Posted on October 29, 2020

By Angela Rapp Kennedy, CQL Vice President of Systems Transformation

Chelsea, an advocate in Tennessee, makes it very clear. “People want jobs. Not to just sit around and be bored all day.” Despite the critical role that employment plays – from sustaining our very livelihood to nurturing a sense of meaning and purpose – people with disabilities face significant disparities in achieving employment-related outcomes. According to a recent employment report from nTIDE, the employment-to-population ratio for working-age people with disabilities is 28.3% in comparison to 70% for those without disabilities. Considering that October is National Disability Employment Awareness Month (NDEAM), this month provides a timely opportunity to explore employment outcomes for people with disabilities further.

In this Capstone, we hear from Dan Rutten from Wise and John Butterworth from the Institute for Community Inclusion (ICI), University of Massachusetts Boston. They take us from theory to practice, looking at the challenges facing employment professionals, barriers to improving employment outcomes, and specific strategies for successfully supporting people in supported, customized, and competitive employment. Carli Friedman, CQL’s Director of Research, starts us off by looking at the broader effect of employment on quality of life and the role of organizations in providing supports.

Connections Between Employment And Quality of Life

By Carli Friedman, Ph.D., CQL Director of Research

According to our analysis of approximately 1,300 interviews with people with disabilities conducted in 2019, there is a significant relationship between where someone works and their overall quality of life. People with disabilities who worked in competitive employment and supported community employment had the highest overall quality of life (out of 21 Personal Outcome Measures® indicators), compared to all other work/activity settings (see figure below). In contrast, those people who worked in enclave work and sheltered work, and participated in day activities had the lowest overall quality of life.

The Relationship Between Work/Day Setting and Quality of Life Outcomes Present

Despite the benefits of integrated employment on quality of life, the overwhelming majority of people (80.5%) participated in segregated work or non-work activities (see figure below). In fact, only 19.5% of people worked in competitive employment or supported community employment.

People’s Work/Activity Settings (2019)

Despite most people currently working or participating in segregated settings, most people didn’t even choose to work there – only 43.0% of people choose where to work (had the outcome present). In contrast, our research tells us that when people are able to choose where to work, they most often select integrated employment options.

Impact Of Organizational Supports On Employment

So how can we ensure people are working in a place of their choosing? According to our research, organizational supports can be key. In fact, people with disabilities are 45.7 times more likely to choose where to work (have the outcome present) when organizational supports are in place. In addition, when organizational supports are in place, people are 4.0 times more likely to work in supported community employment, and 4.3 times more likely to work in competitive employment compared to other settings. Individualized organizational supports are crucial to ensuring people get to choose where they work.

As a result of people’s preferences for more integrated work settings, as well as the benefits of those settings, by simply supporting people to choose where to work, organizations are likely also facilitating people’s quality of life.

Finding The Right Fit For Employment

By Dan Rutten, Senior Program Manager, Wise

The landscape of employment opportunities for people with developmental disabilities is changing shape across the country and around the world. With a focus on individualized priorities and solutions, many are finding success as people move from segregated, low paying work environments into jobs that fit their skills, interests, and talents. One example of this is in the state of North Dakota where they have rolled out a new Customized Employment Policy which provides a channel for people – who previously did not have the option – to access community-based employment services.

During the policy’s development, North Dakota DVR, in partnership with Wise and the North Dakota Center for Persons with Disabilities, invested in capacity-building within employment providers to deliver these services. Over a 3-year period, four agencies received coaching around key tenents such as discovery and planning, community mapping, job carving to match a person and employer’s needs, and identifying team strategies and supports to encourage success on the job. This resulted in 34 people making the transition from segregated settings, to community-based employment.

Keys To Customized Employment Success

While a part of the four-agency pilot, Rikki Trageton of Community Living Services (CLS) in Fargo, stated one of the keys to being successful with Customized Employment was “to remain focused on what individuals can do, not what they can’t.” And as a result, they have created several new positions that are in line with job seeker’s skills and interests. These successes are also proving to show longevity as well.

When reflecting on their successes Rikki mentioned that, “One of these participants works at a local hospital in a position that was customized for him to fit his skills and abilities. He is doing great. He loves his job and has had the opportunity to engage in social activities with people and travel with family as a result of working in a high wage job in our community. He also takes a great deal of pride in working at the same hospital where his mom works as a nurse.” And the successes didn’t stop there; from local grocery stores to creating jobs on the Microsoft campus in Fargo, new opportunities continue to arise as a result of expanding services.

As the fight for equity for people with disabilities continues, North Dakota and many other states across the United States make changes to policies allowing more people to access community-based employment services. In these efforts, one thing becomes increasingly apparent – everyone has the ability to fill a valuable role in the workforce. In the words of Norman Kunc, “Ability does not create opportunity. Opportunity creates ability.”

Moving Beyond Training: Implementation Support for Employment Professionals

By John Butterworth, Institute for Community Inclusion (ICI), University of Massachusetts Boston

Best practices in supporting competitive integrated employment have been well established over the past 50 years. This began with early demonstrations of employment support and systematic instruction, implementation of supported employment, and the development of customized employment strategies. These models of support have been validated by a systematic review of the research and practice literature, and defined in comprehensive standards of practice and certification guidelines by the Association of People Supporting Employment First (APSE) and the Association of Community Rehabilitation Educators (ACRE).

Despite this work, we struggle to attain consistent implementation of best practices in employment support. Employment professionals express confusion about their roles and say they feel unprepared. There continues to be limited access to formal training and professional development, but even when training is available employment professionals report challenges to implementing what they have learned.

Strategies For Supporting Best Practice In Employment

Over the past 10 years the Institute for Community Inclusion at UMass Boston in partnership with the Institute on Community Integration at the University of Minnesota has described the work of employment professionals and explored strategies for supporting best practice. We know from this work that there is a gap between what works and what gets implemented.

Data tell us, for example, that employment consultants spend too much time on administrative tasks, emphasize strategies like cold calling and answering want ads over high value activities like personal networking, and spend limited time engaging with families and significant others. This work has focused on two questions:

1. What is it that employment consultants do?
2. How can we better support implementation of the best practices we have identified?

What we find is that employment consultants are deeply interested in quality improvement. In three cohorts over 175 employment consultants from 29 states provided a snapshot into their work by responding to a daily survey delivered by text once each day that asked what their primary activity was, who they were with, and where they were for the 30 minutes prior to receiving the text.

We know from these data that they are a heterogeneous group with very wide variation in how they use their time, that they have limited access to training, and that they struggle to find the support they need to connect training with implementation of supports. Despite these barriers, each of these employment consultants completed a survey daily for a full year. They overwhelmingly reported that just completing the survey was helpful, sharing for example that “[the survey] causes me to pause for a moment and reflect on how I am spending my time, energy and resources.”

Confronting Challenges Involving Implementation Support

We know much about what employment consultants do, and our challenge is to figure out how to consistently provide high quality implementation support. In the series of research studies that these employment consultants participated in, we did that by supplementing the daily survey they completed with feedback on how they used their time, how it compared to their cohort, and how it compared to best practice. In addition, there were specific month-to-month goals for improvement, opportunities to come together as a learning community, and access to brief “micro-learning” opportunities delivered as part of the daily survey.

This system, currently being refined and automated, is one approach to providing implementation support. Ensuring ongoing mentorship and a requirement that trainees demonstrate new knowledge in the field is a necessary part of training. Building quality review of the strategies we are using into daily workflow, grounded in simple questions like “are we using our time as a team the way we want to?” and “do our strategies match best practices identified in the APSE and ACRE standards” are essential to making progress.

As Rich Luecking and his colleagues said almost 20 years ago, “…Regardless of the job seeker’s level of motivation, skill, experience, attitude, and support system, his or her ability to get a job will often depend on the effectiveness of employment specialists. Simply stated, if they are good, job seekers get jobs. If they are not, the barriers to employment for job seekers can become insurmountable…”

References & Resources

• Luecking, Richard, Fabian, Ellen, & Tilson, George (2004). Working relationships: Creating career opportunities for job seekers with disabilities through employer partnerships.
• For more information on our work in this area visit: https://www.thinkwork.org/rrtc/eec