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The Myths and Realities of Supported Employment

by John Kregel, Paul Wehman, & Michael West

Abstract The Social Security Administration (SSA) disability programs have experienced tremendous growth in both beneficiaries and expenditures, threatening the viability of this safety net for individuals with disabilities. This article suggests that one means of assisting SSA beneficiaries to reduce dependence, thereby slowing program growth, is for SSA to directly or indirectly fund competitive employment initiatives focusing on individuals who are currently served in nonremunerative day support programs. These initiatives require coordination of SSA trust funds with vocational rehabilitation and mental retardation/developmental disability funding streams.

In just a few short years, supported employment have evolved into a widespread, effective community-based employment alternative that has enabled many individuals with significant disabilities their first opportunity to obtain and maintain a real job in their local community. As a service delivery strategy that embodies the principles of individualized, community-based support services and consumer empowerment, supported employment has become the preferred employment alternative for over 140,000 individuals previously excluded from work opportunities.

The national supported employment initiative has grown rapidly over the past decade. The VCU national Survey of Supported Employment Implementation has tracked annual participation rates for individuals participating in supported employment since the initiation of the Title VI-C formula funding program within the 1986 Amendments to the Rehabilitation Act. The results of this survey, fully described below, indicate that the number of individuals participating in supported employment has risen from less than 10,000 in FY 1986 to 140,000 in FY 1995. Nearly 3,700 local community agencies in all 50 states provide supported employment services.

As we approach the end of the twentieth century, a number of "truisms" regarding supported employment as a national service program have emerged. Many of these truisms have developed in the clear absence of empirical information derived from objective research. A few of these myths are listed below.

The supported employment movement has stagnated and growth in the program has slowed. More and more frequently, we are hearing that the supported employment initiative has lost much of momentum and that the program will have a difficult time expanding in the future. The national data on participation rates does not corroborate this view. As we report in this monograph, the number of participants in supported employment rose from 105,000 to 140,000 from FY93 to FY95 alone. Supported employment closures as a percentage of all vocational rehabilitation closures continues to slowly but steadily increase. Far from being a small, isolated program, supported employment currently serves four to five times the number of persons served through Projects with Industry, Javits-Wagner-O'Day Act programs, or other similar programs. Supported employment is a key component of the Rehabilitation Services Administration's efforts to promote meaningful, competitive employment outcomes for individuals with significant disabilities in integrated settings.. More and more frequently, we are hearing that the supported employment initiative has lost much of momentum and that the program will have a difficult time expanding in the future. The national data on participation rates does not corroborate this view. As we report in this monograph, the number of participants in supported employment rose from 105,000 to 140,000 from FY93 to FY95 alone. Supported employment closures as a percentage of all vocational rehabilitation closures continues to slowly but steadily increase. Far from being a small, isolated program, supported employment currently serves four to five times the number of persons served through Projects with Industry, Javits-Wagner-O'Day Act programs, or other similar programs. Supported employment is a key component of the Rehabilitation Services Administration's efforts to promote meaningful, competitive employment outcomes for individuals with significant disabilities in integrated settings.

Supported employment is more expensive than other vocational alternatives for individuals with significant disabilities. It is often stated that supported employment costs more than vocational alternatives. For example, in terms of time limited funding, supported employment closures cost more, on a per closure basis, than other vocational rehabilitation closures. In terms of extended services, regulatory restrictions often required supported employment extended services to be funded through state monies as opposed federal Medicaid monies that fund other types of day services for individuals with developmental disabilities. However, when supported employment is compared to other programs serving individuals with significant support needs, the costs of the supported employment are less than, or equivalent to, those of other programs. For example, a state by state comparison indicates that the costs of extended services for supported employment participants are from 40% to 80% of the costs of other day service options such as sheltered workshops or activity centers. . It is often stated that supported employment costs more than vocational alternatives. For example, in terms of time limited funding, supported employment closures cost more, on a per closure basis, than other vocational rehabilitation closures. In terms of extended services, regulatory restrictions often required supported employment extended services to be funded through state monies as opposed federal Medicaid monies that fund other types of day services for individuals with developmental disabilities. However, when supported employment is compared to other programs serving individuals with significant support needs, the costs of the supported employment are less than, or equivalent to, those of other programs. For example, a state by state comparison indicates that the costs of extended services for supported employment participants are from 40% to 80% of the costs of other day service options such as sheltered workshops or activity centers.

In reality, supported employment costs less than other day support options for individuals with significant disabilities. However, many issues exist related to funding local programs. A number of investigations reported in this monograph address the extent to which funding mechanisms affect a local program's ability to (1) maximize consumer choice and self-determination in the supported employment process, (2) implement program conversion efforts, (3) encourage participation by individuals with the most significant support needs, and (4) promote job mobility and career advancement.

Supported employment only serves individuals with developmental disabilities. While supported employment is viewed by some as a small, specialized program that serves only individuals with cognitive disabilities, nothing could be further from the truth. Individuals with long-term mental illness are the fastest growing segment of the supported employment population, while the percentage of participants with cognitive disabilities has declined over the years. Social Security (SSI/DI) beneficiaries comprise nearly three-fourths of supported employment participants. Perhaps more importantly, the individualized placement and support technologies which form the heart of supported employment are being applied to ever expanding groups of individuals. For example, this monograph contains descriptions of new efforts to apply the principles of supported to individuals with disabilities in institutions of higher education, the Social Security Administration Return-to-Work population, and individuals with disabilities exiting public schools.. While supported employment is viewed by some as a small, specialized program that serves only individuals with cognitive disabilities, nothing could be further from the truth. Individuals with long-term mental illness are the fastest growing segment of the supported employment population, while the percentage of participants with cognitive disabilities has declined over the years. Social Security (SSI/DI) beneficiaries comprise nearly three-fourths of supported employment participants. Perhaps more importantly, the individualized placement and support technologies which form the heart of supported employment are being applied to ever expanding groups of individuals. For example, this monograph contains descriptions of new efforts to apply the principles of supported to individuals with disabilities in institutions of higher education, the Social Security Administration Return-to-Work population, and individuals with disabilities exiting public schools.

Supported employment is "mired" in a debate between the natural support model and the job coach model of supported employment. Researchers such as David Mank, Wendy Wood, David Test and many others continue to attempt to define the key components of the natural support technologies and document the relative efficacy of these strategies. However, at the local level, it seems that community rehabilitation programs are using components of both the natural supports and the job coach model to provide services to individual consumers. For example, we report in this monograph that over 85% of all supported employment programs indicate that they use natural supports in the delivery of supported employment services. At the same time, many programs indicate problems with the implementation of natural support strategies and the services and supports provided directly at the job site continue to be highly valued by consumers participating in studies of consumer satisfaction. At the direct service level, local programs continue (as they always have) to use all available strategies and technologies that will promote high quality employment outcomes for individuals participating in their programs. Researchers such as David Mank, Wendy Wood, David Test and many others continue to attempt to define the key components of the natural support technologies and document the relative efficacy of these strategies. However, at the local level, it seems that community rehabilitation programs are using components of both the natural supports and the job coach model to provide services to individual consumers. For example, we report in this monograph that over 85% of all supported employment programs indicate that they use natural supports in the delivery of supported employment services. At the same time, many programs indicate problems with the implementation of natural support strategies and the services and supports provided directly at the job site continue to be highly valued by consumers participating in studies of consumer satisfaction. At the direct service level, local programs continue (as they always have) to use all available strategies and technologies that will promote high quality employment outcomes for individuals participating in their programs.

In this monograph, the Rehabilitation Research and Training Center on Supported Employment attempts to address many of the major issues affecting the program as it continues to expand and matures. Articles are included that discuss current trends in service delivery, the experiences of local community employment agencies, issues involved in funding supported employment, natural support implementation strategies and transition from school to work. The key issues discussed include:

  • Results of the 1995 national Survey of Supported Employment Implementation

  • Conversion of segregated, facility-base programs to supported employment

  • Use of Social Security Work Incentives such as PASS and IRWE

  • The Social Security Return to Work Initiative

  • Time limited and extended services funding

  • The role of employment specialists within natural support programs

  • The results of consumer satisfaction interviews with supported employment participants

  • Application of support employment strategies to individuals with disabilities in institutions of higher education

  • Transition planning for students with significant disabilities

The results of the investigations contained in this monograph represent the collaborative efforts of large number of individuals from across the country. First and foremost, we wish to thank the large numbers of individuals with disabilities who participate in our own supported employment demonstration programs, as well as many other programs throughout the country. These individuals have assisted us in designing our overall research program, developing the investigations reported in this monograph, and participating in focus groups and structured interviews.

We have also been fortunate to receive the cooperation and support of literally hundreds of local community rehabilitation programs across the country. We were able to engage in lengthy inter-views with 385 local agencies in 40 different states to obtain the perspective of provider agencies on the key issues affecting supported employment implementation. Many other programs have assisted us in depth examinations of program cost, consumer satisfaction, transition from school to work and other topics. We would like to particularly thank the many state chapters of the Association of Persons in Supported Employment which have recognized the importance of research and constantly challenged us to make our research program relevant to the needs of local practitioners.

Many state and federal agencies have also been instrumental in the design and implementation of our research program. The Council of State Administrators of Vocational Rehabilitation and the National Association of State Directors of Developmental Disabilities Services have consistently supported our national Survey of Supported Employment Implementation over the past ten years. Their support has been mirrored in the cooperation and assistance we have obtained from the state vocational rehabilitation agencies and other collaborating agencies in virtually every state. Time and again, state vocational rehabilitation agency directors or supported employment coordinators have gone the extra mile to insure that the data we report is complete and accurate. They have also been extraordinarily helpful when we have imposed on them provide last minute information in response to a request from Congress or a federal agency. We cannot thank them enough for the patience and willingness to go the extra mile to make certain that policy-makers and consumers have update and accurate information on supported employment.

 


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