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Competitive Employment: Has It Become the "First Choice" Yet? (Article)
by Paul Wehman, W. Grant Revell, and Valerie Brooke
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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.
Quality Indicators for Supported Employment Programs
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.
1. Meaningful Competitive Employment in Integrated Work Settings
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:
* How is the person with a disability hired? Is he or she hired by the business where the work is being performed, or is he or she an employee of an employment services organization? * How is the person with a disability supervised? Is she or he supervised by an employee of the business where the work is being performed or by an employee of an employment service organization? * Is the individual with a disability paid wages and benefits that are comparable to those of co-workers who are not disabled? * Does the employee with a disability have the same career advancement opportunities within the worksite as co-workers who are not disabled, as well as equal access to resources at the workplace, such as the Employee Assistance Program? * Is there full social access to co-workers who are not disabled, and is there an absence of a congregation of persons with disabilities within the work site?
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.
2. Informed Choice and Control
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:
* Who selected the service provider? * Who selected the job coach? * Who selected the job? * Does the customer like the job? * Is the customer satisfied with the service? * Is the customer able and willing to retain the job?
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:
* Do customers assist in selecting the support option? * Does the program advocate moving from a least intrusive level of support to a more intrusive support option based upon customer need? * Does the program have staff members who are skilled at identifying possible workplace support options? * Are program staff members skilled at matching support options to the learning style of their customers? * Does the program have staff members who are skilled at interviewing employers and coworkers to gage their interest in providing supports and their willingness to do so? * Are staff members sufficiently skilled to predict which support option will result in the greatest level of independence for the customer? * Do program staff members begin thinking about fading supports from the first day of employment?
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.
4. Employment of Individuals with Significant Disabilities
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 change
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