Posted on October 30, 2023

By Rebecca Kasey, CQL Director of Personal Outcome Measures®

Employment service programs have grown significantly over the past decade, moving from workshops paying sub-minimum wage to programs designed for people to find competitive and integrated employment. 

In our last edition of Capstone, Part I: Provider Tips to Build Successful Employment Services, we shared how you can develop successful employment services (ES) programs and truly discover what people receiving services would like to do for their careers. 

For this Capstone, CQL worked with the same six ES providers to gather tips for attracting and retaining good staff, using technology to improve employment success, and implementing innovative support strategies. Dr. Carli Friedman, CQL’s Director of Research, provides Personal Outcome Measures^® data surrounding work and quality of life in the first section of this article. 

Thanks to all of CQL’s partner organizations who contributed to these articles: 

• Emily Myers, Region Director, Briggs & Associates (Georgia) 
• Gerald Bernard, Chief Executive Officer, and Lois Durrah, Senior Vice President for Community Support Services, Charles Lea Center Inc. (South Carolina) 
• Miranda Kelly, Workforce Innovation Director, Emory Valley Center (Tennessee) 
• Amanda Carroll, Director of Community Services, and Brandy Muntean, Assistant Manager of Community Services, Kreider Services Inc. (Illinois) 
• S. Michael Chapman, Director of Employment Services, UNC TEACCH Autism Program (North Carolina) 
• Heidi Moser, Assistant Director of Employment Services, Sesdac, Inc. (South Dakota) 

Work and Quality of Life

By Carli Friedman, CQL Director of Research 

Work can greatly shape our health and the quality of our lives, so much so that employment is considered to be a social determinant of health. Research indicates if we have jobs, how much we are paid, the working conditions at our jobs, how we are treated at this jobs, and how much a job matches with our skills, can all either make our health worse or make it better (United States Office of Disease Prevention and Health Promotion, n.d.; World Health Organization, 2010). 

Choosing where to work can have a widespread impact on people with disabilities’ quality of life. In fact, when I analyzed Personal Outcome Measures^® interviews from 2022 (n = 620), I found choosing where to work increased the odds of each of the 20 other quality of life outcome measures being present. For example, when people with disabilities chose where to work, the odds of them being respected increased by 298%, their odds of interacting with other members of the community increased by 556%, and their odds of choosing services increased by 759%!  

The Impact of Choosing Where to Work on Other Outcomes 

These are just a few examples of the ways the ability to choose where they work and spend their days, increased people with disabilities’ health and safety, community integration, relationships, other choices, and goals. Despite these extensive benefits, less than one-third of people with disabilities (30%) actually choose where to work in 2022. In addition, only 31% of people received individualized organizational supports to ensure they were able to choose where to work. Due to the lack of supports, and the fact that individualized supports greatly increase the likelihood of people choosing where to work, the strengthening of employment services and supports is greatly needed. 

Attracting and Retaining Good Staff

All HCBS providers have felt the strain of staffing over the years. CQL’s partner organizations have provided some of their tips to find good candidates, onboard and continually develop new staff, and retain quality employment specialists.  

Finding Good Candidates 

Employment specialist positions require a person who is the right fit. Briggs & Associates explains the most important part of their candidate search saying, “Everything we do is about the people we serve and we look for people who work in the same spirit.” Potential staff must also “be self-motivated, passionate, empathetic, and capable of advocating for both employees and employers,” according to Sesdac, Inc.  

To attract staff with these characteristics, several of CQL’s provider partners have provided the following ideas:  

• Sharing Your Success Stories 
  Emory Valley Center suggests “Stories! Showcase the successes your staff have helped people achieve.”  
• Embracing Staff Matching 
  UNC TEACCH Autism Program explains, “Just as we try to match those we support to their ideal careers; we try to make sure our candidates are matched to positions in our program and that they truly want to do this type of work.” 
• Simplifying the Application to Onboarding Process 
  Charles Lea Center has found some success by making “the entire hiring process digital, from the application process to communication (texting). This has made the onboarding process quicker, and improved communication with the applicant (so they know where they are in the hiring process). This approach has proven to be particularly effective with younger applicants who are more accustomed to the digital age that we are in.” 
• Having A Good Reputation 
  Kreider Services explained that presenting their organization in a positive manner and spreading that message by word of mouth have helped their organization. Briggs & Associates was chosen as one of Atlanta’s Best Places to Work in 2022 which they credit to their staff who “get to operate in business while also impacting social change – the best of both worlds!” 
• Taking a Broad Approach 
  Many providers have been using a wide array of recruitment tools, like sign-on bonuses, referral bonuses, real-word job previews, online job posting sites, social media sites, and others.  

Onboarding and Continually Developing New Staff

Onboarding and continual development of employment specialists is key to ensuring that they remain a good fit once they are hired. The initial onboarding process should be focused on acclimating new hires to the culture and values of the organization, while also ensuring an individualized approach to best support new employees. As UNC TEACCH Autism Program explains, “We provide the education they need to succeed. Even though this means a slower pace of onboarding, it pays off in the long run.” 

The continual development of these staff is an investment providers make that can also help with recruitment and retention. Chales Lea Center has had success with this, sharing “we have highlighted professional development opportunities so that employees know there is opportunity for professional growth through onsite training and advancement.” 

UNC TEACCH Autism Program has a similar approach, explaining “we have a philosophy of lifelong learning that applies not just to those we support, but to our employees. By supporting their professional growth and empowering them to provide quality services without micromanaging them, our staff have developed skills that have led many of them to be leaders.” 

Retaining Good Staff

Once employment specialists are stable in their positions, providers have to find ways to retain these employees.  

Providers must demonstrate appreciation and consideration of their staff. Emory Valley Center suggests that providers “encourage and praise your staff for all the hard work and effort they put into supporting people!” Kreider Services, Inc. similarly suggests that employers should be “celebrating each success and showing appreciation.” Briggs & Associates explains that they “value the staff and their contributions,” and they also have kept caseloads at a manageable size. Charles Lea Center explains how diversity, equity, and inclusion are also important, saying “we have put a lot of effort into creating an inclusive culture that is based on many of the principles of servant leadership.” 

Providers should structure their positions to ensure that growth and development are key components of the employment specialist position. As Briggs & Associates explains, “we give staff enough room to be creative and to build careers that work well in the lives of each person.” When employees are able to build careers, they are more likely to stay in their positions. UNC TEACCH Autism Program creates ongoing professional development with these employment specialists, “we know we cannot support everyone, but through supporting professional development, we help increase support to others that we would not be able to reach.” 

Another area that most providers are familiar with is to implement employee benefit programs. These can be programs like store discounts, employee perks programs, retention bonuses, or other programs like the ones that Charles Lea Center have developed. They explain that “several years ago we invested in developing an onsite clinic managed by our nurse practitioner. This proved to be a huge benefit for many of our employees who sometimes struggle with getting appropriate health care. More recently, we also added a wellness program that is for the most part free for our employees. We do longevity awards and have competitions throughout the year where employees can win prizes.” 

Utilizing Technology to Better Support Employment Outcomes

Providers have been using technology to support people in attaining and maintaining employment for years, but the global pandemic led to using more creative technology to best support people. 

Kreider Services Inc. 

“One individual who works at a fast-food restaurant, faded from job coaching after several months. A Wyze watch was purchased for him to wear at home to remind him to start getting ready for work, so he is not late.” Kreider Services also explains that providers may need to help people with online tasks related to their job, such as creating an account for a company’s intranet, logging in to read handbooks, policies, and procedures, setting up their bank information and electronic schedules, downloading an app to check pay stubs, reporting to social security. 

UNC TEACCH Autism Program 

“We work with the individuals we serve to use it in a manner that supports their unique learning style. It may be helping them create reminders or a calendar – creating a checklist for how to do a task at work that they can use over and over. The two areas where we find it most beneficial are in communication and stress reduction. The ability to support a person in a crisis remotely is a game changer in terms of maximizing impact and having true on-demand support. For stress reduction, we work with individuals to create videos and audio routines that they can play on smart devices that walk them through a stress reduction routine. The smart device may even have a reminder set to practice it at a set time throughout the day.” 

Briggs & Associates 

“Briggs also uses technology in the form of timers, tablets, etc. in order to create more effective mechanisms for following a routine, completing tasks, staying on schedule, etc. These tools have been helpful both in the training process and in the person’s long-term success on the job.” 

Charles Lea Center 

“We have been successful in utilizing remote support to provide job coaching, utilizing phones and tablets to check in on an individual at work or provide reminders. This approach allows the individual to be at their job without needing a job coach standing right next to them. We have also used tablets as prompts for individuals to complete their tasks at their job who may require some additional reminders.” 

Emory Valley Center 

“We utilize cell phones with apps for assessments to discover people’s interests, and support independent travel.” Emory Valley Center also has utilized virtual reality games for people to explore interests and be exposed to employment options. The organization has used tablets, applications with prompts and reminders, virtual checklists, and specialized cell phones that are only used for 2-way communication between the job coach and the person. The organization continues to grow, saying “we are in the process now of exploring what remote job coaching with a live video feed might look like.” 

Innovative Support Strategies 

The providers shared several innovative ways they have provided support to people, including specific real-world stories and strategies of people receiving employment services.  

Emory Valley Center 

“We recently supported a person that has bounced around from job to job for several years now but never stayed anywhere longer than a year. We encouraged him to go through a discovery process. During the discovery process, he visited several “hospitality” type jobs. He finally visited Top Golf and he immediately knew that was the place he wanted to be. It offered everything he loved – sports, helping people, and being social. He has now been there for several months, works independently with natural co-worker supports, and utilizes public transportation! He not only found a job that he enjoys, but a community of people that support him and see him as a valued member of their team!” 

Briggs & Associates 

“An example of this was at Children’s Healthcare of Atlanta where someone we support wanted to work, but he required support in order to do so safely. Briggs staff arranged a system in which he would place his phone on the rolling cart he used to stock supplies throughout the unit. He was within view of the camera at all times and his Briggs supports were able to give him verbal feedback in order to ensure compliance to the health and safety requirements of the hospital. The team also utilized natural supports within the hospital unit to reinforce anything that needed to be conducted in-person. Hospital staff were grateful for this outside-of-the-box approach, as it allowed their processes to carry on as normal at such a critical time in the healthcare industry.” 

Kreider Services Inc. 

“Utilize natural supports! A young man that lacks self-confidence due to reading and communication skills recently got hired on at his local convenience store. It’s in his backyard and he is very familiar with the staff and feels comfortable there. He works in an area by himself stocking shelves. The employer created small pictures to align where the drinks go as an accommodation. This has helped him be successful in competitive, integrated employment in his community where he might have been set up for failure in another environment.” 

UNC TEACCH Autism Program 

“We recognize that people on the autism spectrum have a learning style that may be different than those not on the spectrum. We take the time to understand how the individual sees and processes information in the world. Every individual works and learns best when people understand how they think. From there, we use what we call Structured TEACCHing to create visual systems tailored to the individual’s unique learning style. Recognizing that a person may learn better when things are written down, drawn out, or organized in a certain way, really helps them achieve greater success than if they were only verbally told everything.” 

Charles Lea Center 

“We started out as a very traditional employment program. We are embarrassed to say at one point we had over 280 people in this [workshop] setting. However, as we began to embrace employment first, we recognized that our whole approach to employment needed to change. We were successful in moving [most] people from the industrial work setting to community-based jobs. We also recognized that if we expected our community to hire people with disabilities that we needed to do the same as well. We have completely revamped our community employment program to focus on the career interests of potential employees and match them with jobs in the community. We also recognized the need to develop training in soft work skills such as working with your supervisor, how to fit in, and communication.” 

Sesdac, Inc. 

“Success in employment begins with understanding the individual, including their job preferences, preferred working hours, and desired workplace. This understanding can be achieved through formal evaluations, situational assessments, or informal conversations that delve into their interests, likes, dislikes, and work history, allowing for a personalized approach to finding the right employment fit.” 

Transforming Employment Services At Your Organization 

Work brings value to people’s lives and employment services providers have a responsibility to continue evolving and progressing to creatively find people meaningful careers. CQL’s data shows that overall quality of life outcomes are affected by whether someone chooses where they work. 

CQL is incredibly grateful for the insights and responses from all of the provider partners that contributed to this article with practical tips for staff recruitment and retention, how to use technology to better support people to be successful in their careers, and examples of their innovative approaches to employment services.  

For more information about employment services, please see the following resources:  

• Overcoming Challenges in Transforming Day Services: https://www.c-q-l.org/resources/webinars/overcoming-challenges-in-transforming-day-services/ 
• Moving from Sub-Minimum Wage to Supported Employment: https://www.c-q-l.org/resources/newsletters/from-sub-minimum-wage-to-supported-employment/ 
• Advancing Competitive Integrated Employment for People with Disabilities: https://www.c-q-l.org/resources/newsletters/advancing-competitive-integrated-employment-for-people-with-disabilities/ 
• United States Department of Labor Office of Disability Employment Policy: https://www.dol.gov/agencies/odep 
• The Association of People Supporting Employment First (APSE): https://apse.org/ 
• Wise: https://www.gowise.org/ 
• Job Bank For Persons with Disabilities, Canada: https://www.jobbank.gc.ca/persons-with-disabilities 
• Disability, Work, and Inclusion in Ireland: https://www.oecd.org/cfe/disability-work-and-inclusion-in-ireland-74b45baa-en.htm 

References:  

United States Office of Disease Prevention and Health Promotion. (n.d.) Social determinants of health. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. 

World Health Organization. (2010) A conceptual framework for action on the social determinants of health: Social determinants of health discussion paper 2 (policy and practice). Geneva, Switzerland: Author.