Employment is the first question we ask about most adults in society. In part, every adult is defined by their contributions, their work. Even as employment for people with intellectual and/or developmental disabilities has gained attention, there has been a growing awareness that the labor force participation rate for this population has remained flat (Butterworth et al., 2011). Although there is variability across states, there is an absence of a clear message at state and national levels regarding employment of persons with disabilities. This has resulted in inconsistencies in employment policies, practices, and procedures. There are, however, an increasing number of states that are taking notice of this and seeking to develop a clear message that employment for persons with disabilities must be a priority (Hoff, 2011). Some state developmental disabilities agencies have embraced a presumption of employability or the option of employment for all persons with disabilities. This is clearly seen in the efforts of the State Employment Leadership Network (SELN), a network of 23 state developmental disability agencies sponsored by the Institute for Community Inclusion and the National Association of State Directors of Developmental Disability Services (http://www. communityinclusion.info). These state efforts have often been framed under the umbrella of Employment First. Employment First, reflecting a series of policies, practices, and procedures based upon a collection of guiding principles, is leading states and providers to the adoption of service delivery strategies for persons with disabilities, including those with the most significant disabilities, that lead to systemic change and competitive integrated employment. The main point about Employment First is that employment should be the very first option offered to any adult with a disability, before any kind of nonemployment option. There are currently over 25 states that are focused at some level on the concept of Employment First (Hoff, 2011). In some cases, the focus is specifically on individuals with intellectual and/or developmental disabilities, while in other cases this effort is cross-disability. Some of these efforts have been spearheaded by public systems, and in other cases have been grassroots in nature, with advocates pushing for changes in policies and practices that prioritize community employment. Central to Employment First are the establishment of clear public policies (e.g., legislation, policy directives that prioritize community employment. To date, approximately 10 states have such policies in place. As in all major systemic change efforts, there are a set of guiding principles that help shape these change efforts. For Employment First these guiding principles are being discussed by a wide array of people in policymaking, self-advocacy, and practitioner roles. Although there is not always consensus, these principles include: