Almost two decades have
passed since the initial published reports began to appear on
supported employment as a means to help people with significant
disabilities become competitively employed. During these past 20
years, we have learned a great deal about what works in supported
employment and what does not (Mank, Cioffi & Yovanoff, 1997). We have
also learned that there are many challenging implementation issues as
well as persistent philosophical differences that have created major
barriers to full implementation. We have seen greater amounts of
deinstitutionalization (Hayden & Albery, 1994), the closing of state
institutions (Stancliffe & Lakin, 1999), the down sizing of sheltered
workshops, the selective reallocation of funds targeted from
segregated programs to integrated programs and a more significant
voice given to people with disabilities via the statutes, as well as
advocacy movement (Wehmeyer & Lawrence, 1995). We have seen changes
in the way that persons with mental retardation are classified by the
American Association on Mental Retardation (Luckasson, Coulter,
Polloway, Reiss, Schalock, Snell, Spitalnik, & Stark, 1992) with a
movement away from intelligent quotient labels derived from tests and
a movement towards a description of supports, both level and
intensity, that are required by individuals with cognitive
disabilities. In fact, the "hot" term for the 1980s was supports, and
this terminology has only been strengthened through the new "hot term"
of self-determination.The implicit power of supported employment,
supported education, or supported living, when intertwined with the
philosophical depth of self-determination and free choice, is a
powerful means of marrying the programmatic strategy (supports) with
the philosophical foundation (self-determination).
What have we learned over the past 20 years? Well, the most
significant contribution generated through the evolution of supported
employment and other programs that define themselves in a context of
supports is the demystification of disability or, put another way, the
reduction of the impact of disability. When one thinks of disability,
one immediately thinks of terms such as handicapped, impairment,
unable to do, less qualified. These are the thoughts and perceptions
of too many people in society. The gift of supported employment is to
reduce the impact of disability, even if it is only during the time
frame that the individual goes to work. Once that individual departs
the workplace, she may well be forced into a situation where she has
to "put back on" her physical disability or mental retardation label.
For example, consider the case of Roseanne, an individual with a
significant physical and cognitive disability. Roseanne has very
limited speech and requires personal assistant services throughout the
day. When Roseanne is working, placing security scanners on CDs in
Wal-Mart's electronics department, earning $7.20 an hour, receiving
health benefits, and participating in the profit sharing plan; she
does not have a disability label. Roseanne, through the eyes of her
coworkers and management, is non disabled, because they are depending
on her to complete her task. Once the end of her shift arrives;
however, she is totally dependent on the local transit system serving
people with physical disabilities. In fact, once Roseanne wheels out
of the Wal-Mart, she must "put her label on" again and be dependent.
The more that the concepts of supports can permeate not only the human
service system, but communities and society as a whole, the more
infused into the mainstream of daily life will individuals with
disabilities become.
Many people who are reading this have been in the disability field
for many years. Their respective jobs may be in special education,
rehabilitation, advocacy services, administration, psychology, or
occupational therapy. The specific field really doesn't matter. What
does matter is that all of us are vulnerable to a disability or an
injury at any point in time. Many of us experience permanent injury
or chronic illness or disability or live with loved ones who do.
Disability, particularly significant disability, is the great
equalizer across gender, race, and socio-economic status. The
quickest road to humility is to experience significant disability.
The quickest road out of significant disability is to experience
supports from family, friends, and competent professionals who know
how to interact with people in a dignified and non-patriotnizing way.
When we review the progress made in supported employment over the
last two decades, we must always return to our core values. It is
these core values that have defined not only supported employment, but
have created the substantial spill over effect of supports equaling
re-duction of disability. No one is independent. We are all
interdependent (Condeluci, 1991). The concept of true independence
does not truly exist. We may all feel that we are completely
independent at one time or another in our life, but invariably we will
need others to help combat the physical, emotional, and intellectual
disabilities that crowd into our lives. Understanding that we are all
interdependent helps pave the way for understanding the role and
impact of supports in designing systems that can help elevate people
to a higher level.
The core values that have permeated supported employment are
inclusion, consumer choice and involvement, a career path, parity in
wage and hour benefits, parity in work style options and choices and
the opportunity to be employed in the quickest most efficient manner
possible as opposed to being subjected to extensive day program,
nursing home or other segregated program activity. Much of this
activity is well meant, but neither the data nor the philosophical
perspectives of the people who are effected the most are consistent
with this type of service delivery arrangement. The time is long over
due to cease segregated program services and to expand competitive
employment opportunities.
The U. S. economy desperately needs more workers. Only recently the
Chief of the United States Federal Reserve, Allen Greenspan, (Barrons
Financial Magazine, June 28th, 1999) reported his concern that the
number of available workers in the U.S. market was dwindling to a
dangerously low level. Once the number of available workers drops to
an intolerable level, wages must increase significantly to coax
workers to come to work at different businesses. This creates
substantial inflationary pressures. In a tragic irony, we have
hundreds of thousands of individuals with disabilities that could
work. The pending Work Incentives Improvement Act (S 331) will
hopefully open up many more doors into business and industry for
people with disabilities who have not worked before. It will provide
major new provisions to work such as the following:
Those who become ineligible for
Social Security disability benefits on returning to work could
continue their Medicare coverage.
Those with disabilities could buy
Medicaid coverage even if they took jobs and earned income that would
otherwise disqualify them.
States could allow workers with
disabilities to buy Medicaid coverage, even if they lost their
eligibility for cash benefits because their medical conditions
improved.
A pilot program would be created
under which states could provide Medicaid to workers not considered
disabled but who have physical or mental impairments that are
"reasonably expected" to become severe if they lack health care. This
pilot is controversial, because it involves conditions such as
multiple sclerosis or HIV that could lead to disabilities in the
future.
It increases training and job search
programs for those with disabilities and provides assurances that cash
assistance would resume if persons become unemployed.
Even with these positive forces and the
ADA, I suspect that much more will still need to be done. Systems
change at a local and state level, alliances with business,
person-centered planning and self-determination when combined with a
"supports" philosophy and a strong economy will ultimately propel
persons with disabilities into the labor force. As we enter the new
millennium, we must set our sights much higher, building on the
volumes of new knowledge established over the past two decades.
Barrons Financial
Magazine, (June 28th, 1999). Greenspan worries about lack of
available workers, p. 75-81.
Condeluci, A.
(1991). Interdependence: The route to community. Delray Beach, FL:
St. Lucie Press.
Hayden , M., &
Albery, B. (Eds.). (1994). Challenges for a service system in
transition. Baltimore: Paul Brookes Publishing Co.
Luckasson, R.,
Coulter, D. L., Polloway, E. A., Reiss, S., Schalock, R. L.,
Snell, M. E., Spitalnik, D. M. & Stark, J. A. (1992). Mental
retardation: Definition, classification, and systems of supports (9th
ed.) Washington, D.C.: American Association on Mental Retardation.
Mank, D., Cioffi,
A., & Yovanoff, P. (1997a). An analysis of the typicalness of
supported employment jobs, natural supports, and wage and integration
outcomes. Mental Retardation, 35,(3), 185 - 197.
Mank, D., Cioffi,
A., & Yovanoff, P. (1997b). Patterns of support for employees with
severe disabilities. Mental Retardation, 35, 433-447.
Stancliffe, R. J., &
Lakin, K. C. (1999). A longitudinal comparison of day program
services and outcomes of people who left institutions and those who
stayed. The Journal of The Association for Persons with Severe
Handicaps, 24 (1), 44-57.
Wehmeyer, M. L. &
Lawrence, M. (1995). Whose future is it anyway? Promoting student
involvement in transition planning. Career Development for
Exceptional Individuals, 18 (2), 68-84.
Manuals - SE Handbook