Posted on June 19, 2023 by Michael Clausen

People receiving supports have made it clear that they want something other than traditional, facility-based group day program and workshop settings. People want opportunities for employment or meaningful and individualized services that are based in the community. Our research on work/day settings indicates that people involved in community based activities consistently have a higher quality of life than those engaged in segregated activities. 

The Relationship Between Work/Day Setting and Quality of Life Outcomes Present (2015-2022) 

In this Capstone, we share more data about this topic, specifically the disparities that exist between who ends up in segregated work/day settings in comparison to integrated work/day settings. This research is useful in helping you better focus your services. Then, we talk to three organizations that have successfully transitioned their day services. You’ll learn specific action steps and tips you can use at your organization. 

Who’s More Likely to Be Funneled into Segregated Work/Day Settings?

By Carli Friedman, CQL Director of Research

Choosing where to work can significantly improve people with disabilities’ quality of life. Yet, only 29.6% of people with disabilities Chose Where to Work in 2022, which was shared in our latest Personal Outcome Measures^® Benchmarks report. Those people with disabilities that do have the opportunity to choose where to work are three times more likely to select employment opportunities over non-work activities. People with disabilities are also significantly more likely to select integrated community-based work/day settings, rather than segregated work/day settings. In fact, the odds of people being in an integrated work/day setting increases by 404% when they are the one that choose where they work! 

Let’s dig a little deeper and look at who’s most likely to be funneled into segregated work/day settings rather than integrated community-based work/day settings. To do so, I analyzed Personal Outcome Measures^® interview data from 7,000 people with disabilities (2015 to 2022).  

The odds of people with disabilities being in segregated work/day settings (compared to integrated settings) increased by: 

• 2% for each additional 1-year increase in their age. 
• 40% when they had full/plenary guardianship, compared to independent decision-making. 
• 49% when they primarily communicated through methods that weren’t verbal/spoken language. 
• 72% when they had Down syndrome compared to other disabilities. 
• 356% when they were Asian compared to when they were White. 

Meanwhile, the odds of people with disabilities being in integrated work/day settings increased by: 

• 92% when they were Deaf or had significant hearing loss, 57% when they had impulse-control disorder, and 50% when they had personality/psychotic disorder, compared to other disabilities. 
• 921% when they lived in their own homes, 264% when they lived in family homes, and 352% when they lived in host family or family foster care, compared to provider owned/operated homes. 

The research is clear – not only do people with disabilities want to work and do so in integrated settings, but with the right supports they are able to do so successfully! Given the disparities unearthed above, targeted supports would be particularly beneficial to reduce inequities. Yet, in 2022, only 30.7% of people with disabilities received individualized organizational supports to promote employment/day choice! Next, three organizations will share tips about how to transform day programs to be more inclusive and promote the choices of people with disabilities. 

Organizational Insight Into Day Services

While many organizations have desired to move away from traditional facility-based settings, there are often challenges that prevent them from fulfilling this goal. Nevertheless, organizations – like SRVS, Empower Simcoe, and Community Living Oakville – have found ways to systematically break down these barriers to fully transform their day services. 

Prior to this transformation, all three organizations were offering programming that was largely based within their buildings, with services including pre-vocational workshops and traditional day programming. 

Jenny Parisi, Community Living Oakville notes that, “Although some activities were scheduled outside of the building, for the most part, people would stay within the base site for the day. Programs were developed, but most of these programs were developed “in-house,” with people coming into the base site to offer programs (e.g. yoga) instead of people supported accessing activities within already established community programs.” 

Day services at these organizations now look very different, with programming that is focused largely on employment and developing relationships in the community through activities that are centered around individually defined goals and interests.  

Deciding To Transition Day Services

Troy Allen, SRVS: 

SRVS made a commitment to providing the most progressive and inclusive services and supports. We voluntarily collaborated with State IDD in Tennessee to be a model agency for transformation. 

Angie Bendo and Kim Martin, Empower Simcoe: 

Our agency’s strategic plan addressed the re-engineering of day services. With the general thrust in the community living movement, to move away from congregate program settings towards greater inclusion and participation in Community life, Empower Simcoe made the decision to move away from hosting exclusive programs in our own facilities. 

Jenny Parisi, Community Living Oakville: 

When the pandemic hit in March 2020, everything was closed, including our day programs. With programs closed and people supported now having to isolate, it highlighted the fact that people who had attended our ‘traditional day program’ had a limited number of natural supports from the community. Though community inclusion had been a goal for people supported and agencies, segregated programming had contributed to systemic challenges and barriers in our community. In order to advocate and be accountable to the people we serve, we had to begin to address the root causes and barriers to community inclusion. 

Overcoming Challenges

All three organizations encountered significant challenges during this transformation, including a fear of change on the part of families, staff, and some people receiving supports. The organizations note that transportation, individual and program funding, and limited resource availability were significant barriers that had to be overcome to make this transition work. Notably, all three organizations successfully transformed their day services despite an ongoing staffing crisis in both the United States and Canada. All three organizations worked methodically to support people to have a greater amount of opportunity for inclusion within their day services. 

Angie Bendo and Kim Martin, Empower Simcoe: 

We facilitated consistent ongoing communication. We focused on creating a culture of people first and worked to establish strong community connections and partnerships throughout our county. We provided increased bus training and skill building to address transportation issues. 

Jenny Parisi, Community Living Oakville: 

Relying on public transportation or other modes of transportation has helped to break down some barriers. We focused on building partnerships that can/will provide affordable and/or discounted items and provided ongoing education to community members, businesses, and partners. The people we support are the best educators – they are encouraged to advocate for themselves, and through their inclusion in the community, naturally educate community members. 

Troy Allen, SRVS: 

We held a series of meetings for all stakeholders to engage in open discussion and Q&A. Our organization started a media campaign to raise awareness. We applied for and received grants to aid in our transformation. 

Achieving Individualized Outcomes 

All three organizations have worked to find out how each person defines a meaningful day. In contrast to traditional service models where people are plugged into existing programs, groups, and services, the perspective of each person is key to shaping the services that are provided. Angie Bendo and Kim Martin, Empower Simcoe, note that their organization provides “individualized supports based on each person.” 

Troy Allen, SRVS: 

We solicit weekly input from those receiving services and use this information to develop and plan activities of interest. We also use Individual Support Plans to ensure all goals and areas of interest are included in daily activities. We work to create volunteer opportunities and community activities for every person 

Jenny Parisi, Community Living Oakville: 

Information is gathered on who people want to spend their day with and who has similar interests. Activities and opportunities outside the norm are offered consistently: This is to ensure that people have the opportunity to try new things, some of which they might never have considered and as a means to provide The Three E’s: Education, Experience, and Exposure. Staff are also part of the process, as they brainstorm ideas with the people they support. Having people supported and staff part of the planning process is what helps to make this model a success – people want their voices and opinions heard; and we then work through the logistics to make it happen. 

Communicating With Stakeholders

A move from facility-based services with defined locations, schedules, and transportation can present some unknowns. For all three organizations, it was critical to seek perspective from stakeholders and maintain clear communication throughout the transition and as services are delivered. Because community resources and partnerships play a critical role in the success of community-based services, it is important that organizations look to their communities to develop opportunities for meaningful days. 

Angie Bendo and Kim Martin, Empower Simcoe, note that a variety of communication tools have been utilized to support this transition, including: emails, surveys, focus groups, social media, phone calls, individualized meetings. Troy Allen, SRVS notes the creation of a Steering Committee that included representation from all stakeholders; people receiving services, families, board members, business professionals and agency leadership. 

Jenny Parisi, Community Living Oakville, reports that, “Prior to initiating the transformation, information sessions were held with people supported, with their families and natural supports, and with staff. These information sessions provided people an opportunity to ask questions, share their concerns, and have a better understanding of why we were moving in this direction.” 

Building A “Road Map” To Transformation

While there are very real challenges to providing every person with an opportunity to receive meaningful, individualized services that are based in the community, there are organizations that have proven that it is very much possible. It is important to have a plan to move forward. 

Considerations In Developing Your Plan 

1. Communicate with stakeholders 

Start by finding out what people you support really want from their services. What do they enjoy most with their current services, and what would they want their services to look like in the future? What are the concerns of people, staff, families, and other stakeholders? Be transparent, and offer regular opportunities to engage with all stakeholders as changes are implemented.  

“We committed to being transparent with all stakeholders. Prior to the new model beginning, we hosted information sessions for people supported, another for their families and natural supports, and a session with staff. These information sessions provided us with the opportunity to provide information regarding the transformation, while also providing people the opportunity to ask questions and share concerns.” shared Jenny Parisi, Community Living Oakville. 

2. Identify the challenges (and break them down) 

It is important to acknowledge all of the challenges that exist, both real and perceived. Designate leaders, champions, and workgroups to isolate and mitigate any challenge that stands in the way of fully integrated services. 

3. Customize your approach 

It is important that services be tailored to the needs and wants of the people receiving them. Now that you are moving away from facility-based services with set schedules, this might be a good time to find out what works best for people in terms of their daily routines. It is possible that a meaningful “day” will occur only in the afternoon or certain days of the week.  

4. Find the right match 

Identify people and staff members with similar interests to tailor experiences and activities. Use people’s passions, hobbies, and existing connections with the community as the springboard for engagement.  

5. Don’t go it alone 

As organizations, we are often tempted to be the solution, but it is often more productive to be the bridge. It is important to work with our communities, partner organizations, and volunteers to fully realize our vision. Seek out their involvement in every step of your transformation and provide ways to contribute, physically, financially, or virtually. 

6. Celebrate your success 

With the permission of people, share stories, photos, and highlight people’s experiences. Celebrating success is a great way to sustain current efforts and continue building for the future. “The first two people to leave sheltered work have repeatedly said to all ‘we love our jobs’ and they encourage others to embrace supported employment. One person volunteers to read to elderly people in care homes and says, ‘this makes me feel good.’” adds Troy Allen, SRVS. 

A Worthwhile Transformation 

Transforming day service programs to individualized and community-based settings can improve the quality of services at organizations and the quality of people’s lives overall. The process of transformation is a journey, but as demonstrated by SRVS, Empower Simcoe, and Community Living Oakville, a worthwhile one. These organizations prove that it is possible to provide all people with opportunities for a meaningful day that is based not in a facility, but in places that they choose.