative audit report and review because what are they doing over there?

Kristen: From a data reporting perspective, like having historical data to the same reports they pull, they cannot keep changing the reports that you're changing the methodology of that. That was a lesson learned for us is we had to understand what data we were pulling, how were we calculating the numbers we were calculating. And now we have data since 2018, and we can tell when we've made any changes. And so then we can see what are our trends. What does that look like. How can we use that to help us predict in the future. So that was a lesson learned for me. We came in and it wasn't much in terms of data. We built some reports and then it was like, oh, but now we need to kind of be able to track, oh, well, this thing happened. And that's why maybe that spiked or dipped or we did this thing and here's the change we saw. So we were able to speak to that year over year as well.

Carol: Well super cool. So what advice would you guys have for other leaders out there? All the lessons you all have learned. We can try to read the tea leaves, like where is VR heading in the next few years? But what do you all think? Like what do you think where's VR going? And what advice would you have for other leaders? And Kristen, I'll go to you.

Kristen: I just think remain committed to the mission and the purpose of the programs that we have. we're here to serve individuals with disabilities. We'd keep that at the forefront. And, you know, I heard Natasha say to you, the mission is on the wall, right? We all have our missions. We all have our visions. Just don't let that get buried in all of the craziness that is happening and continue to be persistent. Carol mentioned the persistence. I think that is key. You don't let it drag you down. Don't let it burn you out. Just be persistent and know that all of the work that you're doing is for a good reason, good outcomes.

Carol: Good stuff. Natasha, I'm going to give you the last word.

Natasha: Don't get comfortable with how things are going right now. Speaking to what Kristen said earlier? Things will change, and probably for reasons completely outside of your control. And also remember that easy decisions aren't always the best decisions, and the best decisions aren't always the popular ones.

Carol: Well said. Very true. Well, I appreciate you both. Oh my gosh, I'm so excited to see what you all have done. You're two of my favorite directors. Don't tell the, don't tell the other directors that are listening.

Natasha: Yeah, cut that out, Jeff. Don't have that in there.

Carol: Thanks for joining me today. Sure appreciate it.

Kristen: Thank you.

Natasha: Bye.

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Nebraska VR is on a mission to elevate careers and empower businesses through its innovative Disability Innovation Fund Career Pathways Advancement Project (CPAP 2.0). In this episode, Carol Pankow sits down with Cathy Callaway, Nebraska VR’s Assistant Director, to discuss how the program helps individuals with disabilities advance in high-demand fields like STEM and skilled trades. With over 130 business partners signed on, the initiative is breaking barriers, fostering workforce development, and proving that growth doesn’t stop at job placement—it’s about career progression. Tune in to hear how Nebraska VR is redefining success through strategic partnerships and a dual-customer approach!

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Full Transcript:

Carol: Listeners, we would like to dedicate this podcast to Mary Eunice Neary. As the different CPAP 2.0 director. Mary played a vital role in this work, but was unable to join us for the recording. In her absence, Cathy Callaway, the interim director, stepped in for the discussion. Sadly, Mary has since passed away, but her impact on Nebraska VR will always be remembered.

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Cathy: We look to find those clients that were closed previously in VR and work with them to advance them in their careers, and then in conjunction, we work with businesses to create a business model that we can help businesses work to advance people in their business so that it assists them in their workforce as well. The number of business partners we had a goal in the grant of signing 100, and we're at 130 plus with still a year and a half on the grant to go.

^{Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.}

Carol: Well, welcome to the manager minute. Joining me in the studio today is Cathy Callaway, Nebraska VR assistant director and interim director of the DIF CPAP 2.0 project. So, Cathy, how are things going in Nebraska?

Cathy: Cold right now? Other than that? Very well, though. Very well with the grant.

Carol: Excellent. No, it is cold here today, too, in Minnesota. I tell you, we go from 54 degrees down to minus eight. It has been a lot. So for our listeners, three years ago, Nebraska VR received a Disability Innovation Fund grant for the Career Advancement Project, and the Rehab Services Administration funded this initiative and is focused on helping people with disabilities who are eligible for VR services, including those who are previously served and have returned to the program, advance in their careers, and the goal is to help individuals move into high demand, high quality fields like science, technology, engineering and math. Those Stem kind of professions, including computer science, and the initiative also supports entry into career pathways and key industries through programs like pre-apprenticeship, registered apprenticeships and industry recognized apprenticeship programs. And the efforts really designed to help people achieve better jobs with competitive wages, become more financially independent and reduce their reliance on public benefits or state and local support, and promotes independence and full inclusion in their communities. Oh my gosh, that's a bunch. So I know Nebraska has been at this for a bit, so let's dig in and find out what's going on. So Cathy, help our listeners out. Let's start by getting to know you a bit. What's your role and how did you get into VR?

Cathy: That's a long story actually. As you mentioned, I'm currently in the assistant director role. I started when the 1992, amendments to the Rehabilitation Act were implemented. In those amendments, the State Rehabilitation Council was created, and I was hired clear back then to work with the State Rehab Council. And then I just kept working with VR. I actually have a business degree, and I kind of started working in the financial area and really was working in the fiscal area when the push to integrate data and program was kind of a thing. And so I started working on integration of fiscal and program and data and all of that. So I worked very closely in both of those areas and kind of just got to know the program side and the fiscal side and the data side, and moved from then the fiscal arena into the program director for quality assurance for a few years. And after that, just two years ago became the assistant director. So kind of had a little bit of a role in everything.

Carol: Well, excellent. You're a person that takes after me in my heart with having the fiscal program combined. I might have to tap you for some other things about that, because we often talk in our work about combining fiscal with program and data, and there aren't a lot of places that have people who've done all of that. So good to know. Thanks for that fun fact.

Cathy: You're welcome.

Carol: So I hear you had a pretty unique situation in Nebraska that made you the perfect fit to apply for this grant. Can you share a little bit about what that was?

Cathy: Sure. We applied for the grant in 2016 to 2021, and it was our what we call Career Pathways Advancement Project CPAP 1.0, and it focused specifically on promoting, upskilling and backfilling incumbent workers with disabilities. So that project ended in 2021. And at that time then another DIF project was made available. So we applied and expanded that. We are still looking to upskill and advance workers, but we also then included another component that was related to working with businesses directly. So this grant was kind of a add on to the CPAP 1.0. We actually call this one CPAP 2.0. Yeah it's the similar but it expands into working with the businesses as well.

Carol: Well and just for folks, so they know what is CPAP. Can you just tell them...

Cathy: Yes, it's career pathways advancement project.

Carol: Perfect.

Cathy: Advancing clients in those career pathways that you mentioned in those STEM areas.

Carol: Excellent, thank you. I just know VR is notorious for our acronyms. And then some new people are in there like, I don't know what you're talking about. So give us the big picture. What are you really hoping to accomplish with this project?

Cathy: We're hoping to develop a business model under this grant that can be sustainable. And once the grant ends with VR and we look to find those clients that were closed previously in VR and work with them to advance them in their careers. And then in addition to that advancement, whether that's in a new career pathway or in the jobs they're already in, we hope to increase their wages, benefits, maybe their hours, and to help improve their economic self-sufficiency. And then in conjunction, we work with businesses, as I mentioned, to create a business model that we can help businesses work to advance people in their business so that it assists them in their workforce as well.

Carol: I love that you're really living into WIOA, you know, the whole dual customer approach.

Cathy: Yep.

Carol: Now, I know early on when you were introducing this idea to clients, people were thinking you guys were scammers. What was going on with that?

Cathy: They were we started out thinking, well, we'll just call back these clients that we closed and talk to them about advancing. And because of the world today, many of them. Yeah. Thought we were scammers and there's no way somebody's going to pay for my training or me to go back to college and advance. So we really had to kind of refine our outreach efforts. We actually moved to sending them a letter with the name of the counselor that they previously worked with and some more about. Remember when you worked with VR and we assisted you. And so we send out those letters first and provide some information about the grant. And then we follow up about a week after the letter goes out with a phone call from someone. So that's really made a difference. They kind of are like, oh yeah, I worked with VR before, I know who you are. And I remember that counselor. So that's made a difference for us in terms of outreach.

Carol: Well, good. And hopefully your phone isn't showing up as, um, scam possible scam call.

Cathy: Exactly.

Carol: So what have been some of your biggest challenges you faced while getting this project off the ground?

Cathy: Yeah, I would say probably some of the things we wrote into the grant, maybe we would do a little bit different. We had written into the grant that we would like to sign businesses up, I guess, to make referrals to us. And we've had some resistance in terms of the signing of it isn't obligating them to anything, but they kind of some businesses are reluctant to sign anything. And so we've had some resistance that way. Although we've been able to sign over 130 business plans with businesses to offer referrals to the program. So we would probably do that a little bit different. That's been a challenge, I think training. We hired new staff for the grant and then that, of course, learning the VR process and all that goes with it really took a significant amount of time. So we got behind in serving clients and then retaining, of course, with a grant, your staff realize that it's a grant and it will end. And so some staff that worked on the grant have now taken permanent positions with VR. And so we're kind of a work in progress with the keeping the staffing. And then just as I said, building the trust with clients as we reach out to them. And we've adjusted, as I mentioned earlier, but kind of making sure that adjusting our marketing outreach so they realize we're not a scam.

Carol: Well, I know often these projects, you know, you're projecting ahead and you're thinking, okay, I want to do these great things and you create all this in your mind. But typically all of the DIF grants end up evolving in some way a bit from the original plan. And you alluded to this a bit, but I know you guys have had to pivot. And so what have been those ways in which you've pivoted, maybe from what your original intent was in the grant?

Cathy: Yeah, we've pivoted a little bit. The grant, we thought we would get a lot of clients that wanted short term training, and a lot of them want to get advanced degrees or get a degree. And those have been taken much longer time than we thought. So there's been just some different thinking about clients that want the more long term degrees or advancing in degrees. We've had to change our marketing materials. We kind of had just generic flyers, and now we've moved to developing specific marketing materials for the businesses that we're going into, which has really helped with their employees. Instead of just seeing this generic flyer, they can say, oh, the company I'm working for, there's opportunities in these areas and I can advance. And it's been very specific to the business, which I think has created some buy in with the employees. I would say we hired a Career Pathways recruiter specifically to work with individuals with more significant disabilities, specifically developmental disabilities, just because that's a whole different group to work with. And so we've kind of hired an expert in that area, which has helped. And then I would say changing because Nebraska is such a rural state, we had identified originally career pathway recruiters to work with specific areas of the state, and we've had to kind of pivot and say, okay, you can work with anybody across the state given Zoom and Adobe Sign and all those things, because it's allowed us then to serve more clients statewide, rather than limiting it to just areas where we have the career pathways recruiters.

Carol: Yeah, that really has been amazing, especially for states that have more rural sections. You do like we do in Minnesota as well, you know, and the whole ability to serve people remotely is amazing or virtually, you know, you can get at them. I think that's great. I know in your marketing efforts have been super impressive. And like, how are you making that happen? Do you have an in-house person, or are you contracting to make those marketing efforts happen? How are you making that work?

Cathy: We do have an in-house marketing team and they're amazing. They're super flexible. They're willing to work with us, so they work to provide whatever materials we need, as I mentioned, able to work in partnership with businesses to specifically customize those marketing materials for the business. And then the other marketing piece we've really done that's kind of new is what we call lunch and learns. And we go into businesses and we kind of do a presentation over like the lunch hour, or sometimes early in the morning at the beginning of a shift. And we really target the HR managers and the team leaders and the people that can get the word out to their employees about our services and about the grant. So those lunch and learns have been pretty well attended, and we're able to really get the word out to a lot of people in the businesses for them to then refer their employees back to us.

Carol: Yeah, that's excellent. So looking back so far, what accomplishments are you most proud of?

Cathy: I think the number of business partners that we've been able to reach out to and connect with and sign those individualized business plans, we had a goal in the grant of signing 100, and we're at 130 plus with still a year and a half on the grant to go. So just getting that word out. You know, the nice thing about doing that, getting in those businesses is we're not only mentioning the grant, but we're also able to mention Nebraska VR. And if you, you know, can get people just the word out about Nebraska VR, even beyond the grant has really been a benefit. We've had several clients that I say we are really proud to say have gotten advanced degrees. It's not just certifications, but they've been able to go on and get advanced degrees through this program, and then just being able to help contact those clients that we previously served and were able to get a job, and just letting them know you can do more, you can advance and we can help you with that. So I think just all of the clients that we've been able to reach out to and really help them become more economically self-sufficient.

Carol: That's excellent. I know that's a big foundational piece within VR. So it's fun to see it actually happen. So for those folks out there that are thinking about applying for a grant in the future, and hard to say what the future holds, what advice would you give them? Because I know often people are like, oh, I don't know. Or, you know, is it too much of a pain in the butt, you know, to try to do all of this stuff? What kind of advice do you have for them?

Cathy: I would just say, take the plunge and do it. It's given us an opportunity to really think outside the lines, a little bit of what we could do in Nebraska VR, but it's also gives us the opportunity to make those mistakes and adjust and pivot and evolve. So the hope would be, you know, by the time this grant is over, we have created that model that is going to be sustainable under VR, and we have just learned so much more about our dual customer approach, working with the businesses as well as with the clients. So I would suggest if anybody is looking at doing that, to just do it and give yourself the chance to develop things outside of what you think is currently possible.

Carol: I like that. That's great advice. You know, with the dual customer and this focus on business. Are there particular sectors you're seeing that are responding, you know, to this program. Are there certain sectors. You know every state has a different kind of flow to it. So I wondered if there were specifics there in Nebraska.

Cathy: Yeah, we've had a pretty big response in the healthcare industry. We actually just signed a business here. Vetter. And I think they have over 30 locations across the state, so we're going to be working with them. We've had a lot of success with the CDL, the transportation and distribution and logistics area. Those have probably been our two biggest focuses or the ones where we've had the most interest. And then probably we've had some in the manufacturing area as well. But specifically we have a lot of businesses with the CDLs that is popular.

Carol: Interesting. That's very cool. I know Minnesota was doing something and they also were doing it in the transportation area. I guess I hadn't realized how big that is and the need right now.

Cathy: It is, yes.

Carol: So where can our listeners go to learn more about your project? Do you have a project website?

Cathy: We do. It's VR.Nebraska.gov/pathways. And there's contact information on there regarding the Career Pathways Advancement Project. There's some success story videos out there and just a lot of information about our project and our grant.

Carol: Excellent. And then are people able to if they go on the website, are they able to like get at if they had any other questions or something they could get one of you?

Cathy: Yep, there's contact information on there as well for anyone to reach out with. Any questions.

Carol: Yeah, it's been really fun. As of late, I've been hearing from a lot of folks across the country and they said, we sure like hearing these stories because they're trying to plant the seeds and get ideas. And are there things that they could even try in their state right now...

Cathy: Absolutely.

Carol: Different way. Yeah. That's great. So any last parting thoughts for our listeners?

Cathy: No, I just appreciate the opportunity to share information about our project and encourage anyone interested to go to our website and ask any questions, if they have any.

Carol: Well, thanks for coming on today. I really appreciate it. We don't hear much from Nebraska, so I'm like, I have to get at you guys and see what's going on. I look forward to talking to you again when you get kind of in that last year and see where you're standing with all the data and what's happening. So thanks much, Kathy. Appreciate it.

Cathy: Thanks, Carol. Good to see you.

{Music}

^{Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!}

Join host Carol Pankow as she dives into the complexities of Order of Selection (OOS) in vocational rehabilitation with two expert guests: Theresa Kolezar, Director of Indiana Combined, and Chris Pope, Director of the State Monitoring and Program Improvement Division at RSA.

In this episode, they break down:

·      Why agencies implement OOS due to financial and staffing constraints

·      Key regulatory requirements and compliance considerations

·      Strategies for managing and eventually lifting OOS

·      Indiana VR’s data-driven approach to decision-making and communication

·      RSA’s insights on fiscal forecasting and policy compliance

If you're in the VR field, you won’t want to miss this insightful conversation on planning, stakeholder engagement, and using data to overcome challenges.

Listen Here

Full Transcript:

{Music}

Chris: As you know, we have 78 VR agencies and only eight of them have a closed priority category, and only one of those eight have all priority categories closed.

Carol: So by going back and saying hey you gotta look at this other side of the house and really analyze what's happening. It will give you the full picture, than what is playing into what's happening over here on the fiscal side of the house.

Theresa: For the majority of folks. They were maybe even having somewhat of a positive impact because we were able to get them processed, get them in sooner. And you know, there's obvious benefits that go along with lower case load sizes.

^{Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.}

Carol: Well, welcome to the manager minute. Joining me in the studio today is Theresa Kolezar, director of Indiana Combined. And Chris Pope, director of the State Monitoring and Program Improvement division at the Rehabilitation Services Administration. So, Theresa, how are things going with you in Indiana?

Theresa: Oh, we're doing well. Thanks. So happy to be here.

Carol: Thanks for being here. And, Chris, how are things going for you in D.C.?

Chris: Things are cold in D.C. at the moment, Carol, but we're hanging in there.

Carol: Yeah, not as cold as Minnesota.

Chris: I knew you were going to say that.

Carol: Yeah. I'm like, wow, we're 14 below people. Well, there has been a lot happening with the VR program over the past decade, and we certainly have had our ebbs and flows with funding and staffing. And as of late, the fiscal pendulum has been swinging, VR programs have been experiencing a tightening of the belt, so to speak, and discussions about the order of selection have been ramping up. And so for our listeners, order of selection is a process required under the VR regulations. When a VR agency does not have enough resources, whether it's funding staff or both, to serve all eligible individuals, and it's designed to prioritize services for those with the most significant needs. But over the years, order of selection really has sparked a lot of tension. And for some it's seen as just another layer of government red tape adding to the stigma around bureaucracy. Others argue that it undermines the very spirit of the rehab act by limiting access to services instead of promoting inclusion. Critics point out that it can widen service gaps. It leaves individuals with moderate disabilities without support, even though they still face serious barriers to employment.

And for our counselors, order of selection can bring its own challenges, including the emotional burden of explaining to clients why they can't receive immediate services. And for clients, being placed on a waitlist can feel disheartening and frustrating. And at the same time, agencies are grappling with a harsh reality. There's limited resources. Tough decisions have to be made. So how do we balance fairness, inclusion and the constraints of funding? And that is the question at the heart of today's conversation on order of Selection. So, Theresa, I've been a fan of yours for a long time. I think you bring a really thoughtful approach to almost every difficult situation in VR, and you been around a while, so I definitely want to pick your brain about your thoughts and approach on the topic. And Chris, I'm really count on you to bring the facts from an RSA perspective on what needs to happen with the Order of Selection. So let's dig in. So, Theresa, can you just tell us to start out with a little bit about yourself and your journey into VR?

Theresa: Sure. I probably have the least interesting journey, but maybe the most classic. I went from straight from undergrad to graduate school to get my masters in rehabilitation, got my CRC that same summer, and I entered the rehab field initially with a nonprofit, CRP, before coming to Indiana VR in 2004. So I've been with the VR program for a little over 20 years. Made my journey starting from a VR counselor and now director with, as you can imagine, a lot of other roles along the way. And I think I'm a fairly tenured VR director with almost nine years under my belt in this role.

Carol: Yeah, definitely you would be. Because I remember being told when I left, I had six years, you know, and people were telling me usually the lifespan of a VR director is about five years because the job is tough. So you're definitely one of our longer term folks. So, Chris, how about you? How did you venture into the VR world?

Chris: Thanks, Carol. Well, similar to Theresa, my graduate degree in rehab counseling, I became a CRC and began my career as a VR counselor with the State of New York in the general agency at the time, for about four years. And I've been with RSA now for a lucky 13. Just had my 13th anniversary. And in that time have served in a variety of roles. So, yeah, really happy to be here and now leading the division that's responsible for all of our formula grant.

Carol: Yeah, it's super cool. It's been fun to watch your career, Chris, as  you have grown. I remember one of the very first conferences you presented at, and I believe you were still, you know, more kind of on the staff level. And I thought, who's this guy? You were up there, you just had such a great presence about you. And I'm like, he's going somewhere. And you have, it's come true.

Chris: Thanks, Carol.

Carol: So let's talk about the realities of Order of Selection. It's not something that can be implemented at the snap of a finger. And so I want to start with you. What are those factors via our leaders need to take into account.

Theresa: Yeah. You know it's hard I feel like I sort of came to terms with it because it's it didn't feel so much like something we had to choose or decide upon, but more something we had to do. if your circumstances are such that you don't have the resources to serve everyone. So in Indiana, we enter the order in 2017, and I believe that was the first time in our history, as far as I know, it came after years of trying other things, you know, implementing strategies to improve our capacity, stretch our resources. And just a few examples. Implementing efficiencies, changing to our staffing structure, changing our minimum VRC qualifications to a bachelor's degree, and a whole lot more. And those strategies were definitely focused for us at that time around staffing resources. But there were also some fiscal unknowns or concerns because right around that time, the 15 earmark requirement was also, you know, kind of hitting us. And we were trying to figure out how to shift those resources. So the strategies we did pre they were definitely helpful. They were effective, but we still were left with a deficit. You know, we still had high caseload sizes. It was taking way too long for new referrals to get an intake appointment. Our VRC turnover rate was much higher than is optimal. Ultimately led us to identify that we were not able to provide the full range of ER services to everyone who was eligible, and therefore we needed to enter the Order of Selection.

So we started planning for that probably around nine months prior to. The implementation and when I was making my talking points, there's a lot that you have to do, right, to prepare for Order of selection. So discussion with our internal leadership, our VR council, our stakeholders, our staff conversation with RSA, drafting that state plan amendment, getting that out for public comment. We took a couple extra steps and met with our other workforce partners because we thought, hey, they may get more referrals here. We may want to tell them why and what's going on over here and what this means. And then we of course, you have to develop written procedures, adapt your case management system. And then we also wanted to be really careful with our messaging to applicants. So we drafted some materials that we wanted our intake counselors to share and get that consistent message out there and, of course, training our counselors. So I think the nine month runway was probably a fast track Approach, thinking about all those steps. You want to do it right? You want to be planful. But at the same time, once you identify that this is a need, you usually need it to happen pretty quickly.

Carol: Absolutely. I know for me, when I was a new director in Minnesota, I actually faced this. And Minnesota Blind had not been on an order for many, many, many, many, many, many years. And being a little naive, you know, coming into VR going, we have this situation, you know, I'm thinking this all can happen super fast. It does not. But I found for me, really getting grounded in understanding our data was so important because I see these things all going on. But you had to put all the pieces together, get your fiscal side of the house and what's going on and how you're making expenditures and investments in different things and what's happening with that. But what also is happening programmatically, the people that are coming in and the characteristics of your caseload and all those different things, you had to put it all together to really get the complete picture. And for me, I know I had to do that rather quickly. So it becomes super important to have people around you. If you are not that person you know, that can pull all that data and present it in a way so you can really see the picture of what is happening and kind of unfolding in the state.

I think it just so foundationally because I know I have this little list at my desk of people that have called me looking at needing to go on order selection or thinking they're going to need to. And we have over a dozen states that have outreached in the last two months. And part of my advice to them has been back, you know, you have to get grounded to and what was your data telling you? Because you can't just base this all in sort of an assumption or something. You've got to be grounded. So I always think that that's a really important piece to start with. Now, Chris, I know from a regulatory perspective there are items that are absolutely critical for VR to have in place when you were considering Order Selection. Can you help us with that? Because I want to make sure people aren't making a mistake, you know, as they're kind of thinking through the process.

Chris: Definitely. There are several regulatory requirements, and before we address those, I thought I could provide just a little bit of context at the moment of where we're at with Order selection across the country. As you know, we have 78 VR agencies and only eight of them have a closed priority category, and only one of those eight have all priority categories closed. So this is significant progress over the past several years, I'd say since the passage of WIOA in 2014, in the past, as many as a fourth of our VR agencies had at least one closed priority category. And I can say that when RSA meets with congressional committees and other stakeholders, they often ask us for a status check on Order of Selection, and I can tell you that they respond really positively when we share that very few VR agencies are unable to serve all eligible individuals. Further, since RSA and our federal partners approved, the latest state plan would be the 2024 to 2027 state plans, RSA has approved one VR agency's new order of selection, and at the moment, we have 2 to 3 VR agencies that have submitted paperwork and are pending implementation.

Carol: You might have a few more. Chris now coming because I have I have my list of people calling. I mean really we do have 12 now on the list, so I expect maybe some more outreach.

Chris: Yep. So in terms of all of those regulatory requirements, like you said, VR agencies need to have a few things in place as they consider implementation. These include a comprehensive fiscal forecast, cost containment policies if necessary, and assessment of staff resources. And as Theresa talked about, consultation with the State Rehabilitation Council, so that fiscal forecast needs to address six data points. Average case costs, the projected number of new IPEs, the current number of IPEs, the projected number of applicants and the cost of any assessment services that might be needed to determine them eligible for the program. Projected increase or decrease in the cost of providing VR services to these groups of people, and projected income, or in any other budget resources that may become available. The fiscal forecast produces that data, Carol, that you were talking about, that demonstrates whether or not the VR agency can do the following four things. Whether the agency can continue to provide services to all individuals currently receiving services under their plans. Provide assessment services to all those individuals expected to apply to the program over the next fiscal year. Provide services to all individuals who are expected to be determined eligible in the next fiscal year. And finally, that fiscal forecast needs to include data that demonstrates that the VR program will continue to meet all of the various program requirements, like that 15% reserve requirement that Theresa discussed. So in terms of creating an Order of Selection policy, there are about five things that the VR agency needs to include in that actual policy.

First is it's priority categories, including the regulatory definition of what significant disability means, how the VR agency will determine which individuals have the most significant disabilities. And that definition must build on that regulatory definition of significant disability. The policy needs to address whether the agency has elected to serve individuals outside of the order of selection, who may require specific services or equipment to maintain their job or to keep employment, was one of those new requirements. The policy must indicate how the VR program will provide information and referral services to individuals who may be placed on a waiting list. And finally, the policy needs to describe how the agency will carry out the order, how it will be implemented so, in effect, how the waitlist will be managed and how the VR agency will decide when to open all of those other priority categories. I was happy that Theresa also mentioned that VR agencies need to ensure that their case management system can fulfill the administration of the order. And we like to see in the policy some discussion of what tracking mechanisms VR agencies will use to account for such things as cost, staff time and caseload sizes. So in other words, sort of that real time data analysis that That informs whether the order continues to be necessary or whether it can be lifted.

Carol: Awesome. I'm sure people are probably, as they're listening, taking copious notes. So folks need to know that there also is always a transcript that goes along with the podcast. So if your wrist just broke, you will be able to just take a look at the notes and get all those things. That is super helpful. Chris, I wanted to ask as a follow up, so that people that have outreached so far, those states that have outreached are you seeing? Is it a fiscally related issue? Is it a staffing? You know how sometimes the states are really struggling with having appropriate staffing? I know it's only been a few, but do you know kind of what that looks like if it's based on more of the fiscal end of things, or is it they don't have capacity because they don't have any staff?

Chris: It's been a combination of all of those things, Carol. So we're seeing agencies with limited fiscal resources, whether that be state appropriated funds, their inability to kind of fully leverage the federal award. It may be retention and recruitment of VR counselors. It could also be sort of capacity of providers, whether those are community rehab providers or contractors who provide VR services. And oftentimes it's other things that kind of just contribute to those as well. And what we're hoping to see in those justifications that VR agencies submit is a real data informed discussion of those factors, like real time data in terms of both fiscal data and performance data. So the money and the people.

Carol: Yeah, I can't underscore that enough, because I know the folks that have reached out to us a lot of times they tend to talk about, you know, their hair is on fire about this thing. And then I'm always bringing  back. So if they're all focused just on the fiscal. But I said, what's happening in your program, what's going on? And that has been very interesting as people are talking about. And then they call us back. They go, you know, the characteristics of the individuals coming in the case characteristics, kind of pre-COVID to now is different. And so we're finding clientele coming in has many more needs, and so the cost of the case are so much greater. And they hadn't realized it until they went back in. They just knew something was going on with the people, but they didn't understand what. So by going back and saying, hey, you got to look at this other side of the house and really analyze what's happening. It will give you the full picture. And then what is playing into what's happening over here on the fiscal side of the house. So I think for, you know, we've all said it, the data is super important. I just want to underscore that. So Theresa, tell us a little bit about your journey with Order Selection in Indiana and your current picture what's happening?

Theresa: I echo the data conversation, that's critical, and you really have to justify the need for the order. So we did all of that really before we even probably got to that, that nine month runway that I spoke of. But from there, our next step was to get our internal leadership approval. And there were hesitancies, which is understandable. We really had to work to articulate and help them understand the challenges that we were facing. Again, justifying using that data that we were not able to provide the full range of services to everyone, while also meeting the range of other expectations, you know, timeliness, getting people in the door in a reasonable period of time. And we really had to work to articulate the negative impact of having these ongoing high caseload sizes and the cycle that we were in with staff turnover. It just felt like we were getting deeper and deeper into right into a hole and further and further away from optimal capacity. So ultimately, we presented the Order of Selection as one something that is federally required for our agencies, you know, not able to provide that full range of services. And then two, a lever of sorts that would enable us to maybe pause or slow some of that growth in participants, giving us the space to get out of that cycle to rebuild our foundation, which for us primarily at that time, was fixing our long standing staffing capacity challenges. But for those experiencing fiscal deficits, of course, that focus would look very different. Once we got leadership support, we moved as quickly as humanly possible. And now on the other side of it. I'm thrilled to share that we have now opened all of our priority categories. We released the last 200 or so from our waitlist just this past October, so we were in and out of the order in about a seven year period in Indiana.

Carol: I love that. I like that you said you want to project, you know, the ways to get kind of out of the order to open the categories and do that. I know for states that have contacted us, that's one of the pieces of advice I've been giving. I'm like, okay, you're thinking about the right now, but you also have to think about the future because that is everyone's biggest worry. You're going to do this thing and it's never going to go away. People are going to be in a waitlist forever. You're never putting strategies in place to come out on the other side of that. And I know for me in Minnesota, that was very much part of what I had to do. And given the circumstances we had at that time, I had this plan and I said, if you all can hang with me, I believe by about 2018 or so, end of 17-18, we're going to be on the other side of this, which actually ended up playing out and coming true. And so you've got to not only like react to your current situation, but you want to be thinking thoughtfully about what are those things that you can put in play so that you aren't just going to stay there? This is the lever we're pulling and we're going to be here forever. So I really like that you said that. I know, Theresa, when you and I talked earlier, Order selection can often be treated like a bad word in the VR world, and it is loaded with a lot of stigma and frustration. But at its core, you know, when you and I were chatting and, you know, you just boil it down, it really is a mechanism. It's a tool required by law to prioritize services when resources are limited. And so if we can't do everything for everyone, it's a system that outlines how to make those tough decisions. What are your thoughts about Order of Selection and how we can maybe shift the conversation to reduce the stigma and see it for what it is? It can be this necessary lever to balance fairness amongst those limited resources.

Theresa: Yeah, that's probably one of the trickiest parts in communication. Communication, right. Communication. Communicating with stakeholders about Order Selection will probably always be challenging. It's a challenging thing, but I think there's a couple of things that were really helpful. And one is sharing a game plan to address the underlying resource challenges. Is a helpful approach, right. Making sure that there's game plan. This isn't the end result, right? This is going to enable us to make this shift and again kind of get out of the cycle. We also found it helpful to share the federal requirements. So just very factually, if you can't serve all you have to prioritize certain populations first. And the Order of Selection is the prescribed process for complying with that. And I think it's a good process for doing that. It's effective at making sure the prioritization happens. Additionally, we also share data throughout our process on the percent of eligible individuals who were impacted. And what that showed is that the majority of individuals were actually not impacted. You know, relatively speaking, a pretty small percent of folks ultimately went on a wait list. And, you know, you could even argue, and I think we did a couple of times that for the majority of folks, they were maybe even having somewhat of a positive impact because we were able to get them processed, get them in sooner.

And, you know, there's obvious benefits that go along with lower case load sizes. So we often relay that only about 10% of eligible individuals were going on a wait list, and 90% were meeting that criteria for those with a most significant disability, which was our open category for a good bit of our seven years. I will say people were a little wary of that stat. They kind of had a hard time believing that, and I think that it's because that term MSD or most significant disabilities, it definitely has meaning. But also we found it could be a little bit misleading. You know, people thought, oh, to be MSD, someone must look like this, right? And we actually found that those meeting that MSD criteria were really a more inclusive group than maybe that term people would perceive that term to imply. And that was just another educational opportunity for our stakeholders and our referral sources.

Carol: I like that you talked about the communication piece around all this, because that really is important. It's almost as important as all of the plans you're putting in place. All the things that Chris told us about that need to go in developing that communication plan, that goes along with how you discuss this out amongst all the stakeholders and such, is super important. I know, Chris, do you have any insights on this part, on the stigma or anything you wanted to share?

Chris: I guess I just had a couple thoughts on like the element of fairness that you talked about in dealing with fairness and at the same time limited resources. So I guess I would just say that order of selection is only one of the cost containment measures afforded to VR agencies through the law and through regulations. And there are other things, too, that VR agencies may want to consider, and that's comparable services and benefits. How we inform people and refer them to other workforce development programs. Those may be our partners or others. How we balance what VR Agencies by in terms of services and what we provide in-house in the cost kind of associated with both strategies. One of the other things that RSA often considers VR agencies to look at when we're talking about implementing an order is kind of carefully evaluating the need to require additional assessments when the law allows and promotes the use of existing information. So sort of not overdoing that eligibility determination process because that often comes with cost. Right. And then finally VR agencies should also be reassessing sort of their routine practices and policies that result in increased cost. That may not always be necessary. So we're really looking at kind of the entire fiscal picture of the program, not just those VR service costs that are provided to eligible individuals.

Carol: That's good. I'm glad you brought all of that up, because we often do talk about these other factors. And I asked people, are you also looking at what are you getting bang for your buck? And not that we're trying to bang on vendor communities, but do you have vendors where people never like they're never done with service, they never graduate, they never get to the end? I mean, maybe it's looking back at that and going are the ways in which their training really working for your clientele? Maybe not. Maybe you need to circle back and work with them or have a parting of the ways and think about that. I also like the thinking about really leveraging our partners. I mean, the whole rehab act, when it was redone, you know, and we had the 2014 WIOA comes out of that. We always had partners, but I don't think we were very good at leveraging what things are they doing. And I feel like some of this stuff is duplicative. You know, why are we offering these same sort of trainings that are now at the one stop that people can access and go to those courses or whatever, you know, types of things that they're offering. So it does force you to take a look at that and really actually live in to WIOA and leveraging the partnerships and the funds across all these systems. I like that. Thank you Chris, for saying that. Order Selection also has to be a super thoughtful process. And so, Chris, I know you talked about the data points that folks should look at. Theresa, what are the data points you look at regularly? And I like it because some directors talk about kind of they're reading the tea leaves to complete your fiscal forecasting, or there's some other things that you like to do.

Theresa: Oh gosh, yeah, We could talk all day on fiscal forecasting. But to just kind of be brief, you have to look beyond just what did we spend last year and apply that and assume that. And I think if you don't have programs talking to fiscal sometimes that is the fiscal assumption. Right. By fiscal staff being made. So with the pendulum swings that we tend to see in VR, which of course are highly driven by trends and applicant and participant counts, you really need to have a very layered approach to forecasting. This is where, again, that program knowledge and fiscal knowledge, it's essential that they're paired up. Just a few things to consider would be beyond the basics right. What is your data show? What are your trends? Show. But what's in your state plan? What are the goals? What are the initiatives that you have in place? There may be a fiscal impact to those, right? There may be a staff resource impact to those. So for instance, a very obvious example in our state plan, we have some goals around increasing enrollment in post-secondary training. There's some fiscal impact there. We need to know what that is, how to apply that, and then really have an understanding of our ability to sustain that goal into the subsequent years.

Again, the applicant and participant growth trends are super important. So keep your eye on and then any impact of any other outreach or collaborative partnerships that might be contributing to some of that program growth. You know, more people served generally is going to mean more expenses. And then just quickly, from kind of a fiscal standpoint, something that might be a little bit unique beyond, again, all the basic essentials of fiscal forecasting is we really have to account for carrying over a certain portion of our dollars. And that really comes down to making sure we don't have, you know, disruptions and services and can comply with this period of performance requirements. So we find in Indiana that, you know, carrying over like 20 to 25% works well for us, ensures that we can continue authorizations past 9/30 and not have that challenge of waiting until ten/1, you know, to encumber new funds. And that just keeps the flow of services going. So I'll just add that as maybe a nuance that others aren't always thinking about.

Carol: Yeah, I appreciate that because I think that having that strategy I did too, as a director, wanting you have your sweet spot of what you like to have in that carry over, because it really does promote that consistency when you have that hard start and stop, and especially in an era of continuing resolutions, you know your whole strategy with how you're flowing into the next year and how all that's going to work. You need to think about that piece for sure. Now, I know a big problem has existed around priority categories and the most significant disability designation. And many programs have three categories, but almost 90% of the customers are in category one, which makes it difficult, you know, when you're implementing an Order of Selection. How did you address that in Indiana?

Theresa: Yeah, that's exactly what we saw. And we balanced this by a couple of key strategies. One is that we did not release anyone from the waitlist until a little over two years into our process. That's  kind of how we, how bad of a cycle we were in. And again, it's a lever. It's  that dial. We had some targets like caseload sizes, retention rate that we were tracking as a gauge to when we could start moving people off that waitlist. So just for example, average caseload size is getting to under 100, turnover being less than 20%. So those were some indicators to watch to start releasing folks. Another strategy that was really helpful is that we opted to do larger releases each quarter instead of kind of smaller, more frequent releases. And this gave us the opportunity to really have our staff know that it was coming the same time each quarter. They could carve out time because it is a lift on top of the day to day, right? You've got to reach out to folks multiple times. You've got to schedule them for meetings. You've got to get IPEs in place. And then with those reviews of the, you know, again, we might look at like 2 to 300 people to see, can we take 300? Can we take 200? Is it somewhere in the middle? How does that break down across your 26 offices? And inevitably each quarter, one office got hit with a high number. And then there were a few that had very little. So we also had to weigh that and see where we could balance our resources to make those work. You know, at the end of the day, you ultimately have to release more people from the waitlist than new people who came in as eligible that quarter in order to get ahead of it. So that was another data point that we looked at.

Carol: Did you find that actually learning kind of through Covid, a lesson, you know, with working remotely and all of that, did that help as you're looking at distributing across the 26 areas? Because you can I mean, and I've talked to other directors about this now you can work with people. Maybe you're in this part of the state, but you can work with other folks as well to keep them moving. So maybe there isn't this huge one off, it's just got 200 people and the other offices get one, you know, they don't have any. Did you find some ability to flex that around the state?

Theresa: Absolutely. That's exactly what we did. So those offices that were hit hard, of course, they were also the offices with the highest number of vacancies. It just seemed to be how it fell every quarter. So absolutely, our region managers really did it. We have five of those five regions. They really did an excellent job troubleshooting that, you know, we helped where needed. But they for sure did that looking across offices in their region and even across the state. We also have about 7 or 8 working lead counselors, kind of floater counselors. So we were able to deploy them to the areas with the highest need. And then as we progressed through the order, we had a pretty robust outreach process. As we were getting ready to release folks, we ended up centralizing that a little bit to take some of that load off of our field staff as well. So, you know, you kind of have to adjust as you go. Move your resources where you can. But absolutely, we found that to be a great strategy.

Carol: Chris, you have any thoughts on that about the priority categories and the most significant disability? I just wondered because I know folks struggle with that. You were looking contemplative, so I thought maybe you might have something to add.

Chris: My philosophy with a lot of things, Carol, has always been less is more. And you mentioned that most of our agencies have three priority categories. And if I were able to say this is a requirement, that would probably be what I would say. But, you know, VR agencies have flexibility to develop more than three. I would just caution that as you get more complicated, things get more complicated for applicants to understand and for VR counselors to implement. So again, I would just say that the law requires that the significant disability category be identical to what's in the rehab act and the regs, and that that most significant category needs to build upon that. So we often see agencies talking about more functional limitations, more services being needed, more time needed to help the person reach their employment goal. So the more specificity there, the better is. I think that helps VR counselors kind of understand where to place people when they're determined eligible.

Carol: Yeah, that's really good advice. Now I know, Theresa, also, you have talked about wanting to bust the myth that nobody gets off the waitlist. And how can we better do that?

Theresa: I can't tell you how many times I've heard that in Indiana, and that was part of the a lot of the grief is that there was this thought that we'll never get out. So we know that's not true. The facts are there. You know, there are many states. And Chris shared, you know, 25% down to less than ten. So less than ten states. So we know it happens. There are states who've done it. I don't know if we do enough to highlight that to kind of our stakeholders, you know, at large and celebrate that. So maybe that's part of the answer. You know, we have those actual examples. That's an important part of the communication to internal and external stakeholders. The other piece here is outlining the conditions that need to be in place to progress, to opening more categories, to ending the order, and then people can see you hitting those target milestones. They may start believing that, oh wow, there's some actual notable objective progress here. We are getting closer to the end. This does seem doable.

Carol: Yeah, I think going back to that communication strategy for sure can help. I know with our SRC, and I had laid out the plan like I had all these points that we needed to do to kind of get through our struggle. And as things were met or we were able to achieve other savings in certain areas without impacting, you know, a quality of a service. Man ,it was great. Like no stone was unturned as we did that. But I wanted to be super transparent. Here's all the things. And I kept a little chart, like, here was this savings, or here we met this thing so people could see we were actively working a process all the way through, versus okay, we are pulling the lever and the lever is just staying closed down. That's it. They don't see the other end. All that work that's being done behind. So what is your best advice for state directors contemplating pulling the lever?

Theresa: Well, we definitely looked at it as that lever or that dial, and we felt that that gave us an opportunity. We really would not otherwise have had to take action on addressing a really significant foundation or core issue while slowing down that incoming train a little bit and refocusing our resources, staffing and fiscal building adequate resources and capacity. It's an ongoing effort. It never ends. It's one of the more difficult things, probably, that we do, but it's so critical to carrying out services in general, let alone good quality services. And it requires a very thoughtful plan and a lot of simultaneous strategies. You know, all the strategies we implemented from salary adjustments to, you know, creating those working lead counselors I mentioned, we developed a layer of case coordinators to take on some of the case management aspects. I think some states call them rehab techs. Lots of gaining of technology, you know, modernization and efficiencies and then some. Right. It ultimately helped us with two really big systemic needs. And one was getting cancer caseload sizes to manageable levels and reducing our VRC turnover. I mean, those things are gold when it comes to staff capacity.

Carol: Now, Chris, I don't want to steal your thunder, but what I'm going to say to folks too is call RSA. Like, reach out to your liaison and talk to them about your situation. You want to start those conversations because the worst thing I would think is you're a state liaison at RSA and you just get this boom, we want to do it. We need to go on March 1st and today is January, you know, 24th. You want to have that partnership all the way along. And I know, Chris, you can speak a little more to that for sure.

Chris: Carol, you know, we often talk about with clients early and sustained engagement. And I would encourage VR agencies to take the same approach with us at RSA. Reach out early and keep that conversation going. The order of selection approval process is going to be iterative. In 99% of times, RSA will have feedback and will have questions, and we'll want to see justifications be made as strong as possible. So to your point, Carol, our ability to approve orders of selection overnight is not possible. Theresa talked about sort of a nine month on ramp. I wouldn't say it's going to take that long on our end, but it will take at least a couple of weeks. And the stronger the justification we receive, the better. Again, I would just say that consider all of the flexibilities that the Rehab Act offers to VR agencies when it comes to managing the program, in addition to implementing an order. And we talked about some of those before, but they could mean cost containment from financial participation to preferences to instate services, to looking at the administrative costs that you might pay for providing services, your staffing capacity, and really leveraging the ability of your SRC. To advocate for the program, we often talk about the return on investment of the VR program, and it really is unlimited. Our program offers a lot of flexibility to be creative, to help people meet their career goals, and that's kind of the best thing we have going for us to argue for the sustainability of the program moving forward.

Carol: Yeah. Excellent points. The SRC can do so much more than we can do, really, and a lot of venues and have a different voice and a seat with the governor. You know, they're appointed by the governor. They have a different mode of communication that they can use that we cannot. So we definitely don't want to forget about them. All right guys, so we're coming to a conclusion. Any last parting thoughts from either of you for our listeners?

Theresa: Well, I'll just add, I think we've touched on a lot of great lessons learned in communication. Number one, really important. And we've hit on some ideas and strategies around that. And then the second, having that game plan, it's  critical so that we're all viewing Order of selection, not as that end result right, or that indefinite status, but as that lever or that dial that can be adjusted to address the situation at hand and then get back on track, get out of the order, be able to serve everyone who needs those services.

Carol: Awesome. I really appreciate you both and appreciate having this conversation. And for our listeners who were taking notes, because I know you guys read the transcript because that will help you with all of that. You can go back through and highlight the things you need to do. Thanks so much for being here today. Appreciate you.

Theresa: Thank you.

Chris: Thanks, Carol.

{Music}

^{Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!}

This Manager Minute episode spotlights how the Massachusetts Commission for the Blind and MassAbility are leveraging AI to improve service delivery. Host Carol Pankow discusses innovative AI applications with guests Lola Akinlapa, Nathan Skrocki, and John Oliveira. They explore an AI-assisted intake platform designed to streamline processes, enhance multilingual support, and enable faster access to services. The conversation also highlights AI-powered tools like policy lookup systems and data visualization platforms like Tableau. Emphasizing accessibility and transparency, the episode showcases AI’s potential to alleviate administrative bottlenecks, support staff, and empower consumers while preserving the human touch in service delivery.

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Full Transcript:

{Music}

John: We were looking for items that might be helpful to our staff. As many of our veteran counselors move on to retirement, it became imperative that we find a way that the newer counselors could find access to information quickly.

Lola: We're not looking to reduce workforce. We're not looking to reduce your day to day operations, right. We're looking to streamline and to make the consumer's journey at MassAbility more accessible to them.

Nate: What we're doing is just enhancing and streamlining the process to better understand and strengthen their policy knowledge, to make their jobs a little bit easier.

^{Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.}

Carol: Well, welcome to the manager minute. Today joining me in the studio is Lola Akinlapa, director of strategic initiatives in Massachusetts. Nathan Skrocki, Policy director at the Massachusetts Commission for the blind. And John Oliveira, Commissioner for the Mass Commission for the blind. So how goes it, Lola?

Lola: Oh, everything is good. Thank you for having me, Carol. I think this is a really great forum to kind of spread the word on what we've been doing at the state of Massachusetts.

Carol: Excellent. How about you, Nate? How are you doing today?

Nate: Happy new year. Doing well. Glad to be here. Thank you.

Carol: Excellent. And last but not least, John, how is it? How are things? You got a new role.

John: Everything is great. A very cold day today, but we'll get through it. Uh, it's close to zero wind chill. So very cold day here.

Carol: Ah, it's like you guys are in Minnesota...

John: Yeah, I think so.

Carol:  Joining Jeff and I...

John: I think so.

Carol: Yeah. We were three below today. It was fabulous. Well I'm super excited about our topic. So artificial intelligence, although it's really not a new concept, it's gained significant attention in the recent years and the field of AI research was officially established during a workshop at Dartmouth College in 1956, where researchers optimistically predicted that human level intelligence machines would be achieved within a generation. However, it became clear the challenge was really greater than anticipated. But today, you know, we have AI everywhere seamlessly integrated into our life. You know, we've got Siri and Alexa. I rely on them all the time to your biometric scanning at the airports and the list goes on. And I had the good fortune to find out that Massachusetts is really standing out as a state that has embraced the broad implementation of AI and incorporating it extensively across various aspects of daily life and governance. So I want to dig in and learn some more from you guys. So I'd like to start out because our listeners like to get a little insight into all of you. If you could tell us about yourself and your role. And for our my two friends from the Blind agency a little bit. How you got into VR? And Lola, I'm going to start with you first.

Lola: Thank you, Carol. So a little bit about myself, as you mentioned, Lola Akinlapa, I am Director of Strategic Initiatives at now, formerly what used to be the Mass Rehab Commission and now known as MassAbility. I came into the agency back in 2014. I actually started in research and development, doing a lot of the analytic work. I actually was voluntold, I would say, to assist in a new project that we were implementing. It was a statewide case management system for our different divisions at MassAbility. Through that process, I was able to kind of take a step back to say, well, what do we need at this agency to push us toward the future?

Carol: Yeah, Lola, it is great being voluntold, because that leads to some of the best things when you're working on different things. So, Nate, how about you? How did you land at Mass Commission for the Blind?

Nate: I landed at MCB about eight years ago. At this point. I've been a manager within state government for many years and ended up at MCB. Hopefully this is where I'll be staying for many more years. I really like the mission of MCB and the work that we do as an agency to provide services to residents of Massachusetts.

Carol: Good stuff, good stuff. And John, you've switched roles, so I've known you for a while. But tell our listeners a little bit about yourself.

John: All right. Carol, I've been with the agency for, wow, 37 years.

Carol: Oh my gosh.

John: And started out in services and worked with the senior staff, senior consumers, and was in vocational rehab for a while, worked as director of staff development and training for a while. I headed up the assistive technology program for a while. I was deputy commissioner for something like 12 years, oversaw the programs, and I've been commissioner now for a year and a half.

Carol: Good for you. Well, sure good to see you again. So in the fall, I had the had the chance to attend an AI convening with Tony Wolf, who is the MassAbility Commissioner. And Tony was mentioning she kept talking about all these really cool things happening in Massachusetts. And I just I needed to learn more. So now, Lola, like, how is MassAbility moving in this AI space? And I know you're doing some things that are helping the consumer experience be quicker and easier. What's that look like?

Lola: Oh my God. It's been quite a journey to say the least. At our agency, we as many other agencies identified bottlenecks, identified issues with maybe the bureaucratic side of things where it takes longer to get someone from point A to point B. It was through, actually, our centralized intake unit where we discovered there's area for improvement here. And that area of improvement could be resolved through an assisted intake form. So at MassAbility, we're developing an AI assisted intake platform that's meant to support our staff at MassAbility, who are doing the intakes to allow them to have more leeway on doing what's more important to the work, which is getting our folks to the services they need. Through this intake form, we're actually removing the repetitive task. We're looking at some speech to text technology and then also some guided workflows. And we're also able to get multilingual support. And through the intake, it's meant to guide a lot of our consumers to feel a little bit more empowered to get from I'm stuck here, how do I get services that I need, whether I'm going to work or looking to live or transition into the community, instead of waiting months before someone can speak to you to get you through the process.

In this platform, we're actually able to allow our staff to have more time to be dedicated to more personalized interactions with our clients. So it's been a journey to kind of develop what that roadmap looks like. But we are super excited about this. We actually will be going live early this year through our MassAbility site, through our consumer portal, where it will be housed, and individuals will be able to go in, log in and fill out the form, and the form would guide them through the entire process without human interaction. And for us, I think it's really important to take a step back and really understand the purpose of this. Right. It's not to remove the individual from their work, right. It's to make some processes a little bit more streamlined, but then have our staff, our counselors, our case managers be able to focus on more of the human interaction. It's been quite a journey for us, to say the least.

Carol: So, Lola, are you working on that with your own state IT folk or who kind of is helping you mastermind all this?

Lola: So this is in collaboration with our IT folks at Executive Office of Technology. Also, we're working with a contractor who's been helping us build this platform out. They've been super great. It's been a very collaborative effort across the board. I would even have to throw in Microsoft because there's some work that they're assisting us doing, and it's been a team effort to get it to where it is today. And we're actually very proud of what we've done in such a short period of time.

Carol: Very cool, I like it. I know Lola, you had talked to me too, you were interested in doing something kind of in this data realm because I know data isn't cool always. But you were trying to do some stuff with Tableau and AI. So what does that look like?

Lola: Tableau. For folks that don't know, it's a visual data tool that we've been using at MassAbility for a little bit over four years now. The really cool thing about technology is as the years go on, the tools get better. Tableau was another way that we were using to kind of drive our data decision making at the agency. You know, things that are really core to the MassAbility beliefs in our missions. With Tableau, we're able to have a chatbot, and the chatbot would be utilized something similar like ChatGPT, where you could say, show me how many individuals are getting X services, or show me how many individuals are served in certain parts of the region. Right?

Carol: Yeah.

Lola: very cool things like that where you don't have to be a data analyst or a data science...

Carol: right.

Lola: to use Tableau. It kind of makes it more user friendly and at your fingertips. I think of it like on demand data. So that's something that we've been looking at that is in collaboration with an initiative that we have over at Northeastern. And we've submitted a proposal for that. So we haven't started, but we're looking forward to some of the cool and innovative things, because I think many state agencies will agree. Data is really, really interesting to look at, especially when you're looking to tell a story, when you're looking to improve just the overall outcomes of your agency, depending on what you're looking to achieve. So it's really been something great that we're looking forward to getting started. And then also on the back end, kind of showing and empowering our own staff as to what this data means, right? Because not everyone is a data scientist. Not everyone enjoys. It's a very dry subject, but I think this is a way to keep folks engaged in terms of what's really going on at the agency, and it kind of tells a story without having to truly understand the data to tell the story.

Carol: I love that. I think you'll find if you guys can make that all happen, there's going to be a lot of folks across the country that are going to be super interested in that piece because data has been so critical, especially as WIOA passed, and we're looking at so much more of the data and what really is happening for individuals with disabilities and getting into employment. And so I feel like sometimes we're data rich, but we're analysis poor. And people are like, I don't know what all this means. You get a little bit overwhelmed by the data. So I think that would be great for people to be able to do the old ChatGPT kind of thing and just ask a question and get the answer.

Lola: Absolutely.

Carol: I love that, that's very cool. So when you look at AI, there really has been considerable impact, too, for individuals who are blind and visually impaired. And Nathan and John, I mean, what are you guys seeing with the customers you serve? Just in general, when you think about AI and the work you're doing now?

John: Well, obviously in the assistive technology field, there's always been a lot of talk about incorporating AI to serve consumers. And over the past 4 or 5 years, many of the wearables have become very popular. And every year when you see these items, they get better and better. And that's benefiting a lot of our consumers tremendously. I'm sure that you've all heard about the meta glasses. Tremendous assistance for our consumers. You put on this pair of glasses, you can take pictures of the environment you're walking through. You can use it with description services such as Aira and Be My Eyes. And it works great for someone who doesn't know the area. For someone who's trying to do some work and needs to access print immediately, a great way to do this. Many other things are coming down the pipeline, but we were looking for items that might be helpful to our staff. As many of our veteran counselors move on to retirement, it became imperative that we find a way that the newer counselors could find access to information quickly. We do the trainings the usual way, but that takes quite a bit of time. And if you have questions and you want answers right away, we were looking for a solution and we came across this solution in Outlook Insight. I read about it somewhere, I called them, I spoke to an individual at the company and we agreed that we would meet at the NCSAB Conference. And I turned them on to Nate and his policy team. And he can give you more of the story about that journey going forward here.

Carol: So what do you know, Nate?

Nate: Thanks, John.

Carol: John is the idea guy and he's like, Nate, go do the thing.

Nate: And it works out great. So what we did was we connected with Outlook Insight, and we wanted a tool that would allow kind of a quick reference lookup for our case managers. So it could be that they have questions themselves and the policy or procedures. And making sure a case is executed properly or consumer may have a question and they want a quick reference for that. So what we did with Outlook Insight is develop a tool that takes all of our internal policies and all of the other policies that govern us, and kind of housed it all in one place and very similar to ChatGPT or some of these other AIs out there. You can ask it a question and it will provide a response. And when it provides a response, we have the ability to really take a look at where it's coming from. So it will include all the resources that it's pulling from with the response. So it will cite the documentation. So it might be some direction from RSA or some of our internal policies or another piece of policy that is out there, another piece of guidance that is out there. And it will cite that particular piece of policy where it's coming from. You can click on it. When you click on it, it will bring that policy up and you can read further, but it will also provide that response. So if you ask it what form is needed at this step of a case procedure, it will bring up what form is needed. Bring up the form and you can go from there.

Carol: Nice. So where are you at in the process with this rolling out?

Nate: We have rolled it out to some staff. It's not officially rolled out yet as an agency. It's something we're still testing. But we did roll it out to some staff to test to really kind of understand what they're using it for. Another piece of it is we're allowed to add tiles to this particular system. We can create these buttons or tiles above the search bar that will have preloaded questions. So say a consumer is going to college and we you know we might have a button that has the question on it. What is college reimbursement for a student at MCB. You can click on that and we'll bring up all the information about what's appropriate for college reimbursement, how much that college investment can be, so on and so forth. We wanted to get an idea of what people were asking it. We wanted to get an idea of what they're using it for, so we can kind of load in those different tiles on the top as well. And as we go through certain cycles in case management, those will change over the year, in the future when we do roll this out. And we also just were curious on what people were looking up for quick reference. And people are using it. It is a very good tool. It's been helpful for us in the policy unit. We're not getting as many questions for people that are using it, because they're going to that first to see if they can look up the policies on their own and get a response on their own. We do caution people though, because it is AI, so sometimes it does not provide the full picture. I guess is the best way to put it. It might give a partial answer. We haven't seen where it's giving any wrong answers yet, but sometimes it doesn't fill in the whole picture. So that's why we include the policies with the response, because people can go in and search further within that policy if they need to formulate a decision a little bit better.

Carol: Yeah, you bring up a really good point. You always have to trust but verify, even ChatGPT you throw something in there. And I use it a lot because it's super helpful and it'll be going along. It's really great. It gives this response and then you have some kind of wacky line comes in there and you go, I don't really know where that came from, but that isn't right. So you can't just turn it all over to the bot. You still have to use your own kind of critical thinking skills and take a look to apply it.

Nate: For sure. The advantage that we have, as opposed to like an open source AI, is we control what goes in and out of where it's pulling from. So we're the ones putting the policies in. Or as Lola had mentioned before, if you want statistics or something like that, you can put it in a document with certain statistics and it can pull from that. But we control everything in there. So it's not pulling from this open source where it might recognize something as helpful, but it really isn't. It's everything in there. We've kind of vetted and we understand it's something that is needed by the agency.

Lola: Absolutely. And just to Nathan's point, open source, we're talking about like Google, you know, you can get millions of results back and very true at MassAibility. Similarly, we obviously have regulations that we're following with RSA. And there are things that we have to control just to make sure the language is correct. So we're putting in what needs to be said at the bot kind of just follows that logic. So that's kind of the nice thing where you can still have that control, even if it is kind of AI, but it's still guarded. It's not as loose as just an open source would be.

Carol: Yeah, absolutely. It's a great point, Lola. And I know for the both of you, you know you're doing things that are impacting the staff. So staff can definitely have a reaction to this. Sometimes positive, sometimes not. Like we're all super excited. I see your smiling faces like, yay, we're doing the thing. And then they're like, you know, people feel like back what I was saying in the beginning, like, we're going to replace everybody with robots or something. And so staff can get concerned. So I'm going to kick this to you first, Lola, what's been kind of the response from staff about the things that you guys are trying to do?

Lola: Well, I'm very fortunate to work at an agency where folks are very open minded. Change is a little different, but we're very open minded at MassAbility. I think it's all about the messaging and the purpose on why we're doing certain things right. For sure. There are people that are going to have, you know, pros and cons about it, but I think how we message it is we're not looking to reduce workforce...

Carol: right.

Lola: We're not looking to reduce your day to day operations, right? We're looking to streamline and to make the consumer's Consumers journey at MassAbility more accessible to them. The option that we have right now and how we've messaged it to staff is it's an option, right? We're not removing the human aspect of it, but it's an option for individuals who are in certain circumstances that need to get something done a little bit faster, right? It takes a little bit longer to talk to individuals, but if it's something that they feel like, you know, I'm just going in and I'm looking for a job, I know everything I need to have. This is another outlet that they can use where the system itself is like, I'm not a person, but I can guide you like an individual, right? At the end of it, you will be meeting with a person. You will have that personalized experience, that interaction, but mostly for the admin and the data entry, right? We can repurpose that. We can shift that burden to some of the tools that we have available to us, like the AI assisted intake form. So that's really the messaging behind it, right? The messaging is not to impact staff. It's not to scare staff.

Carol: Right.

Lola: But it's more to help think of allowing people to have different options to come into the agency that aren't so impactful or don't feel like a bottleneck.

Carol: Yeah, I love that. I love that point. How about you guys, Nate or John? Have you seen any initial responses from staff, maybe different than you thought or how has it been going?

Nate: I think for us it's a little bit different too, because we're providing human services, so we're not replacing that in any way with an AI tool. We're not going to be replacing us, going out and sitting with a consumer and meeting them where they're at and providing the services that they need to be successful. What we're doing is really just enhancing and, like Lola said, streamlining the process to better understand and strengthen their policy knowledge to make their jobs a little bit easier. We haven't really explored any type of AI that would help with case management work or anything like that, and it's really tough because like I said, in the human service field and in Lola can probably also agree with this. Every consumer is so different. We're meeting with them a lot of times in person, especially at our agency, and providing the services that they need. A lot of it's hands on services, something that we're not going to be able to do with AI. What we're really looking at is how do we enhance their ability to provide and streamline services and make the experience better for the consumers and for our workers. And that's what we've done with this first policy tool. And I think it's been successful. I don't know if you have anything to add there, John.

John: Yeah, we're supporting the staff at this point. So it's not that we're trying to take staff out of the process. We're making it easier for you to do your job and for you to answer questions that you may have about the process of moving the client through the system, or even questions that a consumer may ask you, and you can explain to them. And if you're missing any of that data, you can pull it up on your laptop. And that tool is always with you. You can ask it at that point, or you can refer to other resources we have on that machine. So you could certainly help them get the information they need faster and help yourself process the information they've given you faster.

Carol: Well, having done technical assistance for years with state agencies, and I see the hundreds of pages in all your policy manuals and all this craziness, I'm sure staff will greatly appreciate anything that streamlines some of that work that they have to do, and all the things they have to retain. And you've got your policy and your procedure and your desk and your 14 other directions. It's a lot. I mean, it's a lot to keep track of, as well as just paying attention to the individual that's sitting before you. And so I think anything you can do to streamline that is great. I'm wondering if you all have other ideas. I know Lola, when I talked to you before, you are full of lots of thoughts. Do you have any next steps for accessibility that you're thinking about?

Lola: I have a couple of next steps right now. I have to rein myself in. We're for sure right now really focused on getting our automated intake form out. We're at the tail end of testing and everything has been looking great on the up and up. So we've been really trying to get our messaging around what that looks like, especially to our constituents that are looking for services. So folks just understand the purpose, the why and how we're trying to make this a little bit better. I'm hoping eventually one day I can take this to phase two where the eligibility pieces may come into play, but we're not there yet. Right. We're taking baby steps.

Carol: Yeah.

Lola: I'm really excited we've gotten this far. I know Nathan and I have had conversations a few months back about looking at something similar to what they're doing with the policy, because we have our own policies, right, that are kind of everywhere. They need to be updated and staff need to reference them or individuals are looking for them. So I think definitely what MCB has been doing has been in the back of our minds a little bit. But like we said, we're taking baby steps and hopefully we can get there. But I think across the board, these are all great initiatives.

Carol: Yeah, absolutely. How about you Nate and John are you guys looking at, you thinking a 2.0 on anything or some other areas you'd like to dabble in with AI?

Nate: I think it's rolling this out first and kind of once we get this completely rolled out to staff and kind of understand how well it's working, I think we can take those next steps. We're always keeping our finger on the pulse of technology and how it's advancing, and if it can assist us in any way, and we'll continue to do that. I think an interesting, it kind of fits in with AI is, you know, one of the biggest barriers for our consumers is transportation. And as far as AI goes, one of the big conversations in that community is automated cars and those type of things. And we have in the past provided some input about automation. And when they're creating those type of things for transportation, how to think about how it would benefit people with disabilities and those type of things. It's a long way off, but it's something interesting and something I personally get asked about a lot when I'm out speaking in different areas is, where is that? You know how close that is?

Carol: Yeah.

Nate: That's nothing we'll ever do as an agency. We're never going to be providing, you know, services. But we have provided some just some input in the past on that. But as far as like case management and service to consumers and those type of things, like Lola says, eligibility is something that's very interesting. If there's something that can help with that, it's for different programs within our agency. You know, when you're coming to MCB, we're a little bit different than MassAbility. By law, you have to be registered with us if you reach the threshold of legal blindness in Massachusetts. So you're registered with us. It's the law. But depending on what services you're receiving and what programs you're in and those type of things and maybe something interesting to look at in the future.

Carol: Yeah, definitely. Blind agencies have a lot of moving parts and pieces. So how about any advice you all might have for states that are starting to think about this? Because states are in all different, you know, places and people are kind of, their administrations. Some are very proactive, some are not. Do you have any advice, as you've been working through these projects that might help other people that are starting to dabble? Lola, I'll kick that to you first.

Lola: Yeah, I think that's all dependent just on where you are as a state agency, right? It's taken us a while to come to the realization, like, maybe there's something more we can do to kind of help the process that we're in. And it just so happened some of the things that we've identified as pain points, it looks like AI and technology would really help alleviate. And I'm not going to say remove because we're always going to have issues, but it would help alleviate some of those pain points. I think one of the things that would be insightful for folks to know, and just because the disability community loves the community, it's just when it comes to technology, we have to be very careful, right? We need to be mindful of some of the biases that come along with that. We need to make sure that the accessibility is actually accessible. It's usable, right? To Nathan's point, we serve various consumers ranging from different types of disability. And I think sometimes that gets lost in the conversation because we're so much let's get it to the next level and let's make it work for us and automate it. And I think we forget to take a step back and remember who we're doing it for, right? We're doing it for the folks that maybe don't have mobility, the folks that can't always read or have low vision, or the deaf or hard of hearing individuals. We really try to make this form all about the people. So I think as agencies are probably trying to embark on technology, those are some of the things that they might want to keep in mind. And it depends just where you are in the process. Just it was great timing for us, and I'm sure Nathan would agree. It was probably great timing for his agency to start some of the discovery process around how we can utilize AI.

Carol: Good advice. John, do you have anything you want to add?

John: Yeah. When you're going down this road, be prepared that you understand the process that your state has, because there's many other departments that come in and want to take a look at what you're doing and ask for a lot of different documentation. And so that all has to be done before any product can be deployed. And depending how bureaucratic the state is, it can be different. A large state might have a whole bunch of departments Moving in and wanting to take a look in a smaller state may not be as complicated or as cumbersome process as it can be. So just be aware. Once you understand the idea and you think of a potential product, make sure that you've understood all the steps you have to do at the state level to be able to deploy that product and not have it pulled when you're halfway through, or you've spent money on development so that it gets scrapped in the development stage. So just be very aware of how to get that process through the state.

Carol: Yeah, that's  very good advice. Nate you get the last word on this.

Nate: Patience. For a lot of reasons and pointing at both what Lola and Commissioner Olivera talked about here. You got to have patience to go through the process. But you also have to have patience to make sure that it is accessible. Here at MCB, we obviously have a myriad of different folks using it and with different abilities and ways that they approach the system. We got to make sure it works for all those different ways. And that wasn't easy either, but more so for the process. It's a long process. We're still in the middle of that process, but it's worth it. I do want to say that have the patience, but it is definitely worth it. AI is extraordinarily able to just provide a way to save time. You know, a question that may come up to us where we research a question, decide on what the answer is, reach back out to a worker, give them the answer and they go to a consumer. Give them the answer. It could be days. This is seconds. The time that it saves. And maybe even if you, depending on how it's deployed, the cost it could save in the long run. It's extraordinary and worth the time put in.

Carol: I love that you would mention that. There used to be something that I compared every year that came out from RSA, and I'd compare to the previous year, and so I'd always look at, you know, I'd do this side by side, kind of mark up what all change, what language changed. And it used to take me hours, you know, just to look through the document. Now I send it through a tool and literally in a minute it highlights everything that changed from one year to the next. I'm like, boom, done. You have it. People always are asking us questions as a TA provider, and I'm like able to immediately tell them what change they're like. How'd you do that analysis so fast? Well, I used my friend, you know, an AI tool that was able to do it. It really is an amazing Time saver. So how can our listeners find you guys? Could you leave us with like, an email address or something? Lola, would you mind saying your email address for the listeners in case somebody wants to reach out to what you're doing there?

Lola: Yeah, absolutely. I can be reached at Oluwafunke.Akinlapa@mass.gov. The spelling is o l u w a f u n k e dot a k I n l a p a at mass.gov.

Carol: Oh that's great. And then Nate or  John, do you both want to give your email or who's the contact there.

Nate: It's Nathan.w. Skrocki@mass.gov and I'll spell that out. It's n a t h a n dot w dot s k r o c k I at mass.gov.

Carol: Oh, that is awesome you guys! I really am looking forward to seeing your stuff roll out. You need to give me an update. I am super happy about this. In fact, we were having an AI conversation the other day on our GW team and I said, hey, I'm doing a podcast this week and they're like, you got to give us the names of the people, because some folks are working on something, they like, they're gathering up information from across the country. So I said I'd be happy to share. So thanks so much. And please do keep in touch. I wish you the very best with your projects.

Lola: Awesome. Thank you Carol.

John: Thank you Carol.

Nate: Thanks.

{Music}

^{Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!}

Join host Carol Pankow in this thought-provoking episode of Manager Minute as she sits down with VR fiscal powerhouses Katie Marchesano, Chris Merritt, Allison Flanagan, and Sarah Clardy. Together, they unpack the pressing fiscal issues shaping the vocational rehabilitation (VR) landscape, including:

·  Navigating fiscal forecasting challenges

· Addressing technology gaps

· Strengthening collaboration between program and fiscal teams

The conversation highlights the vital role of policies, training, and institutional knowledge in sustaining VR programs while anticipating future shifts, such as technological advancements, fiscal constraints, and potential WIOA reauthorization.

Don’t miss this episode, packed with actionable insights and expert reflections to keep VR programs thriving!

Listen Here

Full Transcript:

{Music}

Katie: I'm really excited for that tool to be shared, and I think it's going to be a really helpful tool for the agencies.

Carol: This job takes constant attention to detail in what is happening. It is always going to be work.

Chris: More people are going to be reaching out asking for fiscal forecasting and understanding how to look at this program in the future.

Allison: One of the things that pops in my mind that might happen over the next three years is reauthorization of WIOA.

Sarah: I think we're going to see some new resources, hopefully in the technology world develop, that will assist our agencies so that their focus can remain on the customers where it belongs.

^{Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.}

Carol: Well, welcome to the manager minute. Joining me in the studio today are my colleagues Katie Marchesano, Chris Merritt, Allison Flanagan and Sarah Clardy. So this might be a little bit of calamity for our listeners, but we're going to do it. So how y'all doing today?

Sarah: Great

Chris: Great.

Allison: Good.

Katie: Wonderful.

Carol: Awesome to hear it. Well, we have had quite a journey on the QM for the past four years. The fiscal focus was a new aspect of the grant, and we are so grateful to then Commissioner Mark Schultz for realizing that TA in this area was an essential element to the work. And since we're in this final year of the grant, we wanted to have a chance to visit together, share our insights with the listeners into the whole fiscal picture across the VR program, and discuss our perceptions and perspectives. So buckle up, folks, and we're going to dig in. So I want to start with how you each found your way to VR. And I'm going to start with Chris to talk about your journey into VR.

Chris: Well thanks, Carol. Mine's a little bit different than most people. I did not start in VR. I have a very different background. All fiscal for the most part. But I came to work at a fiscal state unit and learned about VR there. Loved it, loved it, loved it. And then was kind of asked to be part of this Ta team and couldn't say no because it's just an incredible program and it's a little complicated. So being able to help the states understand it better is what brought me to this team.

Carol: Well, not you, and you're being modest now. Tell them about like a little bit more of your background because you have an interesting educational background and all of that.

Chris: Yeah, I do. So I'm an environmental engineer by trade. Worked in that field for a while. Learned that sampling sludge was not a cool thing to be doing. So went to work for a small business that was just starting on Department of Defense World. Loved all the fiscal part of that. Went back to school and got my MBA and have been doing fiscal stuff ever since. So yeah, it's a long road that brought me here, but I'm happy I took it.

Carol: Yeah, we're glad you're here. How about you, Miss Allison?

Allison: Well, it's kind of hard to believe that I have over 30 years in this VR journey, and it actually started out in the field as a VR technician, and I just fell in love with the mission and purpose of VR. So I quickly changed my direction to be a VR counselor, and then that evolved to other promotions and positions throughout the year, where I ended up being director of both Kentucky Blind Agency and then moved to Florida as the General Agency Director. And when the VR TKM opportunity came about, I was ready for a change, especially after being a director through the pandemic and through the implementation of WIOA. I was looking forward to just a new opportunity, new learning areas, so this has been a great jump for me. I've enjoyed it very much.

Carol: Why don't you tell them too about your other gig with NRLI a little bit. We'll make a plug there.

Allison: Yeah. So part of the VRTAC-QM is the National Rehabilitation Leadership Institute through San Diego State University. I have the honor of continuing Fred McFarland's legacy, who began this program about 25 years ago. And it is a program that is building the future leaders in the vocational rehabilitation field. And it's been a joy to see these leaders be promoted throughout their careers. Being stepping up, having an interest at that national level, the issues that are facing VR. So it is definitely a part of my job with QM that I hold near and dear to my heart.

Carol: Yeah, it's good stuff, I love it NRLI of our favorite things to participate in when we get to do training. So Katie, over to you next.

Katie: Well, my journey with VR started when my brother was receiving VR services, and he actually is who inspired me to go and get my bachelor's degree in psychology and work in social services. That led me to Department of Workforce Services, where I spent 13 years in various roles and capacities, which ultimately led me back to VR.

Carol: Awesome sauce. And last but not least, Sarah Clardy.

Sarah: So I started out about 24 years ago out of college. I was working in banking full time and going to school full time, and had an opportunity to come on with a state and Missouri vocational rehabilitation, had an opening for an assistant director of accounting and procurement. They had some systems and processes that were a little out of whack and needed some help with reorganizing pretty much the whole accounting structure. So I came over at that time and started in with Missouri, and then spent 20 years there and got to spend half of that time in the field directly with our field staff and counselors and really take this program to heart, and then had an opportunity four years ago to join the VRTAC-QM. I had said for a long time we needed technical assistance in the fiscal realm for years and years. I was thrilled that Mark Schultz saw the vision and made it happen.

Carol: Good stuff. Well, now we're going to enter the danger zone because I have some questions for you all. Not exactly sure how this is going to go, but we are going to do our best. So y'all jump in when you want. So what has been your biggest realization or aha moment since you started with the QM. And Allison, I'm going to have you kick us off and then other folks can jump in.

Allison: Honestly, Carol, there's been a lot of those aha moments for me over the last, you know, almost three years with the Technical Assistance Center since my experience in VR started in the field and I was a counselor, kind of the program side is where my comfort level is or my knowledge and experience. So when I joined the fiscal team there, definitely there was a lot of those aha moments, mainly a lot of the things that I did not know or did not realize even as a director when I came over. So one of those aha's is the director. Even though I received these beautiful monthly budget reports for my fiscal staff, even though I had a leadership team that we reviewed budgets with, understanding the fiscal requirements in and out, the uniform grant guidance and all the regulations. And, EDGAR, all of that, I think, is critical for any director or their leadership team to have knowledge of. And that was definitely one of my aha moments. And one of those things I go back, wow, if I could go back and be a director, I would be a lot smarter after being on the technical assistance side. And like I said, there's been a lot of those aha moments. I could share tons of them, but a couple other ones that jump out is just that critical need for that program side of the House and the fiscal side of the House, to always be communicating and always making sure they're checking with each other. On whether it's a new implementation, whether it's expenses, contracts, doesn't matter. There needs to be that collaboration happening at that level. And then probably the technology challenges is another one of those constant aha moments in the year that we're in and how reliant we are on technology. I am still amazed that there is not technology out there that will do what VR needs it to do, right off the shelf.

Carol: Amen, sister. You said it all. No, but I'm sure there's people that want to say some more.

Chris: I found it interesting when I came over that not every single, not a single state has it right. I thought that there would be more that are fully knowledgeable and are running with it and doing all the great things they are doing, the great things. They just don't have 100% right.

Carol: You are making me laugh with this because I'm just going to say I have to jump in on that. Sarah and I right away, in the beginning, anytime we had met with RSA we learned something new, we're like, uh, I gotta call back to Minnesota, tell them, because we realized, like, hey, we thought we were sort of doing it right, but we all realized things. We went, uh, yeah, we had a little slight misstep on that.

Katie: I would agree with that. Like, we came from a state that was in an intensive agreement. And, you know, I was like, man, we really got it wrong. But then, you know, it's a huge learning curve and there's a lot of people that are putting in their best effort, and they're still just a few things that aren't quite right.

Chris: Absolutely.

Katie: Another realization that I had was we have this table of contents for a grant management manual that we send out to agencies. And when I received it in Wyoming, I was intimidated by all the things that needed to be included. But my aha moment was when you break that down into individual items and you really look at it, it's things that are already in place, the policies and procedures that you're already working on. It's just finding a way to get that on paper and put it into some sort of policy and procedure and internal control. So realizing that states have the capacity to do that, just figuring out how was an aha moment for me.

Sarah: You know, when I came in, I was thinking back to 2017 and RSA came out with guidance on, I'm going to say it, Period of Performance. And it dominated our whole agency for a good nine months, trying to understand the guidance, looking at systems. We had to do a whole overhaul with the way we looked at obligations, just we spent a massive amount of time and effort to right size our systems, internal controls and all of that because prior to performance sets the beat for all of financial within a VR program. So coming into the QM, I really assumed that more agencies knew of Period of Performance and had gone through at least similar steps, or at least had internal conversations. And what I found was completely the opposite. Somehow a lot of folks missed the memo and that work hadn't been done. And of course, we've been running Fred Flintstone style, trying to help agencies get up to snuff. So that's the piece. I think that's been the most interesting. I think for me.

Carol: I think along that same vein for me was really that realization states are more different than I thought because I figured we all had the same information. We all kind of operated sort of the same. You might have your own internal systems, but I remember, Sarah, you and I talking that first year just going like, oh my gosh, everybody is organized so completely differently. They approach their work so completely differently. There isn't just one size fits all. Like, hey, you should do it this way. And like, everybody can do that. Uh uh, it is like having an IPE for how the fiscal is managed. Individualized we need to give very individualized TA. So what do you guys view as the number one challenge facing our programs nationwide? And Sarah, I'm going to have you start us with that.

Sarah: Okay? I'm going to say it I think Allison said it earlier. We are lacking in the technology space. I think a couple of things we have, the pendulum has swung to the other direction and before it was spend, spend, spend, a lot of agencies made adjustments so that they were increasing their spending. The large carryover balances weren't so large. Now my concern is how are we looking at our finances to see if we can still sustain that. And in order to get accurate projections and for leadership teams to have the conversations about where they stand financially, we have to have technology systems in place that are reliable, are tracking period of performance, can provide those fiscal calculations in terms of where we stand on all of the different requirements, so that we have a constant pulse on where do we stand as an agency. And I liken it to being in private industry and a CEO knowing at all times how much does it cost to make the widget? How many widgets are we making and what amount of time? All of those kinds of things. And I feel like in that space right now, we have agencies that are trying to figure that out, and we have some that are in a very delicate position, and it can cause a lot of catastrophe and crisis if that's not solidified. So really, it goes back to having reliable technology that will take care of all of that. And that includes our CMS, our Case Management Systems space. A lot of our vendors are struggling in that Period of Performance area, and we're not there yet. We have a lot more work to do.

Carol: Well, it's like a $4 billion industry, you know, and I feel like we're still using an abacus or something in some cases for tracking the money. It is the most insane thing I have ever seen.

Allison: And, you know, related to that technology challenge, though, is knowing that, that challenge is there, knowing that the technology is not correct. I think what adds to the complexity of that is the fiscal staff or the just the staff within the VR agency. They lack the fiscal knowledge enough to know if their system is working correctly or not, or know how to go in and make the adaptations needed to assist them. And that's a challenge within itself.

Chris: And I will piggyback right on that, because the thing I think that we've struggled with is we have lost so much institutional knowledge that people don't stay in jobs like they used to. And so if these policies and procedures are not written down, you get new people coming in, they don't know what they don't know. And if the technology is not working right, they don't know that that's not something that they can handle. So it's a lack of that long time knowledge that used to be in this program.

Katie: Yeah, Chris, that is exactly where I was going as well, is the loss of staff and institutional knowledge is huge, and it really highlights the importance of getting policies and procedures in place and not waiting till that person has their foot out the door and is ready to head out to make sure that you're getting that in writing. You know, succession planning and really building up success in the team.

Carol: I think for me, one of the things I see, because I love that whole organizational structure and non-delegable responsibilities, I love that area. I think one of the biggest challenges facing the program is the whole shift in how things are organized between if you're in a designated state unit within a designated state agency, and that centralization we have seen of all the fiscal functions along with IT and HR and all of it, but I feel like VR has lost control. And so as these services are centralized, and not that they can't be, but that they get centralized to a point that the VR program has lost complete input control direction. I mean, you've got directors being told you can't spend anything over $5. It has to go through 40 layers. You can't hire anybody. Staff cannot travel to go see customers like all of that. If we can't fix this structure of how things are put into play in each of these states, I really see kind of the demise of the program. As we see things get buried, the program gets buried down within these big agencies. The lack of control ends up leading to problems with them and being able to carry out the mission. And it's really hard to get a handle on that. And I know Congress has given, you know, this leeway so that states can organize like they want. But boy, the way they're organized right now, it's pretty tough.

Allison: It's a double edged sword when you think about it, because you're probably like me Carol, as former directors, we wanted more money going into the consumer services. We wanted it going to support our customers. We wanted to find ways to reduce any kind of administrative type expenses so that that money can go there when the centralized functions were really being pushed at the state levels. In my mind at first, I will say this, at first I saw, yes, this is a benefit because we're going to have these shared services, we're going to be able to spend more of our funds on our customers. And I still somewhat agree with that approach because it is a cost savings. But what has to happen, though, is that balance, what you talked about, the balance where VR still has control over the decisions or they are included in those decisions and the restrictions that have been put in place has to be lifted. But I do see the benefits of those shared services as long as the structure gets set up right.

Carol: Right. And that's been few and far between.

Allison: That needs a national model.

Carol: It does. And that's been a problem. I mean, if there's anything anyone can work on, little congressional assistance in that or whatever, you know, getting some of that rewritten, how that looks.

Sarah: Well, and I came from an agency that was able to retain an entire unit of 13-ish folks when all of those consolidations were occurring because within our Department of Education, our commissioner understood the complexities of our award and knew that if all of those positions rolled up to a department level, they weren't going to be able to support the program and were able to coordinate with our state leadership. And it served the program very, very well. So I think we have a little bit to be desired still in that space to get agencies the support that they need 100%.

Carol: So what has been your favorite thing to work on or accomplishment in your role? And Katie, I'm going to kick that to you to start us off.

Katie: Well, I've really enjoyed my role here with the QM. There's a lot of things that I enjoy, but the task that I've enjoyed the most is really having the ability to dig into the new uniform grant guidance that went into effect October 1st of 2020. For one of the things that I did while doing that was I took the old uniform grant guidance and the new ones and did a side by side where all of the things that were taken out were redlined and all of the things that were added were highlighted, and I'm really excited for that tool to be shared with the agencies right now. That's with RSA to get the stamp of approval, but I've used that tool already to help update all of our things on the website and all the tools that we're sharing with everyone, and I think it's going to be a really helpful tool for the agencies.

Carol: I love that tool, Katie, so much because even when we were down doing to last week and some of the just the nuance pieces that came out, when you're reading it and you go, okay, that language did change. Like there is a slightly nuanced variance to this that I hadn't completely grasped until you see it in the red and the yellow, and it all highlighted up. I mean, it was pretty nice.

Katie: Yeah, they did a lot of plain language changes, which is really evident when you look at the side by side.

Chris: I'll jump in here and tell you what my favorite thing is. And it's when we were working with a state intensively and, you know, we've been working with them for a long time, and you get to know them really well and you understand their environment and how things work, and they come to you and say something really profound, like, I was watching this training the other day and they got this wrong, and they got this wrong and they got this wrong. It is like a proud parent moment. When you go, they understand what the program is supposed to be doing, and they understand when other people not necessarily are getting it wrong, but mostly they're able to recognize what's not absolutely correct. And it just makes you feel like, oh, we have come so far.

Carol: It's like fly, little bird, you're flying.

Chris: Yes.

Allison: That's probably one of my favorite parts too, Chris, is the state work that we've done and how you get to know these state people. There's so many amazing VR staff across the country, and their hearts are all in the right place, and they want to do good. That's what I've enjoyed is getting to know these people better, broadening my network as well because I learn from them. But just being that resource I do like, I'm one of those weird people that likes digging into the laws and regs and finding where is that gray, vague area that we can interpret a little better. So part of the TA work, you know, really digging into some of the laws and some regulatory guidance I've enjoyed as well.

Carol: I have a story I love to share. I was having a breakdown probably a year ago, Sarah's laughing at me, I had a breakdown. You know, you're providing TA to state you're so ingrained with them, especially when they have a corrective action plan, you feel like you're part of them. I always say we, you know, when we're talking because I feel like I'm part of their team and we've been working on a particular piece of it, and nothing that we sent in was anything RSA wanted. All I knew was that this was not what they wanted, but we couldn't exactly figure out what they wanted. And it was driving me crazy. And I'd called Sarah and I said, I think I have to quit being a TA provider because I suck at this. I'm not able to help them. I haven't been able to figure this out. I am done, and I went to bed that night. I actually was on site with another state and I woke up at two in the morning and I do my best thinking as I'm sleeping. It's so weird. I've done it my whole career. I wake up in the middle of the night and have an idea. I woke up at two in the morning. I'm like, oh, I know what they're talking about. And I got up and I typed, I typed for like three hours and then got up for the day and got ready for the other state. But exactly what was needed was that, I mean, when we ended up meeting with the state and then they met with RSA, and that was the thing. It was the thing that was needed to get accomplished. And I felt super proud that we could kind of like, figure it out. It took a while. I almost quit, but, we got there in the end.

Sarah: You know, being in the final year of the grant, everybody's asking the question, what comes next? And of course we don't know what comes next. But I think my favorite part is looking back and building the relationships. So kind of touching on what all of you all have said. Relationships are important to me. Building the trust we are learning alongside of them just like they are. I always say there's no top of the mountain that any of us are ever going to reach when we've arrived. It's a daily learning process, but the program financially is so complex and trying to take those federal requirements And each of the state's requirements, which we've acknowledged already are all different, and bring that together in the center. And there's never been a resource to help agencies get down in the weeds, look at their systems, look at their processes, and help them navigate through that. And so just having something to offer and having directors send an SOS text at 9:00 at night, or we've talked to directors who have been in tears or excited because something really great has happened, and they want to share the success. It's all of that. Just being able to provide that valuable resource and support them along the way has been very rewarding for me. I know, and you all, but especially I think for the States.

Carol: So if you had a crystal ball, what would you predict regarding the financial state of the VR program over the next three years? And Chris, you get to start us on that lovely prediction.

Chris: Okay. Well, since I don't have a crystal ball, I think Sarah touched on this a little bit earlier. So for several years, the message from RSA and from Congress has been to spend, spend, spend. And so there's been a lot of changes in all the agencies to be able to spend more, to spend quicker, to do everything quicker and faster. And I think the spending is catching up. And I think that it might go too far. Like Sarah mentioned, the pendulum is going the other way, and I don't think the fiscal forecasting is robust enough to be able to predict when it's going to get hard. And since most directors do not come from a fiscal background, most directors come with the VR heart that you know is what a counselor has, paying attention to that. Fiscal forecasting is going to be a critical, critical point. And I know that most states are not doing it right. So that's my prediction. More people are going to be reaching out asking for fiscal forecasting and understanding how to look at this program in the future.

Sarah: And I think to tack on to that, I think we're going to see new technology and new resources emerge that will assist our agencies. Again, like Carol said earlier, some days it feels like we have our big chief tablet out and we're still doing things old school. And I think the only direction to go is up. So I think we're going to see some new resources, hopefully in the technology world develop, that will assist our agencies so that their focus can remain on the customers where it belongs.

Allison: And I would have to say ditto to both of that, especially the fiscal forecasting and the pendulum swinging the other way. And a lot of states considering order selection or going into order selection. But one of the things that pops in my mind that might happen over the next three years is reauthorization of WIOA. I know the discussions are happening with Congress right now, and if that implementation happens, you know, what's it going to look like? Because ten years ago when WIOA was passed, it was a huge impact on VR. And it still is. I mean, we're still challenged with trying to get everything implemented, trying to spend the minimum of our 15% on Pre-ETS. There's just so many things that we're still working on through. So very interested to see where that's going to go.

Carol: And I definitely think like nothing ever stays the same. So we always think like we're going to get to the place and it's just going to be even flow, like it's all going to be cool. We don't really have to pay a lot of attention, and I don't think that's ever going to be the state of the VR program. Like it's going to constantly need people paying attention. Whether the pendulum is one way and we have loads of money or it's the other way and we have no money now, like we have to somehow try to like even this out with the fiscal forecasting and all the things you're doing. But if you think you're going to get to the place where like, oh, I've reached it, Nirvana, it's all great. That's never going to be like this job takes constant attention to detail and what is happening. And so it is always going to be work. It's going to take a lot of effort from a lot of people. And as all the new people keep coming and going, figuring that out for the team so that you can sustain the practices and things that you have that help you to understand what's going on.

Katie: Yeah, I would just agree with everything that everyone already said. One of the big pushes that was brought up at CSAVR, is technology, and I think it is going to be interesting to see what kind of technology is introduced in the next three years that's going to help assist our programs.

Carol: So what is your best piece of advice for our listeners? And I'll let anybody open that one up.

Allison: I'm going to say you need to have a deep bench of leaders who are adverse in the financial requirements, maybe incorporating fiscal training for all staff on an annual basis, whether that's just refreshers or making sure new folks being hired understand all the requirements. But fiscal needs to be part of your ongoing training with staff. It's just critical.

Carol: I'd say, for directors coming in, I know the tendency is to want to be like, I have to know everything. I'm the director, I need to know all things. And even when you don't know the things, you pretend, you know the things. Don't pretend you know the things you don't know. Like you need to be humble and figure it out and learn and be willing to learn. For a lot of folks that are growing up in the VR system, having that sort of physical part of your brain, it may not be completely there. You're like, I went into VR because I didn't want to do math, and now you're in charge of, you know, $300 million in a program. And so you've got to just continue to learn and chip away and figure out how you can gain that really strong understanding, because you cannot just hand that off to some other group and think someone's managing that for you, because the buck really does stop with you in the end. As far as the responsibility over the control and allocation of the VR funds. So please keep learning, as Allison said, and be open and be humble when you don't know things and ask.

Sarah: There's a song by the Beatles called With a Little Help from My Friends. Everybody needs a Little help from time to time. And I know over the years we've worked with most of the agencies, but there are some that we haven't, and I've always assumed they're good. They don't need us. They're fine. It's not always necessarily the case. So acknowledging if I pick up a phone and call a peer or a fellow director, or hopefully the TAC continued to exist beyond this grant cycle. Reaching out and asking for help is okay, and it's encouraged.

Katie: Yeah, mine will be through the lens of policy and procedure. That's where I keep hitting. That's my passion on this QM team. We have a ton of resources available, and if you're struggling, you're looking at that table of contents saying, I can't do this. Reach out, give us a call. We can help you with prompting questions just to get the thought process going. And you can do it. It's going to be okay.

Chris: Ok, my piece of advice is to make connections. And I think everybody has kind of said that in their own way. But make those connections so that you have people you can reach out to and ask questions of whether it's us at the TA center, other states, other fiscal people. You need to be able to ask, how do you do this? What do you think of this idea that I have? How would you handle this? I mean, being able to have that connection and that type of conversation is critical 100%.

Carol: Well, I sure appreciate you all. And while we're still around, all our listeners can still connect with us. And we do have a QM fiscal email address. I will spell out for you. It is QM f I s c a l at v r t a c-qm.org. So qmfiscal@vrtac-qm.org. So please do reach out. We still are around for a little while and we can be your phone a friend. So thanks for joining me today guys I really appreciate it.

Chris: Thank you Carol. This was great.

Allison: Thanks for having Us.

Sarah: Thank you.

Katie: Thanks.

{Music}

^{Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!}

Join us for this enlightening episode of VRTAC-QM Manager Minute, where we explore the transformative power of Value-Based Purchasing (VBP), also known as Performance-Based Payment (PBP). In the studio, we have Chip Kenney, Co-Project Director of the VRTAC-QM, and Lisa Mills, a consultant and subject matter expert in VBP, sharing their expertise.

VBP is more than just a financial model—it's a strategic shift designed to drive better outcomes for individuals with disabilities. By aligning provider incentives with measurable performance outcomes, State Vocational Rehabilitation Agencies (SVRAs) can enhance the quality of services, improve consumer results, and optimize costs.

Tune in to hear Chip and Lisa discuss how SVRAs can harness the power of this approach to revolutionize service delivery and create a meaningful impact. Whether you're considering adopting VBP or seeking to refine your approach, this episode is packed with insights you won’t want to miss!

Value-Based Payment Methodologies to Advance Competitive Integrated Employment: A Mix of Inspiring Examples from Across the Country

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Full Transcript:

Chip: Virginia reached out and they wanted to include value based purchasing specifically in their Disability Innovation grant. I said, this is an opportunity we can't pass.

Lisa: Is there anything about our payment structure that incentivizes or rewards this kind of quality that we're saying we're not getting, thus reduce the amount we're investing in unsuccessful closures.

Chip: When we can get to that point where we can identify and measure and demonstrate and get quality outcomes that will move this whole system a gigantic step forward.

^{Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.}

Carol: Well, welcome to the manager minute. Joining me in the studio today are Chip Kenney, Co-Project Director of the VRTAC for Quality Management, and Lisa Mills, Consultant and Subject Matter Expert to the QM on Value-Based Purchasing. So here's a little context for our listeners. Value-Based Purchasing, also known as Performance-Based Payment, is a model that offers financial incentives to providers for meeting certain performance measures. And as state rehab agencies look to improve outcomes for individuals with disabilities, the quality of purchased VR services, and overall cost effectiveness. A Performance-Based approach might be an option, so I don't want to steal their thunder, and I'm going to let my guests discuss what they're doing today. So let's dig in.

Lisa, lets' start with you. Can you tell us a little bit about yourself and how did you find your way kind of into this VR space?

Lisa: Sure. So I've been in the world of disabilities for my career, for the entire career. So, 33 years, I think where now I've lost count. But about 20 years ago, I got really interested in employment working with Self-advocates way back before there was such widespread support for ending Subminimum wage. You know, the support that we do see now, but that was at a time when that it wasn't even being discussed. But Self-advocates were very clear that they wanted to earn more money and have more opportunities. So I got interested in supported employment and why we weren't using it very much. And so I started working with Medicaid and long term support agencies on improving employment services and outcomes. Back then, there was something called the Medicaid Infrastructure Grants, which allowed states to create Medicaid buy ins for working individuals with disabilities. So I really dug in around what were we doing around employment services. And of course, that brought us to the relationship with VR. And about 16 years ago, I started working on customized employment and developing ways to pay for customized employment, and worked with a couple VR agencies at the time on payment structures for customize. And then most recently, I'm a mom of a transition age son who used VR supported employment services to get his first and second jobs, and he's been employed in competitive, integrated employment since 2020. He's about to turn 21 and that has changed his life. So I'm a firm believer.

Carol: Good for him. That's really cool to know. I always love it finding out the stories people have, because you never know, we all get here a different way. But I love your path. So Chipper over to you. And I'm going to say Chipper because I'm naughty. He Chip is my colleague. So for our listeners I do like to rib Chip a bit. So Chip, how did you find your way into the VR space?

Chip: So very similar to Lisa. My whole career has been in public rehabilitation for a bit then technical assistance centers, but fast forwarding to about 2009 was interested in customized employment and its applications, and the need for VR systems to have an employment system that really addressed what people with the most significant disabilities needed to be successful, and I was sort of glommed on to that space ever since. And then with the passage of WIOA, it just seemed a really necessary connection that VR agencies and systems have something new they can offer. People who would have considered going into sheltered employment now are coming out. What are you going to offer them that's new and different from when they went in and have been at it ever since, mainly focused on the implementation side of it, because there's a bunch of trainers in that space and they're all really good. But we learned early on that it takes an infrastructure to embed, implement and sustain customized employment over a period of time. And so that's been my focus the last several years. I mean, we're still learning a lot. And rate structure is part of that, which, I mean, I've known Lisa for years too, but rate structure is something every agency struggles with. And when the opportunity came to work with Lisa on this and move this forward, I thought, this is a big missing piece that we have to fill.

Carol: Absolutely, I'm underscoring that 100% because we know we get a lot of rate work with our QM work and the whole idea and customized employment with that sustainability. You can have the great idea. And we're going to do the thing and we're all excited. But then what happens. Year one and two and three and four as it goes on and it all fades away. And we don't want that to fade away. We need to have that good sustainability plan. So Chip, how did you get involved in bringing Lisa on board? What was kind of the impetus of that?

Chip: Virginia reached out. The state of Virginia reached out to us and they wanted to include value based purchasing. And they mentioned that specifically in their Disability Innovation grant, and somebody referred them to me. I mean, I knew a bit about it, but then as soon as I saw the Lisa connection and started reading her work on it, I said, this is an opportunity we can't pass, even though I don't have any experience. But Lisa brings all that and the knowledge and the background and said, it's really important to be a part of this.

Carol: Very cool. So, Lisa, I understand you have a very unique superpower. You can speak and interpret languages across multiple partner systems. How did you develop that?

Lisa: Well, I guess I'm a bit of a policy wonk. I did a lot of interviewing of people from different systems to try to understand what was going on with partnerships, what were the challenges. And this was probably 12, 13 years ago. I was doing some work with ODEP at the time, blending and braiding. And when I was doing a lot of my interviews interviewing the different partners, including VR, I figured out that a lot of what was going on at that time was sequencing. It was really not blending or braiding, and if we wanted to get to braiding and ultimately to blending, I felt like we really had to find what was going on then as something foundational, you know? And that's where I kind of coined the term sequencing and said, this is really what we're doing, but we can help people understand then what it means to switch from sequencing to braiding, what it means to switch from braiding to blending, and really start to get people interested in the advantages of moving away from sequencing. So it really was just wanting to dig into each system enough to figure out what solutions might improve collaboration and outcomes. Sometimes it can be easy to lay out all the issues, right? Everything that's not working, but to really dig into each system and figure out where could we align ourselves, where are we aligned, and we just don't realize it? That was more, I guess, the policy wonk side of me.

Carol: I love that because I think I've been on lots of work groups over the years, I mean, I just have when we've worked between, you know, departments of education and your state Department of like maybe developmental disabilities or whatever you are calling it back in the day. And then in the VR system when we all had different ways of describing everything and we could get stuck in the what's the problem? Here's all the problems. We got problems. We have a million problems. Here's all the hundred problems we have to get through before we can get to a solution. But if you go in and go, I love that. Like, how are we aligned right now and what are the things that we could build off of right now instead of always focusing on that whole myriad of things? But I think understanding each other, how we speak about things and we may say the same word, but it means something different to each of us. Once we can kind of clear up that dictionary and talk the same language, it makes it much easier to comprehend what's going on in each other's systems and how that can then work together. I love that you have that. So what is the essence of Value-Based Purchasing?

Lisa: So to me it's quality service combined with efficient service that results in quality outcomes. So I think about that. Efficiency without quality that would not lead to quality outcomes. We'd hurry up and do things, but we wouldn't really see the quality outcomes we wanted to see. And at the same time, if you have a quality service that goes on and on and on, you lose the cost effectiveness and you typically you lose the job seeker. They're going to give up or go find a job some other way. So to me, we have to recognize we need both quality and efficiency in the way services are delivered and that we have a set of quality outcomes we want to achieve. And we have to ask ourselves, to what extent are we getting those quality outcomes? And to me, if we can figure out a payment structure that balances rewarding quality and efficiency and is really clear about what is quality and service delivery, what is efficiency and service delivery, and then what are we looking for? As quality indicators and outcomes? We can design a payment structure that really will deliver on that. And I think as you start to think about that, you realize how the existing payment structures really aren't set up to do those things for various reasons. And that really, I think, helps people buy into the idea that there might be a better way to do this. And this idea of value based purchasing might actually have some legs.

Carol: So that payment structure piece, that's my interest. How did you really dig in and kind of figure it out? Because it sounds good and I understand all the things you're saying about quality outcomes, but how when it comes down, like putting the rubber to the road, do you get at the nuts and bolts of figuring out the payment structure?

Lisa: So everybody always wants that. Next they say, so tell me what it is. And I always say it is what you need to develop locally in your system. You need buy in from those who are purchasing and those who are providing, and you've got to bring them to the table in a constructive way. So in a really collaborative way, sometimes we talk about it as co-creation and you dig into what do we agree is quality service, how do we differentiate quality service from service that we would say is not high quality. And then what do we agree is efficient service? How do we differentiate efficient service from service we would say is inefficient but very important to VR agencies, at least those I've spoken to. Are these quality outcomes, the career path outcomes, the jobs with benefits, the jobs with more hours and better pay? You know, some of these things, you're just not necessarily seeing a lot. You're getting outcomes that you can count as a 26 closure, but they aren't the kind of quality outcomes that, and you see some revolving door effect of certain people who and I know that's a big issue in some states or you see a lot of dropouts in the process. So in every state it's important to sit together and figure out what should we be doing better, what does better quality look like, and then what is quality and efficient service look like? That's how you get the buy in to establish a payment structure that where people want to implement it and intend for it to work. I can certainly share examples of how that co-creation works going on elsewhere and what the ultimate outcome was, but that is what happened there. And I really like the idea that and really believe that you've got to do a local co-creation process to get to something everybody's bought into and something that has a high probability of working. I would never say, oh, Value-Based Purchasing is this. It's only this. Or you just take this model from this other state and you plunk it down here. That won't work.

Carol: Yeah, I can see why you sing to Chip's heart there. Because he's all about systems work, you know, and that whole and everybody's systems in your state are so different. How you're set up, what your relationships are like between your providers and yourself and other entities and all of that. So I do like that you're speaking to that and you can't just pick up and replicate because you've got all your nuances that are happening in your state, and you need to understand those before you can get to the agreeable solution. That makes a lot of sense.

Chip: And it's not only that, and we're finding this to be true now that providers are not a monolith, that there's not a state where you can go, okay, every provider looks like every other provider. There are a lot of uniquenesses, a lot of variables that have to be taken into account to bring at least the majority of them on board. And that's we're finding that to be true as every state system is different, every provider network or non-network is different.

Carol: Absolutely. And even when you think about the states, kind of just the like the geographic challenges they have and the things that are going on, we've saw such an increase, especially after Covid with people moving and some of the states go like our cost of living in certain areas has gone up exponentially, like 300% or something. And so you've got everybody like, decided because they could work from anywhere. We're all moving to this town and then other areas become depleted, maybe from people, and there's less resources available and harder to get providers to serve an area even though you have customers there. I just feel like we have a lot of geographic and economic challenges across states, even tiny states. It's been super interesting. We've found that work as we've been just doing plain old rate setting with states, so let alone what you guys are digging into. So what are some of the biggest challenges in implementing this value based purchasing?

Lisa: I would say the time it takes to do it right. I think sometimes state agencies and I'm not singling out VR, but they want quick solutions. You know, they think about it for a long time and then they say, okay, we want to do it. Let's get it done. Can we get this done in three months or can we, you know, and you have to say probably not in a way that would be successful. And so it is something not to take lightly and to really commit to invest in. I think there's a lot of additional benefits to doing this, including provider relationships and the learning that goes on. Providers now understand what it's like to step in the shoes of a funder. Funders understand what it's like to step in the shoes of a provider. I always think that helps with everybody getting on the same page and agreeing to a model they think will work, but it takes patience, it takes partnership. Some states are, they're very uncomfortable with bringing providers in. They tend to develop things and then release them to providers. So you've got to have a level of trust when you identify the providers you want to involve. I always encourage to identify who are your high performers. They are the providers you want this model to work for because you want more high performers and you want those that you have to expand their footprint, for example, to go into geographic areas that are underserved or to hire more staff.

So always thinking about partnering with the high performing providers. But there's a bit of reluctance, you know, and risk in doing that and saying we're going to create something together. Lots of outside the box thinking. It's really hard to get away from payment models that you've been invested in for a long time. Milestone fee for service. Just to think beyond those can be very difficult, but I think once people start to and that's something I do, is kind of bring ideas and thoughts and stimulate thinking to get them to move away from those models and really say, what should we be paying for? What is important to value in the payment structure? I think it really gets to be very exciting, or at least I think so. You really need data to you cannot develop a model without good data. Sometimes the data is readily available. It's reports that VR agencies are already pulling out of their system. Other times the data's in the system, but they don't typically pull it. And so we have to work with them. And it helps to have a data analyst to assist with this process, to be able to pull pieces of data or data analysis and different ways that informs what we're doing. We want a data driven approach. And sometimes, of course, you probably know that data analysts are very, very busy or they're off doing something else. And it may be hard to get them committed to the work.

Carol: Have you seen improvements since? I'm just thinking since WIOA and kind of the requirements that RSA has put on state agencies about collecting a vast amount more of data. Have you seen improvement as you're working with states that they actually have data they may not have had years ago that you can get at. I mean, there might be a little bit of a problem with the staffing or getting your data analysts to pull it, but that availability of the data you need to really to dig into this, that it's actually there.

Lisa: Yeah, I do think the systems are pretty sophisticated, and it's a matter of helping them understand how to use more of the data they have, because we have the standard WIOA measures. We have the way that VR talked about its performance prior to WIOA but I think we're digging in to get it more data elements that help us understand. One of the most important things to understand is demographic information and how that affects maybe how difficult or how easy it is to serve someone. So, for example, adding criminal background to someone's demographic profile, or we know from history that, you know, that does create a challenge. So it's weeding out what are the things that differentiate people who VR would serve and try and understand better how that relates to cost. The other thing that's really important that I don't typically see is what's the average cost of a successful case? So I see this is the average cost of successful closures. So taking all successful closures and dividing it by the number and then average cost of unsuccessful closures, then average cost of a case. But for me what matters most is what are we paying for a successful case if we're including everything we're paying. So including all the that we're spending on unsuccessful closures in that and saying, basically this is what it costs to get a successful case, because we also have to pay for the unsuccessful closures and trying to focus on how do we reduce, how much we're paying for unsuccessful closures, and to really make sure more of the money that we're paying flows to successful closures.

There's a little bit of complacency that goes on with every system where if we just compare ourselves to other states, we may say, look, we're doing better. We should be happy with our performance. We are better than 75% of the states. But if we stand back and compare that to people without disabilities and their participation in the workforce, I think that's when we say we're comparing it to school. Like if you got 60% on a test, would you pass it or would you fail it? So I think we have to challenge ourselves to say we may be doing better than so many other states, but we are not performing at a high level and we want to move up. We want to not just judge ourselves by other states. Now, 100% success is unrealistic. I don't think there's anybody who would disagree with that, but it's important for the providers and the funder to come together and say what kind of improvement above where we've been. Do we want to try to incentivize? Do we want to see and to develop the payment structure, to say we believe this structure will directly influence our ability to move those percentages up over time and thus reduce the amount we're investing in unsuccessful closures without reducing the number of people were serving, without cherry picking, but truly improving outcomes.

Carol: I love that that is a good way to challenge the thinking that's going on out there, because people sort of, I don't know, poo poo or they just this is over there in that bucket and they let it be. And we're kind of complacent with just, you know, we're doing better but is better. What's the next state like. You know, like better than what. And so what does that matter.

Chip: But I think I mean, the key to me is the concepts of quality, the quality of services and quality outcomes. And if you can define and you can measure and you can demonstrate quality of services and quality outcomes, it seems like you don't need to compare yourself with other states. You can say this is quality in our state. This is what we're doing. This is how we're doing it. These are the outcomes. So state by state national comparisons are way less important. So when we can get to that point where we can identify and measure and demonstrate and get quality outcomes that will move this whole system gigantic step forward.

Carol: 100% Chip. So what would be your best advice for states as they're listening. Right. You know, they're listening in and they're thinking, well, I want to do something, but I don't know what to do. Like what would be the next steps? What should they do?

Lisa: To me, it's, start the conversation. I find that the process of bringing state people together with providers, that they're all learning together about this different way of thinking, And it helps because it does take a little bit to get your mind around what Value-Based Purchasing is and how it's different from milestone payments or fee for service. And I've often seen like people have come up to me sometimes and said, you know, it was the third time I heard you talk that the bells finally went on, you know? And I said, that's fine. I think it's just the way it is. It's complicated in a way, because it's so different. So getting the conversation started and thinking about, you know, asking yourself questions like, is there quality in the outcomes that we want as an agency that we're not getting quality and service delivery? We don't feel we're getting quality and outcomes we're not getting. Then think about your payment structure and say, is there anything about our payment structure that incentivizes or rewards this kind of quality that we're saying we're not getting? Sometimes maybe there's something there. Sometimes you could say, no, there's absolutely nothing in the payment structure that does that. And then I always say, think about the providers that you think are doing the best work for you. Are they financially benefiting? Are they doing better financially. And in some cases I've seen no, there's no difference. I'm performing better, but financially that's not being recognized. And in other cases I've seen they're actually earning less because they're doing such a good job and they're very efficient. You know, they're producing quality with efficiency. They're actually doing more poorly financially than some of the providers who are performing at a lower level of quality. So I think when we start to think about those questions, people see that the need to try to figure out a different way to do things, then they're willing to, you know, let's talk about what this Value-Based Purchasing is what the principles are, how it's different, and begin to think about how we might bring our high performing providers into a conversation with us about this.

Chip: My advice for states is that you're in this for the long haul. To Lisa's point very early in this discussion that this isn't a quick solution. That's something that can just be laid in the state and just immediately adapted. It does take that level of discussion, that level of understanding, collecting data. It's complex. And sometimes I think to myself, why am I choosing to get involved in the complexity of Value-Based Purchasing overlaid the complexity sometimes of customized employment, but I think in the end result we will have a much better system, much more equitable service delivery system for everyone, including providers, including customers and job seekers. But just keeping the discussion going on things like this, things that CSAVR presentations Getting this into the national discussion, I think, is the first step.

Carol: Those are really good tips. Where outside of VR is Value-Based Purchasing being implemented?

Lisa: So definitely in the Medicaid world, most of your listeners are probably aware of that, but mostly in the Medicaid world, it's on the acute primary care side. So hospitals and doctors, primary care physicians and things. So I always caution people there's things we can learn from that and those examples. But it's not a wholesale import those approaches over to VR. I don't think that would work. But there are some principles or strategies that we can use, like there's a concept called shared savings. There's some other things that I think we can think about and use, but we still have to develop something that's specific to employment. In my work on this around employment on the Medicaid side has been with the long term services and support agencies, the DD agencies, the mental health agencies, managed care organizations who are doing LTSS and employment is a perfect place to start with them around their thinking, around Value-Based Purchasing. They're facing some pressure. I would say some to use Value-Based Purchasing because it's seen to be working on the acute primary side of Medicaid. So they're saying, why aren't we using it in LTSS? And they want better quality and better efficiency too. They want to see people supported to achieve their highest level of independence. They want their high performing providers to do well.

So we worked on it with employment because it's so obvious that fee for service, which is the typical payment model, disincentivizes all the things that we associate with high quality supported employment, the better you are at getting people jobs, the better you are at coaching and fading because you're good at it. We reward providers under fee for service with less money. And those providers are performing more poorly, end up with more money. So it's not hard to get people to see why fee for service doesn't work for supported employment. So we've worked on models for job coaching that pay for hours worked rather than hours of coaching, so that providers are appropriately financially compensated if they do better at fading, which goes back to what kind of job did they get people, as well as how good they are at coaching. That model incentivizes them to get people more hours. So if you start with 12 hours a week, that doesn't mean you stay with it. If they're doing well, the employer wants to increase that. The person wants that they can get paid more in the model. Fee for service providers don't get any financial remuneration for increasing people's hours worked, even though we say that's a goal.

So that's been a lot of where we see some of the value based models developing. We're paying for things up front services like exploration, which I'm really happy to see the results of states that have added exploration and exploration to their waivers, because we now have a way to tackle people who say no thanks in a planning meeting or I'm not interested, or their families say that we've been paying for developing payment models for that. That's an outcome payment. So they complete the service, then they get paid based on the quality of the information they submit and the efficiency. So there are ways to align what we're doing. Providers certainly appreciate that they would like to be paid the same way. Typically once they experience being paid in a Value-Based structure. So that's where it's happening. But think about just the general business world. There are so many examples of payment based on performance or quality, right. Sales Salespeople earn incentives for sales. So business has long been doing this in terms of creating those kinds of incentives and even nonprofits. Now, United Way and others are funding nonprofits based on outcomes and deliverables. They're no longer funding them to just provide service. So I think if you look, we're seeing it everywhere, really.

Carol: So you brought up a whole lot of points. If people are interested in more information, do you have resources we could send them to?

Lisa: Well, in 2021, I did a publication that looked at examples from around the country that I'd been in some way involved in. That's on the Lead Center website as well as there are a series of webinars we did at the time with representatives from various states. I have a lot of information about what's going on in the Medicaid side. Et etcetera. So I guess I would say that was my thinking in 2021, I continue to learn and evolve my thinking, and I think we're at a point now where we're trying to do in Virginia, is move beyond both fee for service and milestones, because neither are working very well, right? So you've got some state VR agency saying we're paying fee for service. It's not working. Should we move to milestone? But if you talk to states who are using milestone, they will also say it's not working very well. Some of them are thinking about going back to fee for service. And I'm thinking, I don't think we should do either. I think we should work together to figure out what's the next way we attempt this that addresses the shortcomings of both. And I think that pathway is Value-Based Purchasing.

Chip: and helping moving states to. Well, I'm a little concerned about the unknown. What we have may not be working now, but it's the known. I don't really know what's ahead, but I think where in Virginia at least, has done a really good job of creating that safe space. Like, let's explore this together and keep this comfort zone of what we currently have, but move forward into something that's more equitable and beneficial for them.

Carol: So, Chip, if people wanted to reach out, what would be the best thing? Should they contact you or what would be best?

Chip: Either one of us is if it's a state agency, probably me if it's others listening to this. Lisa.

Carol: Do you want to give them your email address?

Chip: It's r k e n n e y at SDSU (San Diego State University) dot EDU.

Carol: Awesome. And, Lisa, do you mind sharing your email address?

Lisa: No, but I'll warn you, it's long. So here we go, Lisa Mills l

L i s a M i l l s, all one word, at M as in Michael, T as in Tom, D as in David, D as in David, dot On Microsoft, all one word, com. And that was my IT friends who gave me that ridiculously long email, which I hate.

Carol: Holy smokes, that is long. Well thank you both. I really appreciate it. And I will put a link in our podcast announcement out to your publication from 2021 as well. Then folks could at least see that. But thanks for your time. I really appreciate the conversation.

Lisa: Thank you.

Chip: Thanks. We really appreciate this opportunity.

^{Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!}

Join us for the latest episode of the Manager Minute podcast, where host Carol Pankow sits down with the incredible Serina Gilbert, Cheryl Carver, and Peter Pike from Colorado's Pathways to Partnership DIF Grant!

In this episode, they dive into their groundbreaking Pathways to Partnership project, a collaborative initiative designed to enhance outcomes for children and youth with disabilities. Discover how they're embedding VR counselors in schools, launching the innovative “Map My Transition” app, and partnering with Centers for Independent Living to create a brighter future.

Tune in as the team shares valuable insights, learning experiences they've faced, and what’s on the horizon for the grant’s second year. Don’t miss this inspiring conversation about transforming lives through partnership and innovation!

Listen Here

Full Transcript:

{Music}

Serina: To support the families that are surrounding these young adults with disabilities, as well, to help them gain the skills to be able to help those students move into competitive, integrated employment.

Peter: The centers for Independent Living are required to deliver core services in one core service is supporting young adults transitioning into high school.

Cheryl: We will actually incorporate those components of the six core skill sets and the age ranges, along with all of those local partners into map my transition.

Serina: Gosh, there's so many things we're doing.

^{Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.}

Carol: Well, welcome to the manager minute. Joining me in the studio today are the Tri-Force from Colorado, Serina Gilbert, Cheryl Carver, and Peter Pike, Co-project, directors for Colorado Partnerships for Partnership DIF Grant. So how are things going for you, Serina?

Serina: I'm doing fantastic. I like that word Tri-Force. It feels really, really fancy. It's October here and it's like almost 80 degrees, so I'm happy.

Carol:  Ahh, good for you. You know what? In fact, I had to use a little ChatGPT because I said, well, how could I describe a fearsome threesome? And they gave me all these different things. And I went, I'm going to go Tri-Force. I really liked it.

Serina: So don't tell people your AI secrets. You came up with that all on your own. you did it.

Carol: I know, I know, how about you, Cheryl? You are old hat at this. I got to talk to you a couple years ago, which was super fun. So Cheryl's like the podcast queen now. She's on this twice.

Cheryl: I'm with Serina, though. I liked that word too. I thought it was empowering. I think this is awesome. We're going to have to use that again. Things are going well. Always busy though, you know, and the DIF grant has added to that, but in an awesome way in terms of growing, expanding and learning. So we're excited to be here today.

Carol: Awesome. And Peter, welcome to the podcast. I'm so excited you are on. How are you doing?

Peter: Well, I got to tell you, I'm a little nervous. This is my first time joining a podcast, so I'm not sure how it's going to go, but I appreciate the opportunity. And I'm coming off of two big meetings today, one with the Centers for Independent Living, where we get to get caught up on priority topics, and of course, our Disability Innovation team meeting. We meet on a regular basis. So the timing is great.

Carol: Good. Well, you're all bringing the energy. So that's great. So I just want to do a little quick refresher for our listeners so they understand what the earth we're talking about. So I have been doing different series on the Disability Innovation Fund grants. And this particular grant has to do with the Pathways to Partnership grant that was funded by RSA, and it supports projects aimed at fostering deeper collaboration between agencies. Turning these collaborations into true partnerships, and the projects aim to enhance service delivery by piloting cohesive models that better manage resources, while coordinating efforts to improve outcomes for children and youth with disabilities and their support systems, ultimately facilitating smoother transitions. And Colorado is wrapping up the first year of the grants. So let's dive in and see how things are progressing. All right. So let's get into it Serina, I'm going to kick off with you first. Could you just start by telling our listeners a little bit about yourself and how you got involved in VR?

Serina: Sure. So you already know my name is Serina Gilbert, and I'm currently a program manager under our youth services team with the Division of Voc Rehab here in Colorado. I actually got involved with VR because I was a recipient of VR services way back when, when I was in college, and while I was receiving services, I kind of flipped the script around, I was like, well, what do you do? This looks fun. Like, I want to learn this. So I got my master's and a few years later, here I am. So I've always enjoyed working with youth. That's always been my passion and I'm super excited to even be in this role.

Carol: Awesome. So, Peter, what's your journey to get to VR? Tell us a little bit about you.

Peter: Well, that's a great question. My name is Peter Pike and I work for what's called the Colorado Office of Independent Living Services, which is part of the Division of Vocational Rehabilitation. And I got to tell you, for a couple decades, I actually worked outside of the Division of Vocational Rehabilitation as a vendor and as like a community partner on different grants. And a few years back, Colorado established this Office of Independent Living Services, dedicated to working with nonprofits called the Centers for Independent Living. That's how I got involved with the Division of Vocational Rehabilitation, and I'm also a person with a Non-visible disability. And so this fits very nicely in terms of my philosophy and being part of the Division of Vocational Rehabilitation.

Carol: I love that because you bring a whole other perspective. Having come from that vendor field. So you've got some things going on that can contribute greatly to the agency and this project for sure. And Cheryl, last but not least, you know, it's been two years, but let's tell our listeners again a little bit about you and your journey into VR.

Cheryl: Well, mine is not as direct as Peter's or Serina. Again, my name is Cheryl Carver. I am the second program manager we have here in the state of Colorado under Voc Rehab for our youth services and transition programming. So Serina and I work very closely together. I kind of fell into this by accident, but I have always been in healthcare related fields. I've worked for the independent living centers. I've also worked in assisted living and I worked as a vendor as well with DVR in the mental health sector. After that, I really lucked out and was able to apply for a position. That was 24 years ago and I joined the youth services team 20 years ago, so it's been an indirect path, but once I found my niche, I have loved growing in this position with youth services at the administrative level.

Carol: I love it, you know, no matter which way, if you come in a direct way or lots of people, it's kind of a long and winding road to get into VR. Whatever way you get here, we love the energy you all are bringing, and we think it's great because people are bringing all kinds of different perspectives to the work now. I was super excited about your project when I was reading through RSA's website and looking at the little synopsis, and I'm like, oh, I got to grab the Colorado people first. You're the first in my group on this particular topic, and I understand that your project has multiple components. Can you give our listeners a little overview of the project and what you aim to accomplish? And I think, Serina, you were going to kind of give us the big picture to start out with.

Serina: Yes, it's a very big picture. So I'm sorry. We dreamed really big when we saw this grant posting last spring. We saw a lot of opportunity in our state to maybe help build some capacity and some connectedness throughout the state. So one piece of it is we started out by deciding to build what we're calling interdisciplinary teams. And what that is, is traditionally in Colorado, we don't usually have DVR counselors housed specifically in the school districts. We do have counselors that liaison with the district, but they are not like actually full time there. So we actually just did some hiring, and we'll have a couple of counselors starting in the next few weeks that will be housed directly in the local school districts and embedded with the school transition teams to make sure that services are able to be delivered to the students with disabilities within those districts. Another super exciting part that coincides with that is that there'll be services provided by the Centers for Independent Living, which Peter will talk a little bit more about as well, to make sure that there's a dedicated service provider to be able to help support those teams. And one really big, huge thing that we're really excited about is what's going to be called Map My Transition. And we jokingly call this the You are Here Website. So it's going to be a website and iOS app and an Android app designed for students, their families, educators and service providers and other community agencies within the state of Colorado. And the way that it'll work is we'll start from the student perspective, as the student will create an account on the site, they'll be asked a few questions about where they reside and what their long and short term goals are, and then they'll be presented with customized resources and videos that are specific to what their needs are, and specifically, how to get connected with the agencies that can support them. The super exciting part about that is that that also allows kind of that turnover resistant piece of things, because The educators and the service providers can also see that same list of community providers that are specific to their geographic region. So if somebody leaves a position, the next person can come into that position and get connected on this website and instantly know who their community partners are within their geographic area to connect with.

Carol: I love that app idea though.

Serina: I'm so excited about it.

Carol: Well, you know, when you talk about kids like students, man, they're not. Don't email them. They're not out looking on the internet.

serina: No.

Carol: like their phone is their life. Like they need everything to be direct connect that way. That's how they're going to, you're very smart to go that route.

Serina: Yeah. So we're super excited. Also gosh, there's so many things we're doing also to support the students. We are partnering with our family led organizations to support the families that are surrounding these young adults with disabilities, as well, to help them gain the skills to be able to help those students move into competitive, integrated employment. But then that's not all, I feel like a game show host.

Carol: Do tell more.

Serina: I know, I know. I'll have Cheryl talk a little bit about our interagency transition building as well, because that Map My Transition is also going to support that aspect of what we're doing here in Colorado.

Carol: I think that's cue to you, Cheryl.

Cheryl: I was just going to say, is that my cue? so five years ago, Colorado began an initiative through the National Assistance Center on Transition Coalition, and we began looking around the state to identify where our own gaps and weaknesses were as it pertains to interagency coordination teams. What we discovered were several of the components that Serina has mentioned that we hope to build into Map My Transition. Things like we were having trouble sustaining interagency transition teams, and that was due in large part because of turnover and staff. When interagency transition teams were coming together locally, they placed those responsibilities with an individual instead of their position. And as a result of that, once that person left, there was nobody to continue on with the work. And these interagency transition teams just eventually dissolved. Additionally, they really didn't have any goals that kept them together and gave them a reason for continuing to come together. So we wanted to help the local partners rediscover their interagency transition teams, identify tools that would help bring them together and give them an actual purpose. As a result of that work, what we created was a workbook for all partners that come to the table locally in these interagency transition team efforts, every partner at that table is required to identify within six core skill set areas that we've put together an age range, what services they actually provide. That way, when education is working on developing an IEP, an Individualized Education Program, or other entities sitting around the table like the division of Voc Rehab, developing their individualized plans for employment, we can look and see what areas does this student need to grow in, depending upon their age and their skill gap.

With that, then we can pick and choose and strategically work together towards the same goals with that student. So we actually have coordinated student outcomes. We are not duplicating services. The challenge we faced was that the workbook, because we didn't have any backing to help us complete this, is overwhelming and it's difficult to use. And as a result of that, again, this is where Map My Transition comes in. We will actually incorporate those components of the six core skill sets and the age ranges, along with all of those local partners into Map My Transition so it will be easier for all users, whether it is the youth themselves or a family member, or any one of the number of entities that sit around an interagency transition table to be able to go in and see, we know what the students ultimate goals are, and these are the areas we are working on. So let's take a look at and consider what are the choices for the service providers. So I am also extremely excited about Map My Transition, because I think it is going to be fabulous in terms of what we are envisioning to create, as well as to help interagency transition teams accomplish that coordinated student outcome.

Carol: I think that is going to be super replicable across the country, like the work you guys are putting into that, because I know that's one of the things with the DIF grant, they're hoping that some of the things you all create are going to help other states out there. And that particular piece, I think that's fascinating. I think that sounds really cool.

Cheryl: I agree. So with that, we'll take it to the next level, if you will, and continue to enhance, we hope at least. What else would do you want me to kick it back to you, Serina, for apprenticeships or family member training?

Serina: I forgot about our apprenticeship piece because we're just doing so many things. We shot for the moon, right?

Carol: Yes, yes you did. There's like, 20 moving parts on this thing. I'm like, wow.

Serina: Cheryl is correct. One other aspect was to make sure that we're connecting young adults with apprenticeship and pre-apprenticeship opportunities. So we are partnering with our apprenticeship representatives here in Colorado within the Department of Labor and Employment, called Apprenticeship Colorado, and they will be helping the counselors and the interagency teams learn about how to connect with employers for apprenticeships and actually be developing apprenticeships in the areas that we're serving. And then they're also going to create training for us to put on Map My Transition for future reference, but also train our staff on it. I did talk a little bit about the family led organizations in the training, but what we didn't talk a lot about was the Centers for Independent Living Partnerships, and I'd love for Peter to be able to cover that a little bit for us.

Carol: Peter, I know you're passionate about those CILs for sure.

Peter: Yeah, I always love the opportunity to talk about the Centers for Independent Living. And maybe a starting point is to just briefly talk about what is the Center for Independent Living, right? These are nonprofit organizations that actually exist in every state of the Union. And so in Colorado, we have nine centers for independent living that are focused on helping people with disabilities of all ages, any disability type, living as independently as they can. And I want to be clear, that doesn't mean they are residential facilities. These non-profits are not residential facilities. They are non-profits that we have contracts with to support people living independently in the community, and they are a key partner. One of the great things about this grant is there was a requirement that Centers for Independent Living be part of this grant. And so with that, it really accentuates some of the strengths that they have. There are two things that come to mind. Number one is the Centers for Independent Living provide peer support services. What that means is that these organizations have over 50% people with disabilities from the board of directors, all the way down to their entry level staff. And that is key because an emphasis of this program is peer support services. So in their work for this grant, that's what they're going to be doing, is working with young adults in high school, transitioning out of high school to Address and navigate some of the adult issues that come up, whether that be employment, post-secondary education and otherwise. So that's an important strength.

The second strength that I believe the Centers for Independent Living offer is that this service system you don't age out of just because you turn 18 doesn't mean, oh no, now there's another program I need to join. As I said earlier, Centers for Independent Living serve all ages of all disability types. So that provides a key continuity of services as folks transition out of high school into what's next. So in addition to that, the Centers for Independent Living will have contracts with the centers for Independent Living, serving on the interagency teams and some of the expectations in terms of the services they're going to be providing are things like benefits, planning services, things like financial literacy. They'll be focused on supporting and educating people on accessing what are called ABLE accounts. Able stands for achieving a Better Life Experience, but it's an opportunity for these young adults to actually increase their assets and resources. In addition to that, they will also be serving as vendors for the Division of Vocational Rehabilitation. And so those are key elements that they'll play in working alongside the interagency transition teams with the school districts, with the Division of Vocational Rehabilitation. So it is a great opportunity for those organizations to really illustrate their strengths and the difference they make in the lives of people with disabilities.

Carol: I love that you are leveraging the Centers for Independent Living, because I think sometimes people I don't know, they're there, but you sort of forget about them as being a resource for more than maybe folks are thinking about. Oh, somebody needs a ramp to get into their house. Let's call the CILs, you know, type of thing. But they have a lot more going for them. And they're strategically positioned throughout your state and in every state. You know, they're all throughout all the geographic areas. So they're excellent partner to leverage. When you're looking at an endeavor like this I think that's smart.

Peter: You know Carol, it also fills one more gap. Like the Centers for Independent Living are required to deliver core services, and one core service is supporting young adults transitioning into high school. So with this particular project, they're actually working with youth in the schools. That's not necessarily part of their core services. So it really complements the opportunity to start the work earlier and support it ongoing even when they're out of high school.

Carol: Yeah, I really like that, Peter, I think that is so great. So I know you guys are you know, you're at the end of year one and you made it. You made it through year one. What kind of learning experiences. And I love it because I'm not going to say what sort of challenges did you have? What learning experiences have you had so far? Cheryl, I think I'm kicking that to you.

Cheryl: You are. So while this is a multi-pronged approach that we are taking, if you will, with several different outcomes for each one, we have encountered challenges that we have had to overcome or lessons we have had to learn along the entire way, starting from the very beginning with communication. Even between this Tri-Force. And I don't think it's a terrible thing to mention. That was one of the things that the grant reviewers brought up how, as three managers, are you going to do this job together? And we were like, we can manage this, we can handle this. We did. We had to learn how to communicate well together. We had to understand one another's styles and figure out what worked best for each of us in order to come together, agree upon things and respect when somebody didn't, and hear them out, even if that was not the direction we were going to go in. Inclusion has been another one. While we put above everything equity and diversity and inclusion. Just because we are the division of Voc Rehab, it's still easy to overlook or forget to give certain audiences the opportunity to have a say in things, especially something this large. And when you're moving forward and you've got deadlines and timelines, having to take a step back and say, wait a minute, did we check with everyone is really, really hard. So fortunately, again, because there's three of us, we always have that one that raises their hand and says, wait a minute, did we do that? So it's good to have that piece there.

When we're working with our planning and advisory team or other partners around the table, we are also learning all about marketing and how to go about getting the marketing. We need to message things correctly and deliver that message out there to the communities about things as simple as trainings that we hope to offer to family members in partnership with our parental consortium here in Colorado. We are maintaining, I think maintaining is a good word, maintaining a huge, massive budget and having to be willing to be flexible within that budget. We are given certain parameters to operate within, and we have to go about getting changes approved periodically. But every time we turn around, there's been another new need or a new requirement or oh, wait a minute, we calculated that wrong. So we've got to go back and recalculate it. It has absolutely been, I think, a learning process for all of us. Another area that we have worked very diligently in is just as a state government, where we have had to learn different processes and procedures. Things have taken longer than we expected, having to write reports in certain manners or fill out certain forms. That in and of itself has been a hurdle that we have had to overcome together in regards to learning things.

Carol: You guys are not unique. I mean, I do ask this question of everybody when I'm talking about the DIF grants, just because the learning opportunities you've had this first year, it is really common because there are so many systems and practices and processes within each state. Everybody's got their own little nuances and things. And when it isn't your everyday job to navigate those and you now are co-directing, you know, this Tri-Force and this lovely DIF grant, and you're getting exposed to all these other processes that you didn't know about. It is quite a learning curve just to get through all of that. And once you get it figured out, then you fundamentally go, okay, you know, year two gets easier. It's like, all right, now we figured out all the pieces of the process and it gets better as you go along. So that is common. Everybody, I don't think I've talked to anybody across the country that hasn't had that as well. So I think you guys stated that really nicely. Now I know you all when I got to visit with you a little earlier, you had mentioned that you had this really important realization about your service model and that maybe it doesn't work like you thought it was going to work. When you are conceptualizing something and then you're going to put it into practice. So I don't know. Peter, can you talk a little bit more about that?

Peter: Yes, thanks. I'd be happy to. So as we've been talking, we talk about establishing three pilot sites or three interagency teams. And so we went through a process with our planning and advisory team, came up with a matrix, and we were able to identify three sites. And so we have this vision in this model about how those sites are going to be implemented and moving forward, including the Centers for Independent Living. And so one of the communities where we are working to establish a pilot site is in northwestern Colorado. And the school district that's involved is based out of a rural community, but it's also a mountainous resort community. And so what that means is the cost of living in that particular area actually is pretty high. And there's been articles on it within the city and across the state talking about challenges, just filling some government positions in that community. And so as we were having conversations with that interagency team, particularly the Center for Independent Living, that serves not just that community, but a five county area, they talked about the challenges. If we're going to have a contract with and bringing on a staff because the wage and the affordability for someone to live in the community that they're serving don't align very well.

And so we've had to sort of pause and talk with our local partners about, man, what does this need to look like in order to meet the needs of the students and families in that school district, and at the same time, navigate some of these real issues around the cost of living. And so we're taking some extra steps in working with the Center for Independent Living and the school district to identify maybe where do we need to bring in new partners or other partners, or what are alternative ways to deliver the services that are necessary to meet the needs of the youth and families, right? Just because you're living in a resort area doesn't mean everybody is of the same economic class. And so our aim with this project is to make sure we're serving underrepresented communities. And sometimes socioeconomic status is kind of an important factor in that way. And so we have to take more time and understand how best to meet the needs of that community and how it might look different than the other two communities where we're continuing to move forward with all the parts.

Carol: That's a really excellent observation. I know VR has been facing this ever since the pandemic, kind of across the country, especially as people moved, you know, we had like floods of people moving to Florida, people moved into Idaho and different communities. And I know the directors have said, boy, it's impacted the program in different ways because now you have whole communities where they've had this big population move in and all the prices have gone up. And so it's tough even to get counselors and different staff working in these different regions and even to get vendors in those regions because the cost of living is so expensive. So you've got people there who've been there for many years, but yet new people are coming in and you've just got this kind of mire of crazy economic conditions that make it really difficult to navigate all of that for the consumers that are in those areas. So that is a really good realization you had. Now, I know we're on year two like you're three days into year two. You guys, what are your plans for year two? Miss Serina.

Serina: Sound like I'm in trouble.

Carol: Oh, no.

Serina: No, no. We have a lot like we talked about it a little bit earlier where we're hiring the school based rehabilitation counselors. We're well into that. And making sure that they have the training and support that they need to get started with everything. We're super excited because we're in the early stages of planning their kickoff meetings, where we'll be on site with each of the teams and help them, A, get on the same page and like kind of level set everything like so everyone has all the same information. And then one of the bigger pieces is that they all walk away with a tangible plan for how they're going to initially start collaborating and coordinating services with one another. So we're super excited about that. Another thing that I'm really personally excited about, because I'm kind of a marketing and social media dork in a way, is we're going to be coming up with some branding and a way to refer to this grant that resonates with the people that we're serving with students, families, educators, and, you know, the service providers that are working with us. Saying DIF grant, unfortunately, doesn't mean much to the average person. And there's a lot of DIF grants now. I believe they just funded the fifth or sixth round of them. So.

Carol: Oh yeah, and there's like 28 of those or something.

Serina: Yeah.

Carol: so there's a bunch

Serina: There's a lot. So we're super, super excited to get some branding and social media going and things like that to get people excited about what we're doing. Um, what else are we doing? Team what am I missing? Those are some really big things that we're doing.

Carol: Do you have anything cool that you're doing with the branding? Like can you share if there's something little or is it all top secret right now.

Serina: No, we just, thanks to our grant manager, Lauren Riley, and our program assistant, Amy Smith, they found us a marketing agency, and we're going to be meeting with them in the next couple of weeks so that they can talk through kind of what our needs are and things like that, and then they're going to have some focus groups with stakeholders to get their input and see what resonates. So I'm super excited.

Carol: Very cool. Very cool.

Peter: You know, Serina, thanks, sort of opened up an opportunity to talk about family and youth engagement. And one of the opportunities we have with this project is we actually can pay honorariums to young adults and families to participate, particularly on the planning and advisory team. And so we definitely want to hear the voice of the people we're serving and bring them to the table so that as we bring this to life, we have their input from the beginning.

Carol: Yeah, I love that, that's great, you guys, the energy of the three of you, it is super funny. I can feel it like our listeners can't see it. But coming off the zoom screen. Like it is so fun. I think you three complement each other very nicely. Now, I know for our listeners, you know, sometimes people want to reach out to you. I know you're in your initial stages, but sometimes folks just have questions or they're super interested, like Map My Transition, they're gonna be like, when's that going to be ready? Because we want to borrow it like we want all of that. Do you have an email or something you can share with our folks on a way to contact you?

Cheryl: We'd like to direct those questions to our actual grant manager, who is Lauren Riley, and her email address is l a u r e n dot R i l e y at state dot co dot US.

Carol: Excellent. Now that's helpful because otherwise the stuff goes kind of all over. And I do end up hearing back from the different folks we've had podcasts with. They're like, oh, we had some people reach out. So I'm hoping folks will do that. Are you three going to be at the CSVAR conference?

Cheryl: Not the upcoming one.

Carol: Possibly in the spring?

Cheryl: Maybe.

Carol: Yeah, because then people can track you down there as well.

Peter: I'd like to. Next time you talk to Kristen, say, hey, Kristen. Sending Peter to the CSVAR conference?

Carol: I'll put in a plug for you, Peter. That's awesome. Well, you three have been an absolute delight and I really appreciate your time. And I'm hoping I get to check in with you down the road to see how things are going. And I wish you the very best with this project. Have a great day.

Cheryl: Thank you, Carol.

Serina: Thanks so much, Carol.

^{Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!}

The RISE-UP project is a transformative initiative to revolutionize rehabilitation services for underserved populations, focusing on racial and ethnic minorities. Dr. Mari Guillermo and Dr. Mark Tucker, Project Directors at San Diego State University's Interwork Institute, highlight how this project seeks to drive systemic change through state agency partnerships and tools like QA Advisor Plus. RISE-UP strives to reshape vocational rehabilitation and improve employment outcomes nationwide by fostering equity, inclusion, and access.

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{Music}

Mark: QA Advisor Plus, a tool that agencies can use to check their RSA 911 data for errors and to help facilitate or expedite analysis of their own data.

Mari: How do we close this gap? Where are people not being served, what populations specifically are not being served? And the emphasis is on systems change because we can't improve these outcomes without really looking at what needs to change within that system.

Mark: So we hope that when you see information about the survey coming out, that you take a few minutes to fill it out and can provide us with information both about what they see as needs related to serving underserved populations. But also, we're asking folks to identify any promising practices that they're aware of with respect to providing effective services to underserved populations.

^{Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.}

Carol: Well, welcome to the manager minute, Dr. Mari Guillermo and Dr. Mark Tucker, are co-project directors with San Diego State University Interwork Institute. And they are joining me in the studio today. So how are things going in San Diego, Mari?

Mari: Uh, well, it's warming up. It's going to be in the 90s by tomorrow, but it's also the start of the semester at San Diego State University. We're in our second week, so things are still trying to settle down, but it's been quite a good busy two weeks for sure.

Carol: Oh, good for you. Well, I was in San Diego back in June and I'm going, okay, why isn't it warm here now? It was warmer in Minnesota than it was in San Diego. It was so crazy with that kind of, I don't know, marine layer or whatever hangs out. Yeah. How about you, Mark? How are things going for you?

Mark: Going well, yeah, That marine layer in June we that's like a typical thing June Gloom we call it. And then we pay the price in September. September is usually warm for us, but we'll get back to our normal San Diego weather in October.

Carol: Nice. I do love your fair city though. It is really awesome. Well, I thought, and I'm so glad I could get you two because I've been trying to snag you. I think I've been talking to you since last December, but now is finally the sweet spot. I thought it was super timely that we talk about the project given you're at the end of year one. October is also National Disability Employment Awareness Month, and I really think the project that you guys are embarking on could have a significant impact on the employment arena for underserved populations. As a little side note, we're super happy as part of the George Washington University team to be a partner on this project. So I want to give our listeners just a little bit of background. Over a year ago, RSA competed a discretionary grant, and the grant was specifically related to section 21 of the Rehab Act, as amended by WIOA, which requires RSA to reserve 1% of the funds appropriated each year for programs under titles three, title six, and seven to provide grant, contract or cooperative agreement awards to minority entities and Indian tribes to carry out activities under the Rehab Act. Secondly, minority entities and Indian tribes to conduct research training to or a related activity to improve services provided under the act, especially services provided to individuals from minority backgrounds. Or thirdly, state or public or private non-profit agencies or organizations to provide outreach and technical assistance to minority entities and American Indian tribes to promote their participation in activities under the Rehab Act.

I learned a whole bunch. I know for our listeners, you're getting a whole history lesson, but I thought this was cool. And so under this priority, the department provides funding for a cooperative agreement for a minority entity or an Indian tribe to provide training and TA to a minimum range of 5 to 15 state VR agencies over a five year period of performance, so they are equipped to serve as role models for diversity, equity, inclusion and accessibility in the workforce system by implementing policies, Practices and service delivery approaches designed to contribute to increasing competitive, integrated employment outcomes for individuals with disabilities from underserved populations. And the other cool part is that you also need to contribute via our research and really good practices that promote access, and this will be really of great benefit across the whole country. So I'm super excited. Let's dig in.

So, Mari, typically our listeners like to know a little bit about our guests, your backgrounds. So can you tell a little bit about yourself and your background?

Mari: Yeah, I'm originally from Hawaii, born and raised in Honolulu, Hawaii. I moved to San Diego in the late 80s to as a graduate student in the rehabilitation program at San Diego State University. So since moving to San Diego, I haven't moved very far from San Diego State University and our rehab counseling program. I'm currently faculty in our graduate program, but I've been with the Interwork Institute since its beginning, when it was started by doctors Fred McFarlane and Doctor Ian Champion, and just worked with some incredible number of leaders in our rehabilitation field. And upon graduating from the master's program, I started working with Doctor Bobby Atkins. And for those of you who few of you who are not familiar with Doctor Atkins, she is a leader. When we look at all diversity initiatives and in fact, when we look at section 21, that was started with her groundbreaking research looking at the involvement and participation of African Americans in vocational rehabilitation. But I worked with Doctor Atkins upon graduating from the program in the capacity building projects funded by this same pool of money. And Doctor Atkins was the national director for the Rehabilitation Cultural Diversity Initiative, which then morphed over into the Rehabilitation Capacity Building Project. So I worked with her from the 90s. All the way up to like 2015 I think is when the project ended. So a lot of the work that we are doing in Rise Up really builds on the foundational work that we did with Doctor Atkins back in the 1990s. So it's an incredible honor.

Carol: I think that is very cool. You've come full circle. Oh my gosh, I love that. I had no idea. And for our listeners too, I just want to say a word about Doctor Fred McFarlane. Fred had passed away this summer. Fred has been a good friend to many, and many of our listeners have benefited from Fred's work with the NRLI and the Leadership Institute. Fred was the founding person developing that and really did such an amazing job touching so many VR professionals over his career. And his legacy definitely lives on. So I just I needed to say that because Fred is definitely missed. So, Marc, how about you? Why don't you tell us a little bit about your background.

Mark: Sure, I've got a Master of Science in rehabilitation counseling, and I'm a certified rehabilitation counselor. And in fact, you know, when I was applying to the graduate program in rehabilitation counseling, Fred interviewed me. Uh, that was a few years back. But that...

Carol: Yeah, 1 or 2.

Mark: Yeah, but he was there right at the start for me. And then kind of in the profession, I got my start in community based non-profit agencies and then from there joined the Rehabilitation Continuing Education program for region nine at Interwork and SDSU in the early 2000. And when I was there, was involved in all kinds of different technical assistance, training and research projects, while also kind of teaching in an adjunct capacity in the Rehabilitation counseling graduate program at SDSU. And then eventually the Rehabilitation Continuing Education programs transitioned into the Technical Assistance and Continuing Education centers. So I continued doing that same type of work with what were called the TACE centers, and then in 2014, joined the Rehabilitation Counseling Program faculty at SDSU full time. So that's sort of where I spend a lot of my time. But I still continue working with, you know, Interwork. The two are just so intricately joined. It's really difficult to be part of one without being part of the other. So I continue doing work at Interwork. One of the recent projects that Mari and I were both involved in a few years back was the California version of the Promise Projects. It was a 5 or 6 years of work with transition age youth who were recipients of Supplemental Security Income. Presently, I'm the coordinator of the Rehabilitation Counseling program at SDSU, and do that while maintaining connections to a variety of projects at Interwork.

Carol: Yeah, you're always wearing about 40 hats. I always think of you, Mark, as being the data guy though, too, because you love the data. I mean, everybody likes data, sort of but you love the data. I mean, you've done some really amazing things with our national data.

Mark: Thank you. I enjoy that. I appreciate being able to bring that to a lot of the projects that I'm involved in. Yeah, you're right. I think I find it fun maybe at times where other people are like, oh, we'll leave that to somebody else.

Carol: Yeah, absolutely. Oh my gosh. So why don't you guys tell us a little bit about your project? I know it's called Rise Up. Maybe you can tell our group like what's that stand for? Everybody's got their fun acronyms and what you're trying to accomplish.

Mari: The name really captures the overall vision for this project, and we have to give a shout out to Doctor Chaz Compton because after several failed acronyms, as we were writing the proposal, it was Chaz who came up with the name. And RISEUP stands for Rehabilitation Improvements in Services and Employment for Underserved Populations. And so that really captures what we're aiming to do, improving the services and in the process of improving services, improving the outcomes for underserved populations, in competitive integrated employment, in careers, in academic achievements and accomplishments now underserved populations. There's many ways we can look at that, but RSA has defined it for us and it concentrates on race and ethnicity. So it encompasses individuals who are black, Latino, indigenous, Native American persons, Asian Americans, Pacific Islanders, and other persons of color. And so that is the specific focus for this grant and the population that we hope to impact ultimately with the work that we do with the state agencies. An important component of the project is the partnerships that we aim to build with ten state agencies. And that partnership is really important because while we think about this work is okay, we'll do training and technical assistance and all these different topics and how it intersects with these different populations based on evidence based practices and promising practices. But we can only do so much with training and technical assistance. We really have to look at, okay, how does this then translate into the work that goes on in the agency and not just in the agency? How does that look at the different levels within the agency? How a director would translate the training will look different than how a counselor or a technician would translate.

We hope that it complements each other, but everyone has a different role in this process. And that's the other part of the project, is that we want to really look at the whole agency and all the different levels, and being able to provide that support to them where they need it. And really looking at how do we close this gap? Where are people not being served, what populations specifically are not being served within a state or a section of the state? And the emphasis is on systems change, because we can't improve these outcomes without really looking at what needs to change within that system. And there's different components that we're going to be incorporating into the project in our partnerships with the state agencies to look at what are the strengths and weaknesses within your agencies and what are the opportunities and gaps. And while there are big challenges that we all are aware of, there's also some great things going on and we want to highlight that, and we believe we'll be able to find that also within each of the state agencies.

Carol: I like a couple of things about what you just said. Well, I like it all, but a couple things stick out to me because holistically, we've seen it as we do TA and as people put in new initiatives in place. If you really get the whole agency going in the same direction, it is the rise or fall of that project for sure, because maybe the director is all in, but the mid-level managers and the counselors are like, I don't even understand what's going on. You're asking us to do this other thing? I don't get it. It seems weird. It's extra. I don't want to. I'm not going to. And then it doesn't happen. And so you really have to get everybody in sync. So I think you're smart to look at the whole organization and how everybody interprets the information and the training and how it actually gets implemented, because it isn't the director implementing it. It's the boots on the ground folks, it's your counselor. You need your line folks engaged and involved and giving you feedback and understanding what's happening. So that I think that is brilliant. Secondly, the data I think it's been interesting and I think Mark, it's some of the work that you've done over the last couple of years that I've known you as well, that as people start to get better about looking at their data, I think folks were looking really high level, not getting into the real intricacies and seeing the maybe the disparities that are happening in employment as you start looking at different races and ethnicities and who's getting what kind of work and what those outcomes are. And then we've seen states be completely shocked, like we didn't know we have a huge problem in this area. So I think getting at the data is super important. So I know, Mark, you and I had spoken to and you talked about this special wrinkle, and we're not using wrinkle in a bad way. It was in a good way. But you have a contractor called Encorpe and they're bringing something special to the project. Tell us a little bit about that.

Mark: Sure, and this relates a bit more to the data aspects of the project that we were just talking about. So Encorpe is a partner on the project. It's an organization that's headed by a couple of individuals with considerable experience with the public VR program, and they offer a tool that's known as QA Advisor Plus. So this is a tool that agencies can use to check their RSA 911 data for errors and to kind of help facilitate or expedite analysis of their own data. So users of the tool can run custom queries on their data. They can do things like track changes from quarter to quarter in things like population served on a variety of measures that might include things like applications or eligibility plan services, competitive integrated employment outcomes. Those are the kinds of things that are of interest, particularly to us as part of the Rise Up project and built into this project is that Rise Up will pay for one year of QA advisor Plus for participating agencies if they elect to use it. So agencies aren't required to use QA Advisor Plus if they don't want to. We have other strategies for helping and assisting with data analysis if they elect not to use it, but that's there as an offer. Rise Up will cover one year of the cost of that service.

And I think one of the things that we're trying to get at is that through the project is to kind of help facilitate kind of long term attention and ongoing attention to things like population served and differences in services and outcomes, and to use that for more data informed planning, in our case, particularly around underserved populations. But agencies can certainly pretty easily extend that out to other groups of interest or other aspects of the rehabilitation process. That may not be maybe the central focus of what Rise Up is doing. And one of the things I sort of want to underscore here is that the project is intentionally designed to make considerable use of data that the state agencies are already gathering and reporting to RSA anyway. So if agencies are interested maybe in participating in Rise Up, but they're like, oh, I don't want there to be like an additional heavy burden on my data folks or my direct service folks. Our intention is that things will be fairly light with respect to those kinds of demands, because we'll take advantage of existing data that's already being gathered, and then we'll either use QA Advisor Plus or some of our own staff to assist with the analyses.

Carol: That's the beauty of this project really, I love that because it isn't like you're going, okay, state, we're knocking on your door to like, come and do this thing. And then you need to add like ten positions to pay attention to this. And I think it's great because I got a chance to look at that QA Advisor Plus. I saw the Encorpe guys at, CSAVR and they were like, hey, do you want to see a little demo of this? I was like, oh my gosh, I know as being a small blind agency director, we had one data person who's doing a million things, and so we were very surfacey. We got a little bit of stuff, but it was really hard. You have one person there doing a million things, and so that tool, I liked how it kind of rose up little things. It had that cool feature and it would just flag something for you to go like, hey, what's going on in this particular area? That would have been so lovely because I know a lot of our programs are small, so you might just have a half a position or one position that's working in this area. They don't have a whole team that's got all this really developed deep skill set in there. I just think having that added resource is amazing and could really take that level of sort of your data analytics to a whole different place than what you've been able to do so far and not, you know, not disparaging anybody's current skill level at it. It's just that people don't have time because there's so many demands. So when you can add like a feature to help with analyzing that data, it really is a great gift. So who are your agencies that are currently participating in the project?

Mari: So we've had initial conversations with a number of agencies, and certainly there were a number of agencies who had written letters of commitment when we wrote the grant, and that was really important. I don't want to mention the states yet until we have agreements in place out of respect for the agencies, our goal is to have by the end of year two, our goal is to have six agreements in place and by the end of year three, another four. So that will be a total of ten. But we've already started to have that conversation and people are at different starting points, right? And trying to map out how will this make sense and be of value to your agency and mapping that out in an individualized agreement with each of the states? So maybe we'll be invited for a second visit a year down the road, and I can at least give you a few more names more specific than what I'm giving you now, Carol.

Carol: No,  that's totally fine. Absolutely. I wasn't sure if, you know, like, are you needing some people? Because sometimes our listeners are like, hey, I want to be part of that project. I want to be in.

Mari: No, absolutely. And we're more than happy to talk to agencies throughout this whole process, because really the intent is we targeted ten agencies because we want to make sure that with the resources that we have available to us, that we use that in a way to really make that impact, to really try to get to that systems change because again, change doesn't happen overnight and it doesn't happen on a zero budget, right? But the hope is the lessons that are learned from the ten agencies in this work will be relevant to the rest of the country.

Carol: That's what I've loved about all of these different discretionary grants that RSA has put out, because I've been talking to people for the last year, and there is such cool things being done and demonstrated that now they're sharing out, you know, with other people and just that wonderful plethora of ideas. It makes it super fun. And everybody gets really excited planting the seeds of a different way of looking at things and doing things. So you are at the end of year one, and I love it when I talk to all our grantees that have gotten these grants, like, what have been your challenges this year?

Mark: I would say some of the challenges that we've encountered are things that it's not like they're not doable. It's just that they're the time and process demands are, you know, things have sort of taken longer, I guess I've started to come to kind of expect it. But still, when you're anxious to kind of get going and get rolling, these things sort of surface as challenges or frustrations. And so some of them are, I think, very predictable things like fleshing out the project staff, developing and executing subcontracts. I think Mari, she's nodding her head often. It's a little bit more complicated or involved than you think it might be. We've been working on things like establishing the technical infrastructure for the project, information management, information sharing systems, and we have a website that's in development that will ultimately use to share information coming out of this project, with many more than just the ten state agencies that we work intensively with. So there will be kind of dissemination of project learning far beyond those ten. We've been comprehensively surveying the literature related to underserved populations in VR, and it's not really just a challenge. It's just kind of a time consuming thing that we're kind of working our way through. We are going to be implementing a national survey of state VR staff around both challenges and opportunities related to serving underserved populations and the instrument development process is always a little time consuming, and you get a lot of feedback and you make revisions and there's several feedback and revision stages.

So that's something that will be surfacing in the near future. That's just it's taken time, but we'll get there. Or going through things like the human subjects institutional review process, just to make sure that everybody's, you know, treated well and treated ethically. So those are all, you know, just things that have moved along or are moving along and we're squaring them away. But for those of us who are like, would like to just get going, all of that process stuff at the beginning is a little bit of a challenge. One thing that I think the team is wrestling with a little bit, and this is something that I think were a challenge that we will contend with going forward, and I've got confidence that we'll be able to address it, but it's just going to require some thought is that, you know, as Mari indicated earlier, the underserved populations of interest are defined by race and ethnicity. And we know already from looking at our data over a long period of time that our clients, like everybody else, often are multiracial, and they check a whole bunch of boxes So we're not going to necessarily be able to look at clients who are folks don't fall neatly into very convenient categories, right. So I think we're going to have to be very sensitive to that dynamic in the process and probably develop multiple ways of looking at race and ethnicity, so that we don't kind of miss any really important lessons that are coming out of this project.

Carol: Absolutely. And regarding that national survey, is there something our listeners can do to be of help in that or something they should be looking out for?

Mark: We're still in the process of piloting it like we want to get it right before it goes out, but we will be working with one of our project partners, which is CSAVR, to disseminate this national survey. It'll be an electronic survey, and it's really designed to go to VR staff at all levels. Like we talked about earlier, involvement of folks, feedback from folks at all levels in VR system really important. So VR staff at all levels, folks like SRC members will be disseminating it through CSAVR. And we would encourage everybody to, you know, I know we survey ourselves all the time in society here in the US. But this one is important. And to me and I think to the overall intent of the project. And so we hope that when you see information about the survey coming out, that you take a few minutes to fill it out and complete it. It will be anonymous. It won't be linked back to you. So we hope people will respond candidly and provide us with information both about what they see as needs related to serving underserved populations. But also, we're asking folks to identify any promising practices that they're aware of with respect to providing effective services to underserved populations. I think both of those types of information can be really helpful to us in terms of planning out the future of this project, designing effective training, effective technical assistance efforts. So we see it as one way of kind of triangulating that information. We will look to triangulate it with other forms of information, but really critical to kind of building some of the key infrastructure to the project.

Carol: Good.

Mark: Yeah.

Carol: And we definitely can be a help to in passing out the word when the survey comes out. I know Chaz, he'll be like, Carol, can you get that out in our email groups too? We have lots of different ways. We communicate out. We have different COPs. We've got lots of mailing lists and such, so we can help kind of promote the word to get at the different groups of folks. So you get kind of a wide range of participation. So I know, Mark, you've alluded to a few things that really you've learned so far this year. One, because always year one's a learning year because people don't fall neatly in boxes. Are there any other kind of learnings you've had from year one so far, or Mari, too. either of you?

Mark: Yeah, I'm going to defer to Mari on this one.

Mari: We've learned a lot. And when you say, what have you learned so far? It's almost what has been confirmed. The whole reason why this funding opportunity is available because there's a gap there, right? And so what the conversations that we've had with agencies is just confirmed that there's a lot of work that we need to do and that we need to do better. But every agency is at a different starting point. Who they consider underserved will vary from state to state, or even from city to city within the same state. Right And where those gaps and inequities occur will also vary. For some states, it's just getting the outreach to communities to that door exists in their area, to certain populations dropping out before they even reach the point of developing an EIP, and other agencies are seeing where the EIP is developed. Things start to roll out and then for different reasons that we want to dig into, we lose people, you know, in certain populations compared to the overall populations being served. And so one of the things we are learning is that we really need to direct the training and technical assistance to where each agency wants to start, but also helping them and working together using that data that Marc talked about to confirm or not confirm whether these actual inequities at different points in the process are occurring.

And then of course, the environment and the climate that agencies operate under impacts what they're tackling, something that we've heard repeatedly. And I'm sure, Carol, you've heard often, is the staffing challenges that our state agencies are experiencing upwards to 40% of unfilled positions, and that will certainly impact the work and the progress and the impact when we start to work with the agencies. Some agencies are further along in the process where they've really looked at the data from their comprehensive statewide needs assessment and saw a hole there and actually started to develop a goal to address that. And so they've already have that beginning understanding and now are at the stage of, okay, what do we do with this information? What kind of training and technical assistance can we provide our staff, and how can you help with this. And getting us to move the needle, at least move the needle forward, right? And I know we're going to get a lot of new information or confirming knowledge from the national survey, but also using that national survey to start the conversation with each of the individual agencies. You know, how does this national data look for you? Is it true or how different it is? And so I think we've learned a lot, and there's a lot more that we're going to unravel in this process.

Carol: I love it. The CSNAs, you know, I think states for a long time did it as a check the box. We have to do the thing. We're going to contract to somebody to do the thing. Here's the thing. It's 300 pages. All right. We put it on the shelf. It's in the electronic folder. But I have noticed this over the years we've been doing the QM work. People are really taking the CSNA and actually paying attention to it and starting to put all the dots together, linking that as the basis for then what flows into the state plan flows into goals and priorities and really connecting and spending more time. The thing I've been very hopeful of is spending time with direct staff so that they understand the whole process, because staff will hear about this stuff, but they don't really understand it or what is that about? And now people are linking like, here's why we're doing all of this. We're actually finding out what's the situation in our state, and we're taking this and we're putting together goals and priorities within our state plan based on this data, this information. So it all links together, because I think people feel like everybody's just doing these random activities, but they actually all come together.

Mari: Yeah.

Carol: So that I have seen as a change, definitely in the five plus years I've been doing

TA work now, I've seen a big swing and I've loved it, because now people are digging down in the organization and including not just your executive leadership and middle managers. They're including the line staff and having them have an understanding of what's going on so that they can understand their contributions to this overall big picture. So I love that.

Mari: Yeah, and we learned that from the Cal Promise Project We had this whole large, comprehensive database and our team were able to put together, I guess, reports of here's what the data is looking like, here's how your region is being impacted, and the transition specialists, the people who are meeting with the families and with the students, like we've never seen this before. We're always feeding data to our supervisor. Our boss is always asking for data, and so we give it to them. But we never know what happens to it. And now it makes sense. This is how my work is impacting people.

Carol: Absolutely. It's mind blowing to the staff because when you go out, you're talking and you're like, okay. They're like, well, why is Congress doing all this crazy stuff with our money or whatever is going on? I always tell them, I go, the only way your story can be told because they don't know all your anecdotal, really neat. You got Joe, a job like this is awesome and it's a great career and you know, all this great things are happening. They don't know any of that. They only know by the data you put in the system. And when you put data in the system, that isn't very good. That's the picture, the story that your agency is telling. This is the only way for other people to make decisions. You just see this. Aha. Like people are like, oh well this stuff actually does matter. And it is being used for something and then they can figure it out. And I love it when you get down in regional levels because then they go like and they'll know what's going on. Sometimes up here the management's like, oh they're trying to figure out what's happening in that region. Talk to the staff. They see boots on the ground, what's going on.

So the data confirms what's been happening in that area. And then the whole agency having that conversation, it's really exciting and super empowering and energizing. I feel like for their customers and what's going to happen for their people, I love that. The other thing I was going to say, Mari too, is we've been seeing a slight improvement in staffing levels. Now it seems like things for some reason, because we work with a load of states and we talk a lot about this particular issue, the staffing levels, it's been leveling off with that whole people leaving, leaving, leaving, leaving, leaving. And now I've had a couple agencies in the last year where they were sitting at 25, 30% now. They're at 5% and 8% turnover. Like there have been significant changes because of all of the things they put into play to not only get staff, but to keep them, to retain them. So we've been trying to do some efforts on our end and we can't say it's all us, you know, but people have been putting a lot of strategy into this, and it's really fun to see on this other side, this more encouraging landscape for the staff out there.

Mari: Wow, that's great to hear.

Carol: Yeah. So I'm hopeful for you guys as you're carrying this out. So now what are your plans for year two as you go into year two? What are you guys hoping to accomplish this year?

Mark: I think it'll be a busy year for us. I think one of the major efforts, you know, we've already kind of alluded to a little bit, which is get the national survey out there to get that information back, have our team kind of start analyzing the results. We'll use that data. As I said before, we'll triangulate that with other information sources that we have our team working on. You mentioned comprehensive statewide needs assessments and state plans. Our team is doing an analysis of that specifically through the lens of underserved populations to see what can be gleaned from those statewide reports. And they're triangulating that also with kind of other forms of published literature around underserved populations. So there's a lot of kind of building that kind of database of information will be focused on executing agreements with the first of the agencies that are going to be involved with kind of the intensive phases of Rise Up, while at the same time kind of establishing the groundwork for agencies that we will add to the Rise Up group, you know, to as we work towards our goal of getting to up to ten state agencies. And then I think as we work with each of the agencies, kind of to begin to identify the populations that they want to focus on for, you know, kind of sustained efforts to enhance getting folks in the door, getting them into plan, getting them services.

The outcomes will also begin to kind of roll out. You know, one aspect of Rise Up will be training. Some of it will be technical assistance. That will be kind of systems change focused efforts. We'll begin to roll out initial training. Some of those will focus on topics like cultural humility And then we'll be using the literature search, the national survey, consultation with the agencies that we're working with to lend direction to the development of additional trainings that will be kind of targeted towards all levels of the organization. And then within the agencies that we begin to work with, we'll also begin kind of identifying the targeted and specific areas of need for technical assistance that will be unique to each of the agencies. So I see those as kind of the major tasks that will be kind of getting into in the beginning of year two and then kind of sustaining through the next year.

Carol: That is super exciting. I'm really excited about this. I would love to talk to you guys too, again at the end of like next year to see where things are at. Now, I understand you to, I believe, or somebody coming to CSAVR and people may want to chat with you. Is there a way folks could reach out to you if they are interested in talking to you about the project?

Mark: Sure.

Mari: Yeah

Mark: Yeah, so we will be at CSVAR, our project coordinator, Letty Vavasour will be there. Mari will be there. I will be there. So we're certainly kind of approachable there. As we mentioned before, CSAVR is a project partner of ours, and we mentioned encore. I think they're going to be there as well at CSAVR. And one other partner we haven't mentioned, but we should give them some credit, is a major partner with us is the George Washington Center for Rehabilitation Counseling, Research and Education. They're also a project partner with us and will be instrumental in kind of our efforts. So CSAVR is one place where folks can connect with us. Our team is working on a website, so we should have that up kind of in the near future. That's another way to get a hold of us. Email is always a good way to get a hold of us. I'm easy to get a hold of by email at MTucker at SDSU.edu and Mari is MGuillermo@SDSU.edu. So those are kind of really easy ways to get Ahold of us. And then of course Interwork Institute and the VRTAC-QM, we're sort of housed right there and involved in a number of those projects going on there so folks can track us down through Interwork or the QM.

Carol: Excellent. And, Mari, would you mind, Mari, would you spell out your email address? Just in case, because like me, it's like, how is that spelled?

Mari: And for those of you who know Spanish, my last name is Guillermo, which is William in Spanish, but it's m g as in George. U I L L E R M as in Mari o at SDSU.edu.

Carol: Excellent. Thank you. I really appreciate you taking the time. I'm super excited. And I wish our listeners could see like, the excitement on both of your faces about this project because it makes me like, super happy. I mean, the project couldn't be in better hands. You guys always do really good work out of Interwork, and I'm really excited to see what comes. So let's definitely chat again down the road.

Mark: That would be great.

Carol: Thanks for joining me.

Mari: Absolutely. Thank you Carol.

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