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CHAPTER TWO: BEST PRACTICE IN 'SUPPORTED EMPLOYMENT': A
LITERATURE REVIEW
Introduction
"By far the greatest challenges facing…supported
employment over the next several years are the
continuing growth and innovation in our field and
assuring that supported employment is a reality for
every individual who wants a real job in his or her
community. (DiLeo & Langton, 1996)
2.1 The above quotation captures a general feeling of
anticipation and promise around the future development of
supported employment evident within the literature. As
Riddell et al (1999) observed, despite reservations, a
"cloak of optimism surrounds supported employment". This
sense of confidence in the model permeated the literature
reviewed for this chapter despite any "underachievement"
identified by research. The purpose of the review of
literature published primarily within the past 5 years was
to summarise main findings from recent research, identify
any gaps in information and highlight the key features of
best practice.
Main findings from recent research
2.2 Best practice in supported employment is discussed
under the following 8 main headings: preserving the
integrity of the support model and supported employment;
the need to tackle systemic barriers to further
development; emergence of the notion of self determination
and the promotion of choice; issues around marketing and
job development; developments in the role of job coach and
using natural supports within the workplace; the need to
enhance social integration outcomes; supported self
employment; and the importance of post employment
services.
Preserving the integrity of the 'support model'
& 'supported employment'
2.3 The literature review suggested a need to re-assert
the values of both the support model and its challenge to
readiness approaches, and of supported employment. The
'support model' evolved from progressive movements in the
field of disability representing a major shift from
facility-based approaches to the provision of individual
supports, which aim to realise individual goals and
aspirations. The keystones of the support paradigm are
community inclusion, an emphasis on quality of life,
individual planning and support. It requires the
development of systems offering options for choice, support
and guidance: facilitation rather than direction. However
as some authors suggest the shift in thinking required
"can't be reversed overnight" (Meyer, 2001) and there is
evidence the readiness model persists.
2.4 Supported employment, emerged in the mid 1980s and
has become a well-established approach demonstrating
success in finding real jobs for a range of disabled people
and maintaining them in these jobs (Schneider et al, 2002).
It has also been found to benefit individuals by
contributing to a higher quality of life (Eggleton et al,
1999). Consumer satisfaction with both the support received
and jobs obtained through supported employment has been
reported (Parent et al, 1996). Employers report
satisfaction with supported employment and find people with
learning disabilities to be reliable, hardworking and
effective employees (Petty & Fussell, 1997).
2.5 Despite this positive picture, the implementation of
supported employment has been somewhat disappointing. A
survey of employment options for people with learning
disabilities, with responses from 60 countries, showed that
despite good practice examples on inclusive employment, the
overall picture "remains one of great concern" (Sutton,
1999). Participation in inclusive or integrated employment
was found to be "very much in the minority". Many countries
in the
EU invest more resources in segregated
or specialist provision than in community employment, and,
it is argued, supported employment has become part of "a
long continuum" rather than providing an alternative to
segregated provision (Beyer et al, 2002). The Policy
Consortium on Supported Employment (O'Bryan et al, 2000a)
further highlighted an urgent need to ensure supported
employment becomes "much more widely available, with
services of consistent quality".
2.6 It was not until the 1990s that the concept of
supported employment was applied to people with
ASD. In the
UK, most supported employment schemes
focused on people with learning disabilities. The National
Autistic Society's specialist initiative,
'Prospects', was devised for people with
ASD who were "more intellectually able",
although a later evaluation of the scheme showed inclusion
of a more diverse population of people with
ASD. An initial evaluation of the
outcomes of the
Prospects initiative reported positive outcomes
(Mawhood & Howlin, 1999). Overall, the 'Prospects
model' of supported employment has been effective with
people with
ASD, and the initial high costs of the
scheme gradually reduced over time as most were no longer
reliant on welfare benefits (Mawhood & Howlin,
1999).
Importance of defining 'supported employment'
2.7 The importance of agreeing a national definition of
supported employment was clear from the literature.
Research in the
US demonstrated that when programmes
define what supported employment is and who receives it,
there are discrepancies between the providers and the
commissioning and funding agencies (West et al, 1994). In
the
UK, which does not have an equivalent
funding mechanism for supported employment, issues of
definition are even more fraught.
2.8 There is wide variability in the practice of
supported employment. Both Weston (2002) and Ridley (2001)
found inconsistencies in supported employment in Scotland,
some of which distorted and watered down the original
concept and affected the quality of individual outcomes.
Further, interviews with key informants providing
employment services in Scotland (Riddell et al, 1999) found
discrepancies between service managers claims to be using
supported employment and what the researchers found to be a
"very partial and half hearted version" of supported
employment.
2.9 The United States Developmental Disabilities Act of
1984 defined supported employment as:
"(i) Paid employment for persons with developmental
disabilities for whom competitive employment at or
above minimum wage is unlikely and who need ongoing
support to perform in a work setting, (ii) is conducted
in a variety of settings in which persons without
disabilities are employed, and (iii) is supported by
any activity needed to sustain paid work including
supervision, training, and transportation. (P2665)
2.10 In 1986, the Vocational Rehabilitation Amendments
Act further defined supported employment as jobs for a
minimum of 20 hours per week. While some providers would
and do argue that this has contributed to the unnecessary
exclusion of people with more severe disabilities, others (
e.g. Moon et al, 1990) have argued that people
with severe disabilities can and should be able to work 20
hours per week or more but might need the flexibility to
work fewer hours initially.
2.11
UK definitions have lacked statements in
respect of the minimum number of working hours and the
target group for supported employment. Consequently, some
have regarded jobs for as little as one hour per week as
supported employment, and as yet only small numbers of
people with more severe learning disabilities have
benefited (Weston, 2002). This is despite research showing
that wage levels, and, to some extent, integration
outcomes, are largely driven by the amount of hours worked
(Kilsby et al, 1995; Mank, 2003).
2.12 Although there is no consensus, writers in the
UK tend to agree on three basic
elements: that is (1) that supported employment offers paid
employment or 'real jobs'; (2) that jobs are offered in
integrated settings or with community employers; and (3)
that there is ongoing 'support' (Pozner & Hammond,
1993; Beyer et al, 1996; Wertheimer, 1996). More recently,
the Policy Consortium for Supported Employment (O'Bryan et
al, 2000a) defined supported employment as a way of
enabling people who need support to obtain and develop
their careers in real jobs, with support provided on an
individual basis to both employer and employee for as long
as necessary.
2.13 Several authors further distinguish between
supported employment and the Department of Employment's
'Workstep Programme', although some suggest the distinction
is far from clear-cut (Leach, 2002). Stalker (2001) however
asserts that supported employment is quite distinct from
Workstep, and Weston (2002) found that using the term
supported employment to describe central government schemes
such as this was contentious as some practitioners and
agencies felt that subsidised employment was entirely
different from the original model of supported
employment.
Supporting people with severe disabilities
2.14 Although originally developed as a way of placing
people with high support needs or severe disabilities in
ordinary jobs, those with the most severe disabilities are
generally "underrepresented in the ranks of those
benefiting from supported employment" (Mank et al, 1998b).
Recent research in the
UK (Weston, 2002) found relatively few
supported employment agencies supporting people with severe
disabilities or 'complex needs'. One reason suggested for
this was that services have found it easier to find jobs
for people with lower support needs and that over time
their support needs reduce making it possible for services
to meet target numbers set by funders.
2.15 In examining the employment features of those with
more severe disabilities in work, Bass (2000) found the
quality of jobs and the wages offered were lower than those
available to more able individuals. They tended to work
fewer hours, to be unpaid and be less well integrated.
Similarly, Mank et al (1998b) found that people with more
severe disabilities in the
US had lower wage and integration
outcomes and less typical features of employment.
2.16 However, research has also uncovered exceptions to
this suggesting that high quality outcomes are possible for
at least some individuals with more severe disabilities.
For example, Mank et al's (1998a) research proved people
with severe disabilities could earn high wages. All 55
individuals in this demonstration project were employed
within the same County government in different departments.
Leadership and commitment from within the Council was found
to be critical. The researchers suggested as significant
that the departments employing people with severe
disabilities were identified as the same departments that
generally accommodated diversity.
2.17 The findings of this and other research point to a
range of successful strategies in working with people with
severe or significant learning disabilities and/or
ASD:
- Diversify the support model for example, support
co-worker; job share; self employed; professional
partnership
- Close attention is paid to both individuals' and
employers' needs
- Recruitment practices are adapted to allow
individuals to perform at their best
- Jobs are paid at or above the going rate
- There is a good 'job match' of the person and the
work environment
- As many aspects as possible are 'typical' for the
workplace, especially in terms of inclusion in the
workforce
- Co-workers are trained by supported employment
personnel
- The use of adaptations and on the job training
using systematic instruction is critical
- It is important to build up the hours worked
gradually, to hold regular reviews, and for support
workers to understand individuals' methods of
communication
- There is good communication between everyone
involved so that any problems are resolved early
on
(Mank et al, 1998b; Beyer, 2001; Weston, 2002)
2.18 The Policy Consortium for Supported Employment
(O'Bryan et al, 2000a) identified the need to avoid
perverse disincentives in the funding system that cause
providers to avoid working with people with the highest
support needs. They proposed adopting premiums for
assisting people with greater support needs.
Importance of tackling systemic issues
2.19 A key theme from the literature was the need to
tackle the systemic barriers inhibiting the development of
supported employment. Recent research carried out in the
US by Mank, Cioffi and Yovanoff (in
press) to examine whether supported employment was being
implemented in better ways than when it initially emerged
in the 1980s, suggested that larger systems issues defined
the extent to which supported employment could deliver
improvements over time. In large part, outcomes such as
wage levels, and to an extent social integration outcomes,
were driven by the amount of hours worked, which in turn
was affected by financial disincentives and other
structural issues related to the jobs market. Mank et al
concluded:
"Future improvements in the career outcomes for
people with significant disabilities will not simply be
a matter of what practitioners do in the next 10 years,
it may be more of a matter of what we are able to do
with the policy, funding and systemic issues that can
be improved to support the work of people in local
communities."
2.20 The 'social model of disability' recognises the
barriers in the way work opportunities, the environment and
support mechanisms are created and organised (Riddell et
al, 1999). This review highlighted aspects of the social
security system, conversion and infrastructure issues, a
lack of strategic development of supported employment, and
recruitment policies and procedures as key systemic issues
impacting upon supported employment.
Aspects of the social security system
2.21 Increases as high as 500% in individuals' annual
earnings have been reported from supported employment in
the
US (
e.g. Kregel, 1997). Financial gains from
supported employment reported in the
UK have been less impressive (Beyer et
al, 1996). Riddell et al (1999) researching the impact of
supported employment on individuals in Scotland concluded
that the economic gain for the people in their study was
"only marginal", and that income from employment had
replaced but not substantially changed these individuals'
overall level of income. It should be noted however, that
published studies will not yet reflect the considerable
developments in benefits and tax credits that have occurred
in the
UK since 1997, and which appear to be
having a positive impact. That the picture is more
optimistic for some people is evidenced by the individual
stories collated in this research and presented in Chapter
6. Further, case studies from North Lanarkshire in Appendix
1 show individuals who are financially better off as a
result of being in supported employment.
2.22 Aspects of the
UK social security system and other
related systems have been identified as causing major
problems for individuals as well as for the development of
supported employment (Simons, 1998; O'Bryan et al, 2000a).
The Policy Consortium for Supported Employment (O'Bryan et
al, 2000a) argued for "a debate about more radical reform
of the benefit system". At the same time, they advocated
exploring "pragmatic options for alleviating some of the
problems with the current benefits system", and highlighted
helpful developments including agencies mobilising
effective welfare rights advice, enabling disabled people
to make the most of opportunities within the benefit
system.
North Lanarkshire Council ensures people
with learning disabilities in supported employment are
financially better off with a combination of wages and
in-work benefits. Social Work Department Welfare Rights
Officers stay well informed of benefit regulations and
changes, introduce the income potential of employment from
the start and perform financial calculations for each
individual (O'Bryan, 2002).
Conversion & infrastructure issues
2.23 The original concept of supported employment
assumed changeover from existing segregated day services
and sheltered workshops and conversion in the use of
financial resources to supported employment. This paradigm
shift has not happened in practice (Wehman et al, 2002;
Beyer et al, 2002). Rather, supported employment has been
added to a continuum of services. Statistics collated by
the Scottish Executive (2004) found that during a 'typical
week' in 2003, around 7,433 adults with learning
disabilities and/or
ASD in Scotland were attending a
day/resource centre while 2,493 adults were participating
in 'voluntary work', 'non-open' and 'open employment'.
Although 48% of those attending day centres were recorded
as getting some sort of alternative day opportunity outwith
the centre including paid or voluntary work, these figures
show segregated provision continues to be the dominant
experience for people with learning disabilities and/or
ASD in Scotland.
2.24 Mank (1994) attributed limited systemic change to
six main problems:
- An underestimation of the current system of
segregated services;
- Limited incentives for change coupled with
disincentives for those interested in dismantling
segregation in favour or supported employment;
- Conflicting policies;
- The lack of sustained investment;
- Over-reliance on social services and under-reliance
on the community;
- Little control on the part of people with severe
disabilities.
2.25 In relation to research in the
UK and Holland, Ritchie (1999) concluded
that strategic redesign issues were not being addressed
either at local or national level. Woodford (1999)
described similar issues in relation to the Australian
experience.
The need for strategic development
2.26 Despite apparent progress, recent studies show that
supported employment services are often developed in
isolation rather than as part of an overall strategic
framework and this leads to duplication of effort,
fragmentation and fragility of the sector (Smyth &
Maynard Campbell, 1997; O'Bryan et al, 2000a). Ritchie and
Stalker (1999) observed supported employment in Scotland to
be a "marginal activity".
2.27 Supported employment requires specific systems and
structures to "ensure mainstream success" and to assure its
quality (O'Bryan, 2002; Weston, 2002). A strategic approach
requires commitment from above for instance at Chief
Executive level; a common and agreed purpose between all
partners; support from employees, trade unions, employers,
and all appropriate local organisations; and effective
monitoring and evaluation mechanisms which involve disabled
people (Smyth & Maynard Campbell, 1997).
North Lanarkshire Council is an example of
a local authority that has adopted a strong policy
leadership and coordinated approach to supported employment
(O'Bryan, 2002). In 1998 Social Work began a supported
employment strategy as part of a broader social inclusion
focus. From there, they were able to actively promote the
benefits of supported employment to the wider Council.
The Glasgow Partnership brings together
the local Council,
NHS Board, Jobcentre Plus, Scottish
Enterprise, Careers Scotland, Further Education colleges,
LECs and
ENABLE Scotland and has produced a plan
as to how agencies in the area should work together under a
common vision (
Equal Access to Employment Strategy). The
partnership identified the need for strong, strategic
leadership within the City as a key issue. The document
articulates the vision, principles objective and targets of
the Equal Access to Employment strategy, outlines the
management structure and work plan for implementing the
strategy.
Recruitment policies and procedures
2.28 Research exploring good practice in employing
disabled people (Smyth & Maynard Campbell, 1997)
highlighted several examples of local authorities in the
UK that had adjusted internal
recruitment policies and procedures to assist the
employment of disabled people. Successful strategies have
included guaranteed interviews for disabled people; targets
for the number of disabled people employed by an
organisation; recruitment and selection training for staff;
and creating groups to discuss issues of concern and review
policies.
Leeds City Council has pioneered a
successful and well-documented approach to inclusive
employment (North Lanarkshire Conference Report, 2004).
They used in-house employment opportunities as the drive
for promoting social inclusion. A flexible stance was taken
to advertising and appointing staff, validated by the
Employers' Organisation Recruitment Guide. Partnership
working between the Human Resources Department and the
Employment Service resulted in setting targets for
employing New Deal job seekers via the Jobcentre Plus
Service. 'Entry level' jobs were ring-fenced and initially
offered to New Deal applicants. This approach is now
perceived as an effective recruitment policy rather than a
social inclusion policy
Self-determination & choice
"Self advocates and advocates are repeatedly
calling for more rapid expansion and improved quality
for all persons, across disability labels, who will
benefit from a job in the community with individualized
supports." (Mank, 2001)
2.29 Although the supported employment model has
expanded the employment options and quality of work life
for many people with disabilities, some authors have argued
that it is primarily controlled by agencies and that
employment specialists could do more to advance the
self-determination of people with disabilities (Sowers et
al, 1996). Several writers have emphasised both the
importance of a consumer-led perspective and of individuals
controlling their vocational destinies through
self-determination and self-advocacy (Wehman & Kregel,
1998; Racino & Whittico, 1998; Martin et al, 2002).
2.30 'Self-determination' is a philosophy advocating
supports and services based on the interests, needs and
preferences of individuals with a disability and those who
are close to him or her. In respect of supported
employment, it means people with disabilities and their
families determining what direction their career searches
should go, how their careers fit with their lives and how
services should best support their goals.
'Self-determination' is also a term used about an approach
that means teaching disabled workers self-management
strategies rather than relying on direct intervention by
employment specialists as requirements change within a job
(Beyer and Kilsby, 1997). This signifies "a paradigm shift"
towards more empowering methods of training people with
learning disabilities (Beyer et al, 2002).
2.31 The key components of a consumer-led approach have
been described as:
- The disabled person as a customer selecting the
supported employment service best suited to meet his or
her needs
- Creating a 'customer profile' of what each
individual wants to achieve through supported
employment, identifying personal strengths, concerns,
desires, and anticipated outcomes
- The individual becomes an active participant in
marketing and career development
- Service providers involve their customers in every
aspect of the employment match process including
employment selection
- Service providers must use existing technology and
best practices extensively described in the literature
and involve the customer in all the decisions regarding
his or her training
- Determine individualised strategies for providing
support that will assist career development for the
customer and employer
- The individual is in charge of the process and the
role of the supported employment professional is to
assist, facilitate and support.
(Barcus, 1999)
2.32 Ensuring services adopt a more consumer-driven
approach includes promoting person centred planning
approaches, emphasising choice and adopting a career-based
approach to job development and support.
Person-centred planning approaches
2.33 Since the mid 1990s, connections have been made
between supported employment and person centred planning,
although individualised planning was always a feature of
the model (Callahan and Garner, 1997). 'Person-centred
planning' has been defined as a set of strategies to help
find and create ways for an individual to participate fully
in his/her community (Sanderson et al 1997; Wolf-Branigin
et al, 1998). More recently person-centred planning
approaches have been shown to be effective at enabling
individuals to direct their own careers and enhancing
long-term employment and career satisfaction (Steere et al,
1995; Sowers et al, 1996; Kregel, 1998).
2.34 Several authors including Rogan et al (2000) have
identified person centred planning as a key feature of best
practice in supported employment. Adopting a person-centred
approach to supported employment achieves better outcomes:
for example, Hagner and DiLeo (1993) argued that job
seekers invest more in the process; employer contacts are
broader in scope and are more creative; the individual is
more motivated to succeed and keep the job; jobs are more
specifically tailored to the individual; and social
integration outcomes are better.
2.35 Person centred planning promotes self-determination
and the central involvement of the job seeker in the
process of supported employment. Meyer (2001), writing as a
person with
ASD, described person centred planning
as a "radical planning paradigm", which was both a planning
and counselling technique. It is now recognised as having
particular relevance for people who have
ASD, particularly those with Aspergers
Syndrome because it addresses one of their main problem
areas that is, "executive function" or planning.
2.36 An evaluation of a person centred career planning
tool, the
Personal Career Plan, found it to be a viable
method for expressing career preferences and attaining
employment based on individuals' preferences and choice
(Menchetti and Garcia, 2003). A better match was obtained
using this tool between individuals' career choice and
current employment. A critical implementation issue was
clarifying the individual's career vision into concrete
statements around such things as preferred hours, wages,
and outcomes. In common with other studies, the researchers
identified the need to invest in staff training in person
centred planning to enhance both the practices and values
necessary for successful implementation.
Promoting choice
2.37 Related to the notion of consumer or person-driven
services and self-determination is the concept of choice
and the importance of ensuring each person has "real
personal choices" in employment (DiLeo, 1999). Wehman et al
(2002) argues that informed choice and control must be a
"key feature" of any employment support service. Moseley
underlined the importance of finding jobs that reflect
individuals' interests and abilities as long ago as
1988:
"The idea that persons with mental retardation, for
example, excel in dull repetitive tasks appears to be
based on handicappist prejudice rather than evidence."
(p217)
2.38 In practice, as Wistow and Schneider (2003) found,
"the opportunity to work seems to be valued more than being
able to choose what sort of work". Similarly, research in 3
supported employment services in Scotland (Ridley, 2001)
found "gaps in information about personal goals and
aspirations coupled with a tendency to fit people into
existing jobs". In some instances, there was greater
reliance on professional knowledge of the current job
market than on exploring individuals' aspirations.
2.39 In another study people with disabilities were
asked about their ideal or dream jobs, and gave both
specific and individual responses (Dufresne, 1996). They
aspired to a wide variety of jobs and it struck the author
that many people with disabilities "have dreams of which
many of us professionals are totally unaware". Furthermore,
their job preferences were found to be "not in synch" with
the types of supported employment jobs on offer, which for
the most part were in fast food and other catering related
posts.
Career-based approach
2.40 While models of career development for the general
population assume changing jobs to be an integral part of
the employment process, this is not always the case for
supported employees (Pumpian et al, 1997). Factors such as
the status of jobs and advancement opportunities have not
always been taken sufficiently into account when
determining suitable job matches (Sowers et al, 1996;
2002).
2.41 Racino and Whittico (1998) assert that self
advocates now demand 'good jobs' with good pay and
benefits, enjoyable work that enables a contribution, and
'quality' education, career planning and the possibility of
advancement. A recent qualitative study of users' views on
supported employment in England (Wistow and Schneider,
2003) found that getting and keeping a job was "not enough"
and that people with learning disabilities sought career
progression. Recognition of these needs has resulted in an
important shift in thinking for supported employment
(DiLeo, 1999).
2.42 Demonstration projects such as Pathways to
Independence in Wisconsin are pioneering innovative ways of
supporting people with disabilities to find satisfying
careers using person centred planning methods, setting up
'career planning teams' and by developing better
partnerships between everyone involved in an individual's
life alongside supported employment providers (Mills &
Fentress, 2002). 'Career planning teams' are similar to
'circles of support' in that they are a group of people who
care about the person and work together to help him or her
find a career. The individual with disabilities is the
'team leader' and the team includes amongst others, the
employment specialist or job coach and a benefits
specialist. Menchetti and Garcia (2003) have pioneered the
use of a 'personal career plan' as a viable method for
finding out about individuals' careers choices.
2.43 Another initiative, piloted in several states in
the
US was 'career services vouchers'
(DiLeo, 1999). These vouchers were given to people with
disabilities to be spent on "pursuing mutually agreed-on
career goals from exploration and job development to
accommodations and additional on-the-job support". Such
initiatives arise out of recognising the importance of
putting control of resources in the hands of disabled
people and thereby increasing their self-determination
(Mank, 1994; 2001). Although not directly comparable,
Direct Payments have rarely been used in this country to
support individuals in employment (Ritchie and Stalker,
1999).
Marketing & job development
"Employers' satisfaction with quality supported
employment services is critical for ongoing support,
integration and future placements. Job developers must
be knowledgeable and skilful in balancing the needs of
employers and consumers with disabilities. Employers
who experience quality supported employment services
may serve as advocates and communicate the benefits to
other potential employers." (Grossi et al, 1998)
2.44 Finding the right job not only relies on a thorough
understanding of an individual's interests, preferences and
goals, but also on understanding the needs of employers.
Focus group research in the
USA found that while supported
employment specialists looked for employers who were aware
and understanding, employers on the other hand emphasised
competence and quality (Luecking, 1996).
2.45 Employers have identified both benefits and
concerns regarding employing individuals with disabilities
(Unger, 2002). Research finds that employers with previous
experience of employing disabled people report more
favourable perceptions and a willingness to hire other
persons with disabilities. Luecking et al (2004) asserted
that such employers develop more positive views even when
these workers have severe disabilities. Unger concluded
that to an extent employers were willing to sacrifice work
performance or work quality in exchange for dependable
employees. Similarly, research by Petty & Fussell
(1997) found employers viewed people with learning
disabilities as reliable, hard-working and effective
employees.
2.46 Hagner & Daning (1996) found that having
experienced job developers who had developed relationships
with a network of employers and were more attuned to
employers' needs was important. Company-centred
negotiations that focused on the needs of the company and
the employer's plans were found to be the most effective
especially in getting employers to create jobs when no
position was open. This approach also led more often to
natural supports being developed in the workplace. Most job
developers in their study highlighted two critical success
factors: presenting a businesslike approach to employers
and second, establishing open and personal
communication.
2.47 Some writers assert that employment specialists
could do more to market supported employment to employers
(Leucking et al, 2004). Further, the language and culture
of disability services has "not jibed with those of the
business world". DiLeo (1999) urged employment services to
avoid marketing messages that focused on disability as well
as project names, logos, business cards and other materials
"relating to human services, charity, hope or pity".
2.48 Pierce (1999) identified backgrounds in healthcare
or human services as a distinct disadvantage for supported
employment staff, as this did nothing to equip them with
the skills necessary to communicate effectively with
employers. It has been suggested that the roles of job
developer and job coach require different sets of skills
and should ideally be separate roles. Studies where this
has happened report positive findings (Mank et al, 1998a).
The advantages for job developers include having the time
to invest in relationships, recruiting managers' interest
and becoming an expert in the human resource system.
Long-term support agencies can invest more in job analysis,
job matching and natural supports.
Importance of awareness raising/training in the
workplace
2.49 Research into employment for disabled people in the
UK concluded that awareness raising and
training for employers was a "vital part of any equality
strategy" (Smyth & Maynard Campbell, 1997). This
finding is supported by the work of researchers in the
US (
e.g. Mank et al, in press). These researchers
found better outcomes for those working in companies where
training was provided about diversity or disability
awareness. Further, providing information and support to
co-workers and supervisors in the workplace was linked to
better wage and integration outcomes, as was less contact
with supported employment personnel (Mank et al, 1999).
Better outcomes were also associated with the provision of
specific information about the support needs of the
individual and providing information to co-workers and
supervisors just as the individual started in the job
rather than later.
Job coach issues
2.50 The role of employment specialist continues to
evolve. At the same time, research shows gaps between what
is expected, and the responsibilities of employment
specialists and their levels pay and training (Agosta et
al, 1996; Grossi et al, 1998). Having trained employment
specialists has been shown to positively affect the quality
of supported employment services (Grossi et al, 1998;
Beyer, 2001). There are better financial outcomes for
supported employees in services that have dedicated job
finders and staff with qualifications (Beyer, 2001).
Conley's research (2003) recommended several enhancements
to supported employment including recruiting and retaining
qualified vocational workers and providing them with
improved training.
'Natural supports'
2.51 A body of writing during the 1990s criticised
traditional paid supports as intrusive and as hindering
successful outcomes, in particular social integration, and
instead advocated for the use of 'natural supports' in the
workplace or greater involvement of employers in
facilitating supported employment (Butterworth et al,
1996). DiLeo and Langton (1996) asserted that natural
supports were an "inevitable outcome in the evolution of
services" and the Rehabilitation Act Amendments (1992)
formalised natural supports in the
US as an "extended service option".
Developments in the area of natural supports have been
perceived as the beginning of a shift in control and in
encouraging the involvement of people with disabilities and
their families in the process of supported employment
(Wehman & Kregel, 1998).
2.52 Nevertheless, there can be great diversity in the
way natural supports are defined and implemented. From
their survey, Murphy et al (1996) concluded that the term
was "neither self-evident nor well understood". Some have
argued (
e.g. Test and Wood, 1996) that there is little
or no convincing empirical evidence about natural supports
or their effectiveness in the workplace for employees with
disabilities. Even so, the use of natural supports has
increased. Mank, (1996; 2003) suggested that natural
supports had become "axiomatic" with the implementation of
supported employment in that supported employment services
assert that they make use of natural supports even though
there are differences of opinion about definition,
measurement and assessment of the impact of natural
supports.
2.53 Recent research by Mank et al (2003) found better
outcomes when employers and co-workers were involved in the
support process from the start. In one study (Mank et al,
1999), where co-workers received training and information
on how to support individuals with disabilities, supported
employees earned 22% more and were significantly better
socially integrated in the workplace. Weston (2002)
established that the use of natural supports overcame
employers' fears around employing people with complex needs
over time. Also when job coaches trained co-workers to
provide ongoing support, supervisors were found to be more
satisfied with accuracy and levels of productivity.
'Typicalness'
2.54 The focus on natural supports and better
understanding workplace cultures has led to further
advances in thinking about best practices in supported
employment through natural or 'typical' processes. The
so-called 'typicalness' of the job acquisition process,
conditions of the job, similarity of work roles with
colleagues, and initial training and orientation has been
positively and strongly correlated with positive wage and
integration outcomes (Mank, 2001; 2003). In other words, if
employment is 'typical', outcomes such as wages, hours
worked, and the degree of integration and interaction are
better. However, in some cases, atypical features of
employment may be needed and should still be considered
valuable (Mank, 1997).
2.55 International research comparisons using data from
Germany, the
UK and Australia (Jenaro Rio et al,
2002) confirm a relationship between providing more typical
interventions during the job development process and the
social, economic and performance outcomes of supported
employment. Weston (2002) found that although experiences
of work were not 'typical' in every respect for people with
severe disabilities or complex needs, 'typical' practice in
terms of inclusion in the workforce was very important as
it ensured people felt part of the team, and this was one
of the most successful ways of retaining people in jobs.
Other
UK research (Beyer, 2001) similarly
finds higher wages for supported employees whose jobs were
similar to others in the same workplace, and where they had
similar terms and conditions.
Enhancing social integration outcomes
2.56 While social integration is recognised as the
"centrepiece" of supported employment (Mank, 1988), the
process of facilitating social integration has been an
ongoing critical development issue. There are mixed
findings and many different views about what constitutes
social integration (Chadsey-Rusch et al, 1997). Most
research commenting on social integration outcomes has
examined opportunities for vocational integration and it is
often assumed that levels and quality of social
interactions at work are synonymous with social integration
(Hughes et al, 1998). In this respect, the social
integration outcomes of supported employment have been
largely positive. Traustadottir (1999) found the social
relationships people developed at work could be the most
important factor in whether or not people kept or lost
their jobs.
2.57 Taking a broader quality of life perspective
suggests that for some, having a job does not automatically
result in broadening of social relationships and networks
beyond the workplace and that facilitating social
integration is a complex issue (Bass & Drewett, 1997).
Riddell et al (2001) found that supported employment did
not always provide sufficient opportunities for individuals
to enhance their social networks. Similarly, Wistow and
Schneider (2003) found variable social integration outcomes
among the 30 supported employees they interviewed.
2.58 Disappointing social integration outcomes have been
associated with jobs that are socially isolated and/or
untypical of other jobs in the same workplace, and with
unpaid or low paid positions (Ridley, 2001). Meeting people
at work was a positive benefit for some individuals in this
Scottish study and such relationships were highly valued.
Further, mixing with others at work had indirect benefits
such as increasing individuals' self confidence, which
encouraged at least one person to be "more sociable and
talkative" in other social situations.
2.59 Research findings therefore point to a need to
focus on the quality of jobs, the social atmosphere and
connections at work, and to use intentional strategies to
promote social integration. The importance of better
support for relationship development including "getting
better at spotting workplaces conducive to social
inclusion" was one of the conclusions reached by Beyer
(2001). Employment specialists could evaluate the strengths
and weaknesses of different workplaces using one of the
many measures designed for this purpose, such as those
devised by the Virginia Commonwealth University (Parent et
al, 1992).
Self directed employment/self
employment
2.60 The prospect of self-employment (sometimes referred
to as 'micro-enterprise') for people with disabilities is a
more recent phenomenon associated with the concept and
promotion of self-determination, person centred planning
approaches placing the individuals' dreams and aspirations
at the centre, and the development of personalised funding
systems such as Direct Payments. Self-directed employment
has been defined as an array of models where people taking
responsibility for the work also have a significant say in
how it is organised and managed (Rizzo and Van Houtte,
2000).
2.61 A nationwide demonstration project in the
USA in 1993 on ways to improve consumer
choice within vocational rehabilitation services,
unexpectedly found that 13% of participants who became
employed chose self-employment over regular employment
(Callahan et al, 2002). They concluded that self-employment
and participant choice/control were closely related
concepts. Since then, the 1998 United States Rehabilitation
Act Amendments officially recognised the importance of
self-employment as an employment option within the
US Vocational Rehabilitation system
(Hagner & Davies, 2002).
2.62 Proponents of this option argue that it presents a
"tremendous opportunity" especially for individuals who are
challenged by the competitive labour market and although
"not for everyone", self-employment is hailed as "the next
logical step in the evolution of supported employment"
(Griffin and Hammis, 2003). In summary, the advantages are
that it:
- Closely matches individual preferences, gifts, and
unique contributions and allows for the creation of
work opportunities when someone does not fit standard
job descriptions
- Encompasses some types of work not found in
existing job opportunities
- Offers another avenue for supported employment and
is a viable alternative to day programmes
- Offers control and self-reliance, which is
appealing to some
- Offers an opportunity to schedule the working day
and week to accommodate personal productivity levels,
personal goals, support needs, lifestyle choices
etc
(Newman, 2001; Hagner and Davis, 2002; Griffin and
Hammis, 2003).
2.63 Self-employed individuals with disabilities may
need access to business training, business plan
development, skills training and education, assistance with
obtaining financial resources and specialist benefits
advice, and mentoring. Griffin and Hammis (2003), alongside
other authors such as Rizzo (2002) emphasise the importance
of providing a wide range of supports, systems for
supported decision making, supportive business structures
and innovative business coaching.
2.64 The literature also identifies one of the biggest
barriers to developing self-employment options as the
attitudes and approach of services supporting individuals
with disabilities (Allen and Granger, 1997; Griffin and
Hammis, 2003). Although other outcomes were positive, the
businesses studied by Hagner and Davies (2002) were what
they called "shoestring operations" in that they were not
economically viable by traditional criteria. Shelley et al
(1999) also found the income from self-employment was
supplemented by other earned and unearned income.
Importance of post employment services
2.65 The Montana/Wyoming Careers through Partnerships
demonstration project illustrated the importance of post
employment services to job retention and career advancement
(Griffin & Hammis, 2003). Many participants in this
project used funds for post employment services such as job
coaching and financial support services (Newman, 2001).
Reid and Bray (1997) concluded that individuals who kept
their jobs for some time had at least one important source
of support, which could be their job coach or someone at
the workplace.
2.66 "Extended services" or ongoing support has rarely
been researched although it is claimed as one of the
"unique features" of supported employment, which has
contributed to its success with individuals with severe
disabilities (West et al, 2002). These researchers found
that most people required very little support once
stabilised in a job even when problems arose and that
strategies involving natural supports in the workplace and
other people such as family members, went some way to
resolve the shortfall in funding for extended services.
GAPS IN INFORMATION
2.67 Scant literature was found relating to adults with
ASD and employment and, what there was
predominantly focused on employment strategies with adults
with Aspergers Syndrome. Nevertheless, a recent report
published by the National Autistic Society (Barnard et al,
2001), suggested employment was the single biggest issue or
barrier facing more able adults with
ASD. Furthermore, Fast (2004) claimed
that 90% of those with Aspergers Syndrome who are in jobs
are what the author describes as "under-employed" in these
jobs, that is, not working to their full capacity.
2.68 The main barriers to employment recognised in the
literature were professionals' lack of understanding of
ASD in the employment context; confusing
recruitment processes; interviewing techniques which
disadvantaged people with
ASD; adjustments in the workplace that
tended to be physical rather than procedural; and the often
high technical and knowledge skills of people with
Aspergers Syndrome. Supported employment and person-centred
planning can be the key to facilitating employment for
people with
ASD (Leach, 2002).
2.69 In examining what makes a successful job for people
with
ASD, Grandin (1999), herself a person
with
ASD, argued that jobs need to be chosen
that make use of the strengths of people with
ASD and in summary, that successful
transitions into jobs or careers can be achieved
through:
- Gradual transitions - work started for short
periods while the person is still in school
- Jobs that have a well-defined goal or endpoint
- Capitalising on the person's work not personality,
and making a portfolio of work
- Supportive employers who recognise the person's
social limitations
- Having mentors - people who have common interests
with the person with
ASD
- Educating employers and employees about
ASD
- Undertaking freelance or self-employed work
(Grandin T, 1999)
BEST PRACTICE FEATURES
2.70 In summary, the literature review has identified
several best practice features, which can be summarised
as:
- A values based approach is taken to implementing
supported employment;
- A user-led approach is adopted promoting
self-determination, person centred services, choice and
a career-based approach;
- Employers' needs are taken into account when
marketing supported employment and job
development;
- Employment specialists adopt a business like
approach to marketing and job development, avoiding the
language and culture of human service systems
- There is awareness raising and training for
employers, co-workers and supervisors
- Employment specialists become consultants and
facilitators rather than experts
- There is training for, and proper support given to
employment specialists, including training in new
approaches
- Employment specialists use 'natural supports'
within the workplace and support jobs in ways that are
as 'typical' as possible for each setting;
- Intentional and systematic ways are found to
enhance social integration;
- Self employment opportunities are considered and
supported by supported employment agencies;
- There are post employment or follow up
services;
- Services use strategies to ensure people with
severe disabilities are included;
- Systemic barriers such as the lack of strategic
development and financial disincentives within the
benefits system are tackled.
CHAPTER TWO: SUMMARY OF KEY FINDINGS
- • There is a gap in the literature regarding
employment and people with ASD
- A value-based approach based on the support model
has been found to be the most effective at promoting
employment
- Given the variability in practice, revisiting the
values and definition of supported employment is called
for
- Implementation of supported employment across
Europe has been disappointing with many countries found
to invest more in segregated provision
- Although there is no consensus about the definition
of supported employment, 3 elements are common - 1)
paid jobs; 2) integrated settings; and 3) ongoing
support
- Individuals with more severe disabilities are
underrepresented in supported employment although
studies show high quality outcomes are possible
- Research supports tackling systemic barriers as
these define the extent to which supported employment
can deliver improvements over time
- While aspects of the social security system are
recognised as unhelpful, effective welfare rights
advice has guaranteed positive financial outcomes for
many people
- The changeover and conversion envisaged at the
start has not been achieved - instead supported
employment has become part of a continuum of
services
- Supported employment is often developed in
isolation, leading to fragmentation and fragility of
the sector. A need for strategic development is
emphasised
- Writers emphasise the importance of a user-led
perspective and of individuals controlling their
vocational destinies through self determination and
self advocacy
- Ensuring a more user-driven approach includes
promoting person centred planning methods, emphasising
individual choice, and adopting a career-based
approach
- Examples exist of local authorities promoting
employment through flexible recruitment policies and
procedures, promoting in-house opportunities, setting
targets, and working in close partnerships with other
agencies
- Finding the 'right job' relies on a proper
understanding of both the individual's needs and the
employer's needs
- Employment specialists could do more to market
supported employment to employers and should avoid the
language and culture of human services systems
- Employers with experience report more favourable
perceptions and willingness to hire other disabled
persons
- Awareness raising and training for employers,
co-workers and supervisors is associated with better
outcomes
- Training for employment specialists is critical for
quality supported employment and is associated with
better outcomes for individuals
- There is a gap between what is expected of
employment specialists and their current levels of pay
and training
- While 'natural supports' have been variously
interpreted, better outcomes are associated with
involving employers and co-workers in the support
process
- When employment is 'typical' outcomes such as
wages, hours worked and social interaction are
better
- To enhance social integration, research suggests
focusing on the quality of jobs, the social atmosphere
at work and adopting intentional strategies
- Self employment opportunities were perceived as
"the next logical step in the evolution of supported
employment", with potential to offer individualised
options
- Post employment or follow-up services to those
established in jobs are critical
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