COMAR 10.21.28

Chapter 28 Community Mental Health Programs — Mental Health Vocational Programs (MHVP)

This chapter establishes the staffing and service requirements that a Mental Health Vocational Program (MHVP) must meet to receive Department approval and be eligible for State or federal funding. Operators must ensure eligible participants in the public mental health system receive vocational assessment, individual vocational planning, job development and placement, employment support, and entitlement education services. Programs must maintain required staff ratios, follow prescribed screening and enrollment procedures, obtain core service agency preauthorization before serving individuals, and adhere to discharge planning and documentation standards.

Code of Maryland Regulations

Chapter 28 Community Mental Health Programs — Mental Health Vocational Programs (MHVP)

Administrative History

Effective date: July 9, 2001 (28:13 Md. R. 1215)

Authority

Health-General Article, §§10-901 and 10-902, Annotated Code of Maryland

.01 Scope.

This chapter outlines the staffing and service requirements that a mental health vocational program (MHVP) shall fulfill to be approved by the Department to be eligible to receive State or federal funds to provide services.

.02 Definitions.

A.
 In this chapter, terms have the meanings stated in 
COMAR 10.21.17
 and in this regulation.

B.
 Terms Defined.

(1)
 Agency-Sponsored Employment.

(a)
 “Agency-sponsored employment” means an employment program designed to assist an individual to obtain employment at locations owned, leased, rented, or managed by the provider, at other locations by an agency-held contract, at a consumer-operated business or program, or work enclave that provides:

(i)
 Compensation to individuals according to the standards established by the Department of Labor;

(ii)
 Opportunity for individuals to have contact with nondisabled individuals and the public to the same extent that nondisabled individuals in comparable positions interact with the public; and

(iii)
 Additional supports, as needed, to the individual in the work setting.

(b)
 “Agency-sponsored employment” does not include sheltered workshops.

(2)
 “Competitive work” means employment in the competitive labor market that pays minimum wage or higher and compensation is consistent with the wage standards provided in the Fair Labor Standards Act.

(3)
 “Consumer-operated business” means a program owned or managed by an individual who has a disclosed mental illness that provides compensated employment for an individual who has a disclosed mental illness.

(4)
 “Employment specialist” means a program staff member who helps individuals in the public mental health system (PMHS) to:

(a)
 Obtain competitive employment;

(b)
 Learn work tasks;

(c)
 Resolve job-related or on-the-job problems; and

(d)
 Maintain competitive employment.

(5)
 “Extended support services” means ongoing support services and other appropriate services needed to support and maintain an individual after the individual has made the transition from time-limited, intensive job-coaching services.

(6)
 “Industry” means the employer hiring an individual in the public mental health system.

(7)
 “Integrated work” means work that provides an individual an opportunity to interact with nondisabled individuals.

(8)
 “Intensive job coaching” means frequent and intensive support provided to an individual at a job site and off a job site during the initial stages of an individual's employment in order for an individual to learn and to manage a job.

(9)
 “Job stability” means a situation in which an individual is performing job duties satisfactorily and is reasonably expected to continue that level of performance.

(10)
 “Natural support” means the assistance received from an individual's family members, significant others, friends, neighbors, and coworkers.

(11)
 “Sheltered workshop” means employment in a workshop or work-activity center or a physically separated department of an agency or organization having an identifiable program of rehabilitation, separate tasks, supervision, records, and compensation for individuals with disabilities.

(12)
 “Supported employment program” means a program designed to assist an individual to obtain competitive employment in an integrated work environment that provides:

(a)
 Compensation to individuals of at least minimum wage;

(b)
 An individualized approach that establishes an hours-per-week employment goal to maximize an individual's vocational potential;

(c)
 Additional supports, as needed, delivered where appropriate; and

(d)
 Transitional employment placements, as appropriate.

(13)
 “Transitional employment” means a series of planned temporary, sequential job placements, with continuous support services, provided to an individual in the public mental health system until job permanency is achieved.

(14)
 “Work enclave” means a group of individuals with mental illness for whom an agency:

(a)
 Has negotiated access to jobs in community businesses;

(b)
 Guarantees completion of the individuals' work; and

(c)
 Provides compensation for the hours worked.

.03 Approval.

The Department may approve a program as an MHVP if the program meets the requirements:

A.
 For approval outlined in 
COMAR 10.21.16
;

B.
 For administration outlined in 
COMAR 10.21.17
; and

C.
 Of this chapter.

.04 Authorization for Services.

Before rendering services to an individual, a provider shall notify the core service agency (CSA) of the jurisdiction in which the individual resides and receive preauthorization for services.

Cross References

10.21.28.12A(3)(a)

.05 Program Model.

The program director shall ensure that services:

A.
 Are designed to:

(1)
 Support an individual in the public mental health system to be able to:

(a)
 Choose, obtain, and maintain employment;

(b)
 Make vocational decisions and career changes; and

(2)
 Enhance an individual's natural supports;

B.
 Are provided in a flexible manner to support an individual's vocational plan throughout an individual's employment, including periods of unemployment;

C.
 Include:

(1)
 Ongoing assessment and planning with an individual and, when appropriate, an individual's family or natural supports;

(2)
 As needed, vocational training;

(3)
 Marketing to industries in the community; and

(4)
 Referral for services an individual needs, which are not provided by the program;

D.
 Promote placement in a work environment that:

(1)
 Is free of recognized hazards likely to cause serious bodily injury or death and comply with any specific safety and health standards set for the industry;

(2)
 If not free of all recognized hazards likely to cause serious bodily injury or death, provides information to employees regarding the exposure to hazardous materials and substances; and

(3)
 Compensates individuals at least at minimum wage; and

E.
 Are adequate to support an individual's placement in a supported employment program or an agency-sponsored employment program.

.06 Eligibility, Screening, and Enrollment.

A.
 Eligibility. An individual is eligible for MHVP services if:

(1)
 The individual:

(a)
 Is a participant in the public mental health system;

(b)
 Has a diagnosis listed in COMAR 10.09.70.02;

(c)
 Is an individual for whom competitive employment has not occurred, has been interrupted, or has been intermittent;

(d)
 Wants to work; and

(e)
 Is in need of ongoing MHVP services to enable the individual to choose, obtain, or maintain employment; and

(2)
 The services are preauthorized by the CSA of the jurisdiction in which the individual resides.

B.
 Screening.

(1)
 Upon receipt of a referral and when appropriate, the program shall request authorization from the appropriate CSA to provide services.

(2)
 Within 10 working days of receipt by the program of CSA authorization for MHVP assessment under 
§A(2) of this regulation
, staff assigned by the program director, in collaboration with the individual, shall conduct a screening assessment to:

(a)
 Assess the individual's:

(i)
 Interest in employment and desire to work;

(ii)
 Willingness to participate in MHVP services; and

(iii)
 MHVP services needs; and

(b)
 Determine the program's ability to address the individual's employment needs identified in 
§B(2)(a)(iii) of this regulation
.

(3)
 After the screening under 
§B(2) of this regulation
, if the program director determines that a program's services are not appropriate for an individual, the program director shall, in writing, promptly:

(a)
 Inform the individual of the determination and the reason;

(b)
 Provide the individual with recommendations for alternative services;

(c)
 With proper consent, notify the family or significant others designated by the individual, of the determination and of any recommendations for other services; and

(d)
 Notify the CSA of the determination.

(4)
 Within 10 working days of the screening conducted under 
§B(2) of this regulation
, unless the program director has notified the individual and the CSA of the determination under 
§B(3) of this regulation
, the program director shall notify the individual that the program either:

(a)
 Accepts the individual and identifies a date that the program proposes to initiate services to the individual; or

(b)
 Will accept the individual, following an updated review of the individual's eligibility status, when program capacity permits.

(5)
 If the individual is accepted under 
§B(4)(b) of this regulation
, the program director shall inform the individual of the:

(a)
 Individual's placement on a waiting list, if any; and

(b)
 Estimated date services may be initiated.

(6)
 If the individual is placed on a waiting list under 
§B(5)(a) of this regulation
, the program director shall discuss with the individual:

(a)
 The option of remaining on the program's waiting list until the date established under 
§B(5)(b) of this regulation
; and

(b)
 Alternative services that are available.

C.
 Enrollment. Within 10 working days of the date established under 
§B(4)(a) of this regulation
 or following an updated review under 
§B(4)(b) of this regulation
, MHVP staff assigned by the program director shall:

(1)
 Provide an orientation to the program, including:

(a)
 A description of the MHVP services available; and

(b)
 The individual's rights and responsibilities; and

(2)
 In writing, inform the individual of the policy and procedures for discharge, including conditions, as outlined in 
Regulation .11D of this chapter
, that may result in the program's discharging an individual, and making recommendations for alternative services.

Cross References

10.21.28.07A(4)

.07 Assessment and Planning Services.

A.
 Vocational Assessment. Within 10 working days of initiation of MHVP services, MHVP staff assigned by the program director to conduct assessments, in collaboration with the individual and, with proper consent, family or significant others designated by the individual, shall complete a face-to-face MHVP assessment that includes, at a minimum:

(1)
 Documentation of the individual's employment interests, preferences, and skills;

(2)
 An evaluation that identifies the individual's competencies, work needs, and readiness for employment;

(3)
 Identification of obstacles and barriers to work such as transportation and impact on entitlements;

(4)
 Relevant information from the screening conducted under 
Regulation .06B of this chapter
; and

(5)
 If appropriate, relevant information from previous vocational screenings or assessments.

B.
 Individual Vocational Plan (IVP).

(1)
 Initial IVP. Within 30 days of initiation of MHVP services and based on the vocational assessment completed according to 
§A of this regulation
, the individual's employment specialist shall prepare an initial IVP:

(a)
 In collaboration with:

(i)
 The individual;

(ii)
 With proper consent, family or significant others designated by the individual and others involved in the individual's care; and

(iii)
 If appropriate and with proper consent, other mental health service providers, as available;

(b)
 That, if applicable and with proper consent, is coordinated with the:

(i)
 Maryland State Department of Education, Division of Rehabilitation Services' (DORS) individual plan for employment; and

(ii)
 Individual's individual treatment plan, individual rehabilitation plan, and case management personal plan;

(c)
 That is designed to assist the individual to identify, obtain, and maintain vocational goals;

(d)
 That identifies the individual's:

(i)
 Strengths;

(ii)
 Vocational service needs;

(iii)
 Vocational goals, including target dates;

(iv)
 Vocational interventions, including but not limited to a systematic plan of instruction in work skills and behaviors to be learned and, if applicable, benefits management and staff responsible for implementation; and

(v)
 Plan for obtaining a job that matches the individual's interests, preferences, abilities, and needed accommodations and adaptations.

(2)
 IVP Review. As frequently as necessary, as determined by an individual's employment specialist, and at least every 6 months, the employment specialist, in consultation with the individual, shall:

(a)
 Review and record in the individual's employment record:

(i)
 The individual's progress toward the accomplishment of previously identified vocational goals;

(ii)
 Goal changes, based on a review of the individual's progress; and

(iii)
 Changes in interventions, including staff responsibility;

(b)
 Communicate promptly the results of the review to:

(i)
 Relevant program staff; and

(ii)
 With the individual's consent, community mental health programs providing services to the individual and family or significant others;

(c)
 Assess the individual's satisfaction with the job and the MHVP services; and

(d)
 When the individual is employed through agency-sponsored employment, assess the individual's preferences and readiness for competitive work.

(3)
 Signature of the IVP and IVP Reviews. The employment specialist shall obtain the individual's written or witnessed verbal agreement or disagreement with the plan, and, in addition, the following shall sign the plan and reviews:

(a)
 The employment specialist; and

(b)
 Other MHVP staff responsible for implementing the plan.

C.
 Continuing Evaluation. At least once a month the employment specialist shall record in the individual's MHVP employment record a progress summary note regarding:

(1)
 The delivery of services, including those outlined in 
Regulation .07B(1)(d) of this chapter
, specified by the IVP;

(2)
 Progress toward goal achievement;

(3)
 Changes in the individual's status;

(4)
 If applicable, coordination with DORS; and

(5)
 If applicable, suggested changes in employment goals and vocational services delivered.

.08 MHVP Services.

A.
 Entitlement and Resource Education Services. The program director shall ensure that MHVP staff educate an individual about:

(1)
 The financial impact of employment on disability benefits, entitlements, and other benefits;

(2)
 Access to such Social Security programs as Plan to Achieve Self- Sufficiency and Impairment-Related Work Expense and the individual's rights and responsibilities under such programs;

(3)
 Access to additional benefits and other resources; and

(4)
 Benefits and risks of disclosure to the employer of the individual's disability.

B.
 Job Development and Placement Services. The program director shall ensure that MHVP staff:

(1)
 Develop close cooperation with industries, unions, and other community resources related to employment opportunities;

(2)
 Regularly survey the local business community and develop an ongoing marketing strategy to increase employment opportunities for individuals served;

(3)
 When appropriate, facilitate an appropriate match between an individual and a job by reviewing the:

(a)
 Benefits and wages;

(b)
 Necessary work skills;

(c)
 Required functional abilities;

(d)
 If applicable, accommodations and adaptations required for the individual;

(e)
 Opportunities to participate in work-related social activities to develop natural support; and

(f)
 Employee orientation;

(4)
 When appropriate, ensure that the individual receives, at a minimum, information regarding the:

(a)
 Job duties;

(b)
 Salary scale and benefits;

(c)
 Work schedule;

(d)
 Responsibilities of the employer;

(e)
 Responsibilities of the individual;

(f)
 Fringe benefits;

(g)
 Wage payment practices;

(h)
 Nondiscrimination provisions; and

(i)
 Process for the filing and resolution of grievances; and

(5)
 When an individual's employment status changes, assists the individual to maintain the goal of employment by facilitating additional job placements.

C.
 Employment Support Services. The program director shall ensure that, as required by an individual's IVP, the individual's employment specialist:

(1)
 Provides or arranges for the provision of:

(a)
 Job coaching, which includes training in job tasks and responsibilities;

(b)
 Assistance, upon request, and with the individual's consent, to the industry on effective strategies to help the individual remain on the job; and

(c)
 Activities directed toward the development of skills, including, but not limited to:

(i)
 Personal hygiene and grooming specific to the employment environment;

(ii)
 Effective communication with supervisor and coworkers; and

(iii)
 Transportation to and from work; and

(d)
 Extended support services, which may include §C(1)(a) — (c) of this regulation, in order to assist the individual to maintain employment;

(2)
 Encourages the individual to:

(a)
 Use natural supports; and

(b)
 Develop an employment-related support system through relationships with coworkers, supervisors, and others in the work environment;

(3)
 Provides the services outlined in this regulation, when appropriate, and with the individual's consent, at the job site or at another location appropriate to the individual's needs; and

(4)
 Has at least two face-to-face contacts a month with the individual.

.09 Additional Requirements — Supported Employment Model.

In addition to the requirements under Regulations .01B(1) and .05E(1) of this chapter, an MHVP supporting individuals in a SEP program shall provide:

A.
 With proper consent, at least one contact per month with the industry to receive information regarding the individual's performance on the job; and

B.
 The services outlined in this chapter.

.10 Additional Requirements — Agency-Sponsored Employment Model.

In addition to the requirements under Regulations .01B(2) and .05E(2) of this chapter, an MHVP supporting individuals in an agency-sponsored program shall:

A.
 Provide additional supports to the individual at the work site, which shall include:

(1)
 Staff, on site, during the hours the individual is employed, to provide:

(a)
 Supervision;

(b)
 Skills assessment;

(c)
 On-the-job training; and

(d)
 Mentoring; and

(2)
 Documentation of an assessment of the individual's potential for community employment at least semiannually;

B.
 In accordance with personnel policy and procedure, provide the individual with the following, if provided to nondisabled employees:

(1)
 Employee benefits;

(2)
 For each pay period, a written statement that indicates gross pay, hours worked, deductions, and net pay;

(3)
 Consistent with federal wage and hour laws at least annually, a review of the individual's wages and work performance; and

(4)
 Wages based on individual performance rather than on group wage payments;

C.
 If paying subminimum wages, be in compliance with DOL regulations, documented by the appropriate DOL certificate; and

D.
 Provide the services outlined in this chapter.

Cross References

10.21.28.12A(3)(b)

.11 Discharge from Services.

A.
 Discharge Policy. The program director shall:

(1)
 Maintain clearly written policies and procedures for:

(a)
 The process for discharge;

(b)
 If the program's services are not appropriate for the individual, making recommendations for discontinuing services and referring the individual for alternative services, including the criteria for discontinuing services according to this paragraph; and

(c)
 Providing the individual with information about how to reaccess services when needed; and

(2)
 Notify the authorizing CSA of the determination under 
§A(1)(b) of this regulation
.

B.
 Collaborative Discharge. When the employment specialist, in collaboration with the individual, determines that MHVP services are no longer appropriate, the employment specialist shall:

(1)
 Prepare a discharge plan:

(a)
 In collaboration with:

(i)
 The individual; and

(ii)
 With proper consent, family or significant others designated by the individual and, if feasible, other treatment and service providers; and

(b)
 That is based on an assessment of the individual's current vocational status, service needs, and mutually agreed-upon goals;

(2)
 As necessary, make appropriate recommendations for treatment, rehabilitation, and community supports;

(3)
 Complete a discharge summary in accordance with COMAR 10.21.17.07D(3); and

(4)
 Notify the CSA of the discharge.

C.
 Individual's Discontinuation of Services. When an individual discontinues services before a planned, collaborative discharge as described in 
§B of this regulation
, the employment specialist shall:

(1)
 If possible, give the individual information about appropriate alternative services;

(2)
 If authorized, provide outreach to encourage the individual to access appropriate services;

(3)
 With proper consent and if needed, provide notice of the discontinuation to the CSA or the Department's administrative services organization for referral for appropriate alternative services; and

(4)
 Complete a discharge summary in accordance with COMAR 10.21.17.07D(3).

D.
 Program's Recommendation to Discontinue Services.

(1)
 If, in consultation with the program director, the employment specialist recommends discontinuing services for an individual for whom, because of the individual's actions, the program's services are not appropriate, the program director shall provide written notice of the intention to discontinue services and recommend referral for alternative services.

(2)
 Except in the case of imminent danger, the program director shall provide the notice at least 30 days before discontinuing services.

(3)
 The program director shall ensure that the notice is sent to the individual and, with proper consent, to the CSA or the Department's administrative services organization for referral for appropriate alternative services.

(4)
 The program director shall include in the notice:

(a)
 The effective date of the action;

(b)
 The reason for the action; and

(c)
 If possible, a discharge plan.

(5)
 The program director shall ensure that staff complete a discharge summary in accordance with COMAR 10.21.17.07D(3).

Cross References

10.21.28.06C(2)

.12 Program Staff.

A.
 A provider of MHVP shall ensure that MHVP staff includes, at a minimum:

(1)
 A program director who:

(a)
 Has sufficient qualifications, knowledge, and experience to execute the duties of the position;

(b)
 Is available for an amount of time calculated on the basis of a half-hour per individual receiving services, up to a maximum of 40 hours per week;

(c)
 Is available to provide MHVP administration and supervision; and

(d)
 May provide MHVP services;

(2)
 Employment specialists who have sufficient qualifications, knowledge, and experience to work with the individuals served by the program; and

(3)
 Program staff sufficient to carry out the:

(a)
 Program model described in 
Regulation .04 of this chapter
;

(b)
 Services delineated under 
Regulation .10 of this chapter
; and

(c)
 Activities outlined in the individual's IVP.

B.
 The program director shall assure that the MHVP:

(1)
 Has a clear description of the role and function of the staff providing MHVP services;

(2)
 Staff is sufficient in numbers and qualifications to carry out the program's service goals and includes, at a minimum, the staff identified in this regulation; and

(3)
 Has a contingency plan for staff availability to provide necessary MHVP services to an individual in the absence of regularly assigned staff.

C.
 Ratio. A provider of MHVP services shall maintain a maximum ratio of one MHVP employment specialist serving each 15 individuals receiving MHVP services.

D.
 Volunteers, Students, and Trainees. The program may use volunteers, students, and trainees according to the provisions of COMAR 10.21.17.09E.