Supported employment

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Definition of Supported Employment[edit]

'''Supported Employment''' was developed in the US in the 1970s as part of both vocational rehabilitation (VR) services and the advocacy for long term services and supports (LTSS) for individuals with significant disabilities in competitive job placements in integrated settings (e.g., businesses, offices, manufacturing facilities). It refers to service provisions wherein people with disabilities, including intellectual disabilities, mental illness, and traumatic brain injury, among others, are assisted with obtaining and maintaining employment originally through the primary models of job crews, enclaves, or the preferred job coach (e.g., New York State Office of Vocational Rehabilitation, 1978). Since the mid-1980s, supported employment in the professional literatures primarily has referred to the "individual placement" model, either with job coaches or through "natural supports" models. Supported employment is worldwide in 2013, and the term has been used for assisting workers of diverse kinds who may need an extra jump start in the workplace, though still associated with its roots in disability which includes deinstitutionalization.

University Development of Supported Employment Concept[edit]

Supported Employment was on the rise nationally in the US in 1985 with growing university support, new dedicated agencies and programs, and preparation of master's and doctoral students in rehabilitation and education. As an example, Thomas Bellamy, Larry Rhodes and Jay Albin of Oregon prepared a new chapter titled Supported Employment which indicated its uniqueness as having no entry requirement and no minimum ability levels (unheard of in vocational programs) in order to include candidates regardless of the nature or degree of their disability". [1]

""Supported employment"" was based upon principles of community integration and the site location termed an "integrated setting" was a core component of the applied and theoretical models. In addition, other critical aspects were paid work, vocational choices, employer development, school to work transition to job sites, and involvement of parents in the employment process.[2] A Rehabilitation Research and Training Center (RRTC) on Supported Employment or related Employment and Disability areas has been funded in the university sector from the federal levels for over three decades under the leadership of Dr. Paul Wehman.

In the psychiatric field, the prominent approach, also very innovative in long term services and supports (LTSS) was transitional employment associated with the now international Clubhouse Model of Fountain House in New York City. Gary Bond (1994) reported supported work as a modification of this approach. [3]Paul Carling (1995) of the University of Vermont supported the development of community employment options in the field of psychiatric disabilities [4]; Paul Wehman conducted critical cross-disability studies near the Medical School [5]; Dr. Steven Murphy (1991) adapted employment supports for the psychiatric field [6]; Julie Ann Racino confirmed related affirmative business and family models (e.g., Racino, 2003) [7], and Dr. William Anthony (Anthony et al, 2002) of Boston University and his research center continues to work since the 1980s on a "get-choose-keep" approach to employment.[8]

US Legal Basis for Supported Employment[edit]

The legal integration base for supported employment was described by Frank Laski, of the Public Interest Law Center in Philadelphia, Pennsylvania, (1985, April) as being the Education for All Handicapped Children's Act (PL 94-142) now known as the Individual Disabilities Education Improvement Act, and the Rehabilitation Act of 1973, amended 1978 passed by the US Congress. He also found strong support for moving from sheltered settings to supported employment in 1978 Developmentally Disabled and Bill of Rights Act and fully supported a "zero reject" policy, individualized work plans, and questioning the notion of the "employability" concept. [9]

Supported employment, emanating from the sheltered and governmental services sectors, has different roots than employment based upon traditional civil rights and discrimination approaches. Employment and disability often shares common roots with others disadvantaged in employment, based on discrimination due to gender, race, ethnicity, family structure, and disability, among other "differences" (e.g., Urban League of Onondaga County, Inc.). Such coalition based strategies emanate from the Civil Rights Act of 1964 and seek redress in employment based upon discrimination in hiring, promotions, terminations, and payments, among others. Such positions are not "dedicated positions", but may involve a reasonable accommodation (e.g., personal assistant, work desk modification) to perform the job as defined by the primary tasks of the employer-based system for "qualified individuals" Americans with Disabilities Act of 1990, now amended in 2008.[10]

United States, Development of Supported Employment[edit]

In the United States, supported employment is defined in the Rehabilitation Act, as amended (1978). The more recent Rehabilitation Act Amendments were contained in the Workforce Investment Act signed into law in 1998. The Rehabilitation Act and its amendments establish and fund the Vocational Rehabilitation program. Vocational Rehabilitation, which is frequently referred to as “V.R.”, is the core national employment program for persons with a disability, but is not the main agency to fund long-term services and supports (LTSS) in the community. Federal funding is funneled through state Vocational Rehabilitation agencies, and categorical state agencies and their regional offices (e.g, New York Office of People with Developmental Disabilities) are also involved, including Home and Community-Based (HCB) Medicaid Services Waiver funded programs nationwide.

Core Definition[edit]

Here is a representation of the core definition of supported employment as it is contained in the Rehabilitation Act Amendments (Public Law 102-569: Supported Employment Definitions). [11] Supported employment means: A. Competitive employment in an integrated setting with ongoing support services for individuals with the most significant disabilities – a) for whom competitive employment has not traditionally occurred; or b) for whom competitive employment has been interrupted or intermittent as a result of significant disability; and c) who, because of the nature and severity of their disabilities, need ongoing support services including both intensive initial support services and also extended services after transition from those initial support services in order to perform work; or B. Transitional employment for individuals with the most significant disabilities due to mental illness.

There are a number of important critically important terms and concepts referenced in this definition of supported employment. These terms are: • Individuals with the most significant disabilities • Competitive employment • Integrated work setting • Ongoing support services and supported employment services.

The most common model of supported employment involves job coaching with the traditional rehabilitation approach to "fade services" into the work setting; however, supported employment has roots in long-term supports and services, and variations based upon "natural supports" (e.g., payments to a coworker to provide assistance). [12]

Costs of Supported Employment[edit]

Costs of supported employment have been an area of research and study since its inception, and include academic studies in categorical disability areas (e.g., psychiatric, traumatic brain injury) regarding long-term services in competitive settings. [13] [14]

Supported employment was designed to be cost-effective and cost-beneficial, and indeed has been documented to be so as a key community services. [15] However, two cost trends are the medical center gates which change the cost structure and personnel (from collaboration between education and medical to medical operations; "physical restoration" by a "physiatrist")[16]; and a government trend to cut the cost of its already lean services (e.g., natural supports to lower costs). [17]

Cimera's 2012 review on the "economics of supported employment" indicated that: 1. Individuals fare better financially from working in the community rather than sheltered workshops, regardless of disability. 2. Relative wages earned by supported employees were up 31.2% since the 1980s, while sheltered workshop wages decreased. Over 30 studies were reviewed in the 1980s and 1990s including in the US, Australia, Great Britain and Canada finding that "individuals with disabilities experience greater monetary benefits than costs when working in the community". [18]

However, concerns regarding subminimum wage and employment extend to the community [19], especially due to the interplay of benefits, entry level versus skilled jobs, wages paid to the employee versus employer benefits, and dead end versus career approaches. However, early studies reported benefits of $1.97 to every dollar in cost with $13,815 in gross wages and fringe benefits to the employee (Hill et al, 1987) [20] whom others viewed as "permanently unemployable" or "unable to work".

Supported Employment and Employment Supports[edit]

Supported employment evolved as a way to assist individuals with the most significant disabilities with employment in their communities...a real job for real pay, and involves personal assistance services including for people who lived in institutions in the US. [21] For over 30 years supported employment has demonstrated that individuals with severe disabilities can work [22], yet today many individuals remain segregated in sheltered workshops and day programs. Efforts to convert sheltered work shops to provide supported employment (now, one person at a time) are underway, and a generation of Master's level students in Rehabilitation Counseling and Special Education have been educated in changing services and organizations from older, outdated segregation models.[23] [24] Verdicts in recent lawsuits upholding the right to work in inclusive settings seem to indicate that integrated employment will soon be the first choice.

Best practices dictate that an individualized support approach to supported employment, funded as a professional "VR" service, is used to assist individuals with gaining and maintaining employment. This may involve a supported employment service provider (professionals)to understand how to customize employment and provide supports, school personnel in transition [25], or it may involve an approach similar to bridgebuilding and person-centered community development. [26] Supports could include: modifiying a job, adding accommodations or assistive technology, enhancing on the job site training among other approaches, such as identifying network relationships (e.g., family business, local job sites and owners). What is needed will vary from one person and one employer to the next, but do involve the human resource offices, the funding agencies, the supervisory levels, and even union leadership, among others. In 2010, customized employment, state employment first policies, and "revisiting key federal policies" are recommended as leadership in "employment of persons with severe disabilities". [27]

Early supported employment agency leaders, shifting from services to supports, included Jerry Kiracofe's Human Services Institute in Maryland (Kiracofe, 1994), Jeffrey Strully originally in Kentucky at Seven Counties Services (now, Rogan & Strully, 2007 in Colorado and California), Richard Crowley's area agency in New Hampshire (Rogan, 1992), ENABLE and Transitional Living Services in New York (the latter simply deciding in 1977 that "long term clients" in the community had a right to seek jobs and work, supported by "residential staff"), agencies in Oregon (Magis-Agosta, 1994), Wisconsin (Racino, 1987) and Great Britain, among others. These groups were associated also with research studies on job supports, workplace culture, and gender and ethnic concerns in employment structures. [28][29]

Personal Assistance Services and Supported Employment[edit]

Personal assistance services, a premier service of public policy and independent living, has a strong national and international research base dating back to the 1980s.(Litvak, Zukas & Heumann, 1987). [30] [31]Personal assistance services (PAS)has expanded to be an important component of "workplace supports" (Soloveiva, et al, 2010) [32] and is part of working schemes in countries such as Sweden (Clevner & Johansson, @2012).[33] Personal assistance services and workplace PAS has been taught through Virginia Commonwealth University as an online course and is available in 2013 as a self-study through the independent living network.(http://www.worksupport.com/pas/funding.cfm) PAS has been developed for use by diverse groups, including in cognitive disabilities, inclusive of mental health, brain injuries and intellectual disabilities, and for individuals with medical and physical needs for assistance (Racino, 1995).

Supported Employment and Systems Change[edit]

Supported employment was visualized as a way to change segregated services systems, based largely upon sheltered workshop facilities, to an integrated community approach to employment for individuals, primarily with intellectual and developmental disabilities. However, while full conversion has not occurred with growth also in adult day programs, new principles in employment have been promoted through the national APSE Network for Employment. These principles include quality indicators on individual choice and control of resources and supports. [34]

Conversion of sheltered workshops was recommended in the 1990s as part of the effort to shift financing and services to integrated settings. [35] State trends in "conversion" to integrated work have been monitored by the Institute for Inclusion in Boston and are available on the internet. [36]

"Local community rehabilitation agencies providing supported employment grew from just over 300 in 1986 to approximately 5,000 in 1993" (McCaughey et al, 1995). However, Wehman and Kregel (1995) indicated that supported employment was established in every state through Title III, Part C of the Rehabilitation Act Amendments in 1986; Gary Smith with Bob Gettings indicated all states were funded for supported employment under the Home and Community-Based Medicaid Waivers, too. Supported employment remains a viable employment option and operates side-by-side with segregated employment options within states in the US and involved 212,000 individuals with severe disabilities in 2002(Rusch & Braddock, 2004). [37] [38]

Racino (1994) reported (conceptual schemes) that the changes required in areas termed "support services" require other than the traditional "organizational" or "systems change" strategies of professional education and training. [39]For example, in a study involving herself, the VR system continued to revert to the 1970s "entry level" position as the agreed upon (employer-school-service provider)bottom up approach to personnel with high educational degrees and extensive work experiences (i.e., one size fits all, "person negligible" as opposed to person-centered approach) similar to parents of children with disabilities who had difficulties with promotions.[40]

Individual Placement Model (IPS)[edit]

IPS Supported Employment helps people with severe mental illness work at regular jobs of their choosing. Although variations of supported employment exist, IPS (Individual Placement and Support) refers to the evidence-based practice of supported employment (as Annie Oakley explains, referring to "everything under the sun") as validated by new universities and medical centers involved in employment.[41] The model appears to be a variation of professional supported employment approaches, based on decades of research study and practice in the field of disabilities.

Characteristic of IPS Supported Employment

  • It is an evidence-based practice
  • IPS supported employment practitioners focus on client strengths
  • Work can promote recovery and wellness
  • Practitioners work in collaboration with state vocational rehabilitation
  • It uses a multidisciplinary team approach
  • Services are individualized and long-lasting
  • The IPS approach changes the way mental health services are delivered

Other Countries[edit]

"No matter whether they live in the most prosperous nations of the world or the least, people with disabilities are among the most economically disadvantaged groups in society." (Schriner, 2001). [42]

Other countries around the globe use the terminology 'supported employment' and each one has its own definition.

References[edit]

  1. ^ Bellamy, G.T., Rhodes, L, & Albin, J.M. (1985). Supported employment. In: W. Kiernan & J. Stark, "Pathways to Employment for Developmentally Disabled Adults". Baltimore, MD: Paul H. Brookes. Not for dissemination in current form.
  2. ^ Wehman, P. & Moon, S. (1985). Critical values in employment programs for persons with developmental disabilities. In: P. Wehman & M. Hill, "Competitive Employment for Persons with Mental Retardation, from Research to Practice, Volume 1". Supported by the National Institute on Handicapped Research, US Department of Education awarded to the Rehabilitation Research and Training Center at Virginia Commonwealth University.
  3. ^ Bond, G.R. (1994). Supported work as a modification of the transitional employment model for clients for psychiatric disabilities. In: L. Spaniol, et al, "Psychiatric Rehabilitation" (pp. 215-229). Columbia, MD: International Association of Psychosocial Providers.
  4. ^ Carling, P. (1995). Creating employment opportunities. In: P. Carling, "Return to Community: Building Support Systems for Persons with Psychiatric Disabilities" (pp. 227-248). Baltimore, MD: Paul H. Brookes.
  5. ^ Wehman, P., Revell, G., Kregel, J., Kreutzer, J., CVallahan, M. & Banks, D. (1991). Supported employment: An alternative model for vocational rehabilitation of persons with neurologic, psychiatric or physical disability. "Archives of Physical Medicine and Rehabilitation", 72: 101-105.
  6. ^ Murphy, S., Racino, J., & Shoultz, B. (1991). "Psychiatric Rehabilitation." Syracuse, NY: Syracuse University, Division of Special Education and Rehabilitation, and Center on Human Policy
  7. ^ Racino, J. (2003). "Boilermaker Road Race: Road Racing and Wheelchair Racing in the US: 25th Anniversary". Rome, NY: Community and Policy Studies.
  8. ^ Anthony, W., Cohen, M, Farkas, M. & Gagne, D. (2002). "Psychiatric Rehabilitation". Boston, MA: Center for Psychiatric Rehabilitation, Sargent College of Allied Sciences, Boston University.
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  40. ^ Racino, J. (1999). "Policy, Program Evaluation and Research in Disability: Community Support for All". London: Haworth Press.
  41. ^ Bond, G.R., Drake, R.F., & Becker, D.R. (2012, February). Generalizability of the individual placement and support (IPS) model of supported employment outside the US. "World Psychiatry", 11(1): 32-39.
  42. ^ Schriner, K. (2001). A disability studies perspective on employment issues and policies of disabled people: An international view. In: G. Albrecht, K.D. Seelman, & M. Bury, "Handbook of Disability Studies". Thousand Oaks, CA: SAGE.

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