Competitive employment strategies in the era of ADA.

"Too much of what we accept as rehabilitation dogma is inadequately tested. All of us should be deeply involved in demonstration and research. Too many organizations exist to protect and defend the past. This is not appropriate for ehabilitation because change is our business; changes which must occur not by chance but by design. Rehabilitation people must become more than critics of current governmental administrations. The rehabilitation movement must accelerate its involvement in politics and help to determine the nature of . . . policies on the national, State and local levels . . . Perhaps the best way to look at our field as it may be in the year 2000, is by looking at the workplace itself. Who will make up the labor force? What types of jobs will be needed? How will rehabilitation facilities train, motivate and recruit disabled workers? . . . We are living through a period of time where people everywhere are demolishing political walls and dogmas, so too must Rehabilitation."--Milton Cohen, 1990 [1]

Today, the field of vocational rehabilitation is being challenged as never before. The growth of rehabilitation services programs is being slowed by constrained public budgets, private financing is harder to generate, contracts are more difficult to obtain in a competitive environment, and there is no one to whom the costs can be passed along. Simultaneouslty, government policy has finally endorsed equal rights for people with disabilities in employment, public accommodation, transportation, and housing. The policies of the past--more government funding, more community financial support, more voluntary support, more business contracts--simply are not sufficient to provide the resources needed to achieve the goals of people with disabilities to participate in the economy. Perhaps nowhere is the pressure on resources so great and the unmet need so large as in the competitive employment arena. Now that we have documented the enormous unemployment among men and women with disabilities, what are we going to do about it?

There can be little doubt that the passage of ADA portends major improvements in employment of people with disabilities, but achieving private sector jobs has already proven to be quite difficult (low labor force participation by people with disabilities has been a very stable trend) an ADA alone cannot overcome all of the barriers that prevent jobs from being offered, accommodations provided and supports being implemented.

In creating a change so that people with disabilties actually can secure large numbers of jobs in the competitive economy, the key questions are: How can this be achieved? What models and strategies are effective or need to be tested? What relationships need to be established among consumers, rehabilitation providers and employers? Is more federal funding essential, or are there ways in which state, local and private resources can be combined to result in many more jobs? To an extent, only actual experience can provide answers to these questions. But, as Cohen points out, changes should be introduced by design and to the extent possible, based on research and demonstration.

Diversity of Rehabilitation Needs

All who are familiar with the history of vocational rehabilitation program development know of the many past "debates" concerning facility-based and community-based employment for people with moderate and sever disabilities. Today, there is widespread recognition that there may not be any one vocational rehabilitation approach that is absolutely indispensable and that rehabilitation must change to "engage with reality." The workplace is becoming the key locale of rehabilitation, and community integration is defining independence for people with disabilities. With these two principles in mind, the challenge for rehabilitation is to meet the requirements of each individual by using the multiple strategies now available and being tested towards obtaining competitive employment. As Nisbet and Hagner point out when discussing natural workplace supports, "Obviously, one support model will not be appropriate for everyone's needs. A series of different options are required, sufficiently broad and flexible to accommodate a wide variety of individual arrangements." [2] A multi-faceted approach is indispensable in responding to the overwhelming need for employment opportunities by people with disabilities. At the same time, it is not easy for many rehabilitation programs to develop expertise in many different options for multiple populations. Perhaps this is one reason why various providers often take a dogmatic approach to particular program strategies with which they are familiar. The rigid rentention of such approaches only leads to restricting opportunities and rejection of innovation.

The major challenge to program rigidity is the diversity of persons with disabilities and the sheer impossibility of providing effective competitive employment strategies through any one (or even several) model(s) for these populations. Change and adaptation are prominent today as rehabilitation providers of all kinds now assist many diverse groups, including people with physical, developmental and psychiatric disabilities, those with drug and alcohol addiction, people with AIDS, disadvantaged youth, the homeless, new

immigrants school dropouts, young people in transition from school to work, older people with disabilities, and people with traumatic injuries. While many programs exist with a specialty focus, it is clearly difficult to recommend any one employment strategy as most effective.

In response to diversity, rehabilitation has become more complex and differentiated. Today, most programs are not unidimensional but often serve multiple populations. This requires interaction with a wider number of funding sources and meeting their requirements has clearly become more and more burdensome for providers. Creating employment choices now necessitates flexibility in terms of management, program design and program application. Moreover, it is well recognized (although not as well actualized) that sound program development requires not only job placement and support but also community integration through residential, transportation and health services and family support. These additional supports have been found to significantly improve job retention and independent living.

Given this diversity, the importance of additional testing through research and demonstration becomes especially critical in defining the most effective ways to achieve employment outcomes which are of significant duration and are accompanied by community supports. In addition, diversity requires flexibility. Tried and true approaches can continue to be used; yet, at the same time, the field must experiment more boldly and develop even stronger partnerships with employers to, in effect, "test the limits of success" even for people with the most severe disabilities. As technology continues to make it possible for increasing independence, simultaneously it often enables productive work to be accomplished. This enhanced aspect of reasonable accommodation also requires further exploration and use in the workplace.

The diversity of people with disabilities and the need for multiple employment strategies is both the challenge and the strength of the future. Success will depend on a divesity of choices and flexible program administration reflecting the individual goals and desires of each person with disabilities to achieve integration in community life.

Employment Options

The rehabilitation literature is replete with descriptions of "successful" competitive employment program models. Sometimes models have been promulgated on the basis that they can be used for all types of persos with disabilities, while at other times models are "disability specific." Also, some approaches have generated controversy due to major differences of opinion concerning their goals, objectives and outcomes.

This review is not designed to either evaluate models or necessarily advocate their adoption. (Well-designed scientific studies which validate the effectiveness and efficiency of employment models are virtually nonexistent.) Rather, the models which follow are presented as guides and examples of the kinds of flexibility needed in responding to the requirements of different subgroups of people with disabilities.

Supported Employment. Clearly the most important "new" approach in vocational rehabilitation, supported employment (SE) [3,4] has gained widespread acceptance among rehabilitation providers throughout the country. Between 1980 and 1989 the number of people served through supported employment grew from under 10,000 to more than 50,000, particularly stimulated by grants from the Rehabilitation Services Administration, U.S. Department of Education. [5] Virtually all state vocational rehabilitation agencies and over one-third of the nation's 6,000-7,000 rehabilitation providers are now using the supported employment approach. In most instances, providers have added supported employment to their existing programs. The individual placement model predominates with nearly 60 percent of supported, employment participants served. Mobile work crew approaches are reported for 20 percent and enclave approaches for 17 percent of participants.

Use of supported employment is growing due to its significant increase in federal funding (from $5.3 million in 1986 to $63.6 million in 1989) as well as state agency funding (from $17.2 million in 1986 to $169.1 million in 1989). While state funds come from a variety of state agencies, including vocational rehabilitation, mental health/mental retardation, Medicaid, and state education agencies, the predminant funding sources are state departments of mental health, mental retardation and developmental disabilities.

Supported employment is currently used primarily for people with mild or moderate mental retardation (53 percent) and mental illness (20 percent). About 8 percent of the time, SE is used with people who have severe or profound mental retardation. Recently, SE has also been initiated for people with cerebral palsy, brain injuries and sensory impairments. A number of adaptations of group supported employment have also been used, including affirmative industries, benchwork, enclaves, mobile work crews, sheltered workshops (where Fair Labor Standards Act employment is used), and small business/entrepreneurial approaches. [6]

Comparison of these models has proven to be very difficult because of the problem of controlling for populations, resource use, pricing, subsidization, as well as other factors. There is obviously a continuum between models emphasizing support services, those focused on employment and those which emphasize both of these characteristics. Each model has its own benefits and costs and each may be more (or less) effective with some types of persons with disabilities. All of the models can be subsidized with government funds.

A crucial element in implementing any of the models is the degree to which they include consumer input and whether consumer decisions in fact determine how the model is used. In general, data are not available to accurately and fairly compare these models or to estimate the number of people who could use these approaches. However, the major goal of these models is employment and, particularly, shifting the focus of many traditional rehabilitation providers to a series of issues related to unsubsidized, competitive employment with fringe benefit packages. This is not to suggest that providers can simply begin to eliminate support services and focus solely on employment objectives. Rather, it means that the multiple alternatives now available can establish a set of options for providers in achieving community integration for larger numbers of people with disabilities. Only through the use of these and other models can rehabilitation ever begin to meet the employment requirements of people with disabilities.

Natural Workplace Supports. While some have suggested that true integration of people with disabilities would mean obtaining employment without any "assistance" from human service personnel (requiring employers to have all the requisite skills for accommodations, support, community services, etc.), others have identified natural employer supports as a viable alternative to supported employment, which requires heavy resource investment in job coaches who, by necessity, can only handle a limited number of clients. As federal and local rehabilitation resources have become much more constrained, virtually every rehabilitation provider has faced the fact that it will be impossible to employ a sufficient number of job coaches to meet client needs.

One alternative to the traditional supported employment job coach model has become known as "natural employer supports" and is based on naturally occurring workplace interactions and supports. The fundamental basis of this model is that reliance is placed primarily on co-workers or employer personnel arrangements for accommodating people with disabilities in the workplace. The influence of an outside human services professional, such as a job coach, is diminished or eliminated. Instead, the naturally occurring social milieu of the workplace is used to support the disabled employee.

Several models of natural workplace supports have been identified, including job mentors, co-workers as trainers, job-sharing, and the personal attendant as a vocational service provider. [7] These are only some of the possible options for employer natural supports for people with disabilities. There is clearly much room for additional innovations based on employer supports; and, in each case, there will be certain technical problems in connection with these options, such as fringe benefit provision, job schedules, accommodations, etc. Also, natural support models may still require formal supports from employers and community agencies to assure retention of employment and community integration. The choice of models must be determined by individual needs and preferences and flexibility must be used in adapting models to fit individual circumstances.

Finally, as with other employment approaches, there is a very real need to examine the processes used and outcomes achieved so that meaningful replication can take place in multiple settings. Only through research and demonstration can the field become more certain that these models will consistently produce desired outcomes.

Projects With Industry. The Projects With Industry Program (PWI) has clearly become the premier approach of involving private industry in the vocational rehabilitation field. From its modest beginning in 1968-70 with just 3 projects, there are now more than 100 PWI projects operating nationwide through $17 million in federal support from the Rehabilitation Services Administration. Data indicate that each year over 25,000 people are being served and more than 15,000 placements are made through PWI.

The fundamental principles of PWI--a partnership between private industry and rehabilitation providers (both public and private) to achieve competitive employment for people with disabilities--are well understood and are being effectively implemented throughout the nation. The challenge ahead is in fact to develop ways to more fully use the PWI network(s) now in place for the benefit of increased numbers of people with disabilities. PWI could easily be linked with people receiving benefits from entitlement programs, such as workers compensation, Social Security and Supplemental Security Income. In addition, with some modifications, PWI's could begin to focus on specialized groups of people, such as brain injured, chronically impaired and older disabled people and youth in transition.

Given the strength of the PWI network, consideration could certainly be given to making the program more stable and more integrated within the structure of the business and rehabilitation communities. The need to frequently re-compete the program in the traditional grant mode is certainly no longer necessary. Providing a stable structure for employer-rehabilitation organization interaction can produce even greater results, particularly if PWI programs are strategically given incentives to broaden their service base and configuration. PWI programs can also be used to experiment with consumer directed service provision and job placement approaches. There is considerable potential for the PWI network to become an innovative force serving a much more diverse population of people with disabilities.

School to Work Transition. In recent years, there has been increasing emphasis on and attention given to students with disabilities who are trying to transition from school to independent living in the community. Most communities may have the various key service components required for successful transition; but, very frequently, the components are not organized sensibly, thus many students do not complete successful transitions.

The community must be the focus of any successful transition program; any such program must, of necessity, involve multiple organizations in the community, including schools, rehabilitation organizations and facilities and housing, health and transportation services.

Perhaps the most critical issue in developing effective transitions is the basic focus of the overall program itself. There is little doubt that the focus must be on the student in providing the opportunity for each person to formulate his/her own goals and to make individual choices about using services and options. Fostering individual growth and development toward independence in the community requires that students and families know their options and how to choose them. A collaborative approach between service providers, students and families is clearly essential in providing individual choice.

Several important characteristics of successful transition programs include the following:

* Agencies cooperate together in various ways to assure service delivery.

* Vocational rehabilitation counseling is available onsite i schools.

* There are linkages between schools, rehabilitation organizations/facilities and local businesses for communications, training and knowledge about job requirements.

* An individual transition plan is developed for each student which usually involves additional postsecondary education/training.

* Opportunities exist for community based education.

* Integrated schools are used wherever possible.

* There is continuing involvement of family and close friends in the transition plan and process.

* There is a continuous focus on job placement rather than "job preparation." [8]

In terms of factors which are associated witth employment after leaving high school, research has shown that:

* Persons who graduate have significantly higher employment rates.

* Vocational education is associated with obtaining employment (including mainstream vocational education).

* Paid part-time or summer jobs lead to subsequent full-time employment.

* "Self-family-friend" networks most often are used to find employment, but when vocational rehabilitation organizations are used employment is more likely.

* Persons who are somewhat older, have their own transportation, contact vocational agencies and obtain job referrals are most likely to obtain employment. [9,10]

Most important are findings indicating the employment status of youth with disabilities is dynamic and changes frequently over time. This means that access to initial jobs is not a sufficient measure of employment success and that economic self-sufficiency is an ongoing process, requiring followup activities by community organizations after transitions occur. [11]

All of the above practices are rarely found in one community or local area, but there are examples of exemplary practices and outcomes which are followed over time to assure that community integration has occurred and is continuing. [12]

A major recommendation that has emerged from these programs is the need for initiating transition planning relatively early (by grades 7-8) and that the process be continuous yet flexible through and beyond high school graduation. In fact, the critical period is often just at the point of graduation and beyond, when community linkages are often not well organized and where the student is most at risk. Since schools cannot reasonably be expected to organize all the community services, educational opportunities and employment/training options to be available at this critical transition phase, rehabilitation providers and facilities can provide the necessary organizational and service resources to assist students in making successful transitions. For this reason, rehabilitation organizations have a crucial role in creating and effectuating organized, school-to-work transition programs which focus on the goals, objectives and wishes of individual students.

Programs Sponsored By Rehabilitation Facilities. While competitive employment "in the community" is a viable goal for many people with disabilities, other types of competitive facility-based employment remain as a practical choice for significant numbers of people. Facility-based businesses operating under the Javits-Wagner O'Day (JWOD) program, Department of Defense subcontracts, federal and state small business set-aside contracts, and competitive contracts in the private market offer ongoing stable employment opportunities at competitive wage rates. In addition, many facilities have established separately located businesses in such areas as product assembly and finishing, information services and others which employ both people with and without disabilities. This type of entrepreneurship has resulted in creating more jobs and training opportunities and is leading to more transition to "community" employment. If more financial incentives can be provided, more business development will occur, thereby increasing employment opportunities.

Conclusion

This brief review has identified some of the more important trends in employment programs for people with disabilities. While many of these approaches are in widespread use, far too few have been evaluated in terms of effectiveness, efficiency and quality standards; and the multiplicity of approaches now available can be viewed as responsive to increasing differentiation among people with disabilities.

The necessity for introducing and maintaining consumer choice and direction within employment program options cannot be overemphasized. Every employment strategy requires creative modification to assure consumer choice and direction; and while employment is the key goal, its achievement requires overall community integration, including residential, health, transportation, and personal assistant supports. This means that rehabilitation must now be viewed in holistic terms based on independence and community integration. Achieving these goals does not depend on only one or another model for employment services.

"Just because an idea, model, or approach seems to work well in one place at one time does not mean that it can work anywhere or at anytime . . ." (Bogdan & Taylor, 1987 [13])

It is time to develop, as Julian Lowitt has said, 14 "unified and workable coalitions in the community of persons with disabilities and serving organizations." Creating these coalitions and developing their effectiveness is the major challenge for rehabilitation at the turn of the century.

Notes

1) Cohen, Milton., "Rehabilitation Facilities: How We Got Where We Are Today", National Association of Rehabilitation Facilities Conference: Partnerships for Progress, August 9-11, 1990., NARF, Washington, DC, 1990.

2) Nisbet, J. & Hagner, D., "Natural Supports in the Workplace: A Re-examination of Supported Employment," Journal of the Association for Persons with Severe Handicaps, V. 13, No. 4, 260-67, 1988.

3) Revell, G., Wehman, P. & Arnold, S., "Supported Work Model of Competitive Employment for Mentally Retarded Persons: Implications for Rehabilitation Services," in P. Wehman & J. Hill, (Eds.), Competitive Employment for Persons with Mental Retardation: From Research to Practice. Richmond: Virginia Commonwealth University, 1995.

4) Wehman, P., Kregel, J. & Shafer, M.S., "Emerging Trends in the National Supported Employment Initiative: A Preliminary Analysis of Twenty-Seven States." Richmond: Rehabilitation Research and Training Center, Virginia Commonwealth University, 1989.

5) Wehman, P., Kregel, J., Revell, G. & West, M., "The National Supported Employment Initiative, Expanding Employment Opportunities for Persons with Disabilities," Office of Special Education and Rehabilitation Services, News in Print, V. 3, No. 3, Winter 1990

6) Coker, C.C., "Vocational Rehabilitation Facilities As Employers of the First Report: Developing Unsubsidized Employment Options," Research and Training Center, Stout Vocational Rehabilitation Institute, School of Education and Human Services, University of Wisconsin-Stout, Menomonie, Wisconsin, June 1990.

7) Nisbet, J. & Hagner, D., "Natural Supports in the Workplace: A Re-examination of Supported Employment," Journal of the Association for Persons with Severe Handicaps, V. 13, No. 4., 260-67, 1988.

8) Wehman, P., "School to Work: Elements of Successful Programs," Teaching Exceptional Children, V. 23, No. 1., 40-43, Fall 1990.

9) Hasazi, S.B., Gordon, L.R. & Roe, C.A., "Factors Associated with the Employment Status of Handicapped Youth Exiting High School from 1979-1983," Exceptional Children, V. 51, No. 6, 455-469.

10) Liebert, D., Lutsky, L. & Gottlieb, A., "Postsecondary Experiences of Young Adults with Severe Physical Disabilities," Exceptional Children, V. 57, No. 1, 56-63.

11) Neubert, D.A., Tillson, G.P. Jr. & Ianacone, R.N., "Postseocndary Transition Needs and Employment Patterns of Individuals with Mild Disabilities," Exceptional Children, V. 55, No. 6,494-500.

12) Getzel, E.E., "Entering Postsecondary Programs: Early Individualized Planning," Teaching Exceptional Children, V. 23, No. 2., 51-53.

13) Bogdan, R. & Taylor, S.J., "Conclusion: The Next Wave," in S. Taylor, D. Biklen, & J. Knoll, Community Integration for People with Severe Disabilities., pp. 212-213, New York: Teachers College Press, 1987.

14) Lowitt, J., "Opening Remarks," National Association of Rehabilitation Facilities, Conferences, Partnerships for Progress Conference, August 1990, NARF, Washington, DC, 1990.

Dr. Morrison is the Director of Research and Program Development, National Association of Rehabilitation Facilities, Reston, Virginia.