Community Resource Trainers: meeting the challenge of providing quality supported employment follow-along services.

Over the past ten years, the supported employment movement has made considerable progress placing individuals into competitive employment in integrated work settings. Data indicate an increase in the number of supported employment clients from 9,882 in FY 86 to 52,023 in FY 89 (Wehman, 1991). During this time the emphasis has been primarily on establishing a variety of service delivery models for individuals with disabilities. As a result the field of supported employment has primarily focused on job placement, securing financial resources, developing federal, state, and local policies and guidelines, and ensuring interagency collaboration.

Currently, a "second generation" of supported employment issues which focus primarily on providing "quality" services are emerging (Kregel, Shafer, Wehman, & West, 1989; Storey, Sandow, & Rhodes, 1990). For example, quality services might include developing worksites in highly valued community jobs that enhance the image of workers (Nisbet, Callahan, & Dileo, 1989), teaching co-workers to assist with training (Hughes, Rusch, & Curl, 1990) and empowering individuals to make career choices (Wood, Steere, Powell, Rammler, & Butterworth, 1989). This focus is also reflected in the growing number of quality assurance documents (e.g., Nisbet, Callahan, & Dileo, 1990; Trach & Rusch, 1989).

One area critical to providing quality supported employment services that has received little attention is follow-along. As individuals are placed and trained, more and more individuals enter into follow-along. As the number of individuals in follow along increases, the ability of the job coach to provide quality services decreases. Today's job coach cannot realistically be expected to develop jobs, conduct job training, and provide follow-along services. One innovative approach to solving this dilemma could be to utilize a new supported employment position called a Community Resource Trainer to provide long-term follow-along support. The purpose of this article will be to: (a) describe how Community Resources Training developed within a private, non-profit supported employment agency; (b) describe the role of the Community Resource Trainer; (c) suggest mechanisms for funding Community Resource Trainers; and (d) provide two case studies to illustrate the range of duties for Community Resource Trainers.

Description of SET, Inc. and The Community Resources Training Program

Supported Employment Training, Inc. (SET, Inc.) is a private, non-profit, free-standing agency that specializes in supported employment services. SET, Inc. does not operate any traditional workshop or adult day activity programs. The agency is headquartered in an office which houses the administrative staff and provides the minimal office space and supplies necessary to provide client services.

Incorporated in 1987, SET, Inc. was one of the ten original supported employment programs initiated through the federally funded North Carolina systems change grant. The agency provides both job coach and workstation services for urban and rural communities. SET, Inc. serves individuals with developmental disabilities and annually places 15 to 20 workers in supported employment services and currently serves 44 workers in individual supported jobs and 16 workers in workstations. Worker salaries in individual supported jobs range from $3.80 - $7.03/hr with an average salary of $4.35/hr. Workers' salaries in workstation range from $.50 - 4.00/hr with an average salary of $3.00/hr. To date, workers placed by SET, Inc. have total earnings over $500,000. Finally, the majority of individuals served by SET, Inc. are labelled as mild, moderate, or severely mentally retarded, however, SET, Inc. currently serves persons labelled as autistic, chronically mentally ill, and persons with traumatic brain injury.

SET, Inc. staff include an Executive Director, a fiscal manager, 3 1/2 full-time job coaches, 2 1/2 full-time Community Resources Trainers, and 1 workstation supervisor. The agency is governed by a five member Board of Directors. At SET, Inc. job coaches provide only the time-limited training services required by workers while Community Resource Trainers provide all follow-along services.

The concept of Community Resource Training is not new. Keul, Spooner, Grossi, and Heller (1987) described the dual role of the Community Resource Trainer as part independent living skills instructor (e.g., teaching bus riding, money skills, and social skills) and part social services/case manager. As such, Community Resource Trainers provide an ideal combination of services to meet the complex follow-along needs of supported employment consumers.

As persons with disabilities enter the workforce through supported employment they begin to encounter all the problems and possibilities of working and living within the community. Some of the issues which will need to be realistically dealt with by workers with disabilities include: (a) spending their earnings, (b) dealing with co-workers without disabilities, and (c) learning to function as individually as possible within the community and the workplace.

The primary responsibilities of the Community Resource Trainer (CRT) are to ensure that job performance remains acceptable to employers and to assist the supported employee with any non-work related issues with which they might need help. These issues could include banking and money skills, personal/sexual concerns or information, and transportation.

Community Resource Trainers enter the picture as workers are ready to be successfully closed from intensive training services. During the final weeks of fading and stabilization the CRT accompanies the job coach to the job site to meet the employer and worker and to view the training environment. At this time the CRT schedules a home visit with the worker and family to develop an ongoing individual program habilitation plan (IPP) for the worker during follow-along.

The IPP is the basis upon which all follow-along activities are implemented. Typically the IPP includes three goals for each worker. The first goal centers on work performance and is designed to address specific issues of work quality, speed, and consistency. The second goal focuses on social interactions and is individualized relative to a worker's need to improve co-worker or supervisor interactions. The final goal targets a specific area of independent living that the worker desires to master. Independent living goals include areas such as handling money, access to leisure opportunities and activities, home living skills, transportation, and use of other community resources or services.

The independent living area can also focus on crisis assistance for workers and their families (e.g., death of a parent, loss of living arrangements, a mental health breakdown). These problems often require immediate attention from the CRT to assist the worker and family directly as well as to help secure additional assistance through community social services, counseling, and mental health professionals. Often the CRT will spend several days or weeks on a worker crisis. At these times it becomes evident how important it is to separate the job coach's time-limited responsibilities from the ongoing case management activities of the CRT. While the CRT provides follow-along services to workers who are in stabilization at SET, Inc., if the worker needs retraining or replacement on a new job for an extended period of weeks, a job coach can re-enter the worker's case with a new authorization for services from the vocational rehabilitation counselor.

Each CRT carries a caseload of 15 to 18 workers. Each worker receives an average of 1 1/2 to 2 hours per week or 4 to 8 hours per month.

Impact on Service Delivery

The rationale for separating the duties of follow-along from those of intensive job coaching rests upon the different client needs required during these two distinct phases of the worker's service delivery. Job coaching focuses on short term intervention and systematic training resulting in the steady acquisition of job skills by the worker over time. The goal of the job coach is to systematically "fade" from intensive training until his/her presence is no longer required by the worker to maintain satisfactory job quality and production. During this training it is essential that the job coach actively develop co-worker supports as well as supervisor confidence and skill in the direct management of the employee with a disability.

At SET, Inc., experience with numerous workers over six years of supported employment led to the decision to introduce more than one job coach early in the training phase. This strategy was successful in stemming the tendency for workers to become too attached to their job coach and not rely on existing job site supervisors and co-workers, especially when job training involved a challenging set of job duties or a worker with severe limitations. In addition the businesses benefitted by having more than one job coach with direct experience training on that job site when job coach illness or annual leave days required changing job coaches.

With this heavy emphasis on encouraging worker independence SET, Inc. has been very successful in achieving one of the highest placement rates in supported employment in North Carolina coupled with only a one third recidivism rate in the first year of employment. However, these outcomes in worker job maintenance would not be possible unless the follow-along component focused more directly on developing a personal/advocacy role with each worker. That role is assumed by the Community Resources Training Instructor (CRT) at the point when the job coach training has ended and the worker case is entering VR Closure, Status 22.

It is the CRT who continues to visit the job site at least twice each month and who assists the employer and worker in continuing to build upon the on-site supervision and co-worker support network initiated during training. The CRT also can focus on other skills training, crisis assistance, and worker advocacy needs that a job coach could not accommodate and still take on additional new workers to train. Additionally, the CRT can schedule more frequent job site visits because extensive initial training is being done by the job coaches.

Worker response to this service delivery model has been positive. Recently all workers placed by SET, Inc. were interviewed to determine their level of satisfaction with then current job and supported employment services received (Test, Hinson, Solow, & Keul, 1991). Findings indicated that the majority of workers: (a) liked their jobs, (b) were satisfied with services provided, (c) had a voice in choosing their job, (d) would rather work in the community than attend a workshop, and (e) said they had friends at work.

Funding Mechanisms

Supported employment services are usually supported by a combination of local and state funding sources. Initially supported employment programs may be established through discretionary money in the form of grants, contracts, or gifts from private or public entities. These funds become the capital needed to start a new program and possibly fund its operation for one or two years. However, since grants and start-up contracts do not ensure ongoing fiscal support, most agencies seek to maintain financial solvency by creating a combination of time-limited and ongoing funding resources using existing local and state funding mechanisms (Bellamy, Rhodes, Mack, & Albin, 1988; Kregel, et al., 1989).

State rehabilitation agency dollars are often used to fund the initial training of workers in supported employment. Case service dollars available through authorization from a vocational rehabilitation counselor can pay for assessment and screening for supported employment services, job development activities, and job site training time required to stabilize a worker at a supported employment job site. Once the vocational rehabilitation counselor places the worker's case in status 26, which closes the worker's case with vocational rehabilitation and terminates funding for that worker, ongoing funding mechanisms must be in place for continued support of the worker in a job and community.

Funds used to support adult day activity centers and programs are available through state departments of mental health and mental retardation. These funds, which have been traditionally used for sheltered workshop and day activity programs, are now being utilized to support workers in the follow-along phase in supported employment. This notion of re-directing existing funding resources from day programs to supported employment programs is a major premise of the supported employment initiative (Kregel, et al., 1989; Shafer, Kregel, Wehman, & West, 1989).

Another emerging source of funding for supported employment follow-along is the use of the social security work incentives PASS (Plan for Achieving Self Support) and IRWE (Impairment Related Work Expenses). These mechanisms can be used to support both initial training costs and follow-along services provided a specific habilitation plan is approved for a worker by the local Social Security Representative.

At SET, Inc. all three sources of funds are used to support the agency's operations. Time-limited funds are used through a vendorship agreement with the North Carolina Division of Vocational Rehabilitation to purchase all services related to the initial training costs for clients in supported employment. These services include initial assessment and screening, job development, and on-site job training. These duties are performed solely by job coaches at SET, Inc. Follow-along services, once the case is established in status 26, are provided by Community Resource Trainers who maintain all post-training contacts with workers, families, and employers.

Thus job coaches at SET, Inc. focus entirely on activities authorized and funded by Vocational Rehabilitation, while Community Resources Trainers are funded entirely from the Adult Day Activity Program funds (ADAP), secured through the local area Mental Health, Developmental Disabilities, and Substance Abuse Authority. Separation of these duties enhances not only the quality of services provided to workers, but also greatly simplifies the administration and fiscal management of the separate budgets.

Case Studies

Following are examples of how a CRT has benefited individuals who are currently served through Supported Employment Training, Inc.

Case #1 - Roy C.

Roy is a 29-year-old, white male who has been receiving SET, Inc. services for 3 years. Until July 1990, he had lived with his parents in their rural home. Roy has held three jobs and the CRT had received many poor supervisor work evaluations. Intensive job training and verbal counseling did not seem to have a lasting impact on his work performance. After repeated questioning over an extended period of time, Roy finally admitted that he never had any access to his paychecks. In fact, he was rarely allowed to even endorse the checks for cashing!

Roy's work performance continued to deteriorate and the supervisor at his present position was constantly working with his CRT to improve the work situation and identify possible life issues with which Roy was struggling. The CRT attempted to work with Roy's parents to improve his work performance and often only the threat of job termination would cause Roy's parents to respond to such issues as purchasing proper work attire or improving Roy's personal hygiene. After several episodes with Roy's parents the CRT began to realize they were dependent on his money. Roy confided to the CRT that his parents frequently used his paycheck for personal entertainment.

At this point the CRT discussed with Roy the option of establishing a savings account. Each payday the CRT would accompany Roy to the bank and help him deposit his check. It was decided that a certain amount would be given to his parents for rent, a certain amount would be deposited in a savings account, and Roy would keep a certain amount for personal spending. Roy was satisfied with this arrangement and the CRT was hopeful that the parents would be agreeable.

Unfortunately, the weekend after the account was opened Roy's father forced him to go to the bank and withdraw all his money. At the bank Mr. C. made such a scene that the bank tellers telephoned Roy's CRT. Roy's supervisor also called the CRT on the following Monday. The CRT notified the Department of Social Services about Roy's case. The CRT also spoke with Roy who, while upset, was not open to discussing the possibility of finding an alternate living arrangement. Roy seemed determined to work out his family problems. At this time, the Department of Social Services could not substantiate any wrong-doing in the family.

After the episode at the bank the CRT conducted a home visit with Roy's parents and found them very bitter and angry. They accused the CRT of trying to take Roy's money and get him fired. Shortly after the visit Roy confided to the CRT that his father was physically abusing him. However, Roy would still not discuss a group home placement. The CRT's contact with Roy was now only through the jobsite as his parents had demanded that they not be bothered. On one of these visits Roy asked his CRT to help him get out of his home. Since Roy was his own legal guardian, with his permission, the CRT immediately notified the local group home board and Roy was accepted.

Since this traumatic period Roy has settled in at his group home and his job evaluations have been excellent. Several months after the move, Roy visited his parents in their home. The visit was somewhat strained because his parents still resent his decision to move. Roy continues to maintain contact through visits with his family. He now realizes that he does not have to live at home to maintain his place in the family as their son.

Case #2 - Gail T.

Gail is a 24-year-old, white female who lives at home with her mother and father. She is classified as severely mentally retarded and has a full scale IQ of 31. Gail has been receiving SET, Inc. services for three years and has held three jobs during this time. She has been employed as a full time laundry attendant at a large metropolitan hotel since March 1989.

In the past, Gail and her CRT have concentrated on such goals as accessing community events and joining a local spa and health club. Recently, Gail expressed interest in improving her money skills.

Gail's CRT chose to teach her a modified form of the "one-more-than" technique. In this modified procedure, when a person is told a purchase amount (e.g., "that will be four dollars and sixty cents"), rather than counting out five dollars, the person is taught to put aside one dollar for the "cents piles" and then count out the correct number of dollars requested. Training was conducted approximately twice a month for six months. During that time Gail learned to use the technique for amounts up to $20.

A key factor in the training program involved teaching Gail's mother how to train and assist her daughter with the technique in the community. As a result, Gail's mother has given her many opportunities to utilize her money skills within the community. Gail has independently purchased cash items including fast food meals and clothing. Gail and her family are pleased with her new skill of making purchases independently and Gail is looking forward to taking greater control over her finances in the future.

Conclusion

As these studies point out, the role of community resource training is a necessary addition to supported employment services. Supported employment has emerged as an adult service with four distinct phases (or services); including community survey/job analysis, job match/placement, training, and follow-along (Goodall, Wehman, & Cleveland, 1983; Wehman & Kregel, 1985). So far, the job coach has been expected to provide all services. However, as increasing numbers of individuals are trained and enter the follow-along phase of supported employment, job coaches cannot be expected to provide all needed services, either practically or financially.

This article has suggested that the field of supported employment has grown to such an extent that it now makes sense to consider two distinct phases--training and follow-along. Training includes community surveys/job analyses, making job matches/placements, and conducting jobsite training. These services would continue to be provided by a job coach (or employment specialist). Follow-along services would be provided by a Community Resource Trainer. This dichotomy makes sense both in terms of service delivery to the worker, as well as, financially since funding for supported employment services is typically split along these lines.

This differentiation brings with it the need for determining what is meant by follow-along services. Clearly the first priority would focus on job maintenance. Recently, Renzaglia, Wheeler, Hanson, and Miller (1991) have recently demonstrated the need for criterion-referenced assessment of worker job performance as a crucial follow-along service and Flynn, Wacker, Berg, Green, and Hurd, (1991) have documented the need for systematic fading plans based on direct assessment of worker performance. However, this is probably only a part of the CRT's job duties. Determining what those services are should be guided by the principal of normalization and enhancing a person's total quality of life. To this extent additional follow-along services could include: (a) a variety of training experiences including social skills, independent living skills, and self-advocacy; (b) case-management services to ensure interagency coordination; and (c) crisis intervention.

In conclusion, the supported employment movement has reached the point where the job coach can no longer provide all services to all workers. If quality is to prevail, help is needed. This article has suggested that the problem can be addressed by the creating of a "new" supported employment position called Community Resource Trainer to provide follow-along services. In this capacity, the CRT can enable each individual in becoming a vital, active member of their community.

David W. Test, Ph.D., Department of Teaching Specialties. University of North Carolina at Charlotte, Charlotte. North Carolina 28223

References

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