WORK A Journal of Prevention,
Assessment & Rehabilitation
ELSEVIER
Work 9 (1997) 237-244
Supported employment: principles and practices for interdisciplinary collaboration Cheryl A. Reed a ,* , Philip D. Rumrill Jr. U
Department of Rehabilitation Education and Research, University of Arkansas, 346 N West Avenue, Fayetteville, AR, USA 72701 bDepartment of Education and Special Services, Kent State University, Kent, OH, USA
Received 29 January 1997; accepted 31 March 1997
Abstract This article provides an overview of the philosophical and practical aspects of supported employment. The authors describe: (1) the primary supported employment clientele; (2) the disciplines and professions involved in delivering community-based employment services for the population; and (3) selected intervention strategies that maximize supported employees' job tenure and satisfaction. Guidelines for interdisciplinary collaboration in identifying and implementing supported employment services are offered. © 1997 Elsevier Science Ireland Ltd. Keywords:
Rehabilitation; Community; Employment
1. Introduction
The ultimate purpose of vocational rehabilitation is to provide people with disabilities with the opportunity to participate in every aspect of
* Corresponding author. Tel.: + 1 501 5756421; e-mail: [email protected]
American society. For people with the most severe disabilities realizing this goal has been a long time coming. Over the past 2 decades, however, there has been a growing societal commitment to the ideals of inclusion. Thanks to the persistence of consumer-controlled advocacy groups, more people with severe disabilities are moving out of institutions and nursing homes and into community-based living, and as a result of the supported
1051-9815/97/$17.00 © 1997 Elsevier Science Ireland Ltd. All rights reserved. PH S1051-9815(97)00045-4
238
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employment paradigm - out of sheltered workshops and into integrated jobs. Supported employment services are delivered at communitybased worksites, which affords employees 'real world' opportunities for meaningful work. A'i these services are often accompanied by allied health interventions, it is important that all members of the interdisciplinary rehabilitation field be familiar with the supported employment model as an extension of the vocational rehabilitation philosophy. The purpose of this article is to provide readers with a comprehensive overview of the supported employment model. The historical, philosophical, and practical bases of supported employment are featured. Specifically, the authors: (1) define the model's key terms; (2) describe innovative, best practices in service delivery; and (3) stress the importance of interdisciplinary cooperation among allied health professionals in achieving successful supported employment outcomes. 2. Principles: what is supported employment?
Supported employment is a job placement and training model designed to prepare people with severe disabilities for competitive employment in regular community settings. The goal of supported employment is to provide an alternative to segregated job training such as sheltered workshops, day activity centers, and rehabilitation centers, to those individuals who have not been successful in integrated employment settings. Individuals in supported employment typically have developmental disabilities, mental illnesses, traumatic brain injuries, and/or multiple physical disabilities. The three main objectives of supported employment are: (1) to provide competitive, paid work opportunities; (2) to place individuals in integrated, community work settings; and (3) to ensure ongoing support services (Wehman, 1993). In a place-then-train approach, people in supported employment engage in real work activities at real job sites - for real pay.
the late 1970s (Rusch, 1990). Prior to that time, people with severe disabilities had to work their way into competitive employment settings through segregated day programs such as sheltered workshops and adult activity centers. The supported employment model evolved as an effort by advocates and parents to more fully include people with severe disabilities in normalized, community living. Legislative initiatives were subsequently introduced to promote supported employment as an alternative employment model. The Developmental Disabilities Assistance and Bill of Rights Act of 1984 and the Rehabilitation Act Amendments of 1986 were the first major laws designed to achieve this goal. The Rehabilitation Act Amendments, in particular, set service-delivery standards for supported employment programs offered by federal-state vocational rehabilitation agencies. The Rehabilitation Act Amendments of 1992 further defined the objectives of supported employment as providing paid, competitive employment opportunities in integrated work settings - with no minimum number of hours per week to be considered productive (Gardner and Chapman, 1993). Under the 1992 regulations, an individual in supported employment may work anywhere from 1 to 39 hours per week. 2.2. Zero exclusion
People who receive supported employment services are those who have historically been excluded from the traditional vocational rehabilitation systems. The supported employment model, however, employs a zero exclusion philosophy (Wehman, 1988). Zero exclusion simply means that any individual, regardless of the severity of the disability will be acCepted for vocational rehabilitation services. Supported employment is an alternative vocational service for those who have been rejected for placement in integrated work settings. 2.3. Alternatives to sheltered workshops
2.1. History
Supported employment was first introduced in
Sheltered workshops were developed for people with severe disabilities to work on a tem-
CA. Reed, P.D. Rumrill Jr.
porary or long-term basis (Rubin and Roessler, 1995). Sheltered workshop programs either contract with businesses or manufacture their own goods. Unlike supported employment, sheltered workshops use a train-then-place approach. Individuals are trained for employment in segregated work environments to develop sufficient job skills and behaviors. They are then evaluated for eventual placement in competitive employment. More typically, however, successful placements from sheltered workshops into integrated, communitybased work settings are the exception rather than the rule (Wehman, 1988; Hanley-Maxwell et aI., 1990; Rusch, 1990;). Promoters of sheltered workshops emphasize the importance of providing a separate environment for teaching and evaluating job skills and behaviors. This segregated model, however, often limits the successful employment of people with severe disabilities. When placed in a sub-culture environment such as sheltered workshops, clients may experience feelings of deviancy and dependency (Rubin and Roessler, 1995). Griffin et al. (1996) found that, among a sample of adults with mild mental retardation, those in supported employment reported significantly higher levels of job satisfaction than those in sheltered workshops. Some argue that sheltered workshops contradict what we know about learning (HanleyMaxwell et aI., 1990). Individuals trained in sheltered workshops frequently have difficulty generalizing what they learn to mainstream employment settings. For example, an individual with mental retardation may develop the social skills necessary to succeed among coworkers in a workshop environment, but when placed in regular employment, he or she may need different skills. As an alternative, supported employment allows individuals to learn necessary skills and behaviors in the actual work environment. 3. Practices: how does supported employment work?
Supported employment services are delivered through the collaborative efforts of several disciplines and personnel. The primary responsibilities of supported employment personnel are to: (1)
I
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assess the needs of the individual with a disability; (2) appropriately place the individual on a job; (3) train and support the individual to learn the job tasks; (4) help the individual develop long-term independence; and (5) monitor and follow along with the employee and the employer to ensure desired job tenure. These core services are delivered through four basic service-delivery options: (1) individual placement; (2) clustered placement (also called enclaves); (3) mobile crews; and (4) entrepreneurial approaches (Moon and Griffin, 1988; Rusch and Hughes, 1990, Wehman, 1993). 3.1. Personnel
Supported employment personnel typically comprise at least two main roles, the job developer and the job coach (Gardner and Chapman, 1993). Other personnel involved in the supported employment model generally include professionals from schools, human services agencies, and the medical field. Finally, natural supports serve as crucial, yet usually unofficial, supported employment personnel. Natural supports are those co-workers or employers who are endemic to the employment setting and who can provide the person with a disability with important long-term support at the job site after professionals have faded out. 3.1.1. Job developer
The role of the job developer is to lay the foundation for placing individuals with disabilities at job sites. Gardner and Chapman (1993) stated that the job developer's functions should include market analysis, worker placement, and follow-up assessments. The market analysis is a critical first step toward understanding the type of work available in any given location. Market analysis begins with a comprehensive survey of employment opportunities from sources such as newspapers, magazines, community centers, civic groups, local business leaders, and any key community organizations. Once the job developer knows the opportunities available and has developed relationships with employers, he or she can better match and place an individual at a job. The placement should be based on a clear understanding of the persons strengths and interests, so that the placement will
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successfully meet both the individual's and the employer's needs (Gardner and Chapman, 1993). Job developers must continually assess and monitor the satisfaction of the supported employee and the employer by conducting follow-up interviews with both parties and communicate regularly with the job coach.
3.1.2. Job coach The most fundamental role in supported employment is performed by the job coach. The job coach may also be known as job coordinator, job trainer, employment specialist, enclave specialist, or mobile crew leader (Kregel and Sale, 1988; Everson and Brooke, 1990; Gardner and Chapman, 1993). Everson and Brooke (1990, p. 288) defined a job coach as 'an individual who provides direct supportedemployment services in anyone or more of the commonly accepted individual placement or group supported employment approaches'. Job coaches are typically hired based on their experiences with providing direct services to people with severe disabilities. Responsibilities of the job coach include: (1) giving specific instructions of job tasks and behaviors at the job site; (2) evaluating work performance; (3) maintaining communication with the employer; (4) developing independence and natural supports; (5) advocating for the employee; and (6) providing follow-along support (Kregel and Sale, 1988; Everson and Brooke, 1990; Hughes et aI., 1990; Gardner and Chapman, 1993). Gardner and Chapman (1993) emphasized that the job coach must clearly understand the tasks required to complete a particular job. The job coach, therefore, can then teach these tasks to the supported employee. Once the employee gains sufficient skills and independence, it is the responsibility of the job coach to employ appropriate fading strategies. Fading refers to the gradual elimination of the job coach from the worksite. The speed and methods for fading vary according to the needs of each employee. 3.1.3. Interdisciplinary personnel Several professionals are typically involved with individuals who receive supported employment services. These include rehabilitation counselors,
special educators, vocational educators, school counselors, psychologists, medical professionals, occupational therapists, speech pathologists, physical therapists, rehabilitation engineers, and other key persons (Szymanski et aI., 1990; Gardner and Chapman, 1993). Rehabilitation counselors and special educators, for example, are particularly important in facilitating supported employment services. Special educators provide transition services linking school services with adult services and employment programs such as the federalstate vocational rehabilitation (VR) system. If an individual is accepted for services from a VR agency and is appropriate for supported employment, the VR counselor will coordinate the supported employment service plan. Typically, direct services are provided by local vendors. A successful supported employment model, therefore, may best be realized through the collaborative efforts of personnel from several disciplines. Gardner and Chapman (1993, p. 112) defined the interdisciplinary team process for people with developmental disabilities as a time for members to 'meet and share information in a gathering that is usually referred to as an interdisciplinary team meeting'. Most importantly, teams must include the individual receiving services and, if appropriate, his or her parents or guardians.
3.1.4. Natural supports Natural supports are typically people that will help an individual maintain long-term independence (Hughes et aI., 1990). Natural supports are co-workers who informally become involved in the job training and maintenance of the supported employee to help the employee better perform the tasks of the job. For example, a natural support could be one or several co-workers who interact with and support the individual on the job. Co-workers may need training to serve as natural supports (Hughes et aI., 1990). 3.2. Follow-along services VR services for people with disabilities are traditionally time-limited (Rubin and Roessler, 1995). Once an individual is placed on a job, post-employment, or long-term follow-along ser-
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tance for several supported employees at one time. Although placed as a group, individuals in clustered placement may work at different tasks and/or work stations at the same job site. The goal, however, is to help people move into individual placements.
vices, are seldom provided (Roessler and Rumrill, 1995). Supported employment, however, is founded on a model of ongoing support. Hughes et al. (1990) suggested that post-employment services consist of three congruent goals: (1) to extend competence; (2) to develop natural supports; and (3) to promote social acceptance. Hughes et al. (1990) proposed several strategies to achieve the goals of post-employment services. The first strategy is to extend individual competence by helping individuals identify their independence objectives using situational assessments. Situational assessments typically consist of interviews with supervisors and direct observations of work performance. If problems are identified, the employee can be taught the task or behavior that needs improvement. The second goal of follow-along services is to create long-term independence. This is best achieved by developing natural supports in the workplace.
Although similar to clustered placement, the mobile work crew contracts for short-term jobs around the community rather than working for one employer. The work that they do is mobile typically based out of trucks, vans, or cars (Gardner and Chapman, 1993). Examples of the types of work that mobile crews may do include landscaping, cleaning, and delivery services. Again, the job coach provides supervision for the entire crew. Mobile crews are most often used in rural areas where transportation and large businesses are limited (Wehman, 1993)
3.3. Service-delivery options
3.3.4. Entrepreneurial
Although the service-delivery options of supported employment are not mutually exclusive, most fall into one of four basic approaches individual placement, clustered placement, mobile work crew, or entrepreneurial. Each approach is described briefly below. 3.3.1. Individual placement
3.3.3. Mobile work crew
Entrepreneurial approaches include any type of small business, generally employing eight or fewer employees, that hires people with and without disabilities. These businesses provide specific services, such as catering, groundskeeping, or manufacturing of goods. Although the business is created to employ supported employees, it is accomplished in integrated work settings by hiring people without disabilities.
The individual placement approach is considered to be the most inclusive form of supported employment. Individuals are placed on jobs in integrated work settings that are consistent with their strengths and interests. Job coaches work with the supported employee to provide direct training and support. The length of time support is provided depends on the individuals' assessed needs.
Regardless of the service delivery approach, several innovative practices are currently being used in supported employment programs. Careful planning and a clear understanding of such practices contribute to the maintenance of a quality supported employment program.
3.3.2. Clustered placement
4.1. Cultivating employer relationships
The clustered placement approach, also called an enclave, consists of a small group of supported employees, around three to eight at a time, who are trained in integrated work settings (Gardner and Chapman, 1993). In this approach, the job coach serves as the supervisor and provides assis-
4. Innovative practices in supported employment
Successful employer relationships begin with the job development phase. According to Parent et al. (1993, p. 20) 'Job development is the process of identifying and assessing community employment opportunities for individuals with severe
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disabilities'. Parent, et al. (1993) outlined the following job development tasks necessary for cultivating successful employer relationships: 1. 2. 3. 4. 5. 6.
conduct a community analysis; develop a marketing strategy; make employer contacts; address employer concerns; complete a job analysis; and negotiate creative job options.
In marketing supported employment, personnel must be prepared to address an employer's fears and concerns. A proactive approach is often the most effective (Parent et al., 1993). Using a proactive approach, for example, a job developer will suggest answers to address potential problems before the problem occurs thus alleviating the employer's unspoken fears. Tilson (1996, p. 71) emphasized the application of 'solid customer service principles' with employers. These principles are driven by viewing employers as customers and serving them accordingly. 4.2. Assessment and evaluation
Because consumer choice is a key component of the supported employment model, use of traditional vocational evaluation measures with individuals in supported employment is often inappropriate. Such measures are normed with samples not representative of those in supported employment, and they are based on prediction studies that do not account for an absence of training and support services for individuals with severe disabilities (Menchetti and Flynn, 1990; Menchetti and Udvari-Solner, 1990). Due to these limitations in vocational assessment, .alternative methods employing on-site evaluations are considered to be more functional in supported employment. 4.3. Ecological evaluation
Menchetti and Udvari-Solner (1990) argued for an ecological model of vocational evaluation which emphasizes a fit between the employee and the work setting. They noted that an ecological model differs from traditional systems in three
areas - measurement, analysis, and decision making. In supported employment, ecological evaluation includes measurement of the social environment and its compatibility with the worker. The analysis of the evaluation takes into account the environmental needs of the individual, such as the level and type of support necessary for the worker's success. According to Menchetti and Udvari-Solner (1990) 'In ecological vocational evaluation, the evaluator must qualify both the worker and the workplace for a supported employment placement'. Rather than screening out those not expected to succeed, decisions from ecological evaluations are made based on the congruence between the person and the environment, with appropriate supports provided. 4.4. Consumer choice
Consumer choice is an integral aspect of the supported employment model. Martin and Mithaug (1990) argued that consumers need to be given more choice in the decision making phase of supported employment than is typically allowed. Strategies for achieving consumer-directed placement include: (1) self-planning sessions; (2) visits to work sites; (3) job tryouts; and (4) staffing teams with parents or guardians. A crucial part of consumer-directed placement involves teaching the individual how to express his or her work preferences. For those people with severe cognitive or perceptual limitations, preferences and self-evaluations may be assessed using picturebased forms of likes, dislikes, strengths, and weaknesses. Martin and Mithaug (1990) suggested that consumer-directed employment plans include such preference assessments and selfevaluations. For people who have been placed, Parent (1996) presented the Consumer Satisfaction Survey as a tool for assessing consumer satisfaction with a supported employment placement. This instrument is administered in a 30-min interview. 4.5. Social acceptance and validation
Social acceptance in the workplace is often the most important goal of follow-along services. So-
CA. Reed, P.D. Rumrill Jr. / Work 9 (1997) 237-244
cial acceptance helps all employees, with and without disabilities, to achieve long-term work adjustment. Hughes et a!. (1990) proposed that a social validation methodology be utilized to assess social acceptance in supported employment. Social validation is simply a method used to identify the employees acceptability to others on the job through discussions and interviews with coworkers and supervisors. Once social acceptance is achieved, the job coach helps the individual maintain acceptance over time through routine evaluations and feedback from supervisors. 5. Interdisciplinary collaboration Almost without exception, people with the most severe disabilities face significant needs in education, daily living, healthcare, and, as discussed herein, employment. Because of these needs, people with disabilities utilize the services of many professionals. A lack of communication and teamwork among professionals may result in fragmented services and unclear goals for the individual. With a common understanding of the principles and practices of supported employment, however, team members can work together to provide more cohesive, unified services. Gardner and Chapman (1993) stated that the team process must include three main components: group leadership, participation by all members, and regular summarization of relevant information. Professionals serving people in supported employment programs, must become involved in collaborative efforts designed to help them succeed. Following are some suggestions for facilitating this process: • • • •
identify the supported employment providers in your region; identify clients who are involved in supported employment; if a client is currently placed in a sheltered workshop, inquire about opportunities for that person in supported employment; when appropriate, contact the supported employment provider to find out how you can become involved in the team process;
• • •
•
243
when an interdisciplinary team does not exist, contact key players to develop a more collaborative effort; talk with individuals in supported employment to find out about their job satisfaction and how you might help them in their program; introduce and discuss the benefits of supported employment programs to potential employers you know through civic or professional affiliations; and continue to learn about innovative practices in supported employment and follow relevant legislation.
6. Conclusion Supported employment represents the single most inclusive VR intervention for people with severe disabilities. In addition, this model benefits employers, other employees, and society at large. Recent Federal initiatives suggest a prominent role for supported employment in the 21st Century. The 1992 Amendments and Reauthorization of the Rehabilitation Act reinforced the commitment of the VR program to prioritize services for people with the most severe disabilities (Rubin and Roessler, 1995). Since that mandate was delivered, the number of people receiving supported employment services in community-based settings has increased dramatically. Supported employment is a proven means of helping people succeed in the workplace and must be viewed as an important component of any holistic rehabilitation program that affords an historically disenfranchised group the opportunity to join the 'mainstream' workforce. References Everson 1M, Brooke V. Training job coaches to serve employees with multiple and low-incidence disabilities: implications for the 1990s. Rehabil Educ 1990;4(4):287-300. Gardner JF, Chapman MS. Developing staff competencies for supporting people with developmental disabilities. 2nd ed. Baltimore: Paul H Brookes Publishing Company, 1993. Griffin DK, Rosenberg H, Cheyney W, Greenberg B. A comparison of self-esteem and job satisfaction of adults with mild mental retardation in sheltered workshops and supported employment. Educ Train Ment Retard Develop DisabiI1996;31(2):142-150.
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Hanley-Maxwell C, Szymanski EM, Parent W, Schriner KF. Supported employment: revolution, passing fad, or a remake of an old song. Rehabil Educ 1990;4(4):233-246. Hughes C, Rusch FR, Curl R. Extending individual competence, developing natural support, and promoting social acceptance. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:181-198. Kregel 1, Sale P. Preservice preparation of supported employment professionals. In: Wehman P, Moon MS, editors. Vocational rehabilitation and supported employment. Baltimore: Paul H Brookes Publishing Company, 1988:129-144. Menchetti BM, Flynn Cc. Vocational evaluation. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:111-130. Menchetti, BM, Udvari-Solner, A. Supported employment: new challenges for vocational evaluation. Rehabil Educ, 1990;4(4):301·.. 318. Martin lE, Mithaug DE. Consumer-directed placement. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:87-110. Moon MS, Griftin SL. Supported employment service delivery models. In: Wehman P, Moon MS, editors. Vocational rehabilitation and supported employment. Baltimore: Paul H. Brookes Publishing Company, 1988:17-30. Parent WS, Hill ML. Converting from segregated sheltered employment to supported employment. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:317-336.
Parent WS, Sherron P, Stallard 0, Booth M. lob development and placement: strategies for success. Vocat Rehabil 1993;3(3):17-26. Parent W. Consumer choice and satisfaction in supported employment. 1 Vocat Rehabil 1996;6(J):23-30. Roessler RT, Rumrill PD. Promoting reasonable accommodations: an essential postemployment service. 1 Appl Rehabil Couns 1995;26(4):3-7. Rubin SE, Roessler RT. Foundations of the vocational rehabilitation process. Austin, TX: Pro-Ed, 1995. Rusch FR, Hughes C. Historical overview of supported employment. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:5-14. Szymanski E, Hanley-Maxwell C, Parker RM. Transdisciplinary service delivery. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:199-214. Tilson G lr. Building relationships with employers by applying solid customer service principles. 1 Vocat Rehabil 1996;6(1):77--82. Wehman P. Supported employment: toward zero exclusion of persons with severe disabilities. In: Wehman P, Moon MS, editors. Vocational rehabilitation and supported employment. Baltimore: Paul H. Brookes Publishing Company, 1988:3-16. Wehman P. Supported employment and opportunities for integration. In: Wehman P, editor. The ADA mandate for social change. Baltimore: Paul H. Brookes Publishing Company, 1993.
Assessment & Rehabilitation
ELSEVIER
Work 9 (1997) 237-244
Supported employment: principles and practices for interdisciplinary collaboration Cheryl A. Reed a ,* , Philip D. Rumrill Jr. U
Department of Rehabilitation Education and Research, University of Arkansas, 346 N West Avenue, Fayetteville, AR, USA 72701 bDepartment of Education and Special Services, Kent State University, Kent, OH, USA
Received 29 January 1997; accepted 31 March 1997
Abstract This article provides an overview of the philosophical and practical aspects of supported employment. The authors describe: (1) the primary supported employment clientele; (2) the disciplines and professions involved in delivering community-based employment services for the population; and (3) selected intervention strategies that maximize supported employees' job tenure and satisfaction. Guidelines for interdisciplinary collaboration in identifying and implementing supported employment services are offered. © 1997 Elsevier Science Ireland Ltd. Keywords:
Rehabilitation; Community; Employment
1. Introduction
The ultimate purpose of vocational rehabilitation is to provide people with disabilities with the opportunity to participate in every aspect of
* Corresponding author. Tel.: + 1 501 5756421; e-mail: [email protected]
American society. For people with the most severe disabilities realizing this goal has been a long time coming. Over the past 2 decades, however, there has been a growing societal commitment to the ideals of inclusion. Thanks to the persistence of consumer-controlled advocacy groups, more people with severe disabilities are moving out of institutions and nursing homes and into community-based living, and as a result of the supported
1051-9815/97/$17.00 © 1997 Elsevier Science Ireland Ltd. All rights reserved. PH S1051-9815(97)00045-4
238
CA. Reed, P.D. Rumrill Jr. / Work 9 (1997) 237-244
employment paradigm - out of sheltered workshops and into integrated jobs. Supported employment services are delivered at communitybased worksites, which affords employees 'real world' opportunities for meaningful work. A'i these services are often accompanied by allied health interventions, it is important that all members of the interdisciplinary rehabilitation field be familiar with the supported employment model as an extension of the vocational rehabilitation philosophy. The purpose of this article is to provide readers with a comprehensive overview of the supported employment model. The historical, philosophical, and practical bases of supported employment are featured. Specifically, the authors: (1) define the model's key terms; (2) describe innovative, best practices in service delivery; and (3) stress the importance of interdisciplinary cooperation among allied health professionals in achieving successful supported employment outcomes. 2. Principles: what is supported employment?
Supported employment is a job placement and training model designed to prepare people with severe disabilities for competitive employment in regular community settings. The goal of supported employment is to provide an alternative to segregated job training such as sheltered workshops, day activity centers, and rehabilitation centers, to those individuals who have not been successful in integrated employment settings. Individuals in supported employment typically have developmental disabilities, mental illnesses, traumatic brain injuries, and/or multiple physical disabilities. The three main objectives of supported employment are: (1) to provide competitive, paid work opportunities; (2) to place individuals in integrated, community work settings; and (3) to ensure ongoing support services (Wehman, 1993). In a place-then-train approach, people in supported employment engage in real work activities at real job sites - for real pay.
the late 1970s (Rusch, 1990). Prior to that time, people with severe disabilities had to work their way into competitive employment settings through segregated day programs such as sheltered workshops and adult activity centers. The supported employment model evolved as an effort by advocates and parents to more fully include people with severe disabilities in normalized, community living. Legislative initiatives were subsequently introduced to promote supported employment as an alternative employment model. The Developmental Disabilities Assistance and Bill of Rights Act of 1984 and the Rehabilitation Act Amendments of 1986 were the first major laws designed to achieve this goal. The Rehabilitation Act Amendments, in particular, set service-delivery standards for supported employment programs offered by federal-state vocational rehabilitation agencies. The Rehabilitation Act Amendments of 1992 further defined the objectives of supported employment as providing paid, competitive employment opportunities in integrated work settings - with no minimum number of hours per week to be considered productive (Gardner and Chapman, 1993). Under the 1992 regulations, an individual in supported employment may work anywhere from 1 to 39 hours per week. 2.2. Zero exclusion
People who receive supported employment services are those who have historically been excluded from the traditional vocational rehabilitation systems. The supported employment model, however, employs a zero exclusion philosophy (Wehman, 1988). Zero exclusion simply means that any individual, regardless of the severity of the disability will be acCepted for vocational rehabilitation services. Supported employment is an alternative vocational service for those who have been rejected for placement in integrated work settings. 2.3. Alternatives to sheltered workshops
2.1. History
Supported employment was first introduced in
Sheltered workshops were developed for people with severe disabilities to work on a tem-
CA. Reed, P.D. Rumrill Jr.
porary or long-term basis (Rubin and Roessler, 1995). Sheltered workshop programs either contract with businesses or manufacture their own goods. Unlike supported employment, sheltered workshops use a train-then-place approach. Individuals are trained for employment in segregated work environments to develop sufficient job skills and behaviors. They are then evaluated for eventual placement in competitive employment. More typically, however, successful placements from sheltered workshops into integrated, communitybased work settings are the exception rather than the rule (Wehman, 1988; Hanley-Maxwell et aI., 1990; Rusch, 1990;). Promoters of sheltered workshops emphasize the importance of providing a separate environment for teaching and evaluating job skills and behaviors. This segregated model, however, often limits the successful employment of people with severe disabilities. When placed in a sub-culture environment such as sheltered workshops, clients may experience feelings of deviancy and dependency (Rubin and Roessler, 1995). Griffin et al. (1996) found that, among a sample of adults with mild mental retardation, those in supported employment reported significantly higher levels of job satisfaction than those in sheltered workshops. Some argue that sheltered workshops contradict what we know about learning (HanleyMaxwell et aI., 1990). Individuals trained in sheltered workshops frequently have difficulty generalizing what they learn to mainstream employment settings. For example, an individual with mental retardation may develop the social skills necessary to succeed among coworkers in a workshop environment, but when placed in regular employment, he or she may need different skills. As an alternative, supported employment allows individuals to learn necessary skills and behaviors in the actual work environment. 3. Practices: how does supported employment work?
Supported employment services are delivered through the collaborative efforts of several disciplines and personnel. The primary responsibilities of supported employment personnel are to: (1)
I
Work 9 (1997) 237-244
239
assess the needs of the individual with a disability; (2) appropriately place the individual on a job; (3) train and support the individual to learn the job tasks; (4) help the individual develop long-term independence; and (5) monitor and follow along with the employee and the employer to ensure desired job tenure. These core services are delivered through four basic service-delivery options: (1) individual placement; (2) clustered placement (also called enclaves); (3) mobile crews; and (4) entrepreneurial approaches (Moon and Griffin, 1988; Rusch and Hughes, 1990, Wehman, 1993). 3.1. Personnel
Supported employment personnel typically comprise at least two main roles, the job developer and the job coach (Gardner and Chapman, 1993). Other personnel involved in the supported employment model generally include professionals from schools, human services agencies, and the medical field. Finally, natural supports serve as crucial, yet usually unofficial, supported employment personnel. Natural supports are those co-workers or employers who are endemic to the employment setting and who can provide the person with a disability with important long-term support at the job site after professionals have faded out. 3.1.1. Job developer
The role of the job developer is to lay the foundation for placing individuals with disabilities at job sites. Gardner and Chapman (1993) stated that the job developer's functions should include market analysis, worker placement, and follow-up assessments. The market analysis is a critical first step toward understanding the type of work available in any given location. Market analysis begins with a comprehensive survey of employment opportunities from sources such as newspapers, magazines, community centers, civic groups, local business leaders, and any key community organizations. Once the job developer knows the opportunities available and has developed relationships with employers, he or she can better match and place an individual at a job. The placement should be based on a clear understanding of the persons strengths and interests, so that the placement will
240
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successfully meet both the individual's and the employer's needs (Gardner and Chapman, 1993). Job developers must continually assess and monitor the satisfaction of the supported employee and the employer by conducting follow-up interviews with both parties and communicate regularly with the job coach.
3.1.2. Job coach The most fundamental role in supported employment is performed by the job coach. The job coach may also be known as job coordinator, job trainer, employment specialist, enclave specialist, or mobile crew leader (Kregel and Sale, 1988; Everson and Brooke, 1990; Gardner and Chapman, 1993). Everson and Brooke (1990, p. 288) defined a job coach as 'an individual who provides direct supportedemployment services in anyone or more of the commonly accepted individual placement or group supported employment approaches'. Job coaches are typically hired based on their experiences with providing direct services to people with severe disabilities. Responsibilities of the job coach include: (1) giving specific instructions of job tasks and behaviors at the job site; (2) evaluating work performance; (3) maintaining communication with the employer; (4) developing independence and natural supports; (5) advocating for the employee; and (6) providing follow-along support (Kregel and Sale, 1988; Everson and Brooke, 1990; Hughes et aI., 1990; Gardner and Chapman, 1993). Gardner and Chapman (1993) emphasized that the job coach must clearly understand the tasks required to complete a particular job. The job coach, therefore, can then teach these tasks to the supported employee. Once the employee gains sufficient skills and independence, it is the responsibility of the job coach to employ appropriate fading strategies. Fading refers to the gradual elimination of the job coach from the worksite. The speed and methods for fading vary according to the needs of each employee. 3.1.3. Interdisciplinary personnel Several professionals are typically involved with individuals who receive supported employment services. These include rehabilitation counselors,
special educators, vocational educators, school counselors, psychologists, medical professionals, occupational therapists, speech pathologists, physical therapists, rehabilitation engineers, and other key persons (Szymanski et aI., 1990; Gardner and Chapman, 1993). Rehabilitation counselors and special educators, for example, are particularly important in facilitating supported employment services. Special educators provide transition services linking school services with adult services and employment programs such as the federalstate vocational rehabilitation (VR) system. If an individual is accepted for services from a VR agency and is appropriate for supported employment, the VR counselor will coordinate the supported employment service plan. Typically, direct services are provided by local vendors. A successful supported employment model, therefore, may best be realized through the collaborative efforts of personnel from several disciplines. Gardner and Chapman (1993, p. 112) defined the interdisciplinary team process for people with developmental disabilities as a time for members to 'meet and share information in a gathering that is usually referred to as an interdisciplinary team meeting'. Most importantly, teams must include the individual receiving services and, if appropriate, his or her parents or guardians.
3.1.4. Natural supports Natural supports are typically people that will help an individual maintain long-term independence (Hughes et aI., 1990). Natural supports are co-workers who informally become involved in the job training and maintenance of the supported employee to help the employee better perform the tasks of the job. For example, a natural support could be one or several co-workers who interact with and support the individual on the job. Co-workers may need training to serve as natural supports (Hughes et aI., 1990). 3.2. Follow-along services VR services for people with disabilities are traditionally time-limited (Rubin and Roessler, 1995). Once an individual is placed on a job, post-employment, or long-term follow-along ser-
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tance for several supported employees at one time. Although placed as a group, individuals in clustered placement may work at different tasks and/or work stations at the same job site. The goal, however, is to help people move into individual placements.
vices, are seldom provided (Roessler and Rumrill, 1995). Supported employment, however, is founded on a model of ongoing support. Hughes et al. (1990) suggested that post-employment services consist of three congruent goals: (1) to extend competence; (2) to develop natural supports; and (3) to promote social acceptance. Hughes et al. (1990) proposed several strategies to achieve the goals of post-employment services. The first strategy is to extend individual competence by helping individuals identify their independence objectives using situational assessments. Situational assessments typically consist of interviews with supervisors and direct observations of work performance. If problems are identified, the employee can be taught the task or behavior that needs improvement. The second goal of follow-along services is to create long-term independence. This is best achieved by developing natural supports in the workplace.
Although similar to clustered placement, the mobile work crew contracts for short-term jobs around the community rather than working for one employer. The work that they do is mobile typically based out of trucks, vans, or cars (Gardner and Chapman, 1993). Examples of the types of work that mobile crews may do include landscaping, cleaning, and delivery services. Again, the job coach provides supervision for the entire crew. Mobile crews are most often used in rural areas where transportation and large businesses are limited (Wehman, 1993)
3.3. Service-delivery options
3.3.4. Entrepreneurial
Although the service-delivery options of supported employment are not mutually exclusive, most fall into one of four basic approaches individual placement, clustered placement, mobile work crew, or entrepreneurial. Each approach is described briefly below. 3.3.1. Individual placement
3.3.3. Mobile work crew
Entrepreneurial approaches include any type of small business, generally employing eight or fewer employees, that hires people with and without disabilities. These businesses provide specific services, such as catering, groundskeeping, or manufacturing of goods. Although the business is created to employ supported employees, it is accomplished in integrated work settings by hiring people without disabilities.
The individual placement approach is considered to be the most inclusive form of supported employment. Individuals are placed on jobs in integrated work settings that are consistent with their strengths and interests. Job coaches work with the supported employee to provide direct training and support. The length of time support is provided depends on the individuals' assessed needs.
Regardless of the service delivery approach, several innovative practices are currently being used in supported employment programs. Careful planning and a clear understanding of such practices contribute to the maintenance of a quality supported employment program.
3.3.2. Clustered placement
4.1. Cultivating employer relationships
The clustered placement approach, also called an enclave, consists of a small group of supported employees, around three to eight at a time, who are trained in integrated work settings (Gardner and Chapman, 1993). In this approach, the job coach serves as the supervisor and provides assis-
4. Innovative practices in supported employment
Successful employer relationships begin with the job development phase. According to Parent et al. (1993, p. 20) 'Job development is the process of identifying and assessing community employment opportunities for individuals with severe
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disabilities'. Parent, et al. (1993) outlined the following job development tasks necessary for cultivating successful employer relationships: 1. 2. 3. 4. 5. 6.
conduct a community analysis; develop a marketing strategy; make employer contacts; address employer concerns; complete a job analysis; and negotiate creative job options.
In marketing supported employment, personnel must be prepared to address an employer's fears and concerns. A proactive approach is often the most effective (Parent et al., 1993). Using a proactive approach, for example, a job developer will suggest answers to address potential problems before the problem occurs thus alleviating the employer's unspoken fears. Tilson (1996, p. 71) emphasized the application of 'solid customer service principles' with employers. These principles are driven by viewing employers as customers and serving them accordingly. 4.2. Assessment and evaluation
Because consumer choice is a key component of the supported employment model, use of traditional vocational evaluation measures with individuals in supported employment is often inappropriate. Such measures are normed with samples not representative of those in supported employment, and they are based on prediction studies that do not account for an absence of training and support services for individuals with severe disabilities (Menchetti and Flynn, 1990; Menchetti and Udvari-Solner, 1990). Due to these limitations in vocational assessment, .alternative methods employing on-site evaluations are considered to be more functional in supported employment. 4.3. Ecological evaluation
Menchetti and Udvari-Solner (1990) argued for an ecological model of vocational evaluation which emphasizes a fit between the employee and the work setting. They noted that an ecological model differs from traditional systems in three
areas - measurement, analysis, and decision making. In supported employment, ecological evaluation includes measurement of the social environment and its compatibility with the worker. The analysis of the evaluation takes into account the environmental needs of the individual, such as the level and type of support necessary for the worker's success. According to Menchetti and Udvari-Solner (1990) 'In ecological vocational evaluation, the evaluator must qualify both the worker and the workplace for a supported employment placement'. Rather than screening out those not expected to succeed, decisions from ecological evaluations are made based on the congruence between the person and the environment, with appropriate supports provided. 4.4. Consumer choice
Consumer choice is an integral aspect of the supported employment model. Martin and Mithaug (1990) argued that consumers need to be given more choice in the decision making phase of supported employment than is typically allowed. Strategies for achieving consumer-directed placement include: (1) self-planning sessions; (2) visits to work sites; (3) job tryouts; and (4) staffing teams with parents or guardians. A crucial part of consumer-directed placement involves teaching the individual how to express his or her work preferences. For those people with severe cognitive or perceptual limitations, preferences and self-evaluations may be assessed using picturebased forms of likes, dislikes, strengths, and weaknesses. Martin and Mithaug (1990) suggested that consumer-directed employment plans include such preference assessments and selfevaluations. For people who have been placed, Parent (1996) presented the Consumer Satisfaction Survey as a tool for assessing consumer satisfaction with a supported employment placement. This instrument is administered in a 30-min interview. 4.5. Social acceptance and validation
Social acceptance in the workplace is often the most important goal of follow-along services. So-
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cial acceptance helps all employees, with and without disabilities, to achieve long-term work adjustment. Hughes et a!. (1990) proposed that a social validation methodology be utilized to assess social acceptance in supported employment. Social validation is simply a method used to identify the employees acceptability to others on the job through discussions and interviews with coworkers and supervisors. Once social acceptance is achieved, the job coach helps the individual maintain acceptance over time through routine evaluations and feedback from supervisors. 5. Interdisciplinary collaboration Almost without exception, people with the most severe disabilities face significant needs in education, daily living, healthcare, and, as discussed herein, employment. Because of these needs, people with disabilities utilize the services of many professionals. A lack of communication and teamwork among professionals may result in fragmented services and unclear goals for the individual. With a common understanding of the principles and practices of supported employment, however, team members can work together to provide more cohesive, unified services. Gardner and Chapman (1993) stated that the team process must include three main components: group leadership, participation by all members, and regular summarization of relevant information. Professionals serving people in supported employment programs, must become involved in collaborative efforts designed to help them succeed. Following are some suggestions for facilitating this process: • • • •
identify the supported employment providers in your region; identify clients who are involved in supported employment; if a client is currently placed in a sheltered workshop, inquire about opportunities for that person in supported employment; when appropriate, contact the supported employment provider to find out how you can become involved in the team process;
• • •
•
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when an interdisciplinary team does not exist, contact key players to develop a more collaborative effort; talk with individuals in supported employment to find out about their job satisfaction and how you might help them in their program; introduce and discuss the benefits of supported employment programs to potential employers you know through civic or professional affiliations; and continue to learn about innovative practices in supported employment and follow relevant legislation.
6. Conclusion Supported employment represents the single most inclusive VR intervention for people with severe disabilities. In addition, this model benefits employers, other employees, and society at large. Recent Federal initiatives suggest a prominent role for supported employment in the 21st Century. The 1992 Amendments and Reauthorization of the Rehabilitation Act reinforced the commitment of the VR program to prioritize services for people with the most severe disabilities (Rubin and Roessler, 1995). Since that mandate was delivered, the number of people receiving supported employment services in community-based settings has increased dramatically. Supported employment is a proven means of helping people succeed in the workplace and must be viewed as an important component of any holistic rehabilitation program that affords an historically disenfranchised group the opportunity to join the 'mainstream' workforce. References Everson 1M, Brooke V. Training job coaches to serve employees with multiple and low-incidence disabilities: implications for the 1990s. Rehabil Educ 1990;4(4):287-300. Gardner JF, Chapman MS. Developing staff competencies for supporting people with developmental disabilities. 2nd ed. Baltimore: Paul H Brookes Publishing Company, 1993. Griffin DK, Rosenberg H, Cheyney W, Greenberg B. A comparison of self-esteem and job satisfaction of adults with mild mental retardation in sheltered workshops and supported employment. Educ Train Ment Retard Develop DisabiI1996;31(2):142-150.
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Hanley-Maxwell C, Szymanski EM, Parent W, Schriner KF. Supported employment: revolution, passing fad, or a remake of an old song. Rehabil Educ 1990;4(4):233-246. Hughes C, Rusch FR, Curl R. Extending individual competence, developing natural support, and promoting social acceptance. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:181-198. Kregel 1, Sale P. Preservice preparation of supported employment professionals. In: Wehman P, Moon MS, editors. Vocational rehabilitation and supported employment. Baltimore: Paul H Brookes Publishing Company, 1988:129-144. Menchetti BM, Flynn Cc. Vocational evaluation. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:111-130. Menchetti, BM, Udvari-Solner, A. Supported employment: new challenges for vocational evaluation. Rehabil Educ, 1990;4(4):301·.. 318. Martin lE, Mithaug DE. Consumer-directed placement. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:87-110. Moon MS, Griftin SL. Supported employment service delivery models. In: Wehman P, Moon MS, editors. Vocational rehabilitation and supported employment. Baltimore: Paul H. Brookes Publishing Company, 1988:17-30. Parent WS, Hill ML. Converting from segregated sheltered employment to supported employment. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:317-336.
Parent WS, Sherron P, Stallard 0, Booth M. lob development and placement: strategies for success. Vocat Rehabil 1993;3(3):17-26. Parent W. Consumer choice and satisfaction in supported employment. 1 Vocat Rehabil 1996;6(J):23-30. Roessler RT, Rumrill PD. Promoting reasonable accommodations: an essential postemployment service. 1 Appl Rehabil Couns 1995;26(4):3-7. Rubin SE, Roessler RT. Foundations of the vocational rehabilitation process. Austin, TX: Pro-Ed, 1995. Rusch FR, Hughes C. Historical overview of supported employment. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:5-14. Szymanski E, Hanley-Maxwell C, Parker RM. Transdisciplinary service delivery. In: Rusch FR, editor. Supported employment: models, methods, and issues. Sycamore, IL: Sycamore Publishing Company, 1990:199-214. Tilson G lr. Building relationships with employers by applying solid customer service principles. 1 Vocat Rehabil 1996;6(1):77--82. Wehman P. Supported employment: toward zero exclusion of persons with severe disabilities. In: Wehman P, Moon MS, editors. Vocational rehabilitation and supported employment. Baltimore: Paul H. Brookes Publishing Company, 1988:3-16. Wehman P. Supported employment and opportunities for integration. In: Wehman P, editor. The ADA mandate for social change. Baltimore: Paul H. Brookes Publishing Company, 1993.
