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