Reflection On The Development, Evolution, And Challenges Of

Supported Employment

Paul Wehman, Ph.D., Virginia Commonwealth University

Professor of Physical Medicine and Rehabilitation

Director VCU-RRTC

European Union on Supported Employment 20th Anniversary Conference

Dublin Ireland, June 12, 2013

Supported Employment in the United States: 2013 Update

U.S Total Persons with a Developmental Disability Served in Day and Employment

Services• FY 1988 287,900• FY 1993 367,700• FY 1999 457,900• FY 2001 477,300• FY 2004 499,500• FY 2007 531,800• FY 2010 569,950• FY 2011 570,400

Example Distribution by Service Category: Day and Employ. Services: FY 2009**

• Integrated Employment Services 20.3%• Facility Based Work 27.1%• Facility Based Non-Work 36.1%• Community Based Non-Work 42.6%

**Some individuals participated in more than one Service. Data is drawn from reports of 27 states.

Source: Institute for Community Inclusion, University of Massachusetts

U.S Total: % & # of Persons with a Developmental Disability Served in Integrated

Employment • FY 1988 12% 33,500• FY 1993 20% 74,200• FY 1999 24% 108,600• FY 2001 25% 117,300• FY 2004 21% 104,700• FY 2007 21% 108,800• FY 2010 19% 108,600• FY 2011 19% 110,300

Supported Employment in the U.S:1988-2013

• From FY 1988 to FY 2011, 98% growth in the # of persons in Day and Employment Services.

• Major growth occurred in the 1990s (288,000 in FY 88; 458,000 by FY 1999)

• Growth has slowed considerably in recent years (532,000 in FY 2007; 570,000 in FY 2011)

• The # of Persons in Integrated Employment peaked in 2001.

• National average of about 20% in Integrated Employment of total Day and

Employment Service Population.

• However, participation varies widely from State to State. Participation rate of up to

and above 50% in a number of states

e.g. Washington State exceeds 80%

• Employment First Initiative is a major Systems change effort in the U.S.

• Federal policy discussions to limit time in Day Services (plan for transition to

employment) and potentially close door to Facility Based Services for

transitioning individuals

• Oregon closing workshops due to law suit.

• U.S. Dept of Justice has made settlements in 20 states to reduce segregation.

• Money clearly directs the flow and type of day and employment services in the U.S.

“The progress towards integrated employment

in the UK”Dr. Stephen BeyerCardiff University

Contextual factors in the UK

• The UK has a significant body of equality legislation to underpin social inclusion of disabled people through employment

• It has a mixed model of employment that includes factories, individualized employment support and supported employment

• There is no dedicated funding for supported employment these services rely on a jigsaw of funding:– Department of Work and Pensions– Local Authority, National Health Service– European Union

• There has been a shift to bring people with health problems on welfare benefit into employment on health and cost grounds

Legislation• A full framework of equality employment

legislation and codes are in place• The Disability Discrimination Act (DDA) of 1995

– Unlawful for employers to discriminate against disabled people by treating him or her less favourably (without justification) than other employees or job applicants because of his or her disability or by not making reasonable adjustments (without justification)

– Defines “reasonable accommodation” and how employers should make adjustments to their recruitment criteria and processes

• A Disability Equality Duty– Requires public services to consider the impact of their

work on disabled people as employees– To take action to tackle systematic inequality

Support Services• Sheltered work since 1944• Remploy:

– A publicly subsidised company, separate to Work Choice

– Provided 54 factories serving 2400 disabled people, and a community jobs programme serving around 20,000 people of all disabilities

– Announced in 2012 a closure programme for 36 of their factories, in line with the recommendations of the Sayce Review.

• Shift from Incapacity Benefit to Employment Support Allowance (ESA) – Care Employment

Support Services• The Work Choice programme

– Module 1: Work entry support (<6 months)• Individualised vocational guidance and development planning • Personal and job-skills support, confidence and capacity building • Job search and job application support• Work with employers

– Module 2: Short to medium in-work support (<24 months)• Discuss with the worker what their career goals • Discuss with the worker and employer how these goals can be met• Agree a support package that is tailored to individual needs • Development plan including in-work support will taper off in time

– Module 3: Longer-term in-work support ( - )• Taking on a job coach role, for example, to help a person with a

intellectual disability adapt to new work task• Delivering disability awareness training to an employer and co-workers

Current Services• Supported Employment Agencies do exist

as a significant type of service in the UK– Shifts to offering job coach supported

employment by some agencies funded by central Government Work Choice monies

– A greater number of smaller agencies that are largely core funded by:

• Local Authority Social Services monies • Access to Work• European project funding

Progress in disability employment• 45.6% of disabled people are employed

compared to 76.2% for non-disabled people• Relative employment suggests the situation for

disabled people getting “less bad” (Gap: 2002=-36.2%, 2011=-28.7)

• There has been a shift in the last 10 years:– From allocation to a programme to a more individualised

service response– From factory to community employment

• People with intellectual disabilities, autism and mental health problems remain relative poorly served

Percentage of DDA disabled people Condition (% in jobs)

Condition (% in jobs)

Skin conditions 71.9%Diabetes 61.5%Heart or circulatory 57.8%Chest or breathing 56.7%Digestive 55.7%Hearing 53.6%Arms or hands 44.5%Progressive illnesses 44.1%Back or neck 41.8%Legs or feet 39.7%

Epilepsy 37.3%Sight 36.4%Depression 27.2%Mental illnesses 14.2%Learning difficulties 12.0% -------------------------------Average for all disabilities as defined by the Disability Discrimination Act (2005) 45.6%

Recent surveys estimate that only: 15%of people with Autism are currently in full-time paid work 6.7% of people with intellectual disabilities in full-time paid work in England much part-time

Aspects of employment quality

• Working 16 hours per week a target:– People with intellectual disabilities can be

between 65% and 95% better-off financially – However, 1/3 work fewer than 16 hours

• Employees in SE have higher QoL and well-being scores than co-workers, and people with ID in day services and sheltered work

• Management model and job coach approach, are related to client outcomes in jobs- job coaching key in ID and autism

Aspects of employment quality

• “Typical” work roles, financial compensation and induction arrangements achieved higher rates of pay and hours worked as in the US

• Job carving known and useful for people with higher needs– People with high support needs not well represented– Not enough emphasis on employer accommodations

• Motivation key and agencies need to be better at identifying it and maintaining it whilst in work

• Social inclusion at work for people with ID remains difficult

Aspects of employment quality

• Net cost of community-based jobs for all disabled people was a saving to the Taxpayer of £ 2925 pp (2003)

• Small scale studies of supported employment for ID found to be cost:beneficial (£7,216 pa vs£14,998 pa in a day centre)

Conclusions• Legislation in place √• Policy reflects the need for Job Coach Supported

Employment, particularly in ID å Work Choices programme:

– A shift to individualised provision positive √– Shift to smaller national providers invites “cherry

picking” and ID/MH at a disadvantage X– People with higher support needs excluded X– Breaking the link with local authority ID services and

SE X

• Core funding of supported employment from local authorities is in danger as public sector cuts bite X

Conclusions• The intensity of input required by these intensive

forms of support are difficult to fund due to downward pressures on employment support costs because:– Numbers entering unemployment due to public sector job

cuts– Competition between government programmes for jobs– Pressure to limit down support costs as part of a shift to

payments by results and new providers front-ending costs– Payment by results– A lack of consensus that people with moderate and

severe disabilities can work and the need for more intensive support

Conclusions• There is a danger that supported employment

provision is shrinking at a time of greatest need

• If inclusion is to be achieved there is a need for adequate investment in the intensity and type of employment support appropriate to the needs of the person

• Consideration should be given to policies that improve the availability of jobs, flexibility and inclusiveness among employers as well as measure that focus on the disabled person

“Spain: Why have we still not taken the decisive step?”

Dr. F. B. Jordán de UrríesUniversity of Salamanca

bjordan@usal.es

Why have we still not taken the decisive step?

• The SE starts late eighties and early nineties.

• Several successful experiences in Mallorca, Barcelona and Andalusia.

• Participation in European programs and HORIZON HELIOS providing financing.

• Not regulated until 2007.• Most disabled people are in traditional

locations, and a growing number of users in Sheltered Employment.

Why have we still not taken the decisive step?

• The SE seems to be more a resource to add than the main action.

• Sheltered employment 1996 (562 centers and 24,823 employees) 2010 (1,871 centers and 59,185 employees)

• SE 1996 (35 centers and 1,067 employees) 2010 (207 centers and 5,538 employees)

• Why has so little progress in supported employment?

• Why has not taken the decisive step?

The focus of the administration from the LISMI (Law 13/1982)

• Redundancy in the historical development of measures for the employment of people with disabilities to strengthen protected employment alternatives.• The Royal Decree of Alternative Measures.• The Royal Decree of Enclaves.• The Royal Decree of Supported Employment.• The Royal Decree regulating units for

supporting professional activity.

The focus of the administration from the LISMI (Law 13/1982)

• The set of measures to promote the inclusion of PWD in regular employment, beyond the establishment of quotas, are reduced to one, the RD of SE in 2007.

• All recent developments have made distinctions in the amounts money depending on the type and degree of disability, but no in sheltered employment.

• Aids to the sheltered employment do not depend of budget availability, however, aids to SE always do it.

The historical gap between sheltered and ordinary

employment• Sheltered employment• Investment 87,250,000 € in 1998 to

214,135,000 in 2007. Cumulative 1,624,000,000

€. • Clear and stable regulation.

• Supported Employment• Lacked funding sources until regulation in

2007. Only specific programs of CCAA.• Even now, funding subject to the availability of

resources.

The historical gap between sheltered and ordinary

employment

(font PES)Year 2008

Year 2009

Year 2010

Sheltered employment219.781.

416263.185.

183231.034.6

50Open employment:

Ordinary companies / SE / Enclaves

76.612.857

78.649.098

79.247.840

• Modify the alternative measures to promote the development of employment in ordinary companies and not sheltered employment.

• Create under the PES Coordinating Joint Bodies for urban or interurban geographical boundaries.

• The PES should have professional and specialized services for PWD to specialized care and actively seeking of employment options for this group.

• Promote and fund research and innovative projects.

Suggestions for changeGeneral

• Appropriate assessment of capabilities to locate people correctly in sheltered or open employment.

• Transition to open employment by a quota criteria.

• Funding differentiated by type and percentage of disability.

• Keep current budget for sheltered employment until matches with supported employment within five years.

• Development of individualized plans and pathways in sheltered employment favoring transition.

Suggestions for changeSheltered Employment

• Open participation to all PWD and in social exclusion.

• Extending duration of actions financed up to five years.

• Understanding the supported employment actions as the result of the work of a team of professionals.

• Allocate aids to any charges associated with program.

• Establish levels of funding based on support needs and each stage of the process.

• Remove the system of competitive grants and ensure them if requirements and results are accredited.

Suggestions for changeSupported Employment

• The assumption as a principle that the employment integration of persons with disabilities must have the final destination in ordinary companies in the Community, and any tool or strategy developed with lower levels of integration must be balanced, structured and developed according of this principle.

Conclusion and responseWhere do we spend the necessary

refocusing?

• The necessary restructuration based on the above principle of special employment centers, to use this tool in perspective, with a clear purpose and direction, and empowering Supported Employment in parallel as a valid tool to achieve the primary objective.

• And finally, but with a crucial importance, that legislative developments and mainly budgetary, take this principle, and properly orient investment to make this possible.

Conclusion and responseWhere do we spend the necessary

refocusing?