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From sheltered to supported employment outcomes: challenges for rehabilitation facilities.

This paper examines the organizational change process as it applies to facilities involved in converting from sheltered workshops and day programs to supported employment services. The internal and external factors which motivate facilities to change their service delivery approach are presented. Second, the obstacles challenging facilities and resources for assistance with the implementation of a conversion change process are reviewed. Potential obstacles include attitudinal, administrative, experiential, and logistical barriers. Suggestions of available local and national resources are provided. Program evaluation is an essential component for monitoring outcomes and assessing the costs and benefits to participants. Outcomes to be evaluated and areas for future research to determine the variables that contribute to successful conversion are discussed.

Historically, sheltered workshops and day programs have been the primary service option chosen for individuals with the most severe disabilities receiving services from the vocational rehabilitation system (Wehman & Moon, 1988). The focus of these programs is on providing skill training and work adjustment to prepare individuals for remunerative work in the real business community Hill, Revell, Chernish, Morell, White, Metzler, & McCarthy, 1987). Individuals are expected to progress through a service continuum of pre-employment training, work adjustment, job placement, and time-limited employment services that will result in independent, paid employment. Yet, statistics show that only 12% of sheltered workshop participants move into competitive employment annually with only 3% maintaining this goal after two years (Bellamy, Rhodes, Bourbeau, & Mank, 1986). Furthermore, the high unemployment rate of 50% to 90% is supportive evidence of the ineffectiveness of this traditional placement approach for individuals with severe disabilities (Louis Harris Poll, 1986; U. S. Commission on Civil Rights, 1983).

Supported employment has developed as an alternative vocational service option to accommodate the individual needs of persons with severe disabilities. These programs are characterized by intensive skill training and on-going support services directly at the employment site after job placement. Attention to the worker's residential and transportation needs are included in this individual model. Supported employment, to a large degree, is targeted for those individuals who are receiving services in sheltered work and day programs or who have been excluded or are waiting for vocational rehabilitation services, and who also require on-going services to remain in integrated, employment situations. The Rehabilitation Act Amendments of 1986 define supported employment as a viable employment outcome in the vocation - Table 1 Steps and Activities for Facility Conversion Define Goals and Objectives

* Evaluate current facility and consumer outcomes

* Assess community resources and funding sources

* Assess goals of consumers and families

* Conduct values clarification workshops for board members

and staff

* Review supported employment programs and literature Reorganize Management Structure

* Develop an organizational change plan with activities and

timelines

* Identify potential obstacles and strategies for reducing their

impact

* Redefine role of management in decentralized, oommunity based

supervision

* Inform participating agencies and businesses

* Plan strategies for utilizing facility space and completing

existing contracts during conversion process

* Consult a lawyer regarding legal liabilities associated with

conversion Train Staff Competencies

* Redefine staff roles and complete a job description of new

responsibilities

* Maintain current staff or hire new staff

* Develop staff supported competitive employment competencies

using an inservice training approach

* Provide field-based training

* Provide on-going technical assistance

* Assist staff with developing personal goals and provide

evaluative feedback

* Develop team building activities and support networks. Redirect Funding Sources

* Identify available funding sources

* Determine operating costs of facility

* Calculate funding received from contracts, per diem monies,

block funds, and contributions

* Determine costs of supported employment

* Apply for vendorship approval

* Develop a vendorship billing procedure and obtain approval

from agencies

* Calculate start-up costs and long-term expected costs

* Provide an accountant to monitor financial output and

cost-effectiveness Implement Supported Employment Services

* Conduct a oommunity analysis of local businesses

* Determine consumers to be served first

* Establish a consumer referral pool

* Assess consumer skills and interests

* Negotiate with family, guardian, or residential counselor

* Contact employers to specific jobs

* Match consumers to specific jobs and make placement arrangements

* Make transportation arrangements

* Make TJTC and Social Security arrangements

* Modify work environment/provide rehabilitation engineering

* Provide individualized behavioral training at the job site

* Fade staff intervention as data indicate

* Provide on-going follow along support services

* Coordinate staff responsibilities to meet needs of consumers

and employers Develop Interagency Agreements

* Learn about roles, services, eligibility criteria, and constraints

of school and adult service agencies

* Conduct workshops for parents and representatives from

rehabilitation, education, and MR/DD agencies

* Increase communication and visibility with other agency and

business oommunity

* Provide outcome data to other agencies

* Develop an interagency agreement for funding and service

delivery Evalutate Outcomes

* Determine facility and consumer outcomes to be evaluated

* Develop and implement data collection procedures

* Provide for management of data

* Provide evaluative feedback to participating agen - cies/employment specialists/parents/consumers

* Monitor completion of facility goals and objectives and modify

accordingly

* Evaluate cost-effectiveness of conversion process

* Evaluate costs and benefits to consumers and related organizations al rehabilitation system and establish funds for program development Federal Register, May 27, 1987).

Numerous supported employment programs have demonstrated that individuals previously excluded as unemployable can work when provided with specialized support services Hill, Wehman, Kregel Banks, & Metzler, 1987; Kiernan, 1986; Rusch, 1986). In addition, supported employment conversion projects have shown that supported employment outcomes can be accomplished by facilities when the necessary steps are taken to change from a sheltered to a community-based approach (June Dipolito, personal communication, March 14, 1988; HilL Revell, Chernish, Morell, White, Metzler, & McCarthy, 1987; Morell O'Bryan, & Pugh, 1985; -Rex Parr, personal communication, September 28, 1987).

The seven major administrative actions described in Table 1 serve as an outline of the key aspects of facility conversion discussed in this paper. These include: goal definition, management reorganization, staff training, funding, program implementation, interagency agreements, and evaluation. Therefore, it is the purpose of this paper to examine the organizational change process as it applies to rehabilitation facilities involved in converting their services from a segregated, center-based approach to an integrated, community-based approach. First, the internal and external motivating factors influencing a facility's decision to change their services are addressed. Second, the challenges presented for facilities committed to changing their service delivery system are reviewed. Third, information about avail - Table 2

Benefits to Participants Consumers * Wages * Hours and fringe bensfits * Integration with nonhandicapped persons * Increased community functioning * Improved perceptions and higher expectations by members

of the community * Reduced dependency * Employment and independent living options and choices * Increased consumerism Family Members/Residential Associates/Staff * Higher expectations for individual with a disability * Service delivery model that meets demands of advocacy

efforts * Reduced responsibility for total care and support * Contributions by a participating member * Increased choice variety Facility * Greater client movement * increased program capacity * Reduced waiting lists * More effective use of resources and skills * Service delivery model in compliance with federal initiatives * Improved image in community * Access to additional funding sources

Increased perceived program quality * Renewed staff learning opportunities * New community industrial relations * Improved staff quality of life Employers * Increase in qualified workers to meet labor market

demands * Individualized on-going supported employment services to

meet needs of employer * Reduced personnel seeking expenses * Guaranteed production value Society * Tax contributions by worker * Reduced government subsidy payments * Reduced day program costs * Opportunities to interact with persons with a disability * Personal contributions by individual with a disability Vocational Rehabilitation Agency * Reduced alternative program costs * Alternative options to meet needs of consumers previously

unserved * Case closures in status 26 * Reduced case reopening value Mental Retardation/Developmental Disability Agency * Assistance with case management demands * Reduced alternative program costs * Alternative options to meet needs of consumers referred

for services * Decreased costs of case management and residential

vices able resources to assist in the planning and implementation of a conversion change process will be discussed.

Motivating Factors Consumer interests

Many parents, guardians, and consumers have developed higher employment expectations as a result of the Education of All Handicapped Children Act of 1975 which guarantees the right to a free and appropriate education for individuals with disabilities. These persons are now demanding and actively pursuing supported employment services. Frequently, consumers respond positively to the question, Do you want to work?, especially when they can make an informed decision based on participation in multiple community-based work or training experiences.

While individuals with disabilities are the obvious consumers of supported employment services, Table 2 describes the benefits available to all participants involved with supported employment.

Rehabilitation counselors and case managers who want to accomplish their client's goals and also obtain services that will reduce their large caseloads are often pressuring for the development of supported employment services in their locality. Rehabilitation counselors have the additional advantages of being able to receive successful case closure in Status 26 and to have a proactive contingency plan for cases requiring additional services after closure (i.e., Status 24, Services Interrupted or Status 32, Post-Employment Services). Employers are another consumer of supported employment services and as such they have a vested interest in a service which will provide them with qualified workers to meet the labor market demands (Shafer, Parent, & Everson, 1988). Organizational Benefits

It is estimated that approximately 1.6 million individuals receive services annually from the over 5,500 sheltered workshops and 2,000 activity centers in existence (Menz, 1987). This reflects a 76% increase in program participation during the period from 1979 to 1984 (Bellamy, Rhodes, Mank, & Albin, 1987). The large numbers of individuals currently on waiting lists to receive services and the lack of movement through the service continuum to community-based employment, indicate the inability of rehabilitation facilities to provide services that adequately meet the needs of the consumers. With the estimated 250,000 students graduating from special education programs annually, the demand for employment services can be expected to increase (Wehman, Parent, Wood, et al., in press; Will, 1984). The options available for rehabilitation facilities are to "add-on" to their existing programs and/or to increase participant movement by converting their service delivery approach. Program Funding Although there are conversion challenges relating to funding, there are also many financial motivators for organizations to convert. The following is a brief description of such motivators.

1. Fees for Service. As organizations establish fees for supported employment services, they are often trading subsidized fees for actual cost fees Hill, Wehman, Kregel, et al., 1987). Organizations which have in the past drawn from many sources the amounts required to provide a service (private and public dollars) are now often approved by service purchasers at actual cost rates. This allows redistribution of the augmented dollars to other needs.

2 Diversification of Service Offerings. As organizations add variety to their menu of marketable services, they also diversify the number and type of service purchasers interested in these services.

3. Reduced Facility Costs. Redistribution of efforts to integrated settings may allow organizations to rent less space or to offer space to rent to outside organizations.

4. Access to New Discretionary Funds. There are many sources of funds now placing emphasis on supported employment. These sources are looking for agencies able to provide supported employment. Often simple written proposals or informal negotiations can facilitate access to these funds. The following are potential discretionary funding sources into which providers might tap: 1) State Developmental Disabilities Planning Council, 2) State Special or Vocational Education Programs, 3) State Vocational Rehabilitation, 4) Joint Training Partnership Act Programs (JTPA) or Private Industry Councils, and 5) State Mental Health/Mental Retardation/Human Resources (Rehabilitation Research and Training Center Newsletter, 1987).

5. Private Sector Diversification. Once an organization's labor force is not limited to in-house work, the number and type of contracts open to that organization expand significantly. Going to the work opens many areas previously untapped.

Challenges Presented

Facility conversion necessitates that changes be made within the traditional rehabilitation system. Those facilities interested in converting to a supported employment service delivery model must make modifications in their current organizational structure, staffing patterns, funding sources, program objectives, and evaluation criteria. In addition, professionals and consumers are expected to adopt different roles and activities as participants in the conversion process. The uncertainty and unfamiliarity associated with something new creates resistance on the level of the organization and the individual which can interfere with program development. Change is facilitated by identifying the sources of resistance and providing viable solutions. Four potential barriers that challenge successful conversion have been proposed (Gardner, Chapman, Donaldson, & Jacobson, 1988). These are attitudinal, administrative, experiential, and logistical obstacles. Attitudinal Challenges

The support of professionals and parents is essential for successful conversion to supported employment. Often a lack of accurate information, a negative experience in the past, or the belief that individuals with disabilities are not capable of competitive employment will be expressed in overt and covert resistance to supported employment. Positive attitudes and personal investment are most likely developed if participants are encouraged to be involved in the planning, implementation, and evaluation activities of the change process (Howes & Quinn, 1978).

A characteristic of successful attempts at organizational change is a demonstrated commitment by the management of the operation Lynn & Lynn, 1984). In fact, the executive director plays a key role in preparing the organization to accept change and assisting with its implementation (Howes & Quinn, 1978). The facility board also plays a critical role in conversion. Board members may doubt the facility's ability to provide supported employment services, the permanency of the new models or the community's willingness to support such a change. Workshop staff may fear the loss of their jobs or a lack of skills to perform the functions of the supported employment provider. Regular meetings with on-going, two way communication can alleviate many of the doubts developing from venturing in unfamiliar territory. The presentation of a clearly written plan describing the steps of the conversion process and the encouragement of critical feedback will increase staff ownership. In addition, written resources on supported employment and actual observations of workers in the community can be a persuasive technique for changing attitudes.

Parents, guardians, and residential representatives have varying expectations for their sons/daughters/consumers (Wehman, Hill, Wood, & Parent, 1987). Some see sheltered employment as an appropriate match to the individual's abilities while others want more independence but are unsure of the services that are available. Still others are beginning to demand integrated employment in the community as well as solutions for their concerns and fears Goodall & Bruder, 1986). Parents are often afraid that their son or daughter may be unsuccessful at the job and have no alternative program to which to return, that they will be teased or harmed by others, or that the program's services will be terminated. Another major fear is loss of Social Security payments and medical benefits. Residential representatives, as well as family members, often express concern over the scheduling inconveniences and increased responsibility they will have to assume following placement into employment in comparison to the routine hours and transportation offered by the day program.

Literature and workshops explaining the components of the supported employment models and the supported employment provider's role can assist parents and guardians with making informed decisions (Anderson, Beckett, & Chitwood, 1985). The individualized training and on-going support services characteristic of supported employment include services for job retention, such as job replacement following separation, intensive intervention, social skills training, and advocacy. Work incentives made possible by the passage of 1619 A and B allows individuals more flexibility to earn meaningful wages and maintain eligibility for benefits (Social Security Administration, 1987). Actively listening to parents, guardians, and residential representatives; providing accurate information for their questions; and linking them with the appropriate resources can increase their trust in the facility's commitment to the consumers receiving services. Administrative Challenges

Facility managers must undergo major changes during conversion both in their management responsibilities and the organizational operations. A community-based service model necessitates a decentralized staffing arrangement. Therefore, the manager win not be able to directly observe the behavior of supported employment providers on a daily basis. One of the initial tasks may be to clearly define staff goals and responsibilities as well as a competency-based evaluation tool.

For example, the employment specialist win contact thirty employers for job development over the next month, the employment specialist will complete four consumer assessments in two weeks, or the employment specialist will place eight individuals into supported competitive employment in one year. Inexperienced employment specialists win often require extensive individualized assistance up front with a gradual reduction of administrative support similar to the employment specialist/consumer training relationship. Arrangements for regularly scheduled meetings for employment specialists are essential for on-going support and information sharing. Furthermore, a manager's schedule win become less predictable as crisis intervention situations occur more frequently with consumers on job sites where environmental variables are less controllable and schedules are varied. The facility manager's role will shift more from direct supervision to that of coordinator and facilitator of supported employment activities. Experiential Challenges

Supported employment program.,, are staffed by professionals sometimes referred to as employment specialists who function in the role of trainer and advocate (Cohen, Patton, & Melia, 1986; Wehman & Melia, 1985). The employment specialist also known as job coach, is responsible for implementation of afl activities of the supported employment models (Mank, Rhodes, & Bellamy, 1986; Rhodes & Valenta, 1985; Wehman & Kregel, 1985). The following competencies are considered important for successful staff functioning in the role of employment specialist: identifying and analyzing jobs in the community, completing functional consumer assessments; writing task analyses; matching job requirements with consumer skills; utilizing behavioral training strategies; implementing systematic fading techniques; communicating with parents, employers, and other agency representatives; developing environmental modifications; and negotiating for additional community support when needed. A written job description can assist managers and workshop staff in assessing current skill levels and identifying areas requiring additional training. Logistical Challenges

Most community service organizations face financial challenges at one time or another. One of the most challenging obstacles to conversion is organizational fears related to funding issues. Hard fought-for existing contracts from a variety of sources may create inertia and resistance to new less predictable funding sources. Many industry based enclaves or small clusters of disabled workers have, however, been started by moving in-house contracts back to the originating company. Previous long-term commitments that the organization has struggled to establish must now be modified to allow funding to follow slots/or persons into the community without the requirement of funding the moved slot with individuals from the waiting fists. Significant effort is required to explain to long-term funding agencies why once funding follows an individual into the community, there is no longer that position in the in-house program. Furthermore, established fee-for-service reimbursement fees may not cover actual costs due to lack of authorized fees, a poor job market, or niscalculation in the estimated rate.

The loss of present contracts or the inability to complete those already committed to can threaten the operational security of the facility. In addition to contributing to the financial income supporting the facility, contracted work from local businesses is the primary activity for participants and the source of their wages. During the initial stages of the conversion process, the contract revenue can continue to maintain the operations of the facility for those individuals waiting for supported employment placements. It is important to develop a plan for completion of the business contracts and to keep the businesses informed of the facility's objectives (Gardner, Chapman, Donaldson, & Jacobson, 1988). As more people are placed into the community, the remaining workers will have additional work to complete which Will result in a higher income for these participants. The reduction in workshop staff required to supervise the decreasing number of participants means that the contract revenue that is generated can be redirected to funding supported employment activities.

With increased placements, the number of persons working in the facility will decline resulting in an excess of unused space. The only space required to implement supported employment is office space for the staff. Therefore, one strategy for utilizing the empty space in the facility is to rent it out to private businesses (Gardner, Chapman, Donaldson, & Jacobson, 1988). Hiring nonhandicapped workers to complete the existing or increased contract work is another option. The advantages of these methods are that the facility will continue to receive an income from the unused space, individuals remaining in the workshop will have opportunities for integration, and additional revenue is generated to fund supported employment services.

Available Resources

Facilities interested in converting to a supported employment approach are confronted by a combination of challenges that are both similar to other programs and/or specific to that organization. Despite the obstacles, an increasing number of sheltered facilities are choosing to change their service delivery approach. What follows is a brief description of possible measures to draw upon. Local Resources Businesses in the community can provide information on labor trends and job openings. Furthermore, companies involved with the workshop either through donations, contract work, or on governing board advisory committees, are potential sources for competitive employment placements or leads to other businesses. A wealth of employer contacts are available from staff, governing board members, parents, and consumers. Many localities have established employer networking meetings to share job leads with other supported employment providers and vocational rehabilitation agencies.

The vocational rehabilitation and developmental disability agencies are excellent contacts for information on available adult services in the community. The vocational rehabilitation agency is responsible for referring individuals for supported competitive employment services. This will necessitate: referring new consumers to the facility, rewriting the goals of the Individualized Written Rehabilitation Plan of current facility consumers to include supported employment services, and re-opening cases closed as employed in sheltered employment situations. Rehabilitation counselors can authorize funds for initial time-limited training to the facility following approval as a vendor of services (Hill, 1986). After the consumer is stabilized on the job and considered successfully employed, the case is referred to another agency for the follow-along funding. Additional employment-related services can be provided by rehabilitation counselors if they are necessary for employment. The developmental disability agency is a possible funding source for long-term, follow-along services. Case managers are also available to provide assistance for consumers such as residential services, money management, and crisis intervention. National Resources

On a larger scale, federal funding opportunities, staff training and technical assistance programs, and manuals for conversion or supported employment implementation are available. Valuable sources of information are other supported employment demonstration and conversion projects around the country. While specific problems may be unique to a particular locality, modifying and building on strategies that have worked in other situations is a more efficient approach for effective service delivery. Furthermore, creativity is enhanced by brainstorming sessions that include input from varied and multiple sources.

Conclusion

This article presented many of the factors which influence rehabilitation facility conversion and the challenges associated with conversion. As suggested, gathering information is the essential first step in planning for organizational change. The next steps for changing from a sheltered to a supported employment service delivery approach are to implement the change process and to evaluate the outcomes. While many of the commonly reported challenges were discussed, it is assumed that each facility win encounter obstacles specific to their locality. Sharing implementation and problem-solving strategies utilized during the conversion process will serve as a motivator influencing other facilities providing traditional services. In addition, dissemination of information will assist with improving conversion implementation procedures and program service quality. Evaluation is a critical component of a conversion model for determining the effectiveness of the change process. Since the goal of facility conversion is to expand rehabilitation services to meet the employment needs of individuals with severe disabilities, program evaluation should focus on the number of individuals placed and retained in integrated employment situations. Facility managers need to identify the facility and consumer outcomes to be evaluated, as well as a procedure for data collection and management. Suggested measures of consumer outcomes are: (a) wages, hours, benefits, and taxes paid; (b) integration, social relationships, and community access; (c) work performance and mobility-, and (d) personal satisfaction. Facility costs and benefits can be assessed by evaluating the following: (a) number of placements and retention rates, b) consumer population served, (c) staff turnover rates, and (d) costs/expenditures. Program evaluation provides a mechanism for monitoring facility goals so that objectives can be modified to achieve program outcomes.

Increasing numbers of facilities are choosing to convert their services yet limited information is available as to the best way to go about changing the facility's service delivery approach. It is important for evaluation plans to include measures to assess the effectiveness of the conversion strategies utilized. Such factors as participant attitudes, staff competencies, interagency impact, cost-effectiveness, facility benefits, and consumer outcomes will assist in developing a model(s) for other conversion efforts. Future research should be conducted to determine the variables contributing to successful organizational change. Suggested questions for further study are: What are the characteristics of organizations that convert to supported employment? What are the most successful strategies for facility conversion? What are the costs to facilities implementing supported employment services? What are the benefits experienced by facilities converting to supported employment?

In closing, it is fair to say that rehabilitation facilities face major service delivery challenges as 1990 approaches. Clearly, there is a wealth of talent and resources with both disabled and nondisabled workers in these 7,000 + day programs. The issue is: are these programs prepared to engage in the critical long term planning which is essential in the change over process. Money, training, the economy and business knowledge are all necessary but underlying each of these elements is values and commitment to integrated employment. The future is now.
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Author:Wehman, Paul
Publication:The Journal of Rehabilitation
Date:Oct 1, 1989
Words:4253
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