Best Practices Guide: IDD Supported Employment Cardinal Innovations Healthcare Best Practices Guide: IDD Supported Employment Table of Contents Introduction ........................................................................................................................................................3 Employment in Disabilities ...................................................................................................................................4 Readiness Issue/Determining Readiness ...............................................................................................................5 Role of the Job Coach ...........................................................................................................................................6 Initial Supported Employment-Individual services may include any of the following: ............................................ 6 Long-Term Follow-Along Supported Employment-Individual services include: ....................................................... 9 Comparison to and Integration with Other Services ............................................................................................ 10 Age Group Learning and Life Stage Considerations .............................................................................................. 11 The Role of Contextual Influences ...................................................................................................................... 12 Addressing Behavioral Needs in Supported Employment .................................................................................... 12 Preference Assessment Across the Lifespan ........................................................................................................ 13 Level or Intensity of Supported Employment Service ........................................................................................... 14 Supported Employment Funding Sources ............................................................................................................ 15 Vocational Rehabilitation Services ...................................................................................................................... 16 References ......................................................................................................................................................... 19 Page 2 of 20 Cardinal Innovations Healthcare Best Practices Guide: IDD Supported Employment Introduction Supported Employment (SE) options have enabled individuals with significant support needs to become employed in the community. In the United States, the definition of Supported Employment is as follows: 1. Supported Employment means: a. Competitive employment in an integrated setting with ongoing support services for individuals with the most severe disabilities i. For whom competitive employment has not traditionally occurred or for whom competitive employment has been interrupted or intermittent as a result of a severe disability; and ii. Who, because of the nature and severity of their disabilities, need intensive Supported Employment services and extended services after transition in order to perform this work; OR b. Transitional employment for individuals with the most severe disabilities due to mental illness.1,5 We know now that individual Supported Employment is superior in terms of program outcomes,1,2 philosophy, and cost.3,4 In the individual approach, a professional Vocational Rehabilitation specialist (often referred to as a job coach) provides an array of supports to assist a person with a significant disability in obtaining and maintaining competitive employment in the community. The initial component of the service involves assisting the job seeker with 1) identifying his or her abilities and how these may relate to work and 2) specifying vocational interests and preferences. Next, job development services geared toward helping the person secure work are offered. Sometimes, existing positions within a business are pursued and, at other times, employers may be approached about creating a specific position for the job seeker. Typically, the job coach first meets with an employer to learn more about a business’ operations and potential labor needs. Then, when viable opportunities begin to emerge, a meeting may be set up between the employer and the job seeker. At this point, the typical pre-employment process begins, which involves completing an application and participating in an interview, all of which is supported by the job coach. The level of involvement will vary from business to business and is dependent on the skill level of the job seeker. If a job is found or developed that is a suitable match for the job seeker and the employer is agreeable, employment is secured. All parties involved benefit from competitive and integrated employment, which provides the individual with a disability a real job, benefits, and the dignity that arises from gainful employment. With SE, the employer gets a good employee and receives specialized support for job acquisition and retention. The family can see the newly employed family member in a fully competent role in the workplace. Finally, taxpayers spend less money than they would to support the individual in a segregated day program. Inherent in the SE process are basic values. See Table 1 Page 3 of 20 Cardinal Innovations Healthcare Best Practices Guide: IDD Supported Employment Table 1. Supported Employment Values Values Explanation Presumption of employment Everyone, regardless of the level or the type of disability, has the capability and right to a job Competitive employment Employment must occur within the labor market in regular community businesses Self-determination and control People with disabilities must choose and regulate their own employment supports and services, which will ultimately lead to career and life satisfaction Commensurate wages & benefits People with disabilities should earn wages and benefits equal to that of coworkers performing the same or similar jobs Focus on capacity & capabilities People with disabilities should be viewed in terms of their abilities, strengths, and interests rather than their disabilities Importance of relationships Community relationships both at, and away from, work leads to mutual respect and acceptance Power of supports A conviction that people with disabilities need to determine their personal goals and receive assistance in assembling the supports necessary to achieve their ambitions Systems change Traditional systems must be changed to support self-determination, which is vital to the integrity of Supported Employment Importance of community People need to be connected to the formal and informal networks of a community for acceptance, growth, and development Wehman, P. Supported Employment: What is it? Journal of Vocational Rehabilitation, 37, p. 141. In addition, all individuals have both a need and a right to develop a meaningful day. Most individuals need to feel a sense of productivity and that they are contributing members to society. Supported Employment provides such an opportunity. In addition to the structure, routine, physical activity, and mental activity, SE provides not only a meaningful day, but it also helps individuals enhance and maintain their skills and independence. Employment in Disabilities As of 2018, over 85% of people6 diagnosed with an intellectual or developmental disability were either unemployed or underemployed. As well, over two thirds of people diagnosed with a disability live below the poverty line.6 Many people with I/DD are placed in position that do not pay competitive wages or in sheltered workshops and prevocational type settings that offer limited options for growth or integration into the community. Not only does this limit opportunity for career growth but continues to reinforce negative stereotypes regarding those with I/DD as well as contribute to an ongoing cycle of poverty. Western culture places a strong emphasis on work ethics and the intrinsic value of work, which is often denied or provided with artificial limitations for those with disabilities. This is compounded by fears from family members or individuals themselves that they may lose supports such as Medicaid, transportation, or other assistance if they earn Page 4 of 20 Cardinal Innovations Healthcare Best Practices Guide: IDD Supported Employment too much money. Evidence indicates that integrated employment options provide benefits such as moving “an I/DD individual’s daily focus away from formal, paid supports and toward an integrated, self-sustaining life alongside individuals without disabilities.”7 Readiness Issue/Determining Readiness A person with I/DD does not have to be determined to be ready for job placement in order to be ready to begin Supported Employment (SE) services. Ideally, a provider should engage in an Employment First policy.8 This means that employment in the “general workforce” at a competitive wage is the first and preferred option.9 It is assumed that the person with I/DD can work until proven otherwise, rather than assuming that they must demonstrate “readiness to work.”10 Studies support that a rapid job search with individual placement is generally more successful than providing more lengthy pre-employment assessments, training, or counseling. There are very few pre-employment assessments for those with I/DD and limited information regarding their usefulness or efficacy in determining “readiness” for employment.