Fiscal Year 2005 Cross-Agency NFI Program:
Comprehensive Service System Initiative Addressing Young Adults with Disabilities
Each year thousands of young people with disabilities under the age of 30 enroll in the Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) programs. These young adults are not moving from high school to postsecondary education, employment and independence successfully. Their unemployment, lack of education, continued dependence on parents, social isolation, inability to secure accessible and affordable housing and lack of involvement in community activities are continuing issues facing young adults, especially those between the ages of 16 and 30 years. Lack of healthcare access creates barriers for these individuals as they transition from high school to postsecondary education, employment and independence. Coordination and integration of Federal, State, Tribal and local services are needed to address these healthcare and human service needs to enhance the ability of young adults to become independent and contributing members of their communities in conjunction with attention to education, employment, housing, and transportation needs.
The President's New Freedom Initiative (NFI), Executive Order 13217, requires the Federal Government to assist States, Tribal and localities in swiftly implementing the Olmstead decision "to help ensure that all Americans have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment, and to participate in community life." To address the comprehensive service needs of young adults with disabilities 1, the Department of Health and Human Services (HHS) Office of Disability will facilitate the development and implementation of a comprehensive Fiscal Year 2005 initiative with participating HHS agencies and Offices 2 in partnership with the Departments of Labor, Education, Transportation, Commerce, Justice, Housing and Urban Development and the Social Security Administration. It will utilize a policy academy planning approach to help participating States (including Territories, District of Columbia and Puerto Rico) and Tribal Governments plan and implement a coordinated and comprehensive systems action plan to support them in developing and implementing action plans which build on available Federal, State and Tribal resources. It will address systems integration infrastructure development/enhancement that builds capacity to support young adults' transition to independence and adulthood. It builds off of HHS agencies' Fiscal Year 2005 young adult and other supporting initiatives and continuing initiatives from Fiscal Years 2002 - 2004 to ensure effective and efficient use of Federal funds. It adds value to initiatives in place or planned by HHS Federal partners including the Departments of Education, Interior, Commerce, Justice, Labor, Housing and Urban Development, Transportation, and the Social Security Administration.
This Fiscal Year 2005 initiative, targeting young adults with disabilities between the ages of 16 and 30 years, is a placeholder recognizing that additional planning will occur during Fiscal Year 2004.
Individual HHS agencies have implemented State, Tribal and local initiatives to help address the unique needs of young adults, however, they have lacked an integrated policy and systems approach. With the support of 1) The President's NFI Executive Order, 2) the Secretary of Health and Human Services requirement for "One HHS," and 3) the Office of Disability's charge to work with other Federal agencies and disability organizations to promote community integration for people with disabilities, this initiative's "Comprehensive Service System Integration" approach will:
- Increase service coordination across HHS systems and among Federal Partners
- Focus on integration of services to target population
- Seek to increase the independence and self-sufficiency of the target population
II. PROGRAM GOAL
The goal is to ensure increased independence and self-sufficiency and improved outcomes in health and human services, education, employment, housing, and transportation facing young adults with disabilities between the ages of 16 and 30 years.
- Build off of HHS agencies' Fiscal Year 2005 young adult and other supporting initiatives and continuing initiatives from Fiscal Years 2002 - 2004 to ensure effective and efficient use of Federal funds. 3
- Provide health and human service interventions for target population
- Facilitate young adults' equal access to education, employment, housing, and transportation.
- Add value to initiatives in place or planned by HHS Federal partners including the Departments of Commerce, Education, Interior, Justice, Labor, Housing and Urban Development, Transportation, and the Social Security Administration.
- Provide a cross-HHS agency program that works in collaboration with Federal partners to facilitate access, provide supports, and coordinate planning and services to help young adults with disabilities during their transition to independence and adulthood
- Enhance understanding, efficient use and access to the array of Federal resources addressing the multiple service needs of young adults with disabilities.
B. Goals and Objectives:
- Policy Academy 4: To utilize a competitive policy academy approach to help participating States and Tribal governments plan and implement a coordinated and comprehensive systems action plan.
Objective 1A: Action Plan Development - To support participating States and Tribal governments in developing and implementing action plans that address systems integration infrastructure development/enhancement which build capacity to support young adults' transition to independence and adulthood;
Objective 1B: Peer-to-Peer Learning - Provide opportunity for State, Tribal and local community public authorities to learn from each other's experiences, lessons learned and promising practices;
Objective 1C: Technical Assistance - Provide ongoing technical assistance to support participating States and Tribal Governments' development and implementation of the infrastructure development action plans; and explore Federal, State, Tribal and local assets and resources available to enhance outcomes of target population.
Objective 1D: Infrastructure Development - Work with participating States, Tribal governments and local communities on developing and/or enhancing various infrastructure elements necessary to form an easily accessible, coordinated and effective system of long-term care for young adults with disabilities (i.e.: data information and sharing systems; regulation development/changes; evaluation; provision and coordination of public and private healthcare coverage; one-stop screening, assessment, service linkage, information, and referral; and/or case management);
Objective 1E: Geographic Representation - Ensure selected States and Tribes represent rural, urban and suburban geographic regions;
Objective 1F: Attention to Multicultural, Racial and Ethnic Disparities - Require States and Tribal governments to discuss how multicultural, racial and ethnic differences will be addressed, e.g., Executive Orders 13216, 13256, 13230.
Objective 1G: Lead Agency Designation -Require State and Tribal governors to identify the initiative's lead agency responsible for carrying out the initiative; and
Objective 1H: Demonstration Sites - Require States and Tribal Governments to select at least one local jurisdiction as a demonstration site.
Integrated Federal Policy, Planning and Funding Process: To provide for a coordinated Federal cross-departmental policy, planning and funding processes to help academy participants implement action plans created at the policy academy that address the health and human services, education, employment, housing, and transportation needs of young adults.
Objective 2A: Demonstrate Federal cross-department modeling (HHS, DOJ, HUD, DOT, DOL, DOE, SSA, Commerce) of desired State, Tribal governments and local community planning and funding collaboration;
Objective 2B: Network Development -Emphasize network development, as modeled by the Federal government, across State, Tribal and local agencies responsible for health and human services, education, employment, housing, and transportation services and support; and
Objective 2C: Steering Committee -Request that a steering committee group help plan and monitor the initiative, consisting of at least 50% of individuals representing all disability groups.
Health and Human Service Interventions: To provide health and human service interventions, including attention to health promotion and prevention of secondary conditions.
Objective 3A: Ensure access to and provision of home and community-based services as a means of providing options to reducing and preventing the need for institutional care;
Objective 3B: Develop coordinated comprehensive, responsive, and cost-effective long-term care service systems;
Objective 3C: Ensure that health and human service providers receive training pre and post discipline education on addressing the medical and human service needs of young adults with disabilities, with attention to screening, assessment and treatment;
Objective 3D: Address the health and human service needs of these individuals which tend to be ignored, misdiagnosed and not included in States and Tribal governments' broader long-term care systems; and
Objective 3E: Address all disability groups, including persons with physical, sensory, intelligence, developmental, psychiatric and substance abuse disabilities.
Equal Access: To ensure that target population has equal access to education, employment, housing, and transportation.
Objective 4A: Collaboration - Promote collaboration among State, Tribal and local community public health and human service authorities in conjunction with authorities responsible for education, employment, housing, and transportation;
Objective 4B: Cross Systems - Focus on the integration and coordination of the multiple systems involved with young adults at the State, Tribal and local levels, including health and human services, education, employment, housing, and transportation; and
Objective 4C: Promote Employment Opportunities at Federal, State, Tribal and Local Government Levels - Encourage and provide advice to young adults with disabilities to apply for positions at Federal, State, Tribal and local government agencies.
Objective 4D: Promote coordination between long-term care and housing providers.
Performance Measures and Evaluation: To provide for an initiative process and outcome evaluation documenting lessons learned identification of evidence-based practices, and development and measurement of performance measures.
Objective 5A: Evidence-based Practices -Develop, use and promote evidence-based practices that have been successfully used to coordinate increased participation of young adults with disabilities in community activities;
Objective 5B: Performance Management - As identified by the Federal government, utilize key performance indicators of independence and participation for young adults with disabilities including scientific analyses of existing national data sets in areas as; health and human services, education, employment, housing, transportation, and public and private insurers;
Objective 5C: National Meeting- Participate in a national meeting convened by the Federal government on the initiative's developing evidence based practices and lessons learned; and
Objective 5D: Ensure initiative sustainability can be maintained at the conclusion of the demonstration.
1 The intent of this proRAM is to address young adults with a single or co-morbid disability (i.e., having one or more disabilities including physical, sensory, cognitive, developmental, mental).
2 This program was developed by the HHS Office of Disability NFI Workgroup Employment and Housing Subcommittees consisting of the Administration on Children and Families, Centers for Medicare and Medicaid Services, Health Resources and Services Administration, Indian Health Services, Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, Assistant Secretary for Policy and Evaluation, and the Office for Civil Rights.
3 For example, the initiative will build off of CMS's' Medicaid Real Choice program, HRSA/Maternal and Child Health Bureau Healthy and Ready to Work Program, SAMHSA Youth Transition Program; ACF Independent Living Vouchers Program and the Ticket to Work Program.
4 Policy academies are teams of State and Tribal governors' health policy advisors, State and Tribal health officials, legislators, and community-based representatives convened to work with national experts identified by the Federal Government to develop customized action plans to address public policy issues in their State, Tribal or Territory.