December 4 - 5, 2019
Process for development of Findings and Observations
SELN team reviewed:
- Illinois Division of Developmental Disabilities (DDD) leadership meetings to discuss identified employment barriers.
- Employment Training Subcommittee Recommendations
- State policy documents and resource materials
- Participant feedback collected during the SELN site visit focus groups with representatives from the state core internal leadership team, Association executives, employment service providers, Supports Coordinators and Division of Vocational Rehabilitation (DRS) staff.
SELN Project Team
- John Butterworth - Institute for Community Inclusion, University of Massachusetts Boston
- Suzzanne Freeze - Institute for Community Inclusion, University of Massachusetts Boston
- Rie Kennedy-Lizotte - National Association of State Directors of Developmental Disabilities Services
- Jeanine Zlockie - National Association of State Directors of Developmental Disabilities Services
The SELN is a membership-based network of state intellectual and developmental disability (IDD) agencies committed to making changes in their respective service systems. The SELN is an active and engaged learning community where members meet to connect, collaborate, and share information and lessons learned across state lines and system boundaries.
Participating state agencies build cross-community support for pressing employment-related issues and policies at state and federal levels. States commit to work together and engage in a series of activities to analyze key elements in their systems to improve the integrated employment outcomes for their citizens with IDD. States receive customized technical assistance to meet the unique needs of their state based on the current system of supports and goals for improvement.
The SELN project team guides member states through a detailed process to both assist the SELN project team with learning about the state system and to assist the state member with organizing and planning for future system changes needed to increase opportunities for those seeking competitive integrated employment and greater community inclusion.
To aid Illinois in the prioritizing and decision-making process, DDD completed the SELN State Strategic Employment Full Assessment describing the state's infrastructure. DDD also invited partners to participate in feedback sessions through in-person focus groups to gather input on 2 current perceptions and experiences. Information gathered throughout the process contributed to this Findings and Observations report prepared by SELN staff.
Organizing the Report
This report identifies the seven key elements, as depicted below in the Higher Performing Framework, that are essential to improving and achieving success as a system in supporting people to become employed in community jobs.
The report summarizes the results of the entire review process as "Key Findings" and suggests opportunities for improvement in "Potential Focus Areas." The state agency and other partners may use the report as the basis for the development of a work plan detailing the outcomes, activities to achieve set goals, and strategies to pursue in the months and years ahead.
The SELN team will conduct follow-up meetings with DDD to identify priority outcomes and develop effective implementation strategies on the state's selected areas of focus. It is important for state leadership to respond through action and implementation of a work plan that includes measurable system improvements over time, communicated regularly to the field, and with consistent stakeholder involvement and feedback.
- Illinois leadership and partners have a strong focus on the importance of individual competitive integrated employment.
- Inadequate individual level outcome data is available to support strategic planning, goal setting, and shared definitions of employment.
- A comprehensive multi-system stakeholder communication strategy is needed as a pathway for the state vision, goals, guidance on service delivery, and promising practices.
- There are substantial financial incentives to maintain facility-based prevocational and day habilitation services. DDD funded supported employment program (SEP) rates do not adequately support individual competitive integrated jobs.
- There are inconsistencies across stakeholders in understanding the service options within DDD, as well as how the services relate to the vocational rehabilitation system.
- There is limited provider capacity to meet demand for delivery of services to support individuals with developmental disabilities in competitive integrated employment services. Currently, there is limited access to the Supported Employment (SEP) within Illinois Division of Rehabilitation Services (DRS) and its SEP milestone payments for people with IDD. The same is true for Customized Employment (CE) with DRS. Marketing and education on both of these DRS services is necessary for community agencies, ISCs, families, people with DD and more. Transparency on data as it relates to people with DD in SEP and CE is essential for ensuring that data reflects an increase in people with DD becoming eligible for SEP and CE. Data can further assist DRS in setting strong goals around increasing DD eligibility for both services.
- The S.T.E.P program is showing promise in preparing students with disabilities for transition to employment and optimum community participation during and after high school.
Priority Action Items
The SELN team recommends early attention to these action areas.
- Develop a strategy for collecting and sharing employment outcome data and related data on employment pathway services to drive decision-making and support clear communication about employment definitions and goals.
- Explore options to rebalance DDD fiscal investments in community-based services and facility based services and provide incentives for expanding individual employment support. Conduct an analysis of the real costs of providing individual supported employment services. State Employment Leadership Network
- Short term: Clarify and provide guidance to the field on billable activities for individual supported employment that incorporate billable services that are not face-to-face.
- Short term: Review and provide recommendations regarding amending current policy regarding contribution to care.
- Develop a training and outreach for Independent Service Coordination (ISC) that clarifies their role and expectations for helping individuals build a vision for employment in the community.
- Short term: Develop and share guidance on using and sequencing the array of employment services offers by DRS and DDD
- Short term: Develop and share guidance on access to and the use of ongoing supported employment services following completion (closure) from DRS services.
- Support providers to develop organizational plans that address the expansion of integrated employment outcomes and organizational realignment and business models to support this outcome.
- Require providers to develop organizational plans that address expansion of integrated employment outcomes
- Establish a provider capacity building initiative that provides technical assistance and other supports to providers that commit to increasing employment participation
- Create a process map and develop a guidance document that addresses the transitions between DRS and DDD services, agency and stakeholder roles (DDD, DRS, ISC, provider, individual, family).
- Clarify and provide guidance on the transition from DRS employment services to DDD ongoing supports (DDD/DRS collaboration).
- Develop guidance for ISCs and providers on the use of waiver funds for ongoing support following DRS closure (DDD) (6) Expand and develop DRS and DDD interagency collaboration to forward the goal of expanding participation in integrated employment for DDD customers including:
- Explore and develop guidance that supports better understanding of access to SEP services and evaluate the effectiveness of current for assessing eligibility for SEP.
- Resolve policy and practice related to DRS referral management including eligibility, intake, and DDD documentation needs.
- Explore opportunities for multi-agency collaboration in the implementation of the Workforce Innovation and Opportunity Act Section 511.
- Clarify and develop guidance on becoming a DRS SEP provider.
- Develop strategy, policy and competency-building activities to support expanding the number of providers who are vendors for both DRS and Medicaid Home and Community Based Services (HCBS) to deliver employment related services.
- Develop a new service that includes discovery and/or job exploration as a time-limited service that supports transition to DRS services.
I. Leadership: Clear and unambiguous commitment to employment in individual community jobs, from top leadership through all levels in the system. Local and state-level administrators are identifiable as champions for employment.
- Illinois has a strong leader in Division of Developmental Disabilities' (DDD) Director Stark who is committed to working with all stakeholders and improving competitive integrated employment outcomes.
- In 2013, the Illinois Employment First Act went into effect identifying, "…competitive and integrated employment shall be considered the first option when serving persons with disabilities of working age".
- Several workgroup and committee discussions led to development of recommendations to strengthen competitive integrated employment and community engagement outcomes for all individuals with disabilities:
- Employment and Economic Opportunities for Persons with Disabilities Recommendations (2017)
- Employment Training Subcommittee - Employment Recommendations (2019)
- IL DDD Employment 1st Stakeholder Workgroup (2016)
- Supported Employment Action Team Summit (SEAT) Key Findings (2018)
- Cohesiveness on messaging goals and expectations on employment and community engagement is split and inconsistent across the stakeholders involved in our review.
- Sheltered/facility-based, congregate and group service structures are deeply ingrained in Illinois' service delivery system. Culturally this has an enormous impact on how leadership may strategically implement changes to prioritize employment and community membership for those receiving IDD services.
- The Division of Developmental Disabilities is facing an influx in the demand for HCB services due to the Ligas v. Hamos Settlement Agreement to address the waiting list (i.e., as of 2025 those eligible for services will wait no longer than sixty (60) months from their 18th birthday for paid supports).
- DDD leadership is supportive of the critical role the service provider network plays in the achievement of employment outcomes and the limitations of the state's current structure especially in the area of financing services.
Potential Focus Areas
- Develop a communication strategy to build a common understanding and investment of DDD's employment goals and expectations.
- Determine what channels of communication work best for Illinois stakeholders about employment opportunities available within the current service structure, successes, and, how to evaluate if current methods are effective and ensure accountability or if additional mechanisms would be of assistance:
- Identify target audiences and communication specific to each audience,
- Identify multiple dissemination methods for key messages, and
- Establish clear messaging strategies across a variety of channels (across DDD, providers, ISC's, individuals and families, etc.).
- Develop a more prominent presence for employment resources on the DDD website for individuals, families, and advocates with stories and scenarios describing how a person is supported on their path to employment through different facets of the system.
- Create guidance and/or frequently asked questions (FAQ) documents that address the employment process and common concerns for specific target groups (e.g., individuals and families, support coordinators, provider organizations, etc.) for the implementation of practices that will lead to competitive integrated employment and community membership.
- Build a statewide network of "champions for employment" among providers, individuals, families and others to mentor and support implementation of the state's Employment First Act.
- Establish a learning community among Illinois service providers and related stakeholders (e.g., DRS counselors, Independent Supports Coordinators) to invest in a long-term vision for employment and to foster a leadership role for providers with regular opportunities to engage with DDD staff and provide feedback on timelines and processes for change across the state.
- Assure that a DDD state employment lead role is established as a key senior leadership position. A key responsibility should be to form an internal working group within DDD to improve systems policy and procedures that promote competitive integrated employment and community participation.
- Continue the strong partnership with the Illinois Council on Developmental Disabilities to identify and fund projects that pilot and message innovative strategies for expanding employment participation and capacity.
- Messaging for employment and partnering in creative ways to identify employment and technology pilot programs
- TA grants to assist providers in transformation efforts, coupled with a targeted amount of state only dollars to support the transition into more individually based supports and services
II. Strategic Goals and Operating Policies: Employment is identified as the preferred outcome in state developmental disabilities policy and is supported by program goals and operating practices that are clearly designed to achieve that objective.
- Illinois passed Employment First legislation, placing emphasis on competitive integrated employment as a priority outcome of public services.
- City of Chicago voted to phase out sub-minimum wage in the next four years.
- Illinois has over 10,000 individuals participating in sheltered work.
- Illinois is the second highest 14c certificate holder state in the nation and the highest number of individuals paid subminimum wages under those certificates.
- Illinois' strong influence of the Intermediate Care Facility (ICF) medical model State Employment Leadership Network 7 service delivery system undervalues the concept of Individuals with IDD leading a self-determined life and their potential for gaining competitive integrated employment.
- The Illinois' person centered planning process was identified during a session with ISC's to be instrumental in achieving an informed choice about employment, but it was identified that employment goals are often altered due to provider capacity or the availability of traditional service options.
- Stakeholders identified need to strengthen collaboration between DDD and DRS to support the implementation of Section 511 under the Workforce Investment and Opportunity Act (WIOA).
- There is inconsistency in implementation of the WIOA Pre-Employment Transition Services (Pre-ETS) across the state, which leads to confusion especially for parents and their understanding of service options available for their student while still in school and upon exit.
- Providers expressed concern about the inconsistency in the referral process to access employment services. Providers described receiving guidance from DRS counselors that a person is not eligible for DRS services if they need long-term supports from DDD. Stakeholders are not clear that it is appropriate to transition from DRS services to long term funding for employment from DDD.
- Due to staff ratios and payment concerns, it is common for DDD supported employment providers to hire a person within their own agency and provide supported employment supports at the same time.
- Providers expressed an understanding that most job seekers use the standard "job placement milestone schedule" and that it is difficult to access the supported employment program (SEP) milestone schedule. A common concern is that the payments schedule does not fund the activity of job development. The supported employment program includes eight (8) milestone payment points that begin prior to job placement, while the standard milestone payments begin after hire.
- Job seekers and their families have limited access to benefits and work incentives planning services. There are only two Work Incentives Planning and Assistance (WIPA) projects active in Illinois.
- Illinois' policy related to room and board payments and post-eligibility treatment of income may create a disincentive for some job seekers to seek employment or to seek better employment with higher wages or for more hours.
- Illinois' National Core Indicator (NCI) data indicates almost half of all surveyed individuals within the sample report wanting to work, but only 25% have an employment goal within their personal plan. Relatedly, during the visit, concern was raised about ISC's tendency to refer to traditional day support services rather than encouraging services leading to competitive integrated employment or community membership.
- Providers expressed an interest in making changes within their organizations to better support employment pathways and outcomes seeking assistance in:
- Identifying and implementing steps to get them from the current "as is" system to the future "to be" system of services and supports
- Staff development to assure experienced and competent staff are available to deliver quality employment services and services that support individual community membership.
- Building capacity to support the cultural shift from Illinois' strong medical model to an inclusion model in service delivery.
Potential Focus Areas
- Work with the State Medicaid Authority (SMA) to consider adding the use of tiered standards as a staged approach to manage and support individuals, providers, and families through the shift from the facility-based legacy services to an expansion of community-based services. Ultimately, the transition should lead to a system fully built on community engagement.
- Identify a structure and forum for addressing employment planning and referral for employment services with the provider and support coordination community. This may include an employment-working group, a regular virtual meeting or forum for employment providers, and specific state and provider level goals.
- Continue efforts to build on work initiated through the Illinois Life Choices System Transformation initiative to:
- be healthy and safe;
- have real relationships with family and friends;
- have a paying job if they want to work;
- make decisions about their lives; and
- have opportunities to contribute to their community.
- Explore how DDD can reframe the services planning process to focus on helping the individual build a vision for employment in the community. Simultaneously consider changes to the personal plan process at both intake and during annual reviews to ensure that individuals are provided the experiences necessary to make an informed decision about employment and to develop both short and long-term steps within their service plan to develop and achieve employment goals.
- Develop a guidance for ISCs to have beneficial employment-related conversations to assure individuals and families have the information needed to make informed decisions about services.
- Strengthen and clarify provider qualifying standards as well as tiered service standards to support the gradual transition to compliance with HCBS setting rule.
- Identify the differences between employment, day, and residential staff roles in supporting employment and develop targeted guidance and expectations for each role in holistically supporting individuals in their person-centered goals.
III. Financing and Contracting Methods: The outcome of employment in integrated community jobs is emphasized and supported through the state's resource allocation formulas, reimbursement methods, and rate-setting practices.
- Illinois' Community Day service definition language specifies support to enhance an individual's involvement in employment or self-employment, including a job exploration component, learning to use public transportation and benefits counseling. However, the service implementation too often leads to continued unpaid facility-based services rather than supporting a person on a pathway to employment as NCI date suggests:
Figure 1. Participation in employment and day activities. Source: National Core Indicators Adult Survey 2017-2018
- DDD has invested in a rate structure review with Navigant to identify gaps in service and funding opportunities. The goal of this work is to revise and rebalance rates and to ensure that providers are adequately compensated and ultimately incentivized to prioritize competitive integrated employment as a service outcome.
- The current rate structure does not support billing for time spent on behalf of an individual (such as job development, travel to the job site, and remote support when services are not face-to-face.
- While sheltered employment was eliminated as a service option in code, facility based work continues to occur in practice under Illinois day habilitation service, which allows separate billing for on-and-off site services.
- Stakeholders were not consistently clear about the role of sheltered employment and did not refer to it differently than competitive integrated employment. When services are not distinct or clear in purpose or intent, the ripple effect extends to funding methodologies, quality management and performance measurement.
- Providers noted that they struggle with how to implement new federal laws and regulations within their current payment structures, which incentivize group services over individual supports.
- There is a continued need to address Illinois current and proposed rates including: unit size, non/billable activities, how employment rates compare to non-work services, why facility-based rates are higher per staff person hour, and ease of using multiple services to support the provision of robust integrated employment services. Currently the rate per hour of staff investment does not support individual employment outcomes and does not account for non-billable portions of employment specialist and job coach time (see Figure 2).
Figure 2. Rates for services
Potential Focus Areas
- Develop and implement a revised rate methodology following rate structure review for all day and employment services to better balance fiscal investments and to meet the increasing demand for long-term HCBS waiver services that offer services that lead to competitive integrated employment and support for community membership.
- Consider adding a financial incentive for providers to become dually certified as DDD Medicaid Home and Community Service providers and DRS vendors to assist in strengthening provider capacity
- Continue to use National Core Indicators data as well as other state and national data to anticipate system vulnerabilities, respond to data trends, and identify needed areas of focus, growth, for policies and procedures changes.
IV. Training and Technical Assistance: Investment in the development and maintenance of a strong, competent workforce. Skill-building emphasizes an expectation for employment across job coaches and developers, supervisors, key employment staff, support coordinators, job seekers including young adults who are still in school, and families.
- DDD is looking for opportunities through DRS to implement additional customized employment strategies by accessing training from Griffin-Hammis and Associates or Marc Gold.
- Providers and ISCs shared that they could benefit from skill-building opportunities related to addressing individuals with more significant support needs and/or those that have historically been in segregated settings.
- Providers, during the site visit, could not identify any specific training related to employment that has influenced the provision of services. They shared that they would like more guidance on what an employment first vision for their organizations could be and some process guidance on how to achieve this over time. Providers also mentioned that they would like support to breakdown the silos between residential, day, and supported employment services.
- Training is needed throughout the system to assure consistency in service expectations, referral processes and service delivery.
- Illinois' 2017-2018 National Core Indicators (NCI) report indicates that among respondents without a paid job in the community, 43% reported they would like a paid job in the community with only 25% of respondents reported to have community employment as a goal in the service plan and is an indicator of need for enhanced ISC training.
Potential Focus Areas
- Collaborate with state agency partners and their provider networks to develop an ongoing statewide interagency committee to reinforce the current training efforts, assure continual opportunities for practicing skills, and that offer mentoring to build competency in providing best practice quality employment services.
- Develop training opportunities to build competencies and expectations across the service system for achieving integrated employment outcomes.
- Establish a strategy and resources to support provider transformation.
- Engage the State's Workforce Development Board to consider development of a career tech curriculum to build tiered credentialing and career pathways for direct support professionals and employment specialists working mainly in the IDD field.
- Develop targeted ISC training to address discrepancies seen in NCI data regarding number of individuals preferring employment verses those with employment goals (long or short) in individual person-centered plans.
- Develop and implement training and technical assistance to refine ISCs skills and competencies to help people discover the benefits of a job, select services that identify a path to fulfilling employment in the general community workforce and support community membership. Achieving this will require support coordinators to ask questions and facilitate discussions that clarify a person's skills and interests, and fuels creative thinking about fulfilling careers.
- Develop training and technical assistance for providers and ISCs regarding their role in ensuring informed and supported choice-making.
V. Interagency Collaboration: Building relationships with advocates, families, businesses, civic groups, key state and local agency partners (vocational rehabilitation, education, mental health, state Medicaid agency) and removing barriers to employment supports.
- DDD has a low level of engagement with local school systems. Lack of information from the school system and transition programs is of concern. Parents appear to have limited awareness about employment opportunities and experiences that should be offered to their student.
- There is inconsistency across the state about flow of referrals to and from the DRS system and when individuals move between systems. Various stakeholders identified variables that impact the way that team members (e.g., ISCs, vocational rehabilitation counselors, long-term employment and day services providers, etc.).
- DDD and DRS are engaged in clarifying roles through their memorandum of agreement.
- There is no alignment of provider qualifying standards between DDD and DVR. e. Stakeholders shared that when individuals express interest in integrated employment and referred to DRS the process has been more of a "check the box" process so that HCBS employment services could be accessed rather than a complete determination for DRS employment services.
Potential Focus Areas
- Develop a process map to detail agency and staff roles and responsibilities when referrals are made to other systems and when individuals move between systems:
- Work to have both systems educate their key line staff on the roles of each including key strategic priorities, who is responsible for assuring expectations are met and where to turn when there are questions.
- In collaboration with DVR, develop joint field guidance sharing how these processes are expected to occur including the availability of long-term employment services following closure from VR services.
- Develop a plain language companion for individuals and families so that they can take an active role in the process. This should include DDD, Medicaid, DRS, and Department of Education.
- Assure all paid supports (e.g., service coordinators, provider staff, and education staff) are aware of expectations.
- Develop accountabilities to reinforce implementation expectations.
- Develop an interagency strategy with DDD, DRS and Department of Education to support individuals with IDD in seeking work identified through the Section 511 process, including strengthening this process as practicable with system partners.
- Engage in a joint initiative with DRS to develop and strengthen the provider network. Address the need to increase the number of providers, improve the competencies of provider organizations and align provider qualifying standards and payment methodologies.
- Work with DRS and Department of Education to establish a collaborative understanding of each other's system demands, policies and procedures when addressing Illinois' Employment First objectives.
VI. Services and Service Innovations: Service definitions and support strategies are structured and aligned to facilitate the delivery of employment supports to all individuals with developmental disabilities regardless of the intensity of their needs. Non-work supports encourage individuals to become involved in typical adult life activities, building employment skills, and community service and volunteering opportunities.
- Current service structures and DDD's historic medical model delivery system do not align with Illinois Employment First Act and stated goals to increase competitive integrated employment opportunities.
- Transportation services are not being implemented consistently as reported by providers and it was confusing to determine how it is handled depending on an individual's funding.
- There is wide variation in ISCs approach in discussing and supporting a person's pathway to employment, causing inconsistencies in how people experience the service options in Illinois.
- Service availability and assistance related to building economic self-sufficiency, asset management, and benefits management is limited across the state and across different service agencies.
- Concern was expressed, during the site visit, about the culture within some parts of the provider network toward staff willingness and competence to support individuals in more community-focused lives. For example, provider staff are struggling to take on community-based and employment-related service responsibilities given their historically facility-based work lifestyle.
- There is the potential for conflict of interest in service delivery as the providers and ISCs strive to implement revised service options to support people in achieving competitive integrated employment outcomes. Provider agencies who hire the individual as regular employees both supervise them and provide the employment supports.
Potential Focus Areas
- Review and amend Illinois' current Medicaid waiver focusing on employment service definitions and billable activities to ensure that service options strike a balance between flexibility for providers and their staff and the need of the individual to move at their desired pace towards employment and community engagement.
- Develop a new service definition that includes discovery and/or job exploration as a time-limited service that supports transition to DRS services.
- Ensure that day supports and other service types emphasize time spent in the community should link to an individual's areas of interest and that there is a clear plan for documenting what the individual learned about themselves and their preferences by participating in the day service funded experience. ISC service documentation should be used to communicate this information and reinforce the integral relationship between building a meaningful role in our communities, receiving support services in the community, learning new skills within the community, and becoming employed.
- Research development of a new support waiver or state plan amendment to target the needs of youth and support the development of employment pathways of those turning eighteen (18) who will be coming off the waiting list for DDD supports and those transitioning from high school.
- Explore the options to develop small group socialization service provided as an hourly service unit. To support continued friendship as people move into individual jobs from facility-based services.
- Job development and pre-employment skill building services both include payment for internships. To alleviate confusion in billing and reporting, consider revising to allow this option only in the pre-employment skill building service and enhance job development service to focus on job finding activities.
VII. Employment Performance Measurement, Quality Assurance and Program Oversight: Comprehensive data systems are used to measure progress, benchmark performance, and document outcomes. Information is gathered on key indicators across employment and other related systems and is used to evaluate and track results, inform policy, and improve provider contracts and service agreements. Data are shared with other state agencies to report results and improve quality.
- Data shows a decline in the number of DRS total closures and successful closures for individuals with an intellectual disability.
- DDD has limited and inconsistent data available at an individual level on outcomes of day and employment services.
- DDD participates in National Core Indicators data collection system as an HCBS quality measurement activity.
- The Bureau of Accreditation, Licensure and Certification (BALC) pulls together various monitoring functions across the different divisions. These monitoring functions are relative to provider services, support coordination, service design, and all have an overarching goal of integration. It is essential for this office to develop skills at implementing agile improvement strategies based on the aggregate data they receive on employment efforts across the state, so they can identify opportunities for improvement and implement changes.
Potential Focus Areas
- Establish a commitment to the collection and use of employment outcome data to drive decision-making. Initiate a thorough review of the current data management system capacity with a goal to determine future strategy toward employment and community engagement outcomes:
- Determine the needed collection frequency (e.g., bi-annually, monthly, etc.)
- Use the development process to communicate outcome priorities
- Develop public reporting of employment participation and outcomes at the provider and regional levels
- Integrate employment outcomes into provider quality review processes.
- Review Quality Management plans to assure monitoring not only addresses compliance but also continuous quality improvement strategies to achieve DDD goals to increase opportunities, competitive integrated employment outcomes, and community membership for individuals receiving services.
- Consider what information is available to help inform providers and ISC actions about where an individual is on the pathway to employment pathway; this data should be made available in as close to real time as possible to ensure responsiveness to the individual and inform decision about when individuals have reached the maximum personal benefit of the service. For example, the service of career exploration is used most efficiently and effectively when there is data available about when someone has reached their maximum need to explore. Providing feedback to providers such as the average amount of time individuals spend in each service would allow providers to track these elements to support their business plans and transformation.
- Build capacity to enter into data sharing agreements with other systems such as DRS, Workforce Development and Medicaid to understand who is seeking what supports, service utilization, quality management, and the relationship to what DDD offers. State Employment Leadership Network