Washington State Case Study

Employment First – Washington State leading the way


In 2011, the National Association of Councils on Developmental Disabilities issued its “The Time Is Now: Embracing Employment First” call to action.   The report revealed the alarming fact that 88 percent of working-age adults with developmental disabilities are unemployed.
Given the following, this is particularly tragic:

  • From an individual’s perspective, working in competitive employment means:
    • More pay—competitive employment pays better wages, rising 31 percent per hour in real terms since the 1980s compared to dropping 41 percent for those in sheltered workshops during the same period.
    • More friends—work supports socialization that leads to more and longer-term relationships and friendships.
    • More happiness—work increases an individual’s self-worth and provides them resources that allow them to contribute to their community.
  • From a taxpayer’s perspective, achieving competitive employments means:
    • More return on investment—every $1 spent on supported employment services yields a return of $1.46, based on taxes alone generated by the individual working.  Simply put, supported employment is good fiscal policy, resulting in a 46 percent ROI.

Washington State has shown that working-age adults with ID/DD don’t have to settle for unemployment.  On July 1, 2006, Washington was the first state to adopt what became the Employment First policy, the most current version of which:

  • Establishes employment support as the first use of employment and day program funds targeted for working-age adults, and ensures that after nine months of employment services individuals may choose community access programs.
  • Applies to all eligible working-age adults who receive or seek employment and day program services from all state, county and contracted providers.

The value of Employment First was best summarized by Linda Rolfe, Washington’s long-time Division of Developmental Disabilities director:
“In Washington, we believe that employment is the easiest, most cost-effective strategy available to us to ensure that people have opportunities to experience the benefits we value. We have focused a lot of energy on getting people opportunities to have real jobs with good wages.”

In 2005, the vast majority of individuals without disabilities took nine months or less to find a job after schooling.   Washington’s approach for individuals with ID/DD was to focus on employment first.  The idea was for adults with ID/DD entering the system to focus their first nine months on that same goal—finding a job.  Leaders and advocates also recognized that employment is a complex and challenging goal to achieve and that the more focused, collaborative and targeted the effort is the more likely individuals are to obtain their employment goals.  And, knowing this, they also recognized that employment is a typical part of a full life for any adult in Washington State, including citizens with developmental disabilities.  Therefore, legislation, policies and practices should be aligned to support the employment goals and outcomes of each individual.  Simply put, Washington State embraced a strategy of doing the hardest thing first, realizing that it would likely never get done otherwise.

The impact of the Employment First priority was profound.  The number of individuals competitively employed rose from 4,440 in 2004 (before the policy) to 5,562 by 2011.  This 25 percent increase in just seven years was particularly impressive given it occurred during the Great Recession from 2008-2011.
Overall, Washington State scored 6th best in the country for its Medicaid programs serving individuals with ID/DD, according to UCP’s 2013 Case for Inclusion ranking (based on 2011 data).  This was a significant jump from its 2007 ranking of just 20th.  In 2011, Washington State tied with Oklahoma for the highest rate of individuals participating in competitive employment (65 percent)—more than three times the national average of just 20 percent.

Not only is the Employment First policy change a positive reform that changes the lives of individuals with ID/DD, it is accompanied by good politics as well.  Washington State did not significantly cut back on sheltered workshop funding.  In fact, the number of participants in sheltered workshops remained unchanged during the Employment First years.  The state did not even significantly increase supported employment funding – it was $30.8 million in 2005 and $34 million in 2011, just a 10 percent increase.  Instead, Washington and its community-based partners “invested [their] advocacy and development effort into continually building and investing in a community system that can support the needs of everyone, one person at a time,” as Cesilee Coulson, executive director of the Washington Initiative for Supported Employment explained.   With all the talk of self-directed services, Ms. Coulson knows, “True choice happens after someone with disabilities gets a paycheck.  The government can only provide you limited choices that are part of a service mix; your own paycheck and employment give you independence.”

The keys to the Employment First success were state and county leadership, training and innovation, quality employment agencies, organized and informed families, and clearly-defined goals.  In addition, training and development was focused on building a “Community of Practice” from best practices.  Mike Hatzenbeler, CEO of PROVAIL, the Seattle, Washington UCP Affiliate, notes that “Community of Practice is critical as there are many hard and big barriers to get to full inclusion.  It is vital that everyone have a strong belief that this is not just a pipe dream but a real possibility.”  Mr. Hatzenbeler credits strong long-term focused leadership within the Administration on the Employment First goals, reinforced with robust advocacy before the legislature, as described below.

To help achieve competitive employment for very complex clients, agencies established the Cross County Collaboration.  Each participating agency, including PROVAIL, identifies their five most challenging clients struggling to realize the employment goal.  All three agencies focused on these 15 individuals, providing intensive support and creating a broader network of employers and community partners.  On average, 265 hours of service from intake through job stabilization are devoted to each individual.  Over 18 months, 14 of the 15 clients (93 percent) found jobs and retained them.


Washington State Employment First Results




% Change

Participants - Number




Participants - Percent








% Change

Average Wages per Person




Cumulative Wages

$29 Million

$40 Million



Source: Washington Initiative for Supported Employment

In addition to the above outcomes, Employment First experiences clearly showed that more working hours results in fewer service hours.  Specifically, the Washing Initiative for Supported Employment’s data showed that having a job means:

  • “On average, for each person almost eight hours worked for every hour of service.
  • On average, for each person, almost 650 annual hours of paid service isn’t needed because the person is working”

In fact, in 2010 Washington State set the lofty goal of doubling the number of supported employment participants by 2015, and is well on its way to accomplishing just that.

Several innovative strategies were used to focus legislators on the power of Employment First:

  • Celebrate—establishing Employment for All Day, organized by the Community Employment Alliance
  • Advocate—an Employment for All Day proclamation issued by the Governor
  • Articulate—developing a winning slogan; “Everyone Deserves a Payday.”
  • Educate—distributing Payday candy bars to legislators with key facts and talking points

With all the competing policy priorities facing legislators, advocates’ clever strategies and inspiring outcomes are keys to sustaining and expanding Employment First success.
As of April 2013, 22 states have adopted Employment First-type strategies:

  • 7 through legislative changes: California, Delaware, Kansas, Pennsylvania, Virginia, Utah, and Washington.
  • 15 through departmental policy changes: Arkansas, Colorado, Connecticut, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, New Jersey, Ohio, Oklahoma, Oregon, Rhode Island, and Tennessee.

If every state matched Washington State’s successes, there would be 228,000 more individuals with ID/DD working today, as shown in the table below. 
Washington has provided a roadmap.  Now, policy-makers can introduce similar legislation (a model bill is provided on the following pages) and executive branches can adopt similar departmental policies (http://www.dshs.wa.gov/pdf/adsa/ddd/policies/policy4.11.pdf).


What if Every State Were Like Washington State?


Model Legislation for Employment First
(based on SB 638 4 of the Washington State Legislature, which passed July 2012)

An Act to Promote Employment First Among Working-Age Adults with Developmental Disabilities


An act relating to ensuring that persons with developmental disabilities be given the opportunity to transition to a community access program after enrollment in an employment program.



  • Clients age twenty-one and older who are receiving employment services must be offered the choice to transition to a community access program after nine months of enrollment in an employment program, and the option to transition from a community access program to an employment program at any time.  Enrollment in an employment program begins at the time the client is authorized to receive employment.
  • Prior approval by the department shall not be required to effectuate the client's choice to transition from an employment program  to  community  access  services  after  verifying  nine  months  of participation in employment-related services.
  • The department shall  inform  clients  and  their  legal  representatives of all available options for employment and day services, including the opportunity to request an exception from enrollment in an employment program.  Information provided to the client and the client's legal representative must include the types of activities each service option provides, and the amount, scope, and duration of service for which the client would be eligible under each service option.  An individual client may be authorized for only one service  option,  either  employment  services  or  community  access  services.  Clients may not participate in more than one of these services at any given time.
  • The department shall work with counties and stakeholders to strengthen and expand the existing community access program, including the consideration of options that allow for alternative service settings outside of the client's residence.  The program should emphasize support for the clients so that they are able to participate in activities that integrate them into their community and support independent living and skills.
  • The department shall develop rules to allow for an exception to the requirement that a client participate in an employment program for nine months prior to transitioning to a community access program.

Effective Date:
This bill takes effect upon enactment.

“The Time Is Now: Embracing Employment First.” National Association of Councils on Developmental Disabilities. November 2011. http://www.nacdd.org/documents/EmploymentFirstFINALNov132011_PRINT.pdf (access March 31, 2013)

Ibid. page 5.

Cimera, Robert Evert. “The economics of supported employment: What new data tell us.” Journal of Vocational Rehabilitation 37. 2012. Page 111. http://www.worksupport.com/documents/economics_jvr.pdf (accessed March 31, 2013)

“Unfinished Business: Making Employment of People with Disabilities a National Priority.” U.S. Senate Committee on Health, Education, Labor and Pension. .July 2012. Page 5. http://www.harkin.senate.gov/documents/pdf/500469b49b364.pdf (accessed March 31, 2012)

Cimera, Robert Evert. “The economics of supported employment: What new data tell us.” Journal of Vocational Rehabilitation 37. 2012. Page 114. http://www.worksupport.com/documents/economics_jvr.pdf (accessed March 31, 2013)

“County Services for Working Age Adults: Policy 4.11.” Washington State Department of Social and Health Services’ Division of Developmental Disabilities. July 2012. http://www.dshs.wa.gov/pdf/adsa/ddd/policies/policy4.11.pdf (accessed March 31, 2013)

Rolfe, Linda. “Voices from the Field: Employment in Washington State.” Alliance for Fulll Participation. March 8, 2010. http://www.allianceforfullparticipation.org/the-news/183-voices-from-the-field-employment-in-washington-state (accessed March 31, 2013)

Cesilee Coulson interview with Tarren Bragdon on April 12, 2013.

Cesilee Coulson. “Washington State Employment Data Presentation.” Slide 7. Available at: INSERTURL1 (access April 15, 2013).United Cerebral Palsy’s Case for Inclusion 2012. Available at: Medicaid.UCP.org (accessed March 31, 2013)

“Employment in Washington State – 2010 Report.” Washington Initiative for Supported Employment. Page 16. Available at: http://www.dshs.wa.gov/pdf/adsa/ddd/2010%20WA%20Employment%20Report.pdf  (accessed April 14, 2013)

Learn more by reading the excellent case study: “Cross County Collaboration C3 Pilot Project – Final Project Report.” PROVAIL, Highline Community College, and Service Alternatives. October 30, 2009.  Available at: LINKURL2 (accessed April 15, 2013)

“Washington State Employment Data Presentation.” Slide 10.

Hoff, David. “Employment First Resource List.” State Employment Leadership Network . Revised April 2013. http://www.apse.org/docs/Employment%20First%20List%204-13%20%28SELN%29.pdf (accessed on April 14, 2013)

“Senate Bill 6384: Ensuring that persons with developmental disabilities be given the opportunity to transition to a community access program after enrollment in an employment program.” Washington State Legislature. 2012 Session. As passed and signed by the Governor on June 7, 2012 becoming  Public Law Chapter 49, 2012. http://apps.leg.wa.gov/documents/billdocs/2011-12/Pdf/Bills/Session%20Laws/Senate/6384-S.SL.pdf (accessed March 31, 2013)

An Analysis of Medicaid Outcomes for Americans with Intellectual & Developmental Disabilities

United Cerebral Palsy (UCP) releases The Case for Inclusion each year, tracking the progress of community living standards for Americans living with intellectual and developmental disabilities (ID/DD). The report examines data and outcomes for all 50 states and the District of Columbia (DC), ranking each on a set of key indicators, including how people with disabilities live and participate in their communities, if they are satisfied with their lives, and how easily the services and supports they need are accessed. By taking these factors into account, UCP is able to develop a comprehensive analysis of each state's progress or failures in providing critical services to individuals living with disabilities.

The findings for 2013 reveal that: 1) All states have room for some improvement, but some have consistently remained at the bottom of the rankings; 2) Despite economic strains, many states have made real improvements in the quality of services being provided; 3) There is still work to be done in ensuring that people with ID/DD can enjoy the same freedoms and quality of life as all Americans.

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