Linking workers with severe disabilities to social supports in the workplace: strategies for addressing barriers.

The phrase, "natural workplace supports" has become the new buzzword in the field of rehabilitation and supported employment. The emphasis on natural workplace supports emerges from social and policy trends over the past two decades which have resulted in refocusing training efforts for persons with disabilities within the functional context of the work environment. Studies published during the 1970's and 80's revealed that instructional training programs provided in pre-vocational and academic settings were not very effective in promoting eventual job placement or retention (Greenleigh Associates, 1975; Wehman Kregel, & Seyfarth, 1985). These studies led to increasingly vocal demands on the part of consumers, parents, and professionals who questioned the relevance that extensive academic and pre-vocational skills instruction had to the world of work (Elder, 1984; Will, 1984). In response to this pressure, Congress enacted special education and rehabilitation legislation, transition from school-to-work and supported employment respectively. This legislation was designed to ensure that individuals with disabilities received basic skills training that was relevant to the workplace.

Studies published during the last five years analyzing outcomes of the national supported employment program initiative revealed that individuals with disabilities were not being successfully integrated into competitive work environments. For example, job retention rates in supported employment were not as promising as had originally been anticipated (Edgar & Levine, 1988; Fabian 1992). Social integration of workers with disabilities also appears to be problematical in supported employment programs (Mank, 1991; Nisbet & Callahan, 1987), although some studies initially reported positive outcomes in this area (Parent, Kregel, Twardzik & Metzler, 1990; Shafer, Rice, Metzler, & Haring, 1989). The accumulation of evidence of potential problems in supported employment programs (Kregel & Wehman 1989), together with a shift in attitudes of rehabilitation professionals toward increasing reliance on business resources for hiring and training workers with disabilities, led to the growing popularity of natural workplace support approaches. The purpose of this article is to describe interventions we have devised during the first 15 months of a three-year demonstration project to develop and test strategies for using natural supports in competitive employment for workers with severe disabilities.

Support in the Workplace

The concept of social support as a powerful mediating force to assist people to cope with environmental stressors has attracted much attention in the mental health literature over the past several decades (Caplan 1974; Pearson 1990). For persons with disabilities, the argument for using existing workplace supports is that they represent powerful resources for mediating workplace problems. Further, proponents of natural support approaches argue that many of these resources are already available to non-disabled employees. For example, Nisbet and Hagner (1988) pointed out that employers provide career mentoring, both formally and informally, to employees on the job. Rhodes, Sandow, Mank, Buckley, and Albin (1991) suggested that company provision of employer support services are becoming increasingly available. Fabian and Luecking (1991) focused on employer-sponsored training programs as another example of employer developed workplace support.

For the purposes of this study, a natural support approach refers to enhancing or linking individuals to existing social supports in the work environment that are available either informally (from co-workers and peers on the job) or formally (from supervisors and company sponsored training programs). In other supported employment approaches, this linking activity or function generally occurs after the individual has received intensive initial support from an on-site paid provider. Natural workplace support approaches require more intensive efforts up-front to link the employee to available supports since the approach does not rely on the continuing presence of the job coach.

Because it is widely accepted that social supports or support networks can ameliorate the potentially harmful effects of environmental stress, strategies for linking individuals to existing supports or for developing support systems have been widely studied across community and work environments (Field & Yegge, 1982; House, 1981; Pearson 1990). For persons with disabilities who may be unable to access existing supports at work and in the community, recent literature suggesting strategies for developing these supports is relevant (e.g., Hagner et al., 1992; Nisbet & Hagner, 1988). Although available research documenting the difficulties an individual with severe disabilities may have accessing these supports in the workplace is lacking, the work of Chadsey-Rusch (1990) and Brown et al. (1989) describing the advantages of teaching functional skills during early school years is also helpful. Additionally, Pearson's (1990) work describing the contextual barriers that all people face in accessing environment supports was useful in the conceptualization of this study.

Methods

This research study is part of a three-year demonstration grant awarded to TransCen, Inc., a non-profit employment services program for persons with severe disabilities located in Rockville, Maryland from the U.S. Department of Education. The purpose of the demonstration grant was to evaluate the viability of using a natural workplace support approach to train, sustain, and maintain employees with severe disabilities at competitive jobs. Since TransCen does not operate any on-site day programs, referrals to the natural workplace support project were encouraged from vocational rehabilitation counselors, area service providers, employers, and the school system. Referral sources were made aware of the project and its services by project staff who promoted it through program visits, letters, and during employer training programs conducted by Transcen staff.

As the project was conceived as a systems change effort, it incorporated both direct and indirect intervention strategies. Indirect activities were defined as those where project staff conducted training and/or consultation to groups about issues affecting the workplace but located away from the work site. An example is training seminars that were conducted for area employers on disability awareness issues. Direct activities were defined as those conducted at the work site on behalf of placing or retaining an individual with a severe disability on the job. Table 1 provides examples of direct and indirect interventions conducted by project staff.

[TABULAR DATA 1 OMITTED]

For the purposes of this report, data on 23 individuals who received direct intervention services from project staff who used natural workplace support strategy are described. It is important to note that there were 86 total direct and indirect interventions conducted by project staff. Of these 23, 16 were persons with moderate mental retardation, 10 of whom had additional disabilities; three people had serious mental illness; two individuals had learning disabilities and two had sensory impairments. Job sites that individuals were placed at included 15 small businesses ranging from paint store to stock broker offices, and seven governmental agencies. Types of jobs reflected a range from entry level service to more highly skilled data entry operator.

The innovative nature of this demonstration project, together with the unique factors posed by each individual and each different workplace, necessitated qualitative analysis of narrative data gathered during the course of the project. The two human resource consultants who comprise project staff maintained project notes describing their individual interactions with employers, coworkers, and employees with disabilities from project start-up (10/1/90) through the end of the data collection time period for this study (1/1/92). The project staff were both individuals with several years of experience in job development and placement of people with disabilities, as well as experience in training employers to work with people with disabilities at the worksite.

Using qualitative data analytic techniques as suggested by Miles and Huberman (1984) the principle investigator (PI) of the project reviewed staff notes and activities and categorized these data into patterns that corresponded to three research questions. These were: 1) What types of interventions were provided at the worksite to facilitate use of natural supports?; 2) Who were the targets of these interventions?; and 3) What, if any outcomes were identified as resulting from these interventions.

Data Analysis

Qualitative data analytic techniques for analyzing this narrative data set consisted of identifying initial data categories that represented the best "fit" for the data and then continuously monitoring to ensure that identified categories were representative and comprehensive. Narrative reports were typed into a word processing program that facilitated easier retrieval of data patterns through word search commands.

The initial data review resulted in three categories of intervention strategies project staff used to link or create natural supports in the work environment. These three included: 1) information and/or skills training to co-workers and/or supervisors at the worksite; 2) re-organizing or re-mobilizing existing work resources; and 3) facilitating attitudes change. These strategies directly addressed three identified environmental barriers which were: lack of resources, lack of information or skills in working with people with severe disabilities, and negative attitudes. Once these initial categories were obtained, further sub-categorization elicited different organizational levels that these interventions were directed toward. These were labelled individual (co-worker or supervisor), work unit or work group, and entire organization. Table 2 illustrates how these dimensions were conceptualized. It also gives examples of strategies used to address specific barriers at specific organizational levels.

[TABULAR DATA 2 OMITTED]

Results

Of the 23 individuals who were provided direct interventions through the natural support project, 20 or 86% remained at the same job for at least six months after the direct intervention provided by project staff as demonstrated by a follow-up conducted in January 1992. Of the individuals no longer working, two left the area and one had returned to the sheltered workshop that initiated the job placement.

Descriptions of intervention Strategies Enhancing Resources

Literature on social support indicates that individuals may not have access to natural supports in the work environment because potential mediators of this support lack time, emotional stamina or money to provide it. In cell 1, for example, a high production work environment coupled with a lack of personnel, impeded coworkers from providing support despite their declared intention and desire to do so. Limited environmental resources may also contribute to poor attitudes on the part of coworkers toward providing support to employees with disabilities.

Strategies that were used to address these resource barriers revolved around resource enhancement or development activities; that is, assisting the employer to identify ways to make better use of work time, schedules, and available personnel, or assisting the employer to procure additional personnel if intensive training is necessary. A case example was Maria, an employee with severe mental illness placed as a copy clerk in a large and hectic government office. The supervisor in the work environment was the initially designated support person for Maria, receiving pre-training from project staff on supervisory skills, sequencing of tasks for Maria, incorporating periodic break times, and maintaining a positive reinforcement schedule. After two months on the job, the supervisor contacted project staff complaining that Maria's slow pace at the copy machine contributed to stressful office situations as doctors and other professional personnel were delayed from conducting their own copying work, particularly since professional staff only had access to two copiers. Maria's supervisor was unable to provide support or assistance to Maria during the peak periods in the xerox room which noticeably diminished her job performance. Employment consultants, in conjunction with Maria's supervisor and Maria, identified the resource barrier as one involving lack of time and poor coordination of existing resources. Framing a solution necessitated problem solving between Maria and her co-workers since all were affected by any adjustment to current xerox room usage.

The actual strategy agreed to and implemented involved setting time periods in the copier room during which Maria would have sole access to machines. These time periods coincided with less hectic time periods for other employees (for example, lunch periods), including her supervisor. It is important to note that the employment consultant only undertook a facilitative role in identifying and solving the problem. The development of strategies and the implementation of these strategies were conducted by the relevant staff, particularly the supervisor. In fact, Maria was noticeably resistant to any direct intervention by the employment consultant at the worksite: she simply would disregard any advice that she tried to provide. As a result of this intervention, Maria maintained her job.

Improving Employer Skills and Knowledge

Project staff encountered workplace barriers to existing supports that could be attributed to inadequate or inaccurate information of coworkers or supervisors. For example, one employee who was deaf and had a learning disability had been originally trained with a job coach and subsequently worked in the same job for over five years. Although Mark's supervisor was interested in providing career advancement opportunities for him, she was unsure about how to retrain him for new positions because of his disabilities, and concerned that the routine he had developed during his five-year tenure in the one position would create difficulties in retraining. Our employment consultants, who had not previously met Mark nor participated in his job placement, focused their intervention efforts on the supervisor, consulting with her about re-training issues and providing suggestions concerning potentially useful workplace technology.

Another experience that demonstrates how inaccurate information affects attitudes involved Harold, who worked for a paint manufacturing company. Harold had moderate mental retardation and had been placed in his job through a supported employment/job coach program not affiliated with TransCen. Over a three-year period, Harold exhibited increasingly inappropriate behaviors which his supervisors and coworkers tolerated and attributed to his "mental retardation." None of the these supervisors believed that they had the skills or ability to properly supervise Harold, and therefore Harold received little or no direct supervision. By the time the employment consultants were contacted, Harold's current supervisor was simply looking for justification to fire Harold for not performing his job. Instead, the employment consultant assisted Harold and the new supervisor to identify what his major work problems were, and how his supervisor could assist him to remain on task. Harold indicated that it was OK with him to have the supervisor or a co-worker inquire at specific intervals how he was doing. This served to both provide immediate reinforcement for task performance, and/or as a reminder if Harold was engaging in off-task behaviors. Further, involving the supervisor and Harold in the identification of supervisory strategies modeled appropriate communication skills for the supervisor to adopt. Although the supervisor implemented this strategy, Harold's continuing need for more intensive supports exhausted available employer resources and after one month of effort, he required re-referral to the original supported employment program so that a job coach could work directly with him. He was no longer at that job at the time of the follow-up study.

Confronting Negative Attitudes

Negative attitudes, even outright rejection of employees with disabilities, were among the most apparent barriers to successfully accessing existing supports. We found that negative attitudes were often the result of inadequate employer resources or use of resources. Other reasons for poor attitudes included negative stereotyping of people with disabilities, a poorly prepared workplace, or individual behaviors that might unconsciously encourage rejection or hostility from others. Generally, improving attitudes toward workers with disabilities required intervention strategies at all three levels: the individual co-worker/supervisor, the work group, and the whole organization. Employment consultants found that communication skills training to co-workers and supervisors, particularly as the training focused on responding to the employee with a disability as an individual rather than focusing on the disability, improved attitudes. In other instances, employment consultants discovered that simply convening a work group to discuss issues of myths and stereotypes about disability in the workplace improved attitudes and morale as the group became aware of its own sources of power and influence in the work environment.

Conclusion

Relying on existing supports in the workplace is not a new method in rehabilitation job placement. Dunn (1974), for example, pointed out that attitudes of co-workers toward an employee with a disability could adversely affect the worker's performance. Walker (1968) outlined the importance of relationships with co-workers in facilitating successful job retention for workers with disabilities. Wehman (1976) proposed that co-workers could be effectively incorporated into job coach models of supported employment both in terms of assisting the training process, as well as being available to the employee during job coach "fading". In addition, linking workers with disabilities to more formal supports in the work environment such as Employee Assistance Programs, have been advocated by business and human resource development personnel (e.g., Noel, 1990; Pati & Stubblefield, 1990).

One of the primary differences between the project described here and some of these earlier examples is the philosophical shift from focusing on what the individual needs to what the environment can provide. The underlying assumption is based on a perspective that emphasizes how to use what is available in the work environment, rather than emphasizing how to help the individual fit into the work environment. Many of the strategies described here are not much different than those that have been described as quality indicators in job coach models of supported employment. The difference is not as apparent in the specific technologies required for successful job matches, but is rather embedded in the assumptions and values adopted by rehabilitation program personnel. The focus in this project is placed on enhancing existing resources in the work environment, rather than making changes in the individual to derive a better "fit". Although this explanation may sound simple, using natural supports requires that rehabilitation personnel adopt an approach that shifts the responsibility for workplace inclusion to the employer: that empowers the employee to identify and/or access his or her own workplace support needs (West & Parent, 1992).

Chadsey-Rusch and O'Reilly(1992), and Balcazar, Fawcett, and Seekings (1991), among others have suggested that assisting individuals to use existing supports requires attention to both contextual and person factors. The strategies described in this paper are contextual ones, identifying those environmental resources that may be modified or enhanced in order to facilitate successful job placement and retention. However, as these authors note, it is critical to identify the person factors, such as social skills and assertiveness, that are functionally related to behaviors required for success on the job. Changing contextual variables in order to remove barriers to accessing social supports by workers with severe disabilities is only half the equation: interaction of these contextual factors with appropriate social behaviors is what ultimately will lead to successful employment integration outcomes.

Accessing existing supports in the workplace to achieve the goal of employment integration for workers with significant disabilities requires rehabilitation professionals to be aware of environmental barriers to these supports and the strategies for overcoming identified barriers. Obviously, the factors that impede access are rarely as discretely categorized as they are presented in this paper. However, a framework for understanding the multiple types and multiple levels that are present provides rehabilitation professionals and job development specialists with a means of devising systematic approaches to what are unique and individual intervention efforts. Support strategies that are simultaneously sensitive to individual needs and provided in the context of environmental barriers will ultimately lead to integrated jobs in the community for people with severe disabilities.

Acknowledgements

This research was supported by Grant no. H128AO2006 from the U.S. Department of Education.

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