Supported employment


Supported employment refers to service provisions wherein people with disabilities, including intellectual disabilities, mental health, and traumatic brain injury, among others, are assisted with obtaining and maintaining employment. Supported employment is considered to be one form of employment in which wages are expected, together with benefits from an employer in a competitive workplace, though some versions refer to disability agency paid employment. Companies such as Skilcraft in the United States are an example of "supported employment" which is defined in law for state and federal reimbursements.

Community foundations of supported employment

Supported employment was developed in the United States in the 1970s as part of both vocational rehabilitation services and the advocacy for long term services and supports for individuals with significant disabilities in competitive job placements in integrated settings. Since the mid-1980s, supported employment in the professional literature primarily has referred to the "individual placement" model, either with job coaches or through "natural supports" models. The critical issue in supported employment was viewed as the need for funding for long-term services and supports in the community often termed beyond "case closure". Supported employment is worldwide in 2013, though moving to new inclusive models, and the term has been used for assisting workers of diverse kinds who may need an extra jump start in the workplace; it is still associated with its roots in disability which includes community integration and deinstitutionalization

University development of concept

Supported employment came from the community non-profit sector as an effort with government to offer services to individuals with significant disabilities, some of whom were moving from institutional life, in local communities for "supported work". Community personnel entered rehabilitation programs, for degrees, and began an academic professionalization of the fields. 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 in order to include candidates regardless of the nature or degree of their disability".
""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. A Rehabilitation Research and Training Center 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.

Diversity in supported employment models

By 1985, supported employment based on community integration had diverse vocational models in the US, including the social relationship concept of "disabled and non-disabled co-workers" working side-by-side in integrated workplaces. Both consumers and parents supported the new movement, seeking better opportunities for jobs, and later careers. A leading text on "Critical Issues in the Lives of People with Severe Disabilities" highlighted Supported Employment as one of the emerging practices with research already available on benefit-costs, consumer wages, social integration, and ongoing support.
In the psychiatric field, the prominent approach, also very innovative in long term services and supports was transitional employment associated with the now international Clubhouse Model of Fountain House in New York City. Gary Bond reported supported work as a modification of this approach. Paul Carling of the University of Vermont supported the development of community employment options in the field of psychiatric disabilities; Paul Wehman conducted critical cross-disability studies near the Medical School; Dr. Steven Murphy adapted employment supports for the psychiatric field; Julie Ann Racino confirmed related affirmative business and family models, and Dr. William Anthony of Boston University and his research center continues to work since the 1980s on a "get-choose-keep" approach to employment.

US legal basis

The legal "Integration" base for supported employment was described by Frank Laski, of The Public Interest Law Center in Philadelphia, Pennsylvania, as being the Education for All Handicapped Children Act and the Rehabilitation Act of 1973 passed by the US Congress. He also found strong support for moving from sheltered settings to supported employment in Developmentally Disabled Assistance and Bill of Rights Act and fully supported a "zero reject" policy, individualized work plans, and questioning the notion of the "employability" concept.
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" . 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 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.
By 1991, proposed rules for the State Supported Employment Grant Program were published in the Federal Register for comment by the US Department of Education, and the announcement was made available to deaf and hearing impaired individuals through a TDD service. The Rehabilitation Services Administration received comments, and the intent was to advance the program authorized under the Rehabilitation Act of 1973, Part C, as amended which supported disability rights in employment in the community. It also advanced the national goals of "literacy and "lifelong learning" for skills in the "global economy". in 2013, the US Department of Education, Office of Special Education and Rehabilitation, Rehabilitation Services Administration, issued a policy directive on supported employment.

United States development of supported employment

In the United States, supported employment is defined in the Rehabilitation Act, as amended. 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 in the community. Federal funding is funneled through state Vocational Rehabilitation agencies, and categorical state agencies and their regional offices are also involved, including Home and Community-Based Medicaid Services Waiver funded programs nationwide.

Core definition

Here is a representation of the core definition of supported employment as it is contained in the Rehabilitation Act Amendments. 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:
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".
Principles of Parents for Positive Futures were: real jobs in real workplaces, services for all, ongoing support, social integration, and individualized and flexible. Self advocates agreed with Real jobs for real pay, especially starting from "make work" in institutional settings.
In the vocational rehabilitation systems, concepts of working with business and industry, competitive employment, transition to the workforces from schools, and traditional obstacles to work including competition, are all addressed in the VR systems.

Costs

Costs of supported employment have been an area of research and study since its inception, and include academic studies in categorical disability areas regarding long-term services in competitive settings.
Supported employment was designed to be cost-effective and cost-beneficial, and indeed has been documented to be so as a key community services in public administration and disability. However, two cost trends are the medical center gates which change the cost structure and personnel ; and a government trend to cut the cost of its already lean services.
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".
However, concerns regarding subminimum wage and employment extend to the community, 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 whom others viewed as "permanently unemployable" or "unable to work".
In addition, reviews of costs and benefits do not indicate the revenue streams for supported employment, especially when these programs can be one service of a large community "disability NGO" and were eligible for Medicaid financing as early as 1991. Government itself in the late 2000s is increasingly concerned about costs, and vocational rehabilitation services, are being reviewed for their cost-effectiveness and ways to increase positive outcomes for clientele of their services

Employment supports

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. For over 30 years supported employment has demonstrated that individuals with severe disabilities can work, yet today many individuals remain segregated in sheltered workshops and day programs. Efforts to convert sheltered workshops to provide supported employment 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 to integrated vocational approaches in the community. 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 vocational rehabilitation service, is used to assist individuals with gaining and maintaining employment. These practices may involve a supported employment service provider to understand how to customize employment and provide supports, school personnel in transition, or it may involve an approach similar to bridgebuilding and person-centered community development. Supports could include: modifying a job, adding accommodations or assistive technology, enhancing on the job site training among other approaches, such as identifying network relationships and training parents regarding better futures. 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"; however, with a newer movement toward the development of "non-work supports".
Early supported employment agency leaders, shifting from services to supports, included Jerry Kiracofe's Human Services Institute in Maryland, Jeffrey Strully originally in Kentucky at Seven Counties Services, Richard Crowley's area agency in New Hampshire, ENABLE and Transitional Living Services in New York, agencies in Oregon, Wisconsin 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. Supported employment was studied early in Canada in relationship to quality of life and an employment support worker.

Personal assistance services

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.. Personal assistance services has expanded to be an important component of "workplace supports" and is part of working schemes in countries such as Sweden. 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. 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.

Natural supports

Natural supports models were funded by the federal and state governments, but public discussion of the concept and implementation has been lacking giving its relevance to workplaces and its federal research status. "Natural supports funding packages" were recommended by the university sector to state employment agencies with preferences for schemes which are based upon coworker training, the use of employment specialists to facilitate natural supports, and matching the supported employee with the natural supports of the worksites. Early models of "natural supports" were proposed by the rehabilitation community as part of research studies, and knowing the colloquial paths of this approach international speaker Racino retorted, "What is natural about natural supports anyway?" The natural supports approaches were also aligned with related initiatives including empowerment and choice in employment, and gender differences in supported employment.

Reasonable accommodations as an employment support

One of the innovations from work with the Rehabilitation Act of 1973 as amended in 1978 was the application of the concept of reasonable accommodations to fields such as psychiatric disabilities. As part of deinstitutionalization efforts, now at the US Supreme Court's Olmstead Decision of 1999, "long-term services and supports" clients were seeking work in communities to support themselves in homes and daily lives. Systemic efforts were made to identify barriers to employment, and legal avenues were also opened as described by Dr. Peter Blanck on the Americans with Disabilities Act of 1990. Reasonable accommodation allowed modifications on the job, while still retaining the competitive job site and pay grades in the community. The term "employment supports" was also applied to efforts to assist individuals which may come to the rehabilitation system with a "mental health diagnosis". These efforts may resemble those termed "natural supports" since job retention, as opposed to job placement may be key.

Systems change

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. For example, in 1995, California leaders Steve Zivolich and Jan Weiner-Zivolich inquired of the provider and governmental sectors: "If Not Now, When?: The Case Against Waiting for Sheltered Workshop Changeover." 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.
Conversion of sheltered workshops was recommended in the 1990s as part of the effort to shift financing and services to integrated settings. State trends in "conversion" to integrated work have been monitored by the Institute for Inclusion in Boston and are available on the internet.
"Local community rehabilitation agencies providing supported employment grew from just over 300 in 1986 to approximately 5,000 in 1993". However, Wehman and Kregel 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.
Racino reported that the changes required in areas termed "support services" require other than the traditional "organizational" or "systems change" strategies of professional education and training. For example, in a study involving herself, the VR system continued to revert to the 1970s "entry level" position as the agreed upon approach to personnel with high educational degrees and extensive work experiences similar to parents of children with disabilities who might be in entry level jobs with high degrees. These issues have been termed "attitudinal" problems or lowered expectations and aspirations for people with disabilities which may emanate from the employers, the public, or from the service workers themselves. In addition, traditional barriers schemas target the agency management and regulatory and legislative bodies as intransegient in modernization.

Individual Placement Model (IPS)

helps people with severe mental illness work at regular jobs of their choosing. Although variations of supported employment exist, IPS refers to the evidence-based practice of supported employment as validated by new universities and medical centers involved in employment. 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
Another earlier model was termed the hybrid case management/supported employment model which was reported on by Carol Mowbray of the University of Michigan, who studied mental health services nationwide, as a WINS research and demonstration model. These models critique earlier models and goals such as zero reject and "linear models" and emphasize the comprehensive planning aspects of multi-agency "individual placements".
The New Hampshire-Dartmouth Psychiatric Research Center considers day treatment programs, often previously known as day habilitation programs in the community, and supported employment to be two kinds of comparative outpatient services. This research group, following others in the US, reaffirms that supported employment can improve outcomes such as integration. Day treatment is also a set of "educational, counseling, and family interventions" which may be used for children and youth per Krista Kutash of Florida's Research Center for Children with Emotional Needs ; whereas these "support services" may be applicable for adults, supported employment typically is an adult service and for youth transitioning to work settings.
By 2006, supported employment was part of a web-based certificate series with a new certificate for "supported competitive employment for individuals with mental illness". Typically, the audience are service providers who offer vocational and supported employment services ; these services build upon both traditional funded vocational rehabilitation categories and newer concepts of career development versus jobs and job placements.

Education and training

Supported employment, commonly a community service in the fields of rehabilitation, has roots both in the university sector, the vocational rehabilitation state and regional offices, and in the categorical service system of intellectual and developmental disabilities. As early as the mid-1980s, supported employment was an accepted inservice training topic with extensive working papers, videotapes, presentations, case studies, written books and products, and very reputable network of university personnel, including in severe disabilities. As indicated above, university certificates have been available since the mid-2000s on the web, and even earlier from the university sector preonline courses. Certification is highly recommended, and indeed in most "providing sectors" needs to be required as providers tend to self-certify only. Traditional rehabilitation programs expected all rehabilitation personnel education programs to prepare for integrative and competitive employment as early as the 1980s.
Early skills recommended were both generic professional helping skills and specific employment-related skills for workers. In addition, exceptional skills are required and more for conversion of traditional day programs to integrated employment systems. Marc Gold's Michael Callahan, after tackling the institutional populations, was one of the 4 decade or more leaders to community employment supporting the provider sector.

Special populations

Autism

In the 21st Century, autism is a primary "disability" that frames the progressive advances in the community services fields. The special issue of the Journal of Vocational Rehabilitation was published on January 1994 with Marcia Datlow Smith as Editor. The focus has a behavioral emphasis and the concept and realities of supported employment are considered revolutionary for "children who had difficulty in communication, speech, and the world in their immediate space." The issue includes a study of 70 individuals with autism served by the Community Services for Autistic Adults and Children in state of Maryland.

Brain injury

Community services in head and brain injury took on a new priority in the 1990s, and for the first time, work and living options were explored in conjunction with the newly formed state associations of head injury administrators. These services were scientifically studied in states such as New York at their Buffalo and Syracuse university centers in the context of changing public policy. The traditional rehabilitation concept of return to work was also developed in depth at the university sector with the relatively new cognitive rehabilitation or cognitive remediation.

Mental health and intellectual disabilities

While for categorical state and local NGOs, work and community employment was accepted relatively early on as possible but difficult in "severe mental illness", but changing the state-federal vocational rehabilitation system was considered more difficult. In 1993, John Kregel at the International Association of Persons with Severe Handicaps, reported that individuals with severe mental retardation, autism, physical disabilities and other groups continue to compromise a small percentage of supported employment participants. A systematic review investigated the effects of supported employment for adults with severe mental illness:

Women and Supported Employment: Gender

The university sector leaders in supported employment in the 1980s included Parents for Positive Futures which were women and men, women CEOs of non-profit organizations, women state and NGO management, and women university professionals and researchers. In addition, it was not until decades later that the complexity of gender and its role in the workforce began to appear in the American literatures "with special population women management".
In part this discrepancy was due to what was termed the "male education of high women in America," such as this author's over 40 male professors and 2 women professors for her Bachelor's degree at Cornell University in 1975 . Our Nordic lead began with gender perspectives on family caregiving and published "in house" a supported employment bibliography from gender perspectives.
In addition, the major federal research center in "mental retardation/intellectual and developmental disabilities" in the US has been "male-led" as Director, Associate Director and Technical Assistance to US States) for over 3 decades However, women have held key roles in labor and disability, including Suzanne Bruyere of Cornell University ILR School. Since supported employment is a subset of employment and now business entrepreneurships, analyses of its role and effects in the broader employment studies is still open for further research.

Other Countries

"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.".
Other countries around the globe use the terminology 'supported employment' and each one has its own definition. In 1995, Steven Byer who visited the US from the United Kingdom, authored a chapter on Real jobs and supported employment for a leading book, "Values and Visions" by the King's Fund Linda Ward. Prior to that book, Britain's Ordinary Lives leader David Towell cited the US supported employment in "Enabling Community Integration" to assist public authorities in the UK to move toward integration in community life. In 2012, the "Journal of Vocational Rehabilitation" highlighted the status in the European Union, inclusive of Germany, Norway and the Scandinavian countries, and the United Kingdom. In particular, the European Union on Supported Employment is examining inclusion skills competencies.
Supported employment remains underdeveloped, in spite of its years of available direct university education and training to the provider, financing and regulatory sectors. In the US, the inquiry can and has been made to state and local governments: "Where are the successes?" based on the decades of infusion of funds, assistance, exemplars, for "state systems change." The Journal of Vocational Rehabilitation celebrated its 20th Anniversary in 2011 under the leadership of Dr. Paul Wehman, and over 3,000 special education or inclusion teachers annually learn of new developments at the International Association of Persons with Severe Handicaps Annual Conference.
Stefan Doose of Germany indicates a new federal Inklusion program which promotes transition from school to work, and from sheltered workshops direct to the labor markets. Great Britain supported opportunities for Ordinary Lives, which included moving from day centres to supported employment as early as the late 1980s.
Today, the United Nations Convention on the Rights of Persons with Disabilities supports the right to employment, among its articles ratified by over 100 countries and in the implementation stages.
Supported employment services may be provided as direct vocational support to job seekers with disabilities, or in the form of affecting demand for labor through employment policies. From an international perspective, examples of employment schemes used on employers to generate an expansion of job opportunities for persons with disabilities include employment incentive structure and minimum employment quota. The employment incentive system is a financial measure taken in an open employment environment to integrate PWDs into the workforce and may encompass benefits such as wage subsidies and funding for adaptations to the work environment. The minimum employment quota is a legislative affirmative action that attempts to create equal opportunity for persons with disabilities by ensuring that a proportion of employees consist of PWDs. The two schemes are not mutually exclusive and may be used in hybridity.
Employment IncentiveEmployment Quota
voluntary engagementlegally mandated participation
provides subsidies to participating employers as compensationestablishes a bottom level percentage for the proportion of PWDs in the workforce
does not penalize non-participating employerslevies employers that fail to meet quota
produces supported employment opportunities through participating employersproduces supported employment opportunities through participating employers and revenue collected by levies

Asia

Hong Kong

The Labor Department of Government of Hong Kong's Labour and Welfare Bureau provides free supported employment services under the Selective Placement Division, which was established in 1980. The SPD launched the Work Orientation and Placement Scheme in 2013, serving to incentivize employers to hire job seekers with disabilities. Through WOPS, participating employers are granted a maximum total allowance of 51,000 HKD per employee with disabilities who have employment difficulties and 30,000 HKD per employee with disabilities who do not employment difficulties. The allowance, respectively, is divided through nine months and six months of employment. The employers participating in WOPS are required to have a mentor staff that can provide on-the-job support for the new employee, and the length of the employment contract must be 3 months or longer. Furthermore, WOPS provides short term pre-employment training to job seekers to strengthen their chance of employment. After completing the pre-employment training, the trainees receive an allowance of $80 per training day.
The Social Welfare Department of the Labour and Welfare Bureau also provides employment assistance to job seekers with disabilities through Supported Employment and Support Programme for Employees with Disabilities. SE provides sheltered workshops to train individuals with disabilities that are unable to obtain open employment. SE service includes employment counseling, job finding and matching, follow-through support and employment-related skills training. On the other hand, SPED is an incentive system for the employers initiated in 2014 to aid employees with disabilities to retain their status as an employee in open employment. SPED provides one-off-subsidy to participating employers for modifying the workspace to accommodate for special needs or equipping the workplace with assistive devices that can enhance the work efficiency of workers with disabilities. The level of subsidy is capped at 20,000 HKD per employee with disabilities.

Singapore

Initiated by the Workforce Development Agency and the Ministry of Social and Family Development in 2014, the Open Door Programme encourages employers to provide employment opportunities to individuals with disabilities and to create an accessible work environment for the employees with special needs. Through the ODP, the employers receive Job Redesign Grant up to 20,000 SGD per employee with disabilities, supporting up to 90% of the costs of redesigning the job scopes to accommodate the employees’ conditions. Moreover, the employers are incentivized to provide special training for PWDs as 90% of the training course fee is funded by the ODP. As of 2015, the Government of Singapore has subsidized 3.2 million SGD through the Open Door Fund.
In addition, the Special Employment Credit started to provide budget initiatives to the employers in 2012 by funding 16% of the monthly wages of employees with disabilities who earn up to 4,000 SGD per month. To encourage re-employment, Additional Special Employment Credit, which funds 22% of the employee’s monthly wages, was initiated in 2015 as an amendment to the SEC program. Singapore Workforce Development Agency also provides Workfare Schemes, which tops up the wages of the employees with Workfare Income Supplement and encourages employers to educate the employees with Workfare Training Support. WIS provides annual payouts capped at 4,000 SGD in terms of monthly cash and life annuity scheme called Central Provident Fund to aid expenditure and retirement savings for employees with disabilities. WTS subsidizes 95% of the training fees in addition to 95% of absentee payroll for the employee in training.

China

, a national nonprofit organization founded in 1988, provides supported employment to job seekers with disabilities through free services such as consultation, rehabilitation and training for employment, and job referrals.
In 2008, a quota system that aims to protect the employment of persons with disabilities was established under Regulations on the Employment of Persons with Disabilities, through which the Chinese Government mandates all public and private organizations to secure at least 1.5% of job opportunities to PWDs. The exact percentage of quota varies amongst different provinces in China but is no less than 1.5%. Employers that fail to meet the quota must pay proportionate amounts of penalty to the Disabled Employment Security Fund. The revenue resulting from the levies is disbursed to provide supported employment in forms of vocational training and job placement career services. Employers that satisfy or surpass the quota are subsidized through taxation benefits, cash rewards and technical assistance to incentivize employment of job seekers with disabilities.
Regulations on the Employment of Persons with Disabilities also encourage self-employment by assisting PWDs with starting their own enterprises. The government helps PWDs who engage in entrepreneurial activities by providing tax exemptions and assistance in obtaining a workplace and licenses.