Extended Services in Supported Employment: What Are Providers Doing? Are Customers Satisfied? Michael West, PhD Paul Wehman, PhD Grant Revell, MS, MEd Rehabilitation Research and Training Center on Workplace Supports Virginia Commonwealth University P. O. Box 842011 Richmond, Virginia 23284-2011 Submitted to the Advance (APSE) This article is excerpted from a manuscript currently in review for the Journal of the Association for Persons with Severe Handicaps. Preparation of this article was supported by the U.S. Department of Education, Rehabilitation Services Administration. The opinions expressed here do not necessarily reflect those of the supporting entity, and no official endorsement should be inferred. Extended services have been a defining characteristic of supported employment since its inception, and the need for extended services a defining eligibility criterion (Federal Register, August 14, 1987). The importance of follow-along supports have been validated in a variety of research studies, particularly in the area of supported employment for individuals with severe mental illness (Bond et al, 2001; Drake, et al, 1998; McHugo, Drake, & Becker, 1998). However, research on supported employment has focused largely on the time-limited phase, in large part due to the political landscape in which the program operates. The time-limited component is funded and administered through State VR agencies using a uniform data collection system (the RSA-911 Case Service Report), subject to a common set of regulations. In contrast, extended services may be funded and administered through multiple state agencies (West, Johnson, Cone, Hernandez, & Revell, 1998). Data collection and reporting requirements and capabilities vary not only across states, but also across agencies within each state. Thus, it is much more difficult to determine both across and within states how extended services operate and how successful they are in achieving desired consumer. Consistent information is needed on what is happening to individual workers with disabilities after initial placement and support plans have been established. From the perspective of making effective decisions about funding, policy development, and program management, access to accurate information on service need, use, and outcomes is critical. Furthermore, from the perspective of consumer choice and self-determination, information is needed on worker satisfaction level with the services being received and the job opportunities being provided. Method Participants and Settings The participants in this study were staff and consumers of eight supported employment provider agencies that were nominated to the researchers. The criteria for nomination and selection included: (1) Nominated agencies should currently serve large numbers of consumers in supported employment and particularly in extended services; (2) Selected agencies should be nationally dispersed geographically; (3) As a group agencies should serve a variety of types of disabilities; and (4) Selected agencies must agree to complete the data collection requirements described further in this report. The eight agencies had a total of 283 individuals receiving extended services. Instrumentation Contact logs. Participating agencies completed logs of extended service contacts delivered during one month. Log entries included (1) whether the contact was a planned job maintenance contact or an unplanned but necessary contact; (2) if unplanned, the individual who initiated the contact; (3) the consumer's period of time post-VR closure, in three-month increments; and (4) space for staff to provide a brief description of the primary activity or activities which occurred during the contact. Contact logs were not designed to be consumer-specific. Satisfaction surveys. A satisfaction survey was developed which requested consumers to indicate their satisfaction, using a Likert-scale, with (1) their pay, fringe benefits, and working conditions when they started their job; (2) current level of contact with their job coach or other agency staff member; (3) the amount of assistance received for job performance or career advancement; and (4) current level of satisfaction with pay, fringe benefits, and working conditions. The survey also included perceptions of respondents' perceptions of their agency's responsiveness to their extended service needs in open-ended format. One item was also included which requested the respondent's status as either (1) a supported employment consumer; (2) a parent, guardian, or other family member of a supported employment consumer; or (3) a paid assistant completing the form under the direction of a supported employment consumer. Results Participating agency staff completed 542 log records of extended service contacts for the 283 extended service consumers, for a mean of 1.92 contacts per consumer over the course of the month. Of all extended service contacts during the one-month data collection period, 80.1% were for planned, routine job maintenance contacts, and 19.9% were for unplanned but necessary interventions. For the unplanned interventions, just under one-third (32.6%) were initiated by the consumers' supervisors. Consumers themselves initiated a contact 30.4% of the time, followed by parents or other family members (13.0%), coworkers (6.5%), and others (17.4%), which included primarily casemanagers, counselors, and the employment specialists or other supported employment staff members. The mean time required for each extended service contact was 67.4 minutes, with a range of 1 minute to 510 minutes (8.5 hours). Table 1 presents mean length of contact by the length of time from VR closure, and therefore time in extended services. --------------------------------------------------------------------- Insert Table 1 about here --------------------------------------------------------------------- The extended service contact log requested respondents to indicate the primary activity that occurred during the contact. Initial reviews of the written responses yielded the following eight categories for post hoc coding: * Routine contacts with the consumer, supervisor, and others to assess the consumer's job performance, job satisfaction, and other general issues; * Assistance with current job duties, either in the form of additional training or physically assisting the consumer perform the work; * Training the consumer in new job duties assigned to the consumer post-closure; * Work-related problem resolution, which could include slow work, low productivity, inappropriate work behaviors, poor hygiene, and other problems; * Non-work related problem resolution, which included areas outside of the work environment but which indirectly impinged on the consumer's employment, including problems with transportation, medications or health issues, clothing needs, housing, etc.; * Crisis management, in which the consumer was in immediate danger of job loss due to extreme circumstances, such as fighting, leaving the job, active psychosis, hospitalization, etc.; * Career advancement activities, such as assisting the consumer to access additional training, increase work hours or salary, locate another position within the same or different company, etc. Table 2 shows the primary activity that occurred during the planned and unplanned extended service contacts. As this table shows, most (59.2%) of the planned contacts were for routine job maintenance (i.e., check-ups). However, in a substantial number of contacts the staff member performed corrective actions, such as resolving problems at the work site (16.1%) or away from the work site (3.5%), or assisted with the consumer's work duties (11.8%). Not surprisingly, the majority (77.7%) of unplanned but necessary contacts were for problem resolution either at work or away from work or for management of crisis situations. Table 3 shows primary activities cross-tabulated with time from VR closure (and initiation of extended services) in months. --------------------------------------------------------------------- Insert Table 2 and 3 about here --------------------------------------------------------------------- Satisfaction Surveys As reported earlier, 123 consumer satisfaction surveys were returned, for a return rate of 43%. Of these 123 surveys, 86 (69.9%) were completed by consumers, 36 (29.3%) were completed by parents or guardians, and 1 (0.8%) was completed by a paid assistant responding on behalf of a supported employment consumer. Results of the satisfaction items are presented in Table 4. As this table shows, high percentages of consumers indicated that they were either very satisfied or somewhat satisfied with their jobs and the services they received. Job satisfaction levels appear to decline to a limited degree from the initial job placement to the time of the survey. The lowest levels of satisfaction appear to be with the frequency of job coach contacts, with 8.1% of respondents indicating that they were somewhat or very dissatisfied. Chi-square analysis showed no statistically significant differences in satisfaction across respondent categories (i.e., consumer, parent or other). --------------------------------------------------------------------- Insert Table 4 here --------------------------------------------------------------------- Thirty-eight individuals (30.9%) indicated that they had spoken with their Vocational Rehabilitation Counselor regarding making a job change. Of these 38, 32 (84.2%) indicated that they thought the Counselor was willing to assist them in finding another job. Of the 123 respondents, 113 (91.9%) indicated that they thought that they could call their job coach or someone else in the supported employment agency with a problem and get help. Summary Although there are some limitations due to fewer contacts (and presumably consumers) in the mid-ranges, some patterns do emerge related to the nature of extended service contacts: * First, time per contact decreases over the course of extended services. Contacts for those who were within three months of VR closure averaged 90 minutes, but less than an hour for those who were at least 18 months post-closure. * Second, the need to resolve work-related problems appears to remain fairly constant even well into the job. This again attests to consumers' need for ongoing support services. * Third, there are "spikes" in the 3-6 month time frame for addressing non-work related problems and career advancement. They both may be due to this time frame being the make-or- break period for a placement and the agency needing to make new placement, work out new transportation problems, address SSI issues, etc. Perhaps most importantly, the study found that consumers were predominantly pleased with the level of help they received and contacts that were being made. Satisfaction was consistent whether the respondent was a supported employment consumer or the parent of a consumer. There were several limitations of this study that preclude us from making more definitive conclusions. First, all eight of the agencies were nominated and agreed to participate, thus suggesting they would have possibly better-developed programs than a purely random sample of providers. The second limitation is the potential for the Hawthorne effect in that all program staff knew that their extended service contacts were being monitored and may have altered their behavior or responses accordingly. The third limitation was that confidentiality concerns and potential risks prevented the use of consumer-specific data, so the extended service contact was used as the unit of measurement. Nevertheless this study has made start to understanding this complex issue of what is happening to keep supported employment consumers working. Extended services investment appears to be relatively minor for the tremendous return that can be realized. This study has shown that very little time is necessary when those interventions need to occur. References Bond, G.B., Becker, D.R., Drake, R.E., Rapp, C.A., Meisler, N., Lehman, A.F., Bell, M.D., & Blyler, C.R. (2001). Implementing supported employment as an evidenced-based practice. Psychiatric Services, 52, 313-322. Drake, R. E., McHugo, G. J., Bebout, R. R., Becker, D. R., Harris, M., Bond, G. R., Quimby, E. (1999). A randomized clinical trial of supported employment for inner-city patients with severe mental retardation. Archives of General Psychiatry, 56, 627-633. Federal Register (August 14, 1987). 52(157), 30546-30552. 34 CFR 363. McHugo, G., Drake, R., and Becker, D. (1998). The durability of supported employment effects. Psychiatric Rehabilitation Journal, 22(1), 55-61. 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. Table 1 Mean Time per Extended Services Contact by Months Post-VR Closure Months Post-VR Closure Minutes per contact Number of contacts Less than 3 90.7 94 3 to 6 76.6 59 6 to 9 61.2 30 9 to 12 73.6 36 12 to 18 65.2 62 More than 18 56.1 228 Table 2 Primary Activity During Extended Service Contacts Planned Contacts (n=434) Unplanned Contacts (n=108) Activity Frequency Percent Frequency Percent Routine job maintenance contact 257 59.2% 3 2.7% Assistance with current work skills 51 11.8% 2 1.9% Training in new work skills 10 2.3% 2 1.9% Work-related problem resolution 70 16.1% 51 47.2% Non-work related problem resolution 15 3.5% 24 22.2% Crisis management 3 0.7% 9 8.3% Career advancement 26 6.0% 10 9.3% Other 2 0.4% 7 6.5% Table 3 Purpose of Extended Service Contact Across Time Post-VR Closure Months Post-VR Closure Purpose of Contact > 3 3 - 6 6 - 9 9 - 12 12 - 18 > 18 Routine job maintenance contact 62.8% 23.7% 60.0% 61.1% 54.8% 45.2% Assistance with current work skills 2.1% 10.2% 3.3% 5.6% 0% 16.2% Training in new work skills 1.1% 0% 0% 0% 0% 4.4% Work-related problem resolution 21.3% 23.7% 36.7% 22.2% 27.4% 19.3% Non-work related problem resolution 4.3% 22.0% 0% 0% 1.6% 7.0% Crisis management 1.1% 0% 0% 5.6% 8.1% 1.3% Career advancement 6.4% 20.3% 0% 2.8% 6.5% 5.3% Other 1.1% 0% 0% 2.8% 1.6% 1.3% Table 4 Extended Service Consumer Satisfaction Initially satisfied with job Satisfied with job coach contacts Satisfied with help received Satisfied with job now Number Percent Number Percent Number Percent Number Percent Very satisfied 92 74.8% 73 59.3% 84 68.3% 74 60.2% Somewhat satisfied 18 14.6% 27 22.0% 20 16.3% 25 20.3% Neutral or N/A 9 7.3% 13 10.6% 12 9.8% 12 9.8% Somewhat dissatisfied 3 2.4% 7 5.7% 3 2.4% 9 7.3% Very dissatisfied 1 0.8% 3 2.4% 4 3.3% 3 2.4% 1