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• Identify the potential partners that can help HIV/AIDS service providers meet the employment and training needs of clients
• List strategies for engaging partners
• Discuss several HIV/AIDS-specific employment initiatives and their key components and outcomes

According to the Rehabilitation Act, an "individual with a disability" is someone who: 1) has a physical or mental impairment that results in a substantial impediment to employment; and 2) can benefit, in terms of an employment outcome, from the provision of VR services.

For reporting purposes, state VR agencies provide the Rehabilitation Services Administration (RSA) with a single primary disability, and, if a secondary disability exists, a single secondary disability. The primary disability is the infirmity or impairment that is most substantial in impeding one's ability to work. The secondary disability contributes to the impediment but is not the primary cause.

There are 19 impairments (e.g., blindness; mobility orthopedic/neurological impediments; general physical debilitation, i.e., fatigue, weakness or pain; other physical impairment; psychosocial impediments). HIV/AIDS is not classified as one of the impairments.

There are 37 codes for the causes of the respective impairments. HIV/AIDS is listed as one of these causes. Other causes frequently contributing to the same impairment as HIV/AIDS include:

• Blood disorders
• Cancer
• Drug abuse or dependence
• Immune deficiencies excluding HIV/AIDS
• Mental illness -not listed elsewhere
• Physical disorders/conditions - not listed elsewhere
• Respiratory disorders other than cystic fibrosis or asthma

An individual is presumed to be able to benefit from VR services unless the VR agency can demonstrate, through clear and convincing evidence that the individual cannot benefit in terms of achieving an employment outcome due to the severity of his or her disability. The Rehabilitation Act of 1973 and regulations prohibit determining any person with a disability, including PLWHA, ineligible under the VR program based on an assumption, belief, or limited information that the individual is incapable of working in an integrated setting.

When in doubt about a PLWHA's ability to benefit from VR services, the Rehabilitation Act and regulations require the state VR agency conduct an individualized assessment. This assessment includes trial work experiences in realistic work settings to determine if he/she is capable of working in an integrated setting when provided appropriate VR services or if there is clear and convincing evidence that he/she cannot perform the work tasks.

When determining whether an individual is eligible for VR services, qualified personnel must determine whether the individual has a physical or mental impairment, and whether that impairment constitutes a substantial impediment to achieving an employment outcome. Additionally, a qualified VR counselor employed by the VR agency must determine whether the individual with a disability requires VR services to achieve an employment outcome. Finally, individuals determined eligible for the receipt of SSI and SSDI benefits, and intending to achieve an employment outcome, are presumed eligible for VR services.

By partnering with VR agencies, HIV/AIDS providers can enhance the services available to PLWHA. As a first step, a director or manager of an HIV/AIDS service organization might contact the local VR field office administrator for an introductory meeting.

HIV/AIDS service providers might also:

• Request information on how to become eligible to serve as a Community Rehabilitation Program (CRP) for the state VR program
• Offer to provide an in-service presentation on HIV/AIDS and local HIV/AIDS services for VR counselors and administrators
• Identify a staff liaison to the VR agency to establish and develop ongoing communication and cross training
• Invite VR staff to visit the HIV/AIDS service provider's facility or explore the potential for a Vocational Rehabilitation Counselor (VRC) to give an in-service presentation to staff to describe VR, the services available, eligibility and strategies to work together to best support the employment goals of shared/referred clients
• Have an on-site event for clients featuring a VRC - ideally to occur on a regular basis. This allows clients to talk with a VR service system representative in a familiar environment, which may reduce concerns about stigma, discrimination and confidentiality

These activities support better informed HIV/AIDS service providers and VR counselors, and better prepared and supported shared clients.

A link to find your local VR agencies can be found in the Handouts and Resources slide of this module.

The Ticket to Work program, a program of the Social Security Administration (SSA), is one of the main "work incentives" available to individuals receiving SSDI or SSI benefits. Through it, eligible individuals between the ages of 18 and 64 receive a "ticket" that allows them to receive career counseling and job placement services from authorized employment service providers called Employment Networks (EN). As a result, SSDI/SSI beneficiaries can seek services from a wider array of providers; the ticket serves as a guarantee of funding on their behalf. Participation in the Ticket program is free and voluntary.

While participating in the Ticket to Work Program, beneficiaries can get help exploring their options without immediately losing their benefits. They can also use a combination of work incentives to maximize their income until they earn enough to support themselves.

In summary, an individual can:

• Go to work without automatically losing disability benefits
• Return to benefits if he or she has to stop working
• Continue to receive healthcare benefits
• Be protected from medical continuing disability review (routine review by SSA to determine that an individual continues to be disabled) while using the Ticket and making the expected progress with work or educational goals.

If an individual and an Employment Network (EN) decide to work together, they jointly develop an individual work plan, defining employment goals and the specialized services to be delivered. These services may include career counseling, training, job placement, and ongoing support. ENs can be organizations, government agencies, employers, or even individuals. Examples of ENs include: many American Job Centers, including all of those that participate in the Disability Employment Initiative, state workforce agencies, and Workforce Investment Boards.

SSI/SSDI beneficiaries may also choose to use their ticket to access services provided by a Vocational Rehabilitation (VR) agency (previously discussed in the VR section of this module). If an individual and VR agency decide to work together, they will also jointly develop a plan for achieving identified work goals. VR agencies typically provide more significant training and rehabilitation services than ENs; thus, when someone needs ongoing support after VR agency support ends, he or she may be able to continue to work with an EN. Through a program called Partnership Plus, a beneficiary may also receive services from a VR agency and then an EN under the Ticket to Work program.

A link to find your local ENs and additional information about ENs can be found in the Handouts and Resources slide of this module.

Community colleges are a primary source of job training programs as well as General Educational Development (GED) and English as a Second Language (ESL) programs in many communities. Often these programs have been created in conjunction with local employers in the context of current and anticipated skills needs. For PLWHA with limited education or experience, as well as those in need of training to pursue new careers, community colleges can be a promising option.

Many community colleges have disability programs and services for students, with disability specialists providing assistance in obtaining accommodations or arranging academic adjustments students need for training and educational success. Reaching out to these offices can help HIV/AIDS service providers learn more about options available to their clients as well as in-demand skills.

One example of a potential partnership activity might be inviting someone from the disability student services office to come to your organization to speak about course offerings, financial aid resources, their services and how to request accommodations in an educational environment. Other educational institutions, including four-year public and private universities in a service provider's local area, may also be potential partners in providing such guidance.

A Client Driven and Focused Employment Program

From January 2013 to December 2013, of the 415 PRC clients served, a total of 194 (31%) were placed in employment, and 41 of the placements included benefits. Fifty-seven individuals still held their positions 90 days after placement. Average hourly wage was $18.95 per hour. Eighty-seven percent of the clients identified themselves as male, 11% as female and 2% as transgender. Seventy-two percent of the participants identified as gay or lesbian, 16% as straight and 5% as bisexual. Regarding ethnicity, 49% percent of the participants were Caucasian, 21% African American, and 20% as Latino/Hispanic. The largest age demographic represented was the 40-49 years of age (39%), with 50-59 year olds a close second (36%). At the time of program entry, income for the majority of the participants (85%) was less than $20,000 per year.

Job Preparedness

Working with community partners, PRC developed a Client-Focused Considering Work Model, which combines individual and group training and counseling services. Under this model, clients are encouraged to utilize a stages-of-change process to make well-informed decisions about returning to work based on an assessment of four domains in their life: medical, financial/legal, psychosocial and vocational.

Job Readiness

PRC offers a self-employment and microenterprise development program, career counseling, employment services, job search skills, resume and cover letter writing and interview preparation.

Job Training

PRC offers structured job training in a state-of-the-art computer lab and a full spectrum of computer training classes, to fit client's level of experience.

Job Placement

PRC provides assistance in the development of job search skills, coordination of job search activities, and identification of appropriate job openings.

Job Retention

Employment retention services support clients and employers in achieving a successful employment outcome.

Program Outcomes

The PRC Employment Services Program serves more than 2,000 individuals a year. The average wage for clients placed in long-term employment has been $19.21 per hour.

A Demand-Driven Workforce Development Program

Founded in the early days of the HIV/AIDS epidemic, GMHC (formerly Gay Men's Health Crisis) in New York City was among the first HIV/AIDS service providers in the U.S. In 2003, in response to increasing requests for employment assistance from clients, it started Moving Ahead Toward Career Horizons (MATCH), a comprehensive, community-based employment services program. MATCH is supported by the Human Resources Administration (HRA) of New York City and the New York State Office of Temporary and Disability Assistance (OTDA).

Job Preparedness

GMHC's Work Center offers certified life coaches who are paired one-on-one with MATCH clients seeking to enter the workforce. These coaches offer support and logistical assistance, supplementing the employment services staff. Roughly 80 percent of MATCH clients use life coaches, including an artistic subgroup seeking careers in the creative arts.

Job Readiness

MATCH offers employment counseling, resume development, interview preparation and mock interviewing; a free of charge wardrobe closet and toiletries for clients going on job interviews; and a GED certificate program.

Job Training

GMHC hosts a state-of-the-art computer lab, through which a wide range of self-directed, interactive training is available, including Adult Basic Education (ABE) reading, writing and math courses to help clients prepare to attain their GED. Many clients have also used the lab resources to acquire the Microsoft Office Specialist Certification. Additional occupational training options include preparation to be an electrician, child-care provider, office worker, carpenter or cosmetologist.

Job Placement

MATCH offers select clients part-time paid internships for administrative positions. These internships are in-house, 20 hours per week at $10 per hour for a 12 month period. GMHC has often hired interns for full-time jobs in the agency. In addition, MATCH helps clients who hold jobs for six months or more obtain and retain higher-paying jobs. Free educational options following job placement include GED certification, financial literacy, and skills-based and certificate-based training to promote advancement in the workplace. Financial incentives are provided to clients who are able to retain their employment at the 30 day and 90 day benchmarks. For employed clients, free tax preparation services are also offered.

Job Retention

MATCH clients can also use all of the service programming at GMHC, such as intensive case management that addresses medical, housing, mental health, legal and other needs that directly relate to the potential for success in employment.

Program Outcomes

GMHC enrolls approximately 800 to 1,000 participants each year into the MATCH program. In 2012, 700 individuals obtained in full-time and part-time paid positions. The average hourly wage for these positions was $11.78. MATCH is now the most requested service at GMHC besides meals.

Holistic Approach to Employment Preparation and Retention

In 2005, Chicago House, the first HIV/AIDS housing provider in the Midwest, conducted a pilot project to determine the feasibility of adding employment services to its array of services. The pilot was successful and, in 2007, Chicago House officially launched the iFOUR Employment Program.

Job Preparedness

The iFOUR job preparation workshop covers workplace culture, conflict communication and resolution, goal setting, money and time management, disclosure and confidentiality, benefits counseling and appropriate accommodation, and maintaining health while working.

Job Readiness

An HIV/AIDS career specialist assists candidates in developing career goals, a job search strategy and a work plan based on identified interests and skill sets. Additional job readiness activities include resume development, interview preparation and mock interviews, and job training.

Job Training

iFOUR offers job training program in the food service area. The training, Foodservice Accelerated Skills Training (FAST), prepares candidates for entry-level positions. The 60-hour classroom and kitchen-based program includes basic skills such as professionalism, customer service and food preparation. Candidates completing FAST are certified in safety and sanitation as Foodservice Managers in the City of Chicago. After completing their training, candidates work with an HIV/AIDS Career Specialist to secure permanent, unsubsidized employment.

Job Placement

iFOUR staff is continually building relationships with potential employers. Through ongoing assessment of participants' and knowledge of employers and job postings, its Career Specialists can help to target appropriate job leads to participants.

Job Retention

Post-employment support services (PESS) are provided, because maintaining employment can be just as challenging—and is just as important as—obtaining it.

Program Outcomes

In FY 2013, 448 participants were served in iFOUR (a total of 987 since the program began). Seventy-one percent of clients served were male, 22% female, and 7% transgender. Seventy-one percent were African American, 15% Caucasian, and 9% Hispanic/Latino. Eighty-two percent were working and/or in school within the first six month of housing. During this period, participants had a 75% placement rate and 61% employment rate. Of this group, 7% retained employment for at least three months and 47% for 6 months. The average hourly earnings for iFOUR clients were $10.89 per hour; however, wages ranged from $4.25 (plus tips) to $30.00 per hour.

Job Preparedness

Through Working Choices, Cascade AIDS Project staff provide a variety of one-on-one services, including weekly orientation sessions and job club meetings. There is also a drop-in "open lab" each Monday, when job searchers can use resources such as computers, phones, fax machines and photocopiers. In addition, a weekly career exploration workshop helps participants create career "maps" that lay out life history, accomplishments and strengths and chart them to possible jobs.

Job Readiness

Through its weekly workshops and "open lab," Working Choices offers one-on-one assistance with resume and cover letter development, networking, identifying job leads, interview preparation, and more.

Job Training

A variety of job training opportunities, including employment workshops, on-the-job experiences, and funding for vocational classes, are facilitated through Cascade AIDS Project's partnership with WorkSource Oregon, the state's American Job Center provider.

Job Placement

Through one-on-one consultation and its partnership with WorkSource Oregon, Cascade AIDS Project helps clients develop job search skills and put them to work identifying appropriate opportunities based on the results of their career exploration activities.

Program Outcomes

In its most recent program year (July 2013 to June 2014), of Cascade AIDS 125 participants, 40 returned to work and 4 entered into college or a formal training program (35.2%). The average wage among those who obtained employment was $10.90/hr. Eighty-nine percent of the clients identified themselves as male, 8% as female and 3% as transgender. Sixty-seven percent of the participants identified as gay or lesbian, 19% as straight and 14% as bisexual. Regarding race, 63% percent of the participants identified as Caucasian and 37% identified as a person of color. The largest age demographic was 45-54 year-old at 37%, and the second largest was the 35-44 year-old category at 33%. Thirty-four percent of participants were homeless at entry, while 87% in a single household, 6% in a household as a couple, and the remaining 7% have children in their household. Forty-three percent noted that they experience mental health challenges, and 26% are challenged by substance abuse. Thirty-nine percent of the participants identified as having a history in the criminal justice system. At the time of program entry, annual household income between $0 and $14,680.

Providing a Second Chance Through Employment

Housing Works serves approximately 60 participants per year, with 28 currently placed in jobs. The average wage for those placed is $26,000-28,000 per year. Sixty-four percent of the clients identified themselves as male, 31% as female and 5% as transgender. Twenty-one percent of the participants identified as gay, lesbian, or bisexual and 21% as straight. The largest age demographic represented was the 45 years of age or over (58%); the second largest group was 35-44 years (21%). Fifteen percent identify as homeless.

Job Preparedness

Participants are first engaged in a peer stipend program. The first step is to learn about jobs at Housing Works.

Job Readiness

JTP provides classroom training is provided, including GED preparation.

Job Training

JTP subsidizes on-the-job training and support.

Job Placement

JTP offers guaranteed employment for all graduates through Housing Works ventures.

Job Retention

JTP assigns a counselor to work with a participant and their employer for a minimum of six months to help smooth the transition into the JTP graduate's new position.