Different states, common issues: Moving mountains one service at a time

BACKGROUND: In an ever-evolving landscape, states are working to achieve new levels of integrated employment outcomes. While states have been building supports for more than five decades to meet the needs of their constituents, a different playing field has emerged in recent years. This is a result of new regulations, requests from advocates and families, shifting expectations and fluctuating state budgets. OBJECTIVE: How are states managing the range of large and small changes needed to update the employment and employment-related service definitions that are offered? How can we ensure connection between employment and other full life outcomes? And most importantly, how can stakeholders establish individual integrated employment as a priority goal? CONCLUSION: This article describes states' efforts towards employment first goals and outlines more changes that need to be made.