3. Pre-ETS questionnaire 3.17.21

OMB Control No: 1230-0NEW

Expiration Date: XX/XX/20XX

INTRODUCTION: The Center for Advancing Policy on Employment for Youth (CAPE-Youth), which is funded by the U.S. Department of Labor, Office of Disability Employment Policy, is conducting research on Pre-Employment Transition Services (Pre-ETS). Section 113(a) of the Rehabilitation Act, as amended by the Workforce Innovation and Opportunity Act (WIOA, P.L. 113–128) requires States to reserve at least 15 percent of their Vocational Rehabilitation (VR) program allotments to provide, or arrange for the provision of, Pre-ETS to all students with disabilities in need of such services who are eligible or potentially eligible for the VR program.

Using a questionnaire, CAPE-Youth is consulting leaders or directors of state VR agencies to understand better how Pre-ETS is being delivered. The questionnaire has three sections:

1. Pre-ETS delivery formats and locations;

2. student completion of Pre-ETS; and

3. Pre-ETS delivery for students who are potentially eligible for VR services.

Before you begin your response it may be helpful to have available the Quarterly RSA Data Dashboards or other agency Pre-ETS database that you use. If available, we will be asking you about data on student completion of each Pre-ETS and on disability types of students who are potentially eligible for VR services.

CAPE-Youth will use this information to inform improvement and further development of resources and services related to Pre-ETS policy and implementation. The resources will be made available to state agencies and policymakers and used for technical assistance. Please note, your state agency and your name and identity will not be disclosed on public materials unless you give us express permission to do so.

The questionnaire will take a maximum of 30 minutes to complete. You can exit the questionnaire and return to it at any time, and your answers will be saved. To answer some questions, you may need to gather data or perspectives from other staff in your agency which may take some additional time.

Thank you in advance for completing this questionnaire. Please complete it by (date). If you have any questions, please contact Dr. Marsha Ellison at Marsha.Ellison@umassmed.edu.

Click here to begin the questionnaire:

Your first and last name:

Your position/title:

Your state/territory: (drop down menu of 50 states plus territories)

Your state/territory Vocational Agency type: (drop down menu)

• Blind

• General

• Combined

Section 1: Formats and locations used to deliver Pre-ETS prior to the COVID-19 pandemic and during the pandemic

We understand that there have been considerable adjustments to Pre-ETS made in response to the COVID-19 pandemic. The following two questions (Q1 and Q2) ask you to think about Pre-ETS services as they were delivered PRIOR TO COVID-19. The third question (Q3) asks you to describe how formats and locations for delivery of Pre-ETS were adapted in response to the COVID-19 pandemic.

Q1. Thinking of your state’s Pre-ETS prior to adaptations in response to COVID-19, indicate the formats used to deliver each required Pre-ETS. Formats can be individual, within a class or group setting, and/or another format. Class or group settings may be disability-specific or may be cross-disability by design. The class or group option applies to classes or groups that receive Pre-ETS and not classes or groups that receive other transition services (i.e., those under Sec. 361.49(a)(7).) Click here for a definition of transition services to groups.

In the table below, please indicate the format(s) used to deliver each Pre-ETS prior to COVID-19. Check all formats that apply.

Pre-ETS formats	Job Exploration Counseling	Work-Based Learning	Postsecondary Counseling	Self-Advocacy Training	Workplace Readiness Training
Individualized
Within a class or group for students with different disability types or impairments
Within a class or group for students with same or similar disability types or impairments	*	*	*	*	*
Other format, describe: _________

• (If the respondent endorses this box, the following question will appear:
  Q1a. For this Pre-ETS class or group, what specific primary disability groups are served? Check all that apply:

• Sensory/communicative disabilities (includes blindness, low vision, deafness, hearing loss, deaf-blindness, or expressive/receptive communicative impairments)

• Physical impairments (includes mobility/orthopedic impairment or neurological impairments)

• Mental - Cognitive impairments (includes ADHD, autism, intellectual disability, traumatic brain injury, developmental disability, congenital condition, or birth injury)

• Mental - Psychosocial impairments (includes interpersonal and behavioral impairments, anxiety disorders, depressive and other mood disorders, eating disorders, personality disorders, schizophrenia and other psychotic disorders, or other mental illness)

• Mental - Other impairments (includes learning disability, alcohol abuse or dependence, or drug abuse or dependence)

Q2. In the chart below, indicate the locations used to deliver each required Pre-ETS prior to the COVID-19 pandemic. Check all Locations that apply.

Location for delivery of Pre-ETS	Job Exploration Counseling	Work-Based Learning	Postsecondary Counseling	Self-Advocacy	Workplace Readiness Training
On-site at high school during school hours
On-site at high school after school hours
On-site postsecondary school (college or training)
VR agency offices
Community non-profit organizations (e.g., Community Rehabilitation Organizations)
Other (non-VR) governmental agency offices (e.g., American Job Centers, Justice/detention or correctional facilities)
Other community settings (e.g., library, eateries, Boys/Girls Club)
Employers/ business sites
Virtual, online
Other, describe

Q3. This question lists adaptations to the formats or locations used for delivery of Pre-ETS that your state may have made in response to the COVID-19 pandemic. For each Pre-ETS, check all adaptations you have used.

Adaptations to formats used for delivery of Pre-ETS	All Five Pre-ETS	Job Exploration Counseling	Work-Based Learning	Postsecondary Counseling	Self-Advocacy	Workplace Readiness Training
VR counselors providing more services virtually
Moving from individualized services to virtual group services
Moving from group-based services to virtual individualized services
Using online modules for each Pre-ETS
Services postponed to a later date
Other adaptation Describe: _______________ _______________

Section 2. Completion of Pre-ETS

To answer questions in this section you may need to have available the Pre-ETS data on completion rates or retention rates in Pre-ETS for your agency. We will be asking you for data on the overall number of students who complete Pre-ETS by each Pre-ETS (Q4a), completion numbers by type of disability for each Pre-ETS (Q4b, c), Pre-ETS retention strategies for students with other barriers to employment (Q4d), and your perception of whether retention in Pre-ETS has changed due to the COVID-19 pandemic for students with other barriers to employment (Q4e).

Q4. Do you have data on the number of students who complete a Pre-ETS, i.e., who participate until the planned conclusion of that Pre-ETS? This would exclude students who dropped out, or for any reason stopped attending before the planned conclusion of the Pre-ETS.
Yes/No (continue if answered yes, if No skip to Q4e).

Q4a. In the following chart, please indicate the number of students who completed each Pre-ETS (i.e., participated until planned conclusion) for the most recent program year.

Program Year: __________	Job Exploration Counseling	Work-based Learning	Postsecondary Counseling	Self-advocacy	Workplace Readiness Training
Number of students who completed Pre-ETS: *

* (This number excludes students who dropped out, or for any reason stopped attending before the planned conclusion of the Pre-ETS.)

Q4b. Do you have data on the number of students who complete Pre-ETS by disability type? Disability types are defined as:

Sensory/communicative disabilities (includes blindness, low vision, deafness, hearing loss, deaf-blindness, or expressive/receptive communicative impairments)

Physical impairments (includes mobility/orthopedic impairment or neurological impairments)

Mental-Cognitive impairments (includes ADHD, autism, intellectual disability, traumatic brain injury, developmental disability, congenital condition, or birth injury)

Mental-Psychosocial impairments (includes interpersonal and behavioral impairments, anxiety disorders, depressive and other mood disorders, eating disorders, personality disorders, schizophrenia and other psychotic disorders, or other mental illness)

Mental-Other Impairments (includes learning disability, alcohol abuse or dependence, or drug abuse or dependence)

Yes/No. (Skip Logic If yes go to Q4c.)

If yes, who does the data include? (check one)

• Only students who are eligible for VR (e.g., have an Individualized Plan for Employment)

• Both, students who are eligible and potentially eligible for VR *

• For a definition of potentially eligible students, click here. (Potentially eligible students are those who are known to have a disability by virtue of receiving special education and related services through an Individualized Education Program [IEP] or students who are an individual with a disability for purposes of Section 504, regardless of whether they have applied for or been determined eligible for VR services.)

Q4c. In the following chart, for the most recent program year please indicate the number of students who completed (i.e., participated until planned conclusion) each Pre-ETS by disability type. Exclude students who dropped out, or for any reason stopped attending before the planned conclusion of the Pre-ETS. (The first row indicates your response to the total number of students who completed Pre-ETS from Q4a.)

Program year: __________	Job Exploration Counseling	Work-based Learning	Postsecondary Counseling	Self-advocacy	Workplace Readiness Training
Total number of students who completed Pre-ETS (populated from previous response in Q4).
Number of students with sensory/communicative disabilities who completed Pre-ETS
Number of students with physical impairments who completed Pre-ETS
Number of students with mental-cognitive impairments who completed Pre-ETS
Number of students with mental-psychosocial impairments who completed Pre-ETS
Percent of enrolled students with other mental impairments who completed Pre-ETS

Q4d. What strategies or methods have you utilized or observed in your state that have helped students with other barriers to employment stay engaged in each Pre-ETS? Click here for a definition of students with other barriers to employment. (Students with other barriers to employment are defined in the RSA-911 data report as students who are: in foster care, homeless, ex-offenders, low income, English language learners, single parents, or have low literacy or cultural barriers.)

	Strategies to retain students with other barriers to employment in Pre-ETS
Job Exploration Counseling
Work-based Learning
Postsecondary Counseling
Self-advocacy
Workplace Readiness Training

Q4e. The COVID-19 pandemic may have affected the Pre-ETS completion rates of students with disabilities who faced other barriers to employment. Click here for a definition of students with other barriers to employment. (Students with other barriers to employment are defined in the RSA-911 data report as students who: are in foster care, homeless, ex-offenders, low income, English language learners, or single parents; or have low literacy or cultural barriers.)

Indicate whether in your experience or observation completion rates due to the pandemic for students with other barriers to employment in Pre-ETS increased, decreased, had no change, or you don’t know . Use “Other” to describe mixed or different changes in completion rates.

	Increased	Decreased	No change	Don’t know	Other
Change in completion rates due to pandemic for students with other barriers to employment					Explain: ___________________________

Section 3. Pre-ETS for students who are potentially eligible for VR services

The following questions concern the number of students who are potentially eligible for Pre-ETS. For a definition of potentially eligible students click here. (Potentially eligible students are those who are known to have a disability by virtue of receiving special education and related services through an Individualized Education Program [IEP] or who are an individual with a disability, for purposes of Section 504, regardless of whether they have applied for or been determined eligible for VR services.)

To answer questions in this section you may need to have available the Pre-ETS data on potentially eligible students receiving Pre-ETS for your agency. First we ask about the numbers of students who are potentially eligible for VR services receiving Pre-ETS in your agency by disability type (Q5a). Next, we ask about referral sources and referral strategies for potentially eligible students (Q6), barriers to their referral (Q7), and strategies used for their skill progression (Q8).

Q5. Does your state collect data on the primary disability or impairment of potentially eligible students who have received Pre-ETS? Yes, No (if no, skip to Q6)

Q5a. If yes, please indicate the number of potentially eligible students, by primary disability, receiving Pre-ETS.

Disability types are described as follows:

Sensory/communicative disabilities (includes blindness, low vision, deafness, hearing loss, deaf-blindness, or expressive/receptive communicative impairments)

Physical impairments (includes mobility/orthopedic impairment, or neurological impairments)

Mental-Cognitive impairments (includes ADHD, autism, intellectual disability, traumatic brain injury, developmental disability, congenital condition, or birth injury)

Mental-Psychosocial impairments (includes interpersonal and behavioral impairments, anxiety disorders, depressive and other mood disorders, eating disorders, personality disorders, schizophrenia and other psychotic disorders, or other mental illness)

Mental-Other impairments (includes learning disability, alcohol abuse or dependence, or drug abuse or dependence)

Impairments	Number of students receiving Pre-ETS Program year: _______
Total potentially eligible students receiving Pre-ETS
Number of potentially eligible students who have Sensory/Communicative impairments
Number of potentially eligible students who have Physical impairments
Number of potentially eligible students who have Mental-Cognitive impairments (*click here to see definition)
Number of potentially eligible students who have Mental-Psychosocial impairments (*click here to see definition)
Number of potentially eligible students who have Mental-Other impairments (*click here to see definition)

Q6. Describe the referral sources and referral strategies that in your estimation have yielded the greatest number of referrals of potentially eligible students in your state. (For example, referral sources may be mental health agencies, foster care agencies, or juvenile justice systems. Referral strategies may be statewide data sharing agreements or co-location of Pre-ETS vendor representatives in community one-stop centers.) (open ended)

_________________________________________________________________________

__________________________________________________________________________________

Q7. Describe any barriers to obtaining referrals of students for Pre-ETS who are potentially eligible for VR services. (open ended)

__________________________________________________________________________________

__________________________________________________________________________________

Q8. Based on your observation and experience in delivering Pre-ETS, describe strategies, program models, or curricula most beneficial to educational/training progression or skill gain among potentially eligible students. (open ended)

__________________________________________________________________________________

__________________________________________________________________________________

This concludes the questionnaire. Thank you for your participation. If you would like to discuss the questionnaire or want any other information about the questionnaire, please contact Dr. Marsha Ellison at Marsha.Ellison@umassmed.edu.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays an Office of Management and Budget (OMB) control number. The valid OMB Control Number for this information collection is xxxx-xxxx. The time required to participate in the questionnaire is estimated to average 30 minutes, including the time to review instructions, search existing data resources, gather the data needed and complete and review the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to US Department of Labor, Office of Disability Employment Policy, 200 Constitution Ave., N.W. Washington, DC 20210 and reference the OMB Control Number xxxx-xxxx.

Privacy Act Statement
Collection and Use of Personal Information

The following statement is made in accordance with the Privacy Act of 1974 (5. U. S. C. 552a). Information collected will be handled and stored in compliance with the Freedom of Information Act and the Privacy Act of 1974, as amended (5 U.S.C. 552a). Furnishing the Pre-ETS data requested is voluntary.

We will use the Pre-ETS data you provide for the CAPE-Youth Pre-ETS Research Project, funded by The United States Department of Labor, Office of Disability Employment Policy. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.