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Competitive Employment
Has It Become the "First Choice" Yet?
Paul Wehman, W. Grant Revell, and Valerie Brooke
Virginia Commonwealth University
Journal of Disability Policy Studies
Vol. 14/No. 3/ 2003/pp. 163-173
Copyright© PRO-ED, Inc.
Reprinted with permission

This article addresses the issue of availability of competitive employment for individuals with significant disabilities compared to segregated day and work services. Despite the passage of the Americans with Disabilities Act, the Supreme Court decision in the Olmstead v. L. C. (1999) case and its emphasis on full community integration for individuals with significant disabilities, and the blending of individualized support strategies with the philosophy of self-determination in the 1990s, the majority of individuals with significant disabilities currently are not working in competitive employment. In addition, the measures used to define quality supported employment outcomes and programs frequently lack clarity. In this article, the authors briefly discuss the underlying values that should be used to guide all competitive employment programs designed to support individuals with disabilities. Second, they detail benchmark indicators through which the quality of supported employment programs should be measured. The article concludes with a description of the importance of using quality indicators in assessing the validity of supported employment services, particularly in the current environment of strained and finite fiscal resources.

Almost two decades ago, published reports began to appear on supported employment as a means to assist people with significant disabilities in becoming competitively employed. During these past 20 years, we have learned a great deal about what works in supported employment (Mank, Cioffi, & Yovanoff, 1999, 2000). Many challenging implementation issues and persistent philosophical differences among practitioners that create major barriers to full implementation of supported employment continue to exist, however (Mank, 1994; Wehman & Kregel, 1995). Still, there are clear indicators of the progress achieved in developing the supports used by many individuals with significant disabilities to live and work more fully integrated within their home communities. Deinstitutionalization has increased (Hayden & Albery, 1994); state institutions have closed (Stancliffe & Lakin, 1999); and some sheltered workshops have downsized or closed, with an accompanying selective reallocation of funds from segregated programs to integrated programs (Murphy, Rogan, Handley, Kincaid, & Royce-Davis, 2002). People with disabilities have acquired a more significant voice via legal statutes and the advocacy movement in influencing the policies and services that affect their lives (Wehmeyer & Lawrence, 1995).

The changes made by the American Association on Mental Retardation (AAMR) in the classification of individuals with mental retardation are an excellent example of the movement away from a focus on perceived levels of impairment and toward use of supports by individuals with a disability. AAMR has shifted from intelligent quotient labels derived from tests to classification based on a description of the supports, in both level and intensity, that are required by persons with cognitive disabilities (American Association on Mental Retardation, 2002. In fact, the "hot term" for the 1980s was supports, and the current hot term is self-determination.

The use of supported employment, supported education, and supported living, when intertwined with the philosophical depth of self-determination, effectively marries supports as a programmatic strategy with self-determination as a philosophical foundation. The use of trained employment specialists, informed coworkers, mentors, and technological supports, accompanied by enlightened legislation such as the Americans with Disabilities Act of 1990 (ADA), have greatly enhanced the employment possibilities for people with significant disabilities. The national number of people participating in supported employment in the United States has increased to more than 140,000 (Wehman, Revell, & Kregel, 1998). Historically, these are individuals who were confined to adult activity centers, sheltered workshops, nursing homes, and institutions. Competitive employment was not a likely otucome as long as they participated in segregated employment. The growth of competitive employment over the last decade through the use of supported employment is an important milestone in the movement to full community integration of people with a disability at work and in other aspects of daily life (Wehman, 1993). The ADA was the reason the Supreme Court upheld the previous decision in the Olmstead v. L. C. (1999) case, a landmark community integration decision (Legal Information Institute, 2002).

A recent policy change by a major federal employment service funding agency is a critically important example of the movement toward increasing opportunities for achievement of competitive employment outcomes by individuals with a significant disability. On January 22, 2001, the Rehabilitation Services Administration of the U.S. Department of Education amended the regulations governing the State Vocational Rehabilitation Program to redefine the term employment outcome to mean an individual with a disability working in an integrated setting (State Vocational Rehabilitation Services Program Final Rule, January 22, 2001). For decades, extended employment (sometimes referred to as nonintegrated or sheltered employment) was approved by state vocational rehabilitation agencies as a potential employment outcome for individuals with a disability who received vocational rehabilitation (VR) services. Because extended/sheltered employment utilizes nonintegrated work settings, the redefining of an employment outcome for a VR participant to mean work in an integrated setting removes extended/sheltered employment as an approved potential employment outcome for VR services.

So, what have we learned over the past 20 years about what is needed for individuals with significant disabilities to live with independence? The demystification of disability is the most significant contribution generated through the evolution of supported employment and other programs that define themselves in a context of supports. Too often, and with too many people in our society, perceptions related to disability are immediately linked to descriptors such as handicapped, impairment, unable to do, dependent, and less qualified. The gift of supported employment is its focus on valuing the abilities of individuals with disabilities and their productivity in the workplace. Supported employment reduces the impact of disability, even if it is only during the 8 hours that the individual is at work. Once that individual departs the workplace, she or he may well be forced into "putting back on" their physical disability or mental retardation label because needed supports are not present at home or other places in the community.

For example, consider Roseanne, a woman with a significant physical disability and a cognitive disability. Roseanne has very limited speech and requires some personal assistance services throughout the day. When Roseanne works at the WalMart store placing security scanners on the CDs in the electronics department, she earns $7.20 an hour, receives health benefits, and participates in the profit-sharing plan. With supports at work, Roseanne reduces or neutralizes the effects of her disability label. In fact, she is not disabled at all during the work day. In the eyes of her of co-workers and manager, as she performs her job duties, she is not disabled because they are depending on her to complete her work assignments. Once her work shift ends, however, Roseanne is totally dependent on and at the mercy of the local transit systems that serve people with physical disabilities. Once Roseanne wheels out of the Wal-Mart, she must again "put on her label" and be dependent. The more the concepts of supports can permeate not only the human service system but also communities and society as a whole, the more individuals with disabilities such as Rosanne will become infused into the mainstream of daily community life.

When we examine where we are currently related to day services, work, and employment, we must ask, Is competitive employment readily available to people with significant disabilities? All too often, the clear answer is no. For example, only about 15% of the more than 130,000 persons receiving day habilitation services in fiscal year (FY) 1999 through the Medicaid Home and Community Based Waiver were in supported employment. The rest were in a variety of day habilitation service categories that were not competitive-work-oriented and frequently not community integrated (West, Hill, Revell, Smith, Kregel, & Campbell, 2002). In FY 2000, state mental retardation/developmental disabilities agencies (MR/DD) served approximately 361,000 individuals in day, work, and sheltered employment programs that did not involve supported/ competitive employment. In comparison, approximately 108,000 persons were served by these agencies in supported/ competitive employment, an approximate 3:1 ratio of noncompetitive to competitive work outcomes for persons served by these agencies (Braddock Hemp, Parish, & Rizzolo, 2002). These reports dramatically demonstrate that for many people with significant disabilities, the dominant experience continues to be a nonintegrated setting.

Segregated day activities are inconsistent with independence and community inclusion (Wehman, 2001). The time is long overdue for cessation of segregated program services and expansion of competitive employment opportunities. The purposes of this article thus are to discuss the underlying core values critical to programs that effectively assist individuals with disabilities in being successful in competitive employment and to describe benchmark indicators through which the quality of supported employment programs should be measured.

Supported Employment: Core Values

Supported employment emphasizes the benefits of individuals with significant disabilities having opportunities for real, integrated work as a primary option. All parties involved benefit from competitive employment. Such employment provides the individual with a disability a real job, benefits, and the dignity that arises from gainful employment. The employer gets a good worker and receives specialized support to train and maintain the individual. The family is able to see its family member in a fully competent role in the workplace. Finally, taxpayers spend less money than they would to support the individual in a segregated day program. Several questions remain, however. Why do the vast majority of individuals with mental and physical disabilities remain in segregated day programs? What values are service providers and advocates following? What are the indicators that best reflect quality employment outcomes?

The answers to these questions lie partially in the inability of advocates and people with disabilities to adequately marshal their collective efforts to increase work opportunities (Wehman & Kregel, 1995). Adult service systems using segregated services remain deeply entrenched, as they have for decades (Albin, Rhodes, & Mank, 1994). Changing this way of providing services is extremely difficult, particularly in times of reduced funding resulting from a recessionary economy. Hence, the positive attributes of supported employment for people with significant disabilities need to be publicized. Table 1 provides a brief description of nine values that have guided supported employment efforts since the early 1980s (Brooke, Inge, Armstrong, & Wehman, 1997). These values reflect the themes discussed at the beginning of this article, and they have been increasingly reflected in rehabilitation legislation, as well as in the Olmsted decision. Presumption of employment, person-centered control, wages, supports, interdependence, and connections within the community-these are the underlying values that are reflected in quality employment programs. Without these values, a program has no beacon to follow in its daily operations. Without these values, a program will wander from funding source to funding source, dependent on the current fad or whim of the moment. Without clear values, a program will dilute its efforts and lose focus.

The question remains: How do values become translated into real operational quality indicators for program guides? What are these benchmarks by which program staff members, consumers, and advocates can discern the value of one program over another? These questions take on special merit when one considers, for example, the emergence of the Ticket to Work and Work Incentive Improvement Act (TWWIIA) of 1999, a program intended to financially empower individuals who receive Social Security Disability benefits to utilize funding from the Social Security Administration to select their own employment program and pay for needed services and supports. What are the core indicators of quality competitive employment services that can be used by (a) an individual with a disability holding a Ticket to Work, (b) a funding agency seeking positive employment outcomes for the dollars spent on services, and (c) an employment service agency seeking to measure its effectiveness and improve its services? What follows is a description of 10 quality indicators that can be used in assessing the quality of a supported employment program.

	TABLE 1 Supported Employment Values
Value	Value clarification
Presumption of employment	Everyone, regardless of the level or the type of disability, has the capability to do a job and the right to have a job.
Competitive employment	Employment occurs within the local labor market in regular community businesses.
Self-determination and control	When people with disabilities choose and regulate their own employment supports and services, career satisfaction will result.
Commensurate wages & benefits	People with disabilities should earn wages and benefits equal to that of co-workers performing the same or similar jobs.
Focus on capacity & capabilities	People with disabilities should be viewed in terms of their abilities, strengths, and interests rather than their disabilities.
Importance of relationships	Community relationships both at and away from work lead to mutual respect and acceptance.
Power of supports	People with disabilities need to determine their personal goals and receive assistance in assembling the supports for achieving their ambitions.
Systems change	Traditional systems must be changed to ensure customer control, which is vital to the integrity of supported employment.
Importance of community	People need to be connected to the formal and informal networks of a community for acceptance, growth, and development.

The goal of supported employment programs is to help people with the most significant disabilities to be successful in paid employment in the integrated work setting of their choice. What exactly is the functional meaning of the phrase paid employment in an integrated setting? Current federal regulations issued by the Rehabilitation Services Administration to govern the national Vocational Rehabilitation Program define integrated setting as a typical community setting where individuals with a disability interact with nondisabled individuals other than the persons who are providing services to the individuals with a disability to the same extent that their nondisabled peers in comparable positions interact with other persons (State Vocational Rehabilitation Services Program, Final Rule, January 17, 2001).

The general wording in this regulation of the phrases "setting typically found in the community" and "interact with nondisabled individuals to the same extent as nondisabled persons in comparable positions" allows for various interpretations as to what actually constitutes paid employment in an integrated setting. As a result, a job can be considered to be competitive employment where the presence of co-workers who are not disabled is the only measure used, without taking into account other key measures of settings typically found in the community. As a result, vocational rehabilitation and other supported-employment-funding agencies, providers of employment services, and individuals with disabilities served by supported employment programs are uncertain as to just what is meant by an outcome to supported employment services generally characterized as paid employment in an integrated work setting. It is clear that the uncertainty surrounding both the regulatory meaning and community-level application of the phrase paid employment in an integrated setting severely compromises the usefulness of general references to "paid employment" and "an integrated setting" as measures of the quality of an employment outcome. Clearly defined and carefully described core indicators of the quality of supported employment programs are needed. Table 2 contains 10 quality indicators that can serve as effective measures of the quality of a supported employment program.

The 10 indicators presented in Table 2 address quality of a supported employment program from a variety of critical perspectives. The first perspective is the point of view of individuals with a disability who turn to a supported employment program for support in getting and retaining a job. Do they consistently achieve truly meaningful job outcomes? Who selects these jobs, and do these employment opportunities reflect informed customer choice and control? The indicators must also reflect the perspective of employers. Are employers satisfied with the work produced by the individuals in supported employment and the quality of the ongoing support services received from the supported employment program? The indicators must also be responsive to the agencies that are funding the supported employment program. Does the provider have a well-coordinated job-retention support system in place, and does the program's management information system accurately track and monitor employment outcomes? Finally, the combined set of indicators must serve as a means for self-assessment by the supported employment program itself to help identify areas of strength that can be used in marketing and areas that need priority attention for improvement.

The 10 quality indicators are derived from the core values of supported employment and from documented best practices critical to ongoing job success. In measuring the quality of a supported employment outcome, it is critically important that observable, functional measures be defined. For example, the first indicator, meaningful competitive employment in integrated work settings, reflects the core value supported employment places on competitive work. Functionally, the true quality of a competitive employment job opportunity is reflected in the wages and benefits paid to the individual with a disability and how he or she is hired, supervised, and paid in relation to the business where the job is located. The second quality indicator, informed choice, control, and satisfaction, is derived from the core value of self-determination and control by the individual with a disability. Functionally, control is measured by the relationship and degree of satisfaction of the individual in supported employment with his or her service provider, job coach, support services, and employment setting. In the discussion that follows, each of the 10 indicators recommended in Table 2 is described in terms of its importance as a quality measure for a supported employment program. The research documenting the best practice content of a number of the indicators is referenced. Probe questions that functionally define the key features of each indicator are also provided.

TABLE 2 Quality Indicators for Supported Employment Programs
Indicator	Example of functional measures
Meaningful competitive employment in integrated work settings	Employee with a disability is hired, supervised, and paid directly by business where job setting is located; receives wages/benefits commensurate with those of nondisabled co-workers.
Informed choice, control, and satisfaction	Employee selects own service provider and job coach, selects job and work conditions,and is satisfied with job and supports.
Level and nature of supports	Program is skilled in identifying workplace support options and developing those options.
Employment of individuals with significant disabilities	Program is serving individuals whose intermittent competitive work history, disability profile, functional capabilities, and other barriers to employment are truly reflective of people who need ongoing workplace supports to retain employment.
Amount of hours worked weekly	Program is achieving employment outcomes at 30 or more hours per week consistently; individuals receiving support are satisfied with their hours of competitive employment.
Number of persons from program working regularly	Program currently has a majority of its participants working in competitive employment; individuals receiving support are satisfied with their program of services.
Well-coordinated job retention system	Program maintains regular contact with its employed customers to monitor job stability and can respond effectively to both planned and unplanned job retention support needs; program replaces individuals who do not retain employment.
Employment outcome monitoring and tracking system	Program maintains an information system that readily provides information to its customers on employment status, longevity, wages, benefits, hours of employment, and jobs.
Integration and community participation	Employees with a disability work in jobs where the work environment facilitates physical and social interaction with co-workers; employees are satisfied with the quality of their work and community integration.
Employer satisfaction	Program viewed as an employment service agency rather than a human service provider; employers are seen as a customer of the service, and the program designs policies and procedures that are responsive to the business community.

An individual in supported employment works in a competitive job in an integrated work setting. What, in fact, characterizes the true quality of competitive work in an integrated setting? The preamble to the 1997 State Vocational Rehabilitation Services Program regulatory announcement frames paid employment in integrated settings in the context of the parity principle by asking the following question: Is the experience of the person with a disability at parity with the experiences of a nondisabled co-worker (State Vocational Rehabilitation Services Program, Final Rule, February 11, 1997)? The importance of this parity principle is supported by the research by Mank and his associates on the positive relations of typical employment features and co-worker involvement with higher wage and integration outcomes for individuals in supported employment (Mank, Cioffi, & Yovanoff, 1999, 2000). Consideration of the parity of experiences between the worker with a disability and the nondisabled co-worker leads directly to the following questions as functional indicators of the quality of the paid employment outcome:

The goal of supported employment never was to simply find jobs for people with significant disabilities. Rather, the focus of quality supported employment dictates that services result in meaningful employment outcomes for customers. A meaningful employment outcome is a job with career possibilities. A worker at a job site who is actually the employee of an outside service provider has limited career opportunities. Most people are not interested in dead-end positions. As with other members of the labor force, people with disabilities are interested in jobs where they can build their resumes and/or employment positions and potentially grow with a company. Meaningful employment outcomes for individuals in supported employment are jobs that have full parity with other jobs within the workplace in terms of how people are hired, supervised, and compensated; the opportunities they have to interact with co-workers; and the access they have to job advancement and career opportunities.

The opportunity to make choices concerning employment, living arrangements, and recreation has been limited or nonexistent for many individuals with disabilities (Gilson, 1998). It has become increasingly evident that the powerlessness and lack of direction frequently felt by people with disabilities are related to attitudes and practices of service providers, caregivers, funding agencies, and society in general, rather than any true limitations as a result of an individual's disability (Brooke, Wehman, Inge, & Parent, 1995; Browder, Wood, Test, Karvonen, & Algozzine, 2001; Wehman, 1981). Quality supported employment programs avoid this trap by empowering their customers to make choices and to take control of their career paths. A critical factor in assessing the overall quality of a supported employment program is analyzing the data to determine if the customers of the service have choice over the process and are truly in control of their rehabilitation outcomes. Organizations that support choice and control shape their service delivery practices by the wants and needs of their customers. Key features or quality indicators of a supported employment program would assess informed choice and control by reviewing the following indicators to determine the level of involvement by customers:

Customers of supported employment must be in a position not only to choose their service provider and employment support personnel but also to have some measure of control over the services they seek. Supported employment customers must be free to participate in supported employment services by choosing a service provider and employment specialist, by accepting or declining a specific job, or by electing to resign or continue employment with a particular company without fear of reprisal. Informed choice and control must be a key feature to any employment support service assisting people with significant disabilities in their search for employment. Customer choice is a core principle of the Workforce Investment Act of 1998 (WIA), which established the one-stop career centers. Customer choice is also a core principle of the Social Security Administration's Ticket to Work program.

3. Level and Nature of Supports

Supported employment is perhaps best characterized as employment with supports. Key to the career success of people with significant disabilities is the unique arrangements of the necessary supports that will assist each customer of supported employment in obtaining and maintaining competitive employment (Brooke et al., 1997). Detailed job analysis, identification and use of community and workplace supports, systematic instruction, compensatory strategies, orientation training, and workplace accommodations have always been the cornerstones of a well-developed plan of support (Inge, 1997; Parent, Wehman, & Bricout, 2001). The term natural supports was first noted in federal policy with the 1992 Rehabilitation Act Amendments, which included "natural supports" as a possible source of ongoing (§ 7.33(C)(vii)) and extended services (§ 635(6)(C)(vii)). Yet, quality supported employment service providers must move beyond the language provided in federal policy and attempt to provide the exact type and intensity of support across all aspects of their services. For example, an employment specialist would not want to provide any more or less support than what was actually necessary to assist the supported employment customer in learning about, obtaining, or maintaining employment. Supported employment providers, in consultation with their customers, would always approach a task by discussing the least intrusive approach, only moving to a more intrusive level of support if (a) it was the desire of the customer and (b) it was needed to achieve the desired outcome. As discussed in the previous section, the supported employment customer must be in control of selecting his or her own supports. The following quality indicators can be used to assess a program's ability to provide the appropriate level and nature of support to achieve the desired employment outcome:

Identifying, selecting, and facilitating supports that promote independence and employment stability is a complex task with multiple factors to consider. Working with the supported employment customer, the employment specialist must be skilled at analyzing data results, along with supervisors' and co-workers' comments, to determine the exact nature and level of intensity of support that will best match the employment situation. When this process is done correctly, supported employment customers will have quality supported employment service.

The 1986 amendments to the Rehabilitation Act of 1973 included Title VI-C, which designated supported employment as a program. It was not until the 1992 reauthorization of the Rehabilitation Act, however, that major changes were made to the eligibility provisions in the regulations and language clearly stating that the program was designed for people with the most significant disabilities was included. Supported employment was never intended to serve the typical vocational rehabilitation customer: It was created for those people with truly significant disabilities who traditionally were not able to obtain competitive employment through typical VR services. The reauthorization further described customers of supported employment as those individuals who have obtained intermittent employment but have not been successful in maintaining competitive employment, who need long-term support to achieve competitive employment.

Supported employment service providers need to work with potential customers and rehabilitation counselors to ensure that the organization is marketing its services to the appropriate customers (Green & Brooke, 2001). Employment service organizations can analyze this quality indicator by determining who is accessing the services and reviewing the following questions:

These indicators should provide a clear and concise picture of the customers who are being served through supported employment services. Service providers need to match these results with the federal regulations to determine if they are truly serving individuals with the most significant disabilities, the group for whom supported employment services are intended.

Number of hours worked weekly is a critical quality indicator for a supported employment program, for a number of reasons. First, on an individual customer basis, hours of weekly employment establish the base for a number of meaningful employment outcomes. Part-time jobs are usually characterized by lower pay and limited benefits. In comparison, employment of 30 or more hours per week is more likely to offer higher wages and potential benefits such as health coverage, vacation and sick leave, and insurance benefits. A higher number of hours of weekly employment also improves access to work-related training provided through the employer and to social interaction with co-workers. From a program perspective, supporting a high percentage of customers in jobs with less hours creates a variety of possible strains on the program. What are the program's funding responsibilities for helping its customers fill nonwork hours? Many funding agencies require a certain level of program involvement per week; lower hours of employment can create situations where programs turn to more center-based, segregated services to fill hours. This practice perpetuates center-based services, ties down staff members who could be shifted to supporting customers in the community, and creates confusion among program participants and their families as customers move back and forth between communityintegrated work and set-apart, center-based services.

On a customer-to-customer basis, hours worked per week should reflect the preferences and choices of each individual. An individual might choose to work under 30 hours a week because of concerns over maintaining Social Security Disability benefits, because of work preferences, or because of work tolerances reflecting the residual effects of the disability and the supports that person needs. For example, an individual who needs personal assistance services at work might have limited hours of this service available and therefore would want to work a more limited number of hours. Overall, however, the hours of weekly employment consistently achieved by participants are a valid indicator of the quality of a supported employment program. Programs can analyze this quality indicator by using data on hours of weekly employment to answer the following questions:

Supported employment programs that have a high percentage of customers working consistently less than 30 hours a week (or working sporadic numbers of hours from week to week) are not achieving quality employment outcomes. State funding agencies can reward achievement of employment outcomes of 30 hours or more per week with funding incentives. Vocational rehabilitation counselors should strongly push for employment outcomes of more than 30 hours a week and should provide the funding support needed to achieve such outcomes.

Earlier in this article, reference was made to the approximate 3 to 1 ratio of noncompetitive to competitive work outcomes for persons served by MR/DD agencies nationally (Braddock et al., 2002). A large number of persons with significant disabilities have very limited access to competitive employment, and the negative impact on their lives is substantial. Participation in noncompetitive work programs severely limits earnings and restricts personal choices in terms of available resources and opportunities. It creates unnecessary dependency and perpetuates the myths and stereotypes related to disability and nonproductivity. Maintaining noncompetitive programs locks down resources within more segregated settings rather than using them to provide community-integrated workplace supports.

Identifying the number of persons from a program working regularly should not be limited to individuals in the supported employment program. Many supported employment programs are a component of larger agencies that offer multiple services, sometimes including noncompetitive employment services (Wehman et al., 1998). The true measure of the quality of supported employment outcomes achieved by a program is reflected in the percentage of individuals in its overall enrollment who are working regularly in competitive employment. In an enrollment of 100 individuals, if 75 are involved in noncompetitive activities and 25 are working regularly in competitive employment, this program is stuck at the national 3 to 1 ratio and fails this quality indicator. If this same program establishes a clearly stated conversion goal and begins making steady progress toward having a majority of its participants working in competitive employment, it is making clearly observable progress. Programs can analyze the quality of their efforts to support their customers in working regularly in competitive employment by using data to answer the following questions:

A number of factors influence the services offered by programs that provide supported employment services. The continuation of noncompetitive employment services can reflect federal, state, and community funding policies and precedents; pressure from families of individuals with disabilities to maintain these services; pressure from the boards and administrators to maintain traditional missions and services; and lack of confidence by program staff members in their ability to support competitive employment outcomes for individuals with significant disabilities. Quality supported employment programs have demonstrated that each of these prohibitive factors can be overcome. The number of persons working regularly in competitive employment is a critical quality indicator.

The provision of ongoing supports after employment has been secured is the core characteristic of supported employment that differentiates it from other employment services. There is strong evidence that the maintenance of ongoing supports after employment is a characteristic of successful supported employment programs that generate better employment outcomes (Bond et al., 2001). Well-coordinated job retention systems provide ongoing individualized supports that assist the employee with a disability in areas such as structuring needed workplace accommodations, monitoring and assessing job stability, adjusting supports to address changing needs both at and away from the job site, and providing other supports that enhance job retention (Ridgway & Rapp, 1998). Well-coordinated job retention systems provide replacement assistance in situations of job loss or job enhancement.

Supported employment providers face the substantial challenge of operating a well-coordinated job retention system that is able to continue after funding from vocational rehabilitation agencies ends. Although very few studies have focused on extended services, evidence does exist to indicate that many supported employment providers have very limited access to funding for these services. Agency funding frequently does not cover the costs of providing these services, and other program revenues must be used for monthly follow-along services (West, Johnson, Cone, Hernandez, & Revell, 1998). This limited commitment by funding agencies to extended services continues despite the findings from a recent study that indicated that maintaining employment supports well into the job and beyond the limited period of VR funding is often critical to addressing work-related problems (West, Wehman, & Revell, 2002). The authors of this study also noted increases in the contact time that occurred 3 to 6 months into employment. These contacts addressed non-work-related problems and career advancement interests. Although funding for job retention services continues to be a problem for supported employment agencies, the most successful supported employment programs clearly are ones that maintain a well-coordinated job retention service.

Programs can analyze the quality of their job retention efforts for customers working in competitive employment by answering the following questions:

8. Employment Outcome Monitoring and Tracking System

Traditionally, supported employment programs have developed standards, objectives, and processes in an effort to build and promote quality supported employment services. Program managers and staff members design standards and indicators to assist in gauging the success of their program services. The typical areas that are assessed are philosophy, mission, administration, fiscal management, image, community resources, personnel, job or career development, job training and support, long-term supports, and employee relations.
With many programs, the primary reason for organizational assessment is to meet an agency need for supported employment provider certification. This certification is required to become a local vendor for supported employment and to qualify for state or local funding. Most supported employment organizations also recognize the need for assessing quality and are committed to providing excellent services, but many supported employment personnel report that collecting and analyzing data on quality indicators is an unrealistic expectation. For this reason, some programs have stopped collecting the data necessary for an accurate assessment of the overall quality of their organization.

Collecting and analyzing data on supported employment service outcomes does not have to be difficult or time consuming. Without accurate and consistent data, it is impossible to accurately assess the quality of a supported employment program, particularly for the core quality indicators of service to persons with significant disabilities, achievement of meaningful employment outcomes, customer choice, employer satisfaction, and job retention. Programs can analyze the quality of their employment outcome monitoring and tracking system by asking the following questions:

9. Integration and Community Participation

Integration and community participation are important outcome measures of quality services. The idea that individuals with significant disabilities can and should work in regular business environments and participate fully in the life of their communities is the guiding philosophy behind supported employment. Work is a highly valued activity in U.S. society and offers wage earners numerous benefits. Having a job and paying taxes can enhance an individual's status in the community and offer the employee an opportunity to interact with coworkers and to develop a host of relationships at work and in the community.

Determining if an employee is integrated in the workplace and participating in the community can be examined through multiple factors. Analyzing a business site to determine if the company offers an opportunity for integration is important, as is the need to repeat the analysis periodically as the customer becomes more familiar to his or her co-workers. In addition, the employee's work area, work hours, and satisfaction level play an important role in assessing a customer's integration and community participation. A negative answer to any of the following questions could indicate that intervention is necessary to improve the overall quality of the employment situation and the services of the supported employment program.

10. Employer Satisfaction

Supported employment service providers must not view themselves as human service providers but rather as employment service agencies that provide valued and needed services to employers. The language must be business to business, and the message must be clear: "Our company will fill your personnel needs!" This approach to business presents the service, as well as the person with a significant disability, in a competent and respectful manner. In addition, it focuses the organization's resources on the business community and is designed to satisfy employment needs (Green & Brooke, 2001).

Job placement personnel within rehabilitation programs are still fairly hidden from the business community. Businesses looking to recruit and hire people with disabilities can't seem to find the rehabilitation programs in the community, nor do they know how to recruit people with disabilities who want to work (Peck & Kirkbride, 2001). It is fair to say that most rehabilitation professionals assisting people with disabilities in obtaining employment do not see themselves as customer representatives with direct responsibility for building ongoing relationships with the business community; yet, the task of customer relationships should be the primary responsibility of all rehabilitation personnel. Programs can measure the quality of their service to employers by reviewing the following quality indicators:

These indicators, if followed, ensure that the community rehabilitation program is developing strong strategies for developing productive business relationships. Business considers these areas as roadblocks to productive relationships with rehabilitation programs (Egan, 2001).

The Critical Importance of Quality Indicators

Over the past 20 years, the development and evolution of supported employment has moved from an embryonic level of episodic, university-based interventions to increasing numbers of community rehabilitation programs focusing on using workplace and related supports to help individuals with significant disabilities achieve competitive employment outcomes. In recent years, there has been even further expansion into other countries.

Unfortunately, as occurs with most innovative programs, there can be-and usually is-a gradual deterioration of the standards of quality under which the innovation was originally designed. In the case of supported employment, the speed with which new programs have been implemented (Wehman et al., 1998) has led to increasing levels of unevenness in program quality. Furthermore, and perhaps more disturbing, many community programs are simply adding on to their segregated services a supported employment segment that is small and does not have a significant impact on many consumers. The use of quality indicators such as those described in this article can help increase awareness of what an appropriate framework of excellence should be. These indicators provide benchmarks programs, consumers, families, and funding agencies can use to determine the validity of individual employment programs.

Is the program doing what it purports to do? This is not an unreasonable question. The 10 quality indicators are easily operationalized behaviorally so that those stakeholders who are interesting in affirming the validity of a given supported employment program will have tools to use in assessing the program. If we choose not to utilize these kinds of evaluative measures, it will not be surprising if programs begin to lose their credibility by taking the easiest clients, having poor longterm job tenure rates, or being unable to demonstrate longterm outcomes for all clients in the program. The indicators certainly may be expanded or modified as the field of research expands, but having credible ways to assess program quality is critically important now.

PAUL WEHMAN, PhD, is a professor of physical medicine and rehabilitation, with joint appointments in the Department of Curriculum and Instruction and the Department of Rehabilitation Counseling at Virginia Commonwealth University (VCU). Dr. Wehman has written extensively on issues related to transition from school to adulthood and special education as it relates for young adulthood. W. GRANT REVELL, MS, MEd, conducts research and provides technical assistance in the area of funding for supported employment services at VCU. VALERIE BROOKE, MEd, is the director of training at the Rehabilitation Research and Training Center on Workplace Supports at VCU. Her current interests include increasing the employment of people with disabilities. Address: Paul Wehman, VCU-RRTC,1314 W. Main St., Richmond, VA 23284-2011; e-mail: pwehman@atlas.vcu.edu

Albin, J. M., Rhodes, L., & Mank, D. (1994). Realigning organizational culture, resources, and community roles: Changeover to community employ
ment. Journal of the Association for Persons with Severe Handicaps, 19,105-115.

American Association on Mental Retardation. (2002). Mental retardation: Definition, classification and systems of support. Washington, DC: Author.

Americans With Disabilities Act of 1990, 42 U.S.C. § 12101 et seq.

Bond, G. B., Becker, D. R., Drake, R. E., Rapp, C. A., Meisler, N., Lehman, A. F.,et al. (2001). Implementing supported employment as an evidenced based practice. Psychiatric Services, 52, 313-322.

Braddock, D., Hemp, R., Parish, S., & Rizzolo, M. (2002). The state of the states in developmental disabilities: 2002 study summary. Boulder: University of Colorado, Coleman Institute for Cognitive Disabilities and Department of Psychiatry.

Brooke, V., Inge, K., Armstrong, A., & Wehman, P. (Eds.). (1997). Supported employment handbook: A customer-driven approach for persons with significant disabilities. Richmond: Virginia Commonwealth University, Rehabilitation Research and Training Center on Workplace Supports.

Brooke, V., Wehman, P., Inge, K., & Parent, W. (1995, December). Toward a customer-driven approach of supported employment. Education and Training in Mental Retardation and Developmental Disabilities, 30, 308
320.

Browder, D., Wood, W., Test, D., Karvonen, M., & Algozzine, B. (2001). Reviewing resources on self-determination: A map for teachers. Remedial and Special Education, 22, 233-244.

Egan, K. (2001). Staffing companies opening new doors to people with disabilities. Journal of Vocational Rehabilitation 16, 93-96.

Gilson, S. F. (1998). Choice and self-advocacy: A consumer's perspective. In P. Wehman & J. Kregel (Eds.), More than a job: Securing satisfying careers for people with disabilities (pp. 3-24). Baltimore: Brookes.

Green, H., & Brooke, V. (2001). Greater success through new partnerships: The business connection. In P. Wehman (Ed.), Supported employment in business: Expanding the capacity of workers with disabilities (pp. 23-34).
St. Augustine, FL: Training Resource Network.

Hayden, M., & Albery, B. (Eds.). (1994). Challenges for a service system in transition. Baltimore: Brookes.

Inge, K. (1997). Job site training. In V. Brooke, K. Inge, A. Armstrong, & P. Wehman (Eds.), Supported employment handbook: A customer-driven approach for persons with significant disabilities (pp. 159-204). Richmond: Virginia Commonwealth University, Rehabilitation Research and Training Center on Workplace Supports.

Legal Information Institute. (2002). Olmstead v. L. C. [Online]. Available: http://supct.law.cornell.edu/supct/html/98-536.ZS.html

Mank, D. (1994). The underachievement of supported employment: A call for reinvestment. Journal of Disability Policy Studies, 5(2), 1-24.

Mank, D., Cioffi, A., & Yovanoff, P. (1999). Impact of coworker involvement with supported employees on wage and integration outcomes. Mental Retardation, 37, 383-394.

Mank, D., Cioffi, A., & Yovanoff, P. (2000). Direct support in supported employment and its relation to job typicalness, coworker involvement, and employment outcomes. Mental Retardation, 38, 506-516.

Murphy, S. T., Rogan, P. M., Handley, M., Kincaid, C., & Royce-Davis, J. (2002). People's situations and perspectives eight years after workshop conversion. Mental Retardation, 40, 30-40.

Olmstead v. L. C., 527 U.S. 581 (1999).

Parent, W., Wehman, P., & Bricout, J. (2001). Supported employment and natural supports. In P. Wehman (Ed.), Supported employment in business: Expanding the capacity of workers with disabilities (pp. 93-114). St. Augustine, FL: Training Resource Network.

Peck, B., & Kirkbride, L. T. (2001). Why businesses don't employ people with disabilities. Journal of Vocational Rehabilitation, 16, 71-75.

Rehabilitation Act Amendments of 1992, 29 U.S.C. § 701 et seq.

Ridgway, P, & Rap, C. (1998). The active ingredients in achieving competitive employment for people with psychiatric disabilities: A research synthesis.
Lawrence: University of Kansas, School of Welfare.

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, 44-57.

State Vocational Rehabilitation Services Program, Final Rule, 62 Fed. Reg. 6311 (Feb. 11, 1997) (codified at 34 C.F.R. § 361).

State Vocational Rehabilitation Services Program, Final Rule, 66 Fed. Reg. 4382-4389 (Jan. 17, 2001) (codified at 34 C.F.R. § 361).

State Vocational Rehabilitation Services Program, Final Rule, 66 Fed. Reg. 7249-7258 (Jan. 22, 2001) (codified at 34 C.F.R. § 361).

Ticket to Work and Work Incentive Improvement Act, 42 U.S.C. § 1305 et seq. (1999).

Wehman, P. (1981). Competitive employment: New horizons for severely disabled individuals. Baltimore: Brookes.

Wehman, P. (1993). The ADA mandate for social change. Baltimore: Brookes. Wehman, P. (2001). Supported employment in business: Expanding the capacity of workers with disabilities. St. Augustine, FL: Training Resource Net
work.

Wehman P., & Kregel, J. (1995). Supported employment: At the crossroads. Journal of the Association for Persons with Severe Handicaps, 20,286-299.

Wehman, P., Revell, W. G., & Kregel, J. (1998). Supported employment: A decade of rapid growth and impact. American Rehabilitation, 24(1), 3143.

Wehmeyer, M. L., & Lawrence, M. (1995). Whose future is it anyway? Promoting student involvement in transition planning. Career Development for Exceptional Individuals, 18, 68-84.

West, M., Hill, J., Revell, G., Smith, G., Kregel, J., & Campbell, L. (2002). Medicaid HCB Waivers and supported employment: Pre- and post-Balanced Budget Act of 1997. Mental Retardation, 40(2).

West, M., Johnson, A., Cone, A., Hernandez, A., & Revell, G. (1998). Extended employment support: Analysis of implementation and funding issues.
Education and Training in Mental Retardation and Developmental Disabilities, 33, 357-366.

West, M., Wehman, P., & Revell, G. (2002). Extended services in supported employment: What are providers doing? Are customers satisfied? In D. Dean, P. Wehman, & J. Kregel (Eds.), Achievements and challenges in employment services for people with significant disabilities: A longitudinal impact of workplace supports (pp. 85-98). Richmond: Virginia Commonwealth University, Rehabilitation Research and Training Center on Workplace Supports.

Workforce Investment Act of 1998, Pub. L. No. 105-220, 112 Stat. 93 (1998).