As We Mark 10 Years as an Employment First State, It’s Time to Say Goodbye to Our Rise to Work Blog

/ August 28, 2023

By Janet Shouse

Tennessee officially celebrated 10 years as an Employment First State this month! For many of us, this is a huge milestone. Being an Employment First State means focusing on the idea that all individuals, including those with the most significant disabilities, are capable of  participation in competitive, integrated employment and community life with the right supports. More specifically, Employment First means that employment in the general workforce should be the first and preferred option for individuals with disabilities receiving assistance from publicly funded systems. And it means real jobs with real wages.

In June 2013, Gov. Bill Haslam signed what is called Executive Order No. 28, designating Tennessee as an Employment First State. The order came as a result of efforts of multiple people in the disability community who worked together to get a federal grant to create TennesseeWorks. They wanted individuals with disabilities to have expanded work opportunities. Working with leadership of several state agencies and the governor, this group included Wanda Willis, the now-retired longtime executive director of the Tennessee Council on Developmental Disabilities; Elise McMillan, the recently retired co-director of the Vanderbilt Kennedy University Center for Excellence in Developmental Disabilities; and Erik Carter, also a former co-director of the VKC’s UCEDD. These individuals as well as several others envisioned the TennesseeWorks Partnership as “an innovative and coordinated statewide effort to ensure every youth and young adult with IDD would have the aspirations, preparation, opportunities, and supports to access competitive and integrated work.” (By naming names, I know I’ve left key people out, but please don’t be hurt. I appreciate your efforts, too!)

Why was this effort necessary? Because for many years, a situation that originally came from a place of compassion became unacceptable to many people. Years ago, “sheltered workshops” were created to help people with disabilities have some kind of job, and these workshops provided close supervision/supports, but paid their workers literally pennies per hour for such tasks as folding pizza boxes or stuffing envelopes. As individuals with disabilities moved out of institutions, they also wanted to move out of sheltered workshops, and they wanted real jobs with real wages.

The reality, though, was and is that many individuals with disabilities need supports in order to work in competitive, integrated employment, and Tennessee began the work of figuring out how to make our various systems all work together toward this end. The state agencies involved included:

  • The Department of Intellectual and Developmental Disabilities
  • The Department of Education
  • The Department of Mental Health and Substance Abuse Services
  • TennCare
  • The Department of Human Services/Division of Vocational Rehabilitation
  • The Department of Labor and Workforce Development
  • The Department of Economic and Community Development
  • The Department of Health

By getting together in these TennesseeWorks Partnership meetings, which also include disability advocacy organizations, teachers, employers, family members, self-advocates, and Medicaid waiver provider agencies, a whole bunch of folks learned what other departments or organizations do. They have been able to network, and they worked to streamline processes for those interested in finding employment.

On Aug. 15, DIDD held a celebration of the first 10 years of being an Employment First State, with the commissioner of DIDD, Brad Turner; the commissioner of the Department of Human Services, Clarence Carter; the commissioner of the Department of Mental Health and Substance Abuse Services, Marie Williams, and the deputy commissioner and director of TennCare, Stephen Smith. Members of the Employment First Task Force were treated to some tasty goodies and a sing-along with Commissioner Williams to Eric Clapton’s “Change the World,” as we marked some of milestones we’ve seen in competitive, integrated employment.

One of the key outcomes of this effort was the 2016 launch of the Employment and Community First CHOICES waiver program, which encourages people with intellectual and developmental to explore the world of work and then helps provide the supports and services people need to pursue and gain employment in their communities. There are issues with ECF CHOICES, certainly, with one of the major ones being the critical lack of direct support professionals, personal assistants, job coaches and job developers. However, many people with disabilities are now working who would not be able to have a job if they did not have the supports and services of ECF CHOICES.

Other major efforts of this Partnership include:

  • The expansion of Project SEARCH sites across Tennessee. We now have 17 of these internship opportunities, with some connected to school districts and some aimed at adults already out of school. Project SEARCH programs have very high rates of employment for their graduates. Learn more here:
  • The expansion of inclusive higher education programs for students with intellectual and developmental disabilities across our state. Seven universities now have postsecondary programs, and one community college has a program. A second community college also has an inclusive higher education program in the works. These programs give students an opportunity for a college experience, classes in self-advocacy and self-determination, and internships and work experience. Graduates of these inclusive higher ed programs also have high rates of employment. Tennessee Believes grants, which were launched by DIDD two years ago, are offering more colleges and universities a chance to create or expand inclusive higher ed programs. You can find out more here:
  • The expansion of the Individual Placement and Support program, which helps individuals with mental health conditions gain and retain employment by providing supports and services. Some IPS programs also include people with IDD and mental health conditions. IPS also has strong data on employment outcomes. Learn more here:
  • A greater focus on Enabling Technology, which is allowing some individuals with disabilities to have greater independence and greater opportunities for employment. Check out DIDD’s Enabling Technology program here:
  • The Medicaid Alternative Pathways to Independence program, also known as MAPs, is helping young adults who either may not yet be enrolled in ECF CHOICES or who may not qualify to use technology to allow them more job opportunities and greater participation in their communities. Learn more about MAPs here:
  • Tennessee in 2021 became a “State as a Model Employer.” This legislation stressed that our state government should be leading the way in the employment, retention, and advancement of people with disabilities. This was long a strategic goal of the Employment First Task Force, and it’s come to fruition. Find out more here:
  • The creation of an Inclusive Employer Award for Tennessee employers, businesses and state agencies that strive to be inclusive of workers with disabilities. This was another goal of the Employment First Task Force. Learn more here:–first/task-force/inclusive-employer-award.html

All of these initiatives and the desire of people with disabilities to work plus employers who are willing to hire those with disabilities have allowed our state to narrow the gap between the employment rates of typical workers and workers with disabilities. There’s still a long way to go before that gap completely disappears, but we’re making progress.

As we mark 10 years of Employment First, I’m going to be bringing the Rise to Work blog to a close. When I was hired as part of the TennesseeWorks team in 2014, my role was to serve as a liaison to individuals with disabilities and their families. As a family member of a young man with autism and an intellectual disability who was then 18 and getting ready to graduate (although not exit) from high school, I began to realize how difficult it was to navigate adult supports and services. School had often been our “go-to” place for information and support, and I knew families whose children had already exited at age 22 had a hard time figuring out where to go and what to do next for their young adult.

We also learned that many adults with disabilities and their families were not connected to state waiver programs, and we didn’t have a good way to get information about pressing disability issues, meetings, new programs or opportunities to these folks. So, I offered, since I’d been in the newspaper business for nearly 30 years, to write and coordinate a blog called Rise to Work as a way to share information with many people in the disability community. As time went on, I was able to get other folks to write the posts about the programs and services and issues that they were connected with, and I mostly got to edit their work. (And I love editing!)

The blog provided information about the Employment First work mentioned above, but also touched on topics such as supported living, the dignity of risk, why an autism diagnosis might be vital for an adult, and the importance of mental and physical health for people with disabilities. Officially, the blog posts were to somehow connect to employment of people with disabilities, but I generally selected topics that I personally felt were important to those with disabilities and their families.

I have been delighted that the Vanderbilt Kennedy Center allowed me the freedom to write about issues I am passionate about, and I loved the fact that the blog allowed me to connect with people all across the nation. I routinely ended each post with my email address and wrote that if people had questions, they could contact me. I often get multiple emails a week asking how to access certain programs or services or how to find psychologists to make an autism diagnosis or what do when a student with a disability exits high school. And I’ve tried to answer each of those emails. If you’ve read this far, and you’re thinking of emailing me such questions, I’m going to recommend that you contact Tennessee Disability Pathfinder at or by calling 1-800-640-4636. If you live outside of Tennessee, you may want to contact your state’s Council on Developmental Disabilities. You can find your state’s council here:

My work at the Vanderbilt Kennedy Center will continue, but I will be focusing primarily on improving physical and mental health care for people with intellectual and developmental disabilities. This will include efforts at expanding the public health outreach for people with IDD. I have served as the program coordinator for the IDD Toolkit,, since 2013, and I will continue that work. I’m also part of a team that is launching an IDD ECHO program for health care clinicians and mental health therapists to enhance the care of adults with IDD in Tennessee. I’m very excited about that work!

Thank you for reading Rise to Work. I hope you found the information and stories shared were useful and easy to read. The posts will be archived, and they can be accessed at

Thank you for the positive feedback that I’ve received through the years! You all made me feel like maybe I could write after all. I appreciate you and the opportunity to be part of helping Tennessee be an Employment First State!


Janet Shouse is a parent of a young adult with autism, and she is passionate about inclusion, employment of people with disabilities, medical issues related to developmental disabilities, supports and services, public policy, legislative initiatives, advocacy, and the intersection of faith and disability. She wears many hats at the Vanderbilt Kennedy Center, including one as a disability employment specialist for TennesseeWorks.


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