Building and Grounds Cleaning and Maintenance Occupations
Office and Administrative Support Occupations
Installation, Maintenance and Repair Occupations
Protective Service Occupations
Personal Care and Service Occupations
Community and Social Services Occupations
Total: (Sum of 14A through 14X)
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QUARTERLY CONTRACT MONITORING REPORT (QCMR)
LEVEL OF SERVICE REPORT
CAREER SERVICES (SUPPORTED EMPLOYMENT)
NAME OF AGENCY:
NAME OF PROGRAM: __________________
Supported Employment (SE) BUDGET MATRIX CODE: 34
Levels of Service
Total number of new consumers (unduplicated) to be enrolled in SE services during this quarter (This number is a subset of total number served on SE caseload this quarter).
Total number of transferred consumers to be enrolled in SE services during this quarter (Transferred consumers are all individuals transitioning into SE from your agency’s other programs. For example, an individual is moving from PC to SE from the same agency).
Total number of consumers (unduplicated) to be enrolled in SE services during this quarter (New Consumers + Transferred Consumers. Include total number of consumers that are on assigned caseload of the SE staff at any time during the reporting quarter). Item 17 = Item 15 + Item 16
Number of consumers (unduplicated) working in a full-time competitive integrated employment during this quarter (Full-Time- 35 hours or more. Integrated competitive employment is defined as a community based job that pays at least minimum wage, is available to any person, belongs to the worker and does not have a time limit determined by the rehab/mental health agency. (Consumers who have and/or secured Full Time Employment).
Proportion of Ending Active Caseload:
18b. =Item18a/Item 17
Number of consumers (unduplicated) working part-time in a competitive integrated employment during this quarter (Part-Time- less than 35 hours. Consumers who have and/or secured Part-Time Employment).
Proportion of Ending Active Caseload:
Number of consumers placed multiple times (more than once) in a competitive integrated employment during this quarter (Full-Time & Part-Time).This includes consumers who were initially placed in an employment setting this quarter but quit or was fired and needed assistance with employment placement again. This includes consumers who transitioned from job into a new job during this quarter).
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Total number of consumers working competitive integrated employment during this quarter. (Unduplicated Full-Time + Part-Time & Re-placed Full-Time + Part-Time. Sum of #18A +19A +20)
Number of NEW job starts for ALLconsumers during this quarter (Include all job starts. For example, one person starts three new jobs, which equals three job starts. Only count the jobs NOT the consumers placed).
Number of consumers assisted into post-secondary educational opportunities or settings during this quarter (This is the number of consumers the SE staff provided support or aid to in order for the consumer to enroll in a credit-bearing education program this quarter. This includes technical school, college & GED prep classes).
Number of hours of educationally related coaching during this quarter (This is the number of hours provided to consumers in preparation of the educational program. This includes but not limited to educational readiness development, information sharing, and referral and application preparation).
Number of hours of pre-employment related interventions during this quarter (This is the number of hours provided to consumers prior to becoming employed. This includes but not limited to intake,readiness determination, career planning and profiling, employment assessments, individualized job development and support planning).
Number of hours of on & off-the-job coaching during this quarter (This is the number of hours of job support for working consumers provided by the employment specialist either on, or off the job site).
Number of hours of extended supports provided during this quarter (The definition of extended supports mean the long-term follow-along services and other appropriate employment services that are needed to support and maintain a consumer in employment. Extended service delivery beginning after job retention.
Number of consumers working successfully in integrated competitive employment who transitioned off SE caseload during this quarter (Consumer has gained independence, and is working on his/her own; with natural supports).
Total units of service provided during this quarter. (Sum of 24+25+26+ 27)
30. Termination: Complete this section during this quarter (This should equal the total number of termination from the program during the quarter).
30a. Number of enrolled consumers lost to contact:
30b. Number of enrolled consumers who decided not to seek employment: 30c. Number of enrolled consumers who moved out of the area: 30d. Number of enrolled consumers who needed a higher level of care: 30e. Number of enrolled consumers who passed away (Deceased): 30f. Number of enrolled consumers who returned to school: 30g. Number of enrolled consumers who were incarcerated: 30h. Others
Caseloads: Complete this section during this quarter. 31a. Number of consumers on Employment Specialists (ES) Caseload (excluding the supervisor_):
31b. Number of consumers on Supervisor’s/Team Leader’s Caseload:
31c. Total number of consumers on ES and Supervisor’s/Team Leader’s Caseload:
(This number should equal to the ending case load (Item #6).).
32. Total FTE Employment Specialists (excluding the supervisor) with Caseload - (FTE = full-time equivalent). Include full-time and part-time positions. For example, 2 employment specialists working 20 hrs/week = 1 FTE.
Page 5 of 7 DEFINITIONS
Supported Employment (SE) – Services consist of intensive, ongoing supports that enable participants, for whom competitive employment at or above the minimum wage is unlikely absent the provision of supports, and who, because of their disabilities, need supports, to perform in a regular work setting. Supported employment may include assisting the participant to locate a job or develop a job on behalf of the participant. Supported employment is conducted in a variety of settings; particularly work sites where persons with disabilities are employed. Supported employment includes activities needed to sustain paid work by participants, including supervision and training. When supported employment services are provided at a work site where persons without disabilities are employed, payment is made only for the adaptation, supervision and training required by participants receiving waiver services as a result of their disabilities but does not include payment for the supervisory activities rendered as a normal part of the business setting.
Unit of Service: 1 hour
Competitive Employment – Work in the competitive labor market that is performed on a full-time or part-time basis in an integrated setting and for which the individual is compensated at or above minimum wage, but not less than the customary wage and levels of benefits paid by the employer for the same or similar work performed by individuals who are not disabled.
Education is defined as a “credit-bearing educational program”--- such as a technical school, college– for which the consumer will receive documentation upon completion. Include GED prep classes
Educationally Related Coaching- Includes the unit of service provided for the consumer- includes the support services needed to maintain a consumer in obtaining/completing vocational/technical/GED/College degree.
Extended Support Services (Long- term follow along) – Includes the unit of the ongoing support services needed to support and maintain the individual in supported employment. Extended services are provided after an individual has achieved job retention. Rehabilitation occurs when the individual is employed for a length of time adequate to ensure the stability of the employment outcome (a minimum of 90 days). Extended services are provided both on and off the job site, as frequently as necessary, to assess and maintain employment stability.
Job Coaching (On & Off site) – Includes the unit of service of support services provided to the consumer who has been placed in employment (working) in order to stabilize the placement and enhance job retention.
Job Starts- All the job starts for consumers. For example, one person starts three new jobs, which equals three job starts. Only count the jobs NOT the consumers placed.
New Consumers- Consumer new to the agency and program.
Pre-Employment Related Interventions– Includes the unit of service provided following service: A referral to a specific job resulting in an interview, whether or not the consumer obtained the job. Job Readiness– To prepare the consumer for the world of work (e.g. appropriate work behaviors, getting to work on time, appropriate dress and grooming, increasing productivity). Job Related Services – Job related services include job search assistance, job placement assistance, and on-the-job support services. Job Search Assistance – Job search activities support and assist an eligible individual in searching for an appropriate job. Job search assistance may include help in resume preparation, identifying appropriate job opportunities, developing interview skills, and making contacts with companies on behalf of eligible individuals. Page 6 of 7
Placed Multiple Times- Consumers that are assisted in finding a job and placement in multiple jobs. This includes consumers who transitioned into other job.
Post-Secondary Educational Opportunities or Settings- This is the number of consumers the SE staff provided support or aid to in order for the consumer to enroll in a credit-bearing education program. This includes technical school, college & GED prep classes.
Transferred consumers- Consumer transition into SE program from the same agency’s other programs. For example, an individual is moving from PC to SE from the same agency.
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Revised 11/23/15 Submit forms 30 days after the close of the Quarter to the QCMR Portal https://dmhas.dhs.state.nj.us/qcmr/