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Supported employment and vocational rehabilitation: merger or misadventure?

Supported employment has become a cornerstone of new state and federal initiatives to improve the quality of life of persons with severe disabilities (Will, 1984; Elder, 1984; US Department of Education, 1984). The language of the federal initiative describes the following primary characteristics of supported employment (Rehabilitation Act Amendments of 1986): (a) "Supported employment is designed for individuals who are served in day activity programs because they appear to lack the potential for unassisted competitive employment (6) ...involves the continuous provision of training, supervision, and support services that would be available in a traditional day activity program; (c) ...is designed to produce the same benefits for participants that other people receive from work and these can be assessed by normal measures of employment quality, e.g., income level, quality of working life, security, mobility, and advancement opportunity; and (d) ...incorporates a variety of techniques and services to assist individuals to obtain and perform work, including assistance to a service agency that provides training and supervision at an individual's worksite; support to an employer to offset the excess costs of equipment or training; supervision of individuals with severe disabilities; and salary supplements to coworkers who provide regular assistance in performance of personal care activities while at work" (p.3501).

By its very nature, supported employment implies a significant philosophical and practical departure from traditional vocational rehabilitation programs which have served individuals with severe disabilities in sheltered settings with little or no opportunity to perform and reap the benefits of real work (U.S. Department of Labor, 1977; Whitehead, 1979; Buckley & Bellamy, 1985; Bellamy, Rhodes, & Albin, 1986). A close analysis of current implementation practices is necessary to determine if supported employment has, in fact, been established according to its underlying values and principles. Vocational Rehabilitation (VR) has been designated as the lead agency for supported employment, providing initial short-term monies, while State Offices of Mental Retardation and Developmental Disabilities (OMRDD) have emerged as the primary source of long-term support dollars. Despite the fact that OVR is only one piece of the supported employment pie, federal regulations have been written solely for VR. Therefore, this paper will primarily focus on the VR service system, though the federal emphasis on VR as the primary medium of supported work should be a topic of further debate and discussion.

The purpose of this article is to outline the basic underlying tenets of supported employment and of traditional VR practice, to illustrate how supported employment has not been applied according to its founding principles, and to recommend steps which need to be taken in order to implement supported employment programs within the VR system.

Principles of Supported Employment

The underlying principles of supported employment include four primary ingredients: integrated work settings, paid employment, ongoing support, and priority service provision to people with the most severe disabilities. (Rehabilitation Act Amendments, 1986; Federal Register, 1987). Another component which is not included in federal language, but which is sanctioned by advocates of supported employment is unconditional inclusion. Each of these characteristics is described briefly.

Integrated work settings are those where people with disabilities work in close physical and social proximity to nondisabled coworkers who are not paid caregivers (McLoughlin, Garner, & Callahan, 1987).

According to the federal regulations, a work setting is considered integrated when as many as eight people work together with people who are not disabled (Federal Register, 1987).

The second basic ingredient of supported employment is paid employment. Federal regulations specify that an individual must be engaged in paid work for an average of 20 hours per week. Individuals may be paid a sub-minimum wage in accordance with the Fair Labor Standards Act.

The third element of supported employment is the provision of ongoing support for as long as, and in whatever intensity, is needed. Such supports may be provided both on the job and outside of work as long as they are necessary for successfully maintaining employment. Ongoing support typically takes the form of supervision, but may/ also include job adaptations and modifications, transportation/mobility, personal care, coworker stipends, social skills, money management, etc.

The fourth major component of supported employment is that services be directed toward persons with the most severe disabilities. The term "severely disabled" is subjective and open to various interpretations. One popular definition offered by Brown, et al., (1983) refers to individuals who comprise the lowest functioning 1% of the population. Populations suitable for supported employment have labels such as moderate, severe, or profound mental retardation, autism, severe physical or sensory disabilities, severe traumatic head injury, and/or psychiatric disabilities. The federal definition is somewhat broader, but nonetheless widely accepted. It refers to people "for whom competitive employment has not traditionally occurred, or individuals for whom competitive employment has been interrupted or intermittent as a result of a severe disability" (Federal Register, 1987, p.20). Madeleine Will, as quoted in the Rehabilitation Act Amendments of 1986, noted that supported work "was designed for individuals in day activity programs because they appear to lack the potential for unassisted competitive employment" (p. 31).

A corollary to the provision of services to those with the most severe disabilities is the notion of unconditional inclusion. This refers to the assumption that people with severe disabilities are eligible and appropriate for supported employment. Implicit in this assumption is the belief that people with severe disabilities are capable of, and have the basic right to, work in real community jobs, regardless of ascribed labels, if provided appropriate training and support (McLoughlin, Garner, & Callahan, 1987). The emphasis is on inclusion rather than screening and exclusion. With unconditional inclusion, the burden of responsibility for accessing integrated work rests squarely with practitioners, rather than individuals with severe disabilities.

It will be argued in this paper that the federal-state vocational rehabilitation system has only superficially addressed these critical components of supported employment. With the exception of paid employment, each component will be discussed further as it relates to the VR system.

Federal-State System and Integrated Work

Integrated work has always been a stated outcome of the federal-state VR system, yet it has rarely been a priority goal for service recipients with severe disabilities. Many such people are rejected for services and many more are referred to sheltered facilities (U.S. Department of Labor, 1979; Whitehead, 1979; Murphy & Ursprung, 1983; Murphy & Hagner, 1988). Some are viewed as potentially capable of community employment at some later date (Johnson & Mithaug, 1977; Mithaug, Hagmeier, & Haring, 1977). Others are seen and accepted as permanent workshop clientele, and their cases are closed as such (Bellamy, Rhodes, Mank, & Albin, 1988; U.S. Department of Labor, 1977).

Even when community employment has been offered as a viable option for persons with severe disabilities, it is offered as one of several equally appropriate service alternatives. For example, a person with a severe disability may be deemed appropriate for individual supported work, for a work station/enclave, for a mobile work crew, or for transitional sheltered training and employment (Wehman & Moon, 1988). Alternatively, an individual may be declared unfeasible for VR services and referred to a non-vocational day treatment program for which he/she may be expected to advance from sheltered to supported and ultimately to competitive employment (Bellamy, Rhodes, Mank, & Albin, 1988). All of these options are generally viewed by the VR system as equally valid alternatives, depending upon the perceived characteristics of the service recipient. Moreover, the step-by-step progression from one option to another is viewed as desired movement within a continuum of service model (Buckley & Bellamy, 1984).

Neither is integration seen as an integral condition of training within the federal-state system. While many recipients of VR services are trained in typical universities or technical schools, most people with severe disabilities have been routinely trained in segregated facilities, job/social clubs, and/or work stations as part of a readiness model of service delivery (Bellamy, Rhodes, & Albin, 1986; Whitehead, 1986). Within traditional VR services, the readiness approach presumes that: a) people must acquire a prescribed set of behaviors and skills to function in the real world of work; b) people with disabilities who have not acquired these presumed prerequisite behaviors and skills would not succeed if placed in community work situations; c) individuals can be effectively assessed for and taught these skills in separate facilities for people with disabilities; and, d) people with disabilities will then successfully transfer these behaviors and skills to real, community settings (Brown et al., 1984; Gold, 1980). Thus, separate services are legitimated because an individual is seen as not ready to enter the community and requires time to become prepared properly for community entrance.

Wolfensberger and Tullman (1982) indicated that integration must go beyond the mere physical presence of a person with a disability in particular settings. Rather, true integration mandates the development of ongoing social relationships between individuals with disabilities and nondisabled people who are not paid to be with them. Federal guidelines for integrated work settings, however, provide minimal standards which do not ensure social proximity. Work stations/enclaves and work crews of up to eight people (Federal Register, 1987) vary in the degree of integration they typically provide (Mank, Rhodes, & Bellamy, 1986), and are often differentially viewed as most appropriate for particular kinds of people (Wehman, Kregel, Barcus, & Schalock, 1986; Wehman & Moon, 1988). For example, an individual with a mild or moderate disability is frequently seen as appropriate for an individual supported placement, while a person with more severe disabilities might be viewed as best suited for an enclave or work crew.

Work stations (enclaves) and work crews are congregations of people with disabilities (Brown et al., in press). Conte, Murphy, & Nisbet (in press), found that while work stations offered some advantages over sheltered workshops, they were physically and socially segregated settings where people most often worked when and where nondisabled workers were absent. In addition, work stations were found to have strong professional and financial ties to a sheltered workshop. Such ties precluded individuals with disabilities from being considered full fledged employees, and from experiencing typical employer-employee relationships. Conte and his associates found, for example, that employees were paid by the workshop, were supervised by a workshop employee, and performed work tasks which were structured in artificial ways which did not exist in the actual work setting.

Integrated work should not be considered a relative term, applied differentially to one group or type of person. McLoughlin, Garner, & Callahan (1987), defined integrated employment as "employment in a regular, nonhuman service setting in which a person with disabilities works alongside and interacts with co-workers, supervisors, and if appropriate, customers who are not disabled in the performance of tasks typically performed in the workplace" (p. 11). Within this definition, distinctions are not made between integration for people labelled mildly disabled versus severely disabled.

Supported employment does not employ a readiness mentality within its services. There is no such thing as a continuum of services through which people must move toward community employment, and within which program distinctions are made according to people's disabilities (Governor's Planning Council on Developmental Disabilities, 1987; Powell, et al., 1988). Rather, integrated, community employment is both the means and end of supported work. People, irrespective of their disabilities, are presumed entitled to integrated services and are placed and trained in community jobs which are matched to their abilities, needs, and interests. To produce truly integrated employment services, we must shift from what Taylor (1988) has called our conditional thinking, and stop using phrases such as "to the extent possible, most appropriate or feasible" and, "least restrictive." We must begin to employ an unconditional commitment to integration in non-restrictive and typical settings.

Long Term Support Within the

Federal-State System

The VR system has traditionally provided time-limited follow-up services to people placed in competitive employment who could succeed with minimal assistance. Those who might require more intensive support were excluded from community employment and placed in sheltered settings to "get ready." The multiple problems with this readiness model were discussed earlier in this article and have been well-documented elsewhere in the literature (Bellamy, Rhodes, & Albin, 1986; Brown et al., 1984; U.S. Department of Labor, 1979; Brown, Nietupski, & Hamre-Nietupski, 1976).

Supported employment was designed to circumvent the inherent inadequacies of sheltered services while still providing necessary, individualized supports. Specifically, the intent of supported employment is to provide assistance to individuals with severe handicaps who are not able to function in competitive employment without ongoing support (Federal Register, 1987). Ongoing supports include the provision of periodic or continuous services which may be provided both on the job (e.g., job coaching, paid coworkers, job modifications and adaptations), and outside of work (e.g., transportation and mobility instruction, time and money management). The underlying assumption is that individuals should be provided as much assistance as needed for as long as needed to maintain employment. Furthermore, if individuals do not require long-term support, they should not be considered supported employment candidates and should, therefore, be served through traditional VR services.

State agency responsibility for supported employment services has been limited to 18 months (Federal Register, 1987). States have been given the responsibility of establishing interagency agreements in order to insure the provision of long-term support services after the 18-month period has expired. Moreover, states such as New York have determined that individuals should be closed and transferred to extended services when they require less than 20% on-site support per week for three consecutive weeks. Such a transfer could occur before the 18-month period has expired.

It should be noted, however, that the intent of Congress in the provision of support services was flexibility. Amendments to the Rehabilitation Act (PL 99-506) stipulate that the use of absolute limited restrictions in the preparation of people for supported employment should be no more applicable than restrictions applied to the training regimens of all other service recipients. There exist no comparable limitations on the provision of vocational rehabilitation services for any other group of state agency service recipients.

The 20% standard appears nowhere in federal legislation. In fact, this standard represents a narrow interpretation of supported employment as defined by federal law. Further, the 20% on-site staff presence refers only to one model of supported work -- the job coach model. Congress, however, intended that a variety of different support options be used, including salary supplements to coworkers, in which the 20% requirement has no application.

States such as New York are also imposing financial limits on both short and long term support. For example, in New York State there is currently a $3,500 state agency cap on post-placement job coaching which would supersede the 18-month period. If agencies were awarded on OMRDD grant, they could receive an additional $3,000 per person for the first year. Thus, $6,500 would be available to a supported employee during the first year. If agency costs are calculated around $22 per hour, this allocation amounts to approximately 296 hours per year; about six hours of support services per week; or about one hour per day. One hour per day is hardly enough time to support most people with severe disabilities during their first year on the job.

In New York State, long-term OMRDD support is financially limited to $ 1,600 per year after the first year. Once again, these amounts are not enough for individuals with severe disabilities who need "intensive ongoing support services" to work in integrated settings (Rehabilitation Act of 1986, p. 32). The obvious result of these funding limits is that those who require minimal supervision are being served, while those for whom supported employment was intended are being excluded or dropped.

By limiting support services through financial and temporal caps VR programs have superseded the congressional intent in order to fit supported employment into its traditional service delivery model. There is clear pressure to provide very limited amounts of support services to people who are selected on the basis of arbitrary service projections. This practice not only modifies the initial intent of support, but also promulgates continued reliance on conditional inclusion. The last section elaborates upon this point.

Services to Persons with Severe

Disabilities

The third ingredient of supported employment programs is the provision of services to persons with the most severe disabilities. "Severe disability" is a subjective phrase which is open to various interpretations. In fact, since 1973 the federal-state system has been mandated to give service priority to people considered severely disabled. However, they have continued to exclude members of this group by employing a restrictive interpretation of employability, and by failing to successfully serve this group. Several issues surrounding the inclusion of people with severe disabilities have been mentioned in this paper e.g., temporal and financial restrictions on services, and will be further elaborated in this section.

According to federal guidelines, the target population for supported work includes three groups of individuals with severe disabilities for whom competitive employment has not traditionally occurred, or has been interrupted or intermittent as a result of their disabilities. Specifically designated are: (a) "severely disabled, multihandicapped youth aging out of the education system who would have been targeted for day treatment or sheltered employment; (b) individuals in long term sheltered employment; and (c) individuals whose disabilities are so severe that they may have been previously considered ineligible for vocational rehabilitation services" (Federal Register, 1987, p. 20).

These groups seem completely appropriate for inclusion in supported work programs. However, because of the manner in which the funding has been arranged, these groups may not be the ones who ultimately receive such services. Pressure is on service providers to select people whom they feel very confident will not exceed the arbitrary financial and temporal service restrictions which are contained in state guidelines. Thus, providers must attempt to accurately predict the supported employability of people with severe disabilities. Such predictions are risky for most groups and virtually impossible for those with the most severe disabilities. The tendency will be to screen people quite conservatively so that any "mistake" (e.g., a person who requires more support than is allotted financially or temporally) will not be made on the expensive side. Within such an atmosphere there exist obvious disincentives for selecting persons who are the most severely disabled. Supported work agencies are filling their caseloads with persons whose service costs will fall well within state funding guidelines, and taking far fewer risks with the population of people for whom supported work was initially designed and intended.

Traditional vocational rehabilitation and unconditional inclusion. In order to combat exclusionary practices, VR must adopt a policy of unconditional inclusion. The current practice within the VR system is conditional inclusion which is defined as the determination of an applicant's employability. In order to receive services, individuals must be evaluated and declared eligible and employable, or feasible. To be eligible means a person is declared to have a recognized disability which constitutes a vocational handicap. Employability (or feasibility in VR terms) means that an idividual must have a reasonable expectation for successfully achieving supported employment as a result of VR intervention.

Supported employment adovcates believe that most, if not all persons, regardless of the severity of their disability, are capable of successfully achieving remunerative community employment. The onus of placement responsibility resides with the professional to develop and structure a community job which meets an individual's needs, interests, and skills. Thus, there is neither a need nor a justification for determining an individual's employability or feasibility. Everyone is presumed to be employable. In fact, many proponents of supported employment would go further and declare that everyone has the right to a real community job and that determinations of employability are merely arbitrary barriers to that right, and are therefore discriminatory (Rogan & Hagner, in press).

Predicting a person's employability is a controversial subject, especially for individuals with severe disabilities. Many writers have articulately and extensively pointed out the discriminatory nature of predicting the vocational potential of individuals with severe disabilities using traditional assessment techniques and instruments (Gold, 1980; Rudrud, Ziarnik, Bernstein, & Ferrara, 1984; Schalock & Karan, 1979; sherman & Robinson, 1982). These critiques and criticism have been recognized by professionals and policy makers who have called for reforms in the way vocational evaluation and employability determinations are conducted within supported work programs. Szymanski, Hanley-Maxwell, and Parker (1987) for example, in proposing extended evaluation as a viable alternative to traditional federal-state measures of employability, have argued that: "Rehabilitation counselors using dated constructs of 'job readiness' and traditional assessment approaches may screen out potentially successful supported employment candidates without even affording them the benefit of an extended evaluation (of up to 18 months) of rehabilitation potential" (p. 7). In a recent editorial, Corthell (1988) stated that "in some cases vocational evaluation has not served all people with disabilities well" (p. 6), that "it is persons who are the most intellectually and cognitively disabled who have traditionally been difficult to evaluate for specific jobs" (p. 3), and that "we must sharpen our practices and retrain ourselves to provide better community-based situational assessment" (p. 6).

While these critiques seem consistent with the principle of nonevaluative assessment, their authors have failed conceptually and practically to include the idea of unconditional inclusion in their proposed solutions. Thus, assessments of vocational potential continue to be justified incorrectly within supported work programs, and applied to persons for whom they are clearly inappropriate. Corthell (1988), for exampole, after pointing out the shortcomings of traditional evaluation practices with people labelled severely disabled and recommending some reformulations of those practices, called for continued reliance on vocational predictions using work samples and standardized testing procedures, noting that "...with regard to vocational evaluation and particularly work and job sampole testing, an individual's ability to learn to follow a standardized set of instructions has a significant influence over performance capability. For if a client is unable to understand the instructions provided in a work sample, it is unlikely that he will acquire the requisite behaviors necessary to perform the assigned task" (p. 4).

While traditional methods of testing for empoloyability within supported employment programs have been modified in many cases, the federal-state system has retained its reliance on employability as a criteria for service delivery. The format for employability determination has merely been changed. Within the 1986 Amendments to the Rehabilitation Act of 1973 (PL 99-506), for example, the guidelines for supported employment indicate that supported work services may be provided to anyone who has been determined by an evaluation of rehabilitation potential to: have the ability or potential to engage in a training program leading to supported employment; have a need for ongoing support services in order to perform competitive work; or, to have the ability to work in a supported employment setting. This language certainly indicates that evaluation of employment potential has been retained as an important service emphasis within the federal-state interpretation of supported work.

Many of those who have criticized traditional methods of determining employability within the VR system have failed to question critically the concept of employability, or call for its aboliton. In merely calling for an altered form of employability determination, they have, in fact, legitimated conditional inclusion as a part of the services offered, and endorsed the counselor as the gatekeeper of employability. For example, Szymanski, et al. (1987) have stated that: "rehabilitation counselors carefully evaluate their individual constructs regarding feasibility and their approaches to assessment before screeing out persons with severe disabilities as not feasible for vocational rehabilitation services" (p. 8).

Within the preceding conception of supported employment, extended evaluation has been proposed as a viable, acceptable alternative when uncertainty exists regarding an individual's employability. Employability determination is therefore presented as a legitimate, integral endeavor for the state agency, and extended evaluation is offered as the means of clarifying employability uncertainty when it appears. Szymanski, et al. (1987) have clearly outlined such a position: "Extended evaluation provides counselors with the option to deliver services for up to 18 monhts in order to determine feasibility for vocational rehabilitation services. Extended evaluation, however, requires some uncertainty regarding the feasibility determination" (p. 9).

Employability determination has assumed many different forms. However, unless the entire idea of employability is discarded, and replaced by the principle of unconditional inclusion, we will continue to erect barriers for groups arbitrarily considered "unemployable." The important issue should not be whether one has potential, but in what community job and with what supports can one best apply the potential one possesses. This is not to say tht no pre-placement assessments should be conducted. However, such assessments should focus on how to best achieve integrated employment for a particular individual.

Recommendations

Despite its initial intent, supported employment has been included in the vocational rehabilitation continuum as one of several officially sanctioned employment alternatives available to people with severe disabilities. However, supported employment is offered as an alternative to the continuum of vocational services currently available to people with severe disabilities. That is, supported employment is viewed as a replacement for existing readiness-oriented sheltered services. Such a replacement was meant to not only supplant one kind of service for another, but also to change the way in which professionals think about providing services for people with severe disabilities. The following recommendations are offered as necessary changes in the traditional vocational rehabilitation system to accommodate supported employment as it was initially intended.

The policies and practices of vocational rehabilitation agencies must be reexamined and revamped in light of the overwhelming evidence available which indicates that the continuum of sheltered services has failed in preparing individuals with severe disabilities for community work. VR agencies must make strong commitments to integrated employment for all individuals, regardless of the severity of their disability. Aggressive policies supporting conversion from segregated to integrated services are necessary. Such policies and practices must include the following components:

Community integration will not be realized until restrictions are imposed on the congregation of individuals with disabilities in community settings. Proponents of grouping have argued that to restrict numbers would mean reducing access to supported employment by people with severe disabilities. Others believe integration can still occur when up to eight people work in the same area. In justifying their regulations, the federal government has stated that flexibility in service models is needed to promote supported employment. However, the authors believe that people should not be grouped at the expense of integration. Grouping perpetrates and reinforces social distance between people with and without disabilities. People with varying support needs can be placed in dispersed cluster sites; either in different departments of the same building, or different businesses geographically proximal to each other. In this eay, job coaches can frequently rotate between each work area, spending more time with those who need it. The underlying principle, as delineated by Brown et al., (1987), is that no more than two people with severe disabilities work in any one work area, and only approximately 1% of the total work force has severe disabilities. In addition, methods of supporting individuals with severe disabilities using natural supports available from employers and co-workers should be explored and implemented.

Vocational rehabilitation counselors need to become more knowledgeable about supported empoloyment and more responsive to people with severe disabilites by: (a) presuming that people with severe disabilities are employable and that the responsibility for integrated employment rests with those who are trained and paid to make community employment a reality; (b) imposing a freeze on referrals to sheltered services; (c) supporting the use of functional, ecological evaluation strategies instead of traditional tools and techniques; and, (b) increasing efforts to place individuals considered transitional employment candidates who are currently being served under the guise of supported empoloyment.

Incentives must be provided to encourage the development of supported employment programs. Current disincentives center upon the lack of adequate funding. No program can, nor should, be totally immune from temporal or financial restraints. However, such restrictions should be made on an individual basis, free from arbitrary quantitative standards. When dealing with supported employment recipients, policy makers must show equity. In the provision of sheltered services, large amounts of money are spent to maintain people in workshops and day activity centers year after year. To be fair, such amounts should be allocated to "follow" individuals in order to purchase the necessary supports for those who seek integrated employment.

People with severe disabilities must receive priority for supported employment service provision. Many programs have found it desirable to serve a heterogeneous population who, despite their label of severe disabilities, have varying degrees of support needs. Often times, the people considered easiest are placed first. Even when people with severe disabilities have been the focus of placement efforts, providers often get side tracked as job leads arise by filling jobs with more highly skilled individuals. Instead of being the last to be placed in supported employment, people with severe disabilities and intensive support needs must receive priority status, as was initially intended by the federal government.

Summary

Supported employment was originally intended to provide people with severe disabilities a unique and formerly nonexistent opportunity to experience real employment in integrated community settings with appropriate supervision and supports. It has become apparent that through implementation, the underlying tenets of supported employment have been redefined from their orignal intent in order to become more compatible with the existing service system. Without basic changes in the way rehabilitation professionals think about such issues as community integration, eligibility, employability, assessment, support, and peopole with severe disabilities, supported employment cannot be implemented in the way it was initially intended. The current system has done much to jeopartize opportunities for integration, reduce chances for receiving services, and limit the provision of adequate supports. The future of supported employment will surely exceed current expectations if the basic tenets remain consistent with its initial intent, and if quality is the goal over quantity. If, however, we cannot resist efforts to homogenize supported empoloyment within traditional mainstream vocational rehabilitation agencies, the model will fail and, once again, those who need the most will recieve the least.

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PAT ROGAN, Syracuse University, School of Education, 805 South Crouse Avenue, Syracuse, New York 13244-2280.
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Author:Murphy, Stephen
Publication:The Journal of Rehabilitation
Date:Apr 1, 1991
Words:5898
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