When I think about the current employment structure we have in Ohio for people with a developmental disability it seems like it was built around the idea of separate but equal. Much like the initial residential and educational options created to support people with a developmental disability, Ohio’s employment settings were created when there were no real services in a person’s community. I don’t mean community based options, but rather parents had to look outside of their own communities (cities and counties) for service options. Puts a different spin on the meaning behind community based services when you go back 30 years ago or more.
Nonetheless, here we are. When it comes to employment for a person with a developmental disability, Ohio, historically, has invested its resources into an infrastructure of supports that seemed, unintentionally, born out of the idea of separate but equal. Our communities created large, efficient centers where people with a developmental disability could pursue work with other people who have a developmental disability. The focus was safety, the focus was efficiency and the focus was on an economy of scale. Basically, protection, working smarter not harder, and being frugal with public money. Those seem like three very good goals or accountabilities that anyone might hold their public officials to.
There are two issues I can see with those directives though. The secondary issue, but just as relevant is that along the way towards building a better mousetrap, Ohio and the local boards brought Medicaid into the equation. Specifically they opted for a way to draw down Federal money to match the local monies the good people of Ohio generated through their local levy. This action expanded services greatly from county to county. However, when the Feds are paying, they also are playing. Which means, they get to define how their money is used, and in this case, what constitutes an institutional versus community based setting. Ohio professionals and families may be upset with the recent guidelines from CMS (Centers for Medicare and Medicaid), and the transition plan Ohio submitted in response to those guidelines, but we invited them to the party, and asked them to bring the music. They are changing the tune right now.
There is another issue, and I think it is the primary concern of advocates across the state who feel more needs done to support people who want options of work and socialization in their communities. As money has been spent to create settings that are able to support people with complex and challenging needs, it appears that we have resigned all people with a developmental disability to that regulatory and structured environment. Most, if not all, a community’s resources were used to build sheltered environments, and supports using community-based options were an after thought. During a time when there was nothing, sheltered or community, to offer, advocates, families and people with disabilities I am sure were very happy and proud of what they were able to accomplish. They should have been and should be now.
I believe that it was the creation of these services and successes by early advocates that have paved the road Ohio is on right now. We no longer are able to initiate person centered, and strengths based support plans without realizing that people having the same diagnosis is just not enough to base our public infrastructure around. We need more and varied options that can parallel the varied strengths and abilities we come in contact with as professionals. Make no mistake; there are shared experiences between people who have a developmental disability and the challenges that their families endure over the years. People with a developmental disability have the highest unemployment rate in the country, and experience some of the highest rates of physical and sexual abuse. Prejudice and acts of violence, however, are not qualities of a group, but rather actions done to a group.
Having engaged in Ohio’s Project Transformation I know there are incredible ideas that are being developed. I know it will take more than structuring rates and changing regulations, but this is one of the first steps to allow for funding to support community based options as well as center based services. Employment First is another part of this change, and it is mainly a change for our communities and our professionals. We must expect more from ourselves, those we support, and our communities. We must challenge what has gotten us this far, and our communities cannot allow professionals to be the only ones who engage with people who have a developmental disability.