Scottish Government

CHAPTER TWO: BEST PRACTICE IN 'SUPPORTED EMPLOYMENT': A LITERATURE REVIEW

Introduction

"By far the greatest challenges facing…supported employment over the next several years are the continuing growth and innovation in our field and assuring that supported employment is a reality for every individual who wants a real job in his or her community. (DiLeo & Langton, 1996)

2.1 The above quotation captures a general feeling of anticipation and promise around the future development of supported employment evident within the literature. As Riddell et al (1999) observed, despite reservations, a "cloak of optimism surrounds supported employment". This sense of confidence in the model permeated the literature reviewed for this chapter despite any "underachievement" identified by research. The purpose of the review of literature published primarily within the past 5 years was to summarise main findings from recent research, identify any gaps in information and highlight the key features of best practice.

Main findings from recent research

2.2 Best practice in supported employment is discussed under the following 8 main headings: preserving the integrity of the support model and supported employment; the need to tackle systemic barriers to further development; emergence of the notion of self determination and the promotion of choice; issues around marketing and job development; developments in the role of job coach and using natural supports within the workplace; the need to enhance social integration outcomes; supported self employment; and the importance of post employment services.

Preserving the integrity of the 'support model' & 'supported employment'

2.3 The literature review suggested a need to re-assert the values of both the support model and its challenge to readiness approaches, and of supported employment. The 'support model' evolved from progressive movements in the field of disability representing a major shift from facility-based approaches to the provision of individual supports, which aim to realise individual goals and aspirations. The keystones of the support paradigm are community inclusion, an emphasis on quality of life, individual planning and support. It requires the development of systems offering options for choice, support and guidance: facilitation rather than direction. However as some authors suggest the shift in thinking required "can't be reversed overnight" (Meyer, 2001) and there is evidence the readiness model persists.

2.4 Supported employment, emerged in the mid 1980s and has become a well-established approach demonstrating success in finding real jobs for a range of disabled people and maintaining them in these jobs (Schneider et al, 2002). It has also been found to benefit individuals by contributing to a higher quality of life (Eggleton et al, 1999). Consumer satisfaction with both the support received and jobs obtained through supported employment has been reported (Parent et al, 1996). Employers report satisfaction with supported employment and find people with learning disabilities to be reliable, hardworking and effective employees (Petty & Fussell, 1997).

2.5 Despite this positive picture, the implementation of supported employment has been somewhat disappointing. A survey of employment options for people with learning disabilities, with responses from 60 countries, showed that despite good practice examples on inclusive employment, the overall picture "remains one of great concern" (Sutton, 1999). Participation in inclusive or integrated employment was found to be "very much in the minority". Many countries in the EU invest more resources in segregated or specialist provision than in community employment, and, it is argued, supported employment has become part of "a long continuum" rather than providing an alternative to segregated provision (Beyer et al, 2002). The Policy Consortium on Supported Employment (O'Bryan et al, 2000a) further highlighted an urgent need to ensure supported employment becomes "much more widely available, with services of consistent quality".

2.6 It was not until the 1990s that the concept of supported employment was applied to people with ASD. In the UK, most supported employment schemes focused on people with learning disabilities. The National Autistic Society's specialist initiative, 'Prospects', was devised for people with ASD who were "more intellectually able", although a later evaluation of the scheme showed inclusion of a more diverse population of people with ASD. An initial evaluation of the outcomes of the Prospects initiative reported positive outcomes (Mawhood & Howlin, 1999). Overall, the 'Prospects model' of supported employment has been effective with people with ASD, and the initial high costs of the scheme gradually reduced over time as most were no longer reliant on welfare benefits (Mawhood & Howlin, 1999).

Importance of defining 'supported employment'

2.7 The importance of agreeing a national definition of supported employment was clear from the literature. Research in the US demonstrated that when programmes define what supported employment is and who receives it, there are discrepancies between the providers and the commissioning and funding agencies (West et al, 1994). In the UK, which does not have an equivalent funding mechanism for supported employment, issues of definition are even more fraught.

2.8 There is wide variability in the practice of supported employment. Both Weston (2002) and Ridley (2001) found inconsistencies in supported employment in Scotland, some of which distorted and watered down the original concept and affected the quality of individual outcomes. Further, interviews with key informants providing employment services in Scotland (Riddell et al, 1999) found discrepancies between service managers claims to be using supported employment and what the researchers found to be a "very partial and half hearted version" of supported employment.

2.9 The United States Developmental Disabilities Act of 1984 defined supported employment as:

"(i) Paid employment for persons with developmental disabilities for whom competitive employment at or above minimum wage is unlikely and who need ongoing support to perform in a work setting, (ii) is conducted in a variety of settings in which persons without disabilities are employed, and (iii) is supported by any activity needed to sustain paid work including supervision, training, and transportation. (P2665)

2.10 In 1986, the Vocational Rehabilitation Amendments Act further defined supported employment as jobs for a minimum of 20 hours per week. While some providers would and do argue that this has contributed to the unnecessary exclusion of people with more severe disabilities, others ( e.g. Moon et al, 1990) have argued that people with severe disabilities can and should be able to work 20 hours per week or more but might need the flexibility to work fewer hours initially.

2.11 UK definitions have lacked statements in respect of the minimum number of working hours and the target group for supported employment. Consequently, some have regarded jobs for as little as one hour per week as supported employment, and as yet only small numbers of people with more severe learning disabilities have benefited (Weston, 2002). This is despite research showing that wage levels, and, to some extent, integration outcomes, are largely driven by the amount of hours worked (Kilsby et al, 1995; Mank, 2003).

2.12 Although there is no consensus, writers in the UK tend to agree on three basic elements: that is (1) that supported employment offers paid employment or 'real jobs'; (2) that jobs are offered in integrated settings or with community employers; and (3) that there is ongoing 'support' (Pozner & Hammond, 1993; Beyer et al, 1996; Wertheimer, 1996). More recently, the Policy Consortium for Supported Employment (O'Bryan et al, 2000a) defined supported employment as a way of enabling people who need support to obtain and develop their careers in real jobs, with support provided on an individual basis to both employer and employee for as long as necessary.

2.13 Several authors further distinguish between supported employment and the Department of Employment's 'Workstep Programme', although some suggest the distinction is far from clear-cut (Leach, 2002). Stalker (2001) however asserts that supported employment is quite distinct from Workstep, and Weston (2002) found that using the term supported employment to describe central government schemes such as this was contentious as some practitioners and agencies felt that subsidised employment was entirely different from the original model of supported employment.

Supporting people with severe disabilities

2.14 Although originally developed as a way of placing people with high support needs or severe disabilities in ordinary jobs, those with the most severe disabilities are generally "underrepresented in the ranks of those benefiting from supported employment" (Mank et al, 1998b). Recent research in the UK (Weston, 2002) found relatively few supported employment agencies supporting people with severe disabilities or 'complex needs'. One reason suggested for this was that services have found it easier to find jobs for people with lower support needs and that over time their support needs reduce making it possible for services to meet target numbers set by funders.

2.15 In examining the employment features of those with more severe disabilities in work, Bass (2000) found the quality of jobs and the wages offered were lower than those available to more able individuals. They tended to work fewer hours, to be unpaid and be less well integrated. Similarly, Mank et al (1998b) found that people with more severe disabilities in the US had lower wage and integration outcomes and less typical features of employment.

2.16 However, research has also uncovered exceptions to this suggesting that high quality outcomes are possible for at least some individuals with more severe disabilities. For example, Mank et al's (1998a) research proved people with severe disabilities could earn high wages. All 55 individuals in this demonstration project were employed within the same County government in different departments. Leadership and commitment from within the Council was found to be critical. The researchers suggested as significant that the departments employing people with severe disabilities were identified as the same departments that generally accommodated diversity.

2.17 The findings of this and other research point to a range of successful strategies in working with people with severe or significant learning disabilities and/or ASD:

• Diversify the support model for example, support co-worker; job share; self employed; professional partnership
• Close attention is paid to both individuals' and employers' needs
• Recruitment practices are adapted to allow individuals to perform at their best
• Jobs are paid at or above the going rate
• There is a good 'job match' of the person and the work environment
• As many aspects as possible are 'typical' for the workplace, especially in terms of inclusion in the workforce
• Co-workers are trained by supported employment personnel
• The use of adaptations and on the job training using systematic instruction is critical
• It is important to build up the hours worked gradually, to hold regular reviews, and for support workers to understand individuals' methods of communication
• There is good communication between everyone involved so that any problems are resolved early on

(Mank et al, 1998b; Beyer, 2001; Weston, 2002)

2.18 The Policy Consortium for Supported Employment (O'Bryan et al, 2000a) identified the need to avoid perverse disincentives in the funding system that cause providers to avoid working with people with the highest support needs. They proposed adopting premiums for assisting people with greater support needs.

Importance of tackling systemic issues

2.19 A key theme from the literature was the need to tackle the systemic barriers inhibiting the development of supported employment. Recent research carried out in the US by Mank, Cioffi and Yovanoff (in press) to examine whether supported employment was being implemented in better ways than when it initially emerged in the 1980s, suggested that larger systems issues defined the extent to which supported employment could deliver improvements over time. In large part, outcomes such as wage levels, and to an extent social integration outcomes, were driven by the amount of hours worked, which in turn was affected by financial disincentives and other structural issues related to the jobs market. Mank et al concluded:

"Future improvements in the career outcomes for people with significant disabilities will not simply be a matter of what practitioners do in the next 10 years, it may be more of a matter of what we are able to do with the policy, funding and systemic issues that can be improved to support the work of people in local communities."

2.20 The 'social model of disability' recognises the barriers in the way work opportunities, the environment and support mechanisms are created and organised (Riddell et al, 1999). This review highlighted aspects of the social security system, conversion and infrastructure issues, a lack of strategic development of supported employment, and recruitment policies and procedures as key systemic issues impacting upon supported employment.

Aspects of the social security system

2.21 Increases as high as 500% in individuals' annual earnings have been reported from supported employment in the US ( e.g. Kregel, 1997). Financial gains from supported employment reported in the UK have been less impressive (Beyer et al, 1996). Riddell et al (1999) researching the impact of supported employment on individuals in Scotland concluded that the economic gain for the people in their study was "only marginal", and that income from employment had replaced but not substantially changed these individuals' overall level of income. It should be noted however, that published studies will not yet reflect the considerable developments in benefits and tax credits that have occurred in the UK since 1997, and which appear to be having a positive impact. That the picture is more optimistic for some people is evidenced by the individual stories collated in this research and presented in Chapter 6. Further, case studies from North Lanarkshire in Appendix 1 show individuals who are financially better off as a result of being in supported employment.

2.22 Aspects of the UK social security system and other related systems have been identified as causing major problems for individuals as well as for the development of supported employment (Simons, 1998; O'Bryan et al, 2000a). The Policy Consortium for Supported Employment (O'Bryan et al, 2000a) argued for "a debate about more radical reform of the benefit system". At the same time, they advocated exploring "pragmatic options for alleviating some of the problems with the current benefits system", and highlighted helpful developments including agencies mobilising effective welfare rights advice, enabling disabled people to make the most of opportunities within the benefit system.

North Lanarkshire Council ensures people with learning disabilities in supported employment are financially better off with a combination of wages and in-work benefits. Social Work Department Welfare Rights Officers stay well informed of benefit regulations and changes, introduce the income potential of employment from the start and perform financial calculations for each individual (O'Bryan, 2002).

Conversion & infrastructure issues

2.23 The original concept of supported employment assumed changeover from existing segregated day services and sheltered workshops and conversion in the use of financial resources to supported employment. This paradigm shift has not happened in practice (Wehman et al, 2002; Beyer et al, 2002). Rather, supported employment has been added to a continuum of services. Statistics collated by the Scottish Executive (2004) found that during a 'typical week' in 2003, around 7,433 adults with learning disabilities and/or ASD in Scotland were attending a day/resource centre while 2,493 adults were participating in 'voluntary work', 'non-open' and 'open employment'. Although 48% of those attending day centres were recorded as getting some sort of alternative day opportunity outwith the centre including paid or voluntary work, these figures show segregated provision continues to be the dominant experience for people with learning disabilities and/or ASD in Scotland.

2.24 Mank (1994) attributed limited systemic change to six main problems:

• An underestimation of the current system of segregated services;
• Limited incentives for change coupled with disincentives for those interested in dismantling segregation in favour or supported employment;
• Conflicting policies;
• The lack of sustained investment;
• Over-reliance on social services and under-reliance on the community;
• Little control on the part of people with severe disabilities.

2.25 In relation to research in the UK and Holland, Ritchie (1999) concluded that strategic redesign issues were not being addressed either at local or national level. Woodford (1999) described similar issues in relation to the Australian experience.

The need for strategic development

2.26 Despite apparent progress, recent studies show that supported employment services are often developed in isolation rather than as part of an overall strategic framework and this leads to duplication of effort, fragmentation and fragility of the sector (Smyth & Maynard Campbell, 1997; O'Bryan et al, 2000a). Ritchie and Stalker (1999) observed supported employment in Scotland to be a "marginal activity".

2.27 Supported employment requires specific systems and structures to "ensure mainstream success" and to assure its quality (O'Bryan, 2002; Weston, 2002). A strategic approach requires commitment from above for instance at Chief Executive level; a common and agreed purpose between all partners; support from employees, trade unions, employers, and all appropriate local organisations; and effective monitoring and evaluation mechanisms which involve disabled people (Smyth & Maynard Campbell, 1997).

North Lanarkshire Council is an example of a local authority that has adopted a strong policy leadership and coordinated approach to supported employment (O'Bryan, 2002). In 1998 Social Work began a supported employment strategy as part of a broader social inclusion focus. From there, they were able to actively promote the benefits of supported employment to the wider Council.

The Glasgow Partnership brings together the local Council, NHS Board, Jobcentre Plus, Scottish Enterprise, Careers Scotland, Further Education colleges, LECs and ENABLE Scotland and has produced a plan as to how agencies in the area should work together under a common vision ( Equal Access to Employment Strategy). The partnership identified the need for strong, strategic leadership within the City as a key issue. The document articulates the vision, principles objective and targets of the Equal Access to Employment strategy, outlines the management structure and work plan for implementing the strategy.

Recruitment policies and procedures

2.28 Research exploring good practice in employing disabled people (Smyth & Maynard Campbell, 1997) highlighted several examples of local authorities in the UK that had adjusted internal recruitment policies and procedures to assist the employment of disabled people. Successful strategies have included guaranteed interviews for disabled people; targets for the number of disabled people employed by an organisation; recruitment and selection training for staff; and creating groups to discuss issues of concern and review policies.

Leeds City Council has pioneered a successful and well-documented approach to inclusive employment (North Lanarkshire Conference Report, 2004). They used in-house employment opportunities as the drive for promoting social inclusion. A flexible stance was taken to advertising and appointing staff, validated by the Employers' Organisation Recruitment Guide. Partnership working between the Human Resources Department and the Employment Service resulted in setting targets for employing New Deal job seekers via the Jobcentre Plus Service. 'Entry level' jobs were ring-fenced and initially offered to New Deal applicants. This approach is now perceived as an effective recruitment policy rather than a social inclusion policy

Self-determination & choice

"Self advocates and advocates are repeatedly calling for more rapid expansion and improved quality for all persons, across disability labels, who will benefit from a job in the community with individualized supports." (Mank, 2001)

2.29 Although the supported employment model has expanded the employment options and quality of work life for many people with disabilities, some authors have argued that it is primarily controlled by agencies and that employment specialists could do more to advance the self-determination of people with disabilities (Sowers et al, 1996). Several writers have emphasised both the importance of a consumer-led perspective and of individuals controlling their vocational destinies through self-determination and self-advocacy (Wehman & Kregel, 1998; Racino & Whittico, 1998; Martin et al, 2002).

2.30 'Self-determination' is a philosophy advocating supports and services based on the interests, needs and preferences of individuals with a disability and those who are close to him or her. In respect of supported employment, it means people with disabilities and their families determining what direction their career searches should go, how their careers fit with their lives and how services should best support their goals. 'Self-determination' is also a term used about an approach that means teaching disabled workers self-management strategies rather than relying on direct intervention by employment specialists as requirements change within a job (Beyer and Kilsby, 1997). This signifies "a paradigm shift" towards more empowering methods of training people with learning disabilities (Beyer et al, 2002).

2.31 The key components of a consumer-led approach have been described as:

• The disabled person as a customer selecting the supported employment service best suited to meet his or her needs
• Creating a 'customer profile' of what each individual wants to achieve through supported employment, identifying personal strengths, concerns, desires, and anticipated outcomes
• The individual becomes an active participant in marketing and career development
• Service providers involve their customers in every aspect of the employment match process including employment selection
• Service providers must use existing technology and best practices extensively described in the literature and involve the customer in all the decisions regarding his or her training
• Determine individualised strategies for providing support that will assist career development for the customer and employer
• The individual is in charge of the process and the role of the supported employment professional is to assist, facilitate and support.

(Barcus, 1999)

2.32 Ensuring services adopt a more consumer-driven approach includes promoting person centred planning approaches, emphasising choice and adopting a career-based approach to job development and support.

Person-centred planning approaches

2.33 Since the mid 1990s, connections have been made between supported employment and person centred planning, although individualised planning was always a feature of the model (Callahan and Garner, 1997). 'Person-centred planning' has been defined as a set of strategies to help find and create ways for an individual to participate fully in his/her community (Sanderson et al 1997; Wolf-Branigin et al, 1998). More recently person-centred planning approaches have been shown to be effective at enabling individuals to direct their own careers and enhancing long-term employment and career satisfaction (Steere et al, 1995; Sowers et al, 1996; Kregel, 1998).

2.34 Several authors including Rogan et al (2000) have identified person centred planning as a key feature of best practice in supported employment. Adopting a person-centred approach to supported employment achieves better outcomes: for example, Hagner and DiLeo (1993) argued that job seekers invest more in the process; employer contacts are broader in scope and are more creative; the individual is more motivated to succeed and keep the job; jobs are more specifically tailored to the individual; and social integration outcomes are better.

2.35 Person centred planning promotes self-determination and the central involvement of the job seeker in the process of supported employment. Meyer (2001), writing as a person with ASD, described person centred planning as a "radical planning paradigm", which was both a planning and counselling technique. It is now recognised as having particular relevance for people who have ASD, particularly those with Aspergers Syndrome because it addresses one of their main problem areas that is, "executive function" or planning.

2.36 An evaluation of a person centred career planning tool, the Personal Career Plan, found it to be a viable method for expressing career preferences and attaining employment based on individuals' preferences and choice (Menchetti and Garcia, 2003). A better match was obtained using this tool between individuals' career choice and current employment. A critical implementation issue was clarifying the individual's career vision into concrete statements around such things as preferred hours, wages, and outcomes. In common with other studies, the researchers identified the need to invest in staff training in person centred planning to enhance both the practices and values necessary for successful implementation.

Promoting choice

2.37 Related to the notion of consumer or person-driven services and self-determination is the concept of choice and the importance of ensuring each person has "real personal choices" in employment (DiLeo, 1999). Wehman et al (2002) argues that informed choice and control must be a "key feature" of any employment support service. Moseley underlined the importance of finding jobs that reflect individuals' interests and abilities as long ago as 1988:

"The idea that persons with mental retardation, for example, excel in dull repetitive tasks appears to be based on handicappist prejudice rather than evidence." (p217)

2.38 In practice, as Wistow and Schneider (2003) found, "the opportunity to work seems to be valued more than being able to choose what sort of work". Similarly, research in 3 supported employment services in Scotland (Ridley, 2001) found "gaps in information about personal goals and aspirations coupled with a tendency to fit people into existing jobs". In some instances, there was greater reliance on professional knowledge of the current job market than on exploring individuals' aspirations.

2.39 In another study people with disabilities were asked about their ideal or dream jobs, and gave both specific and individual responses (Dufresne, 1996). They aspired to a wide variety of jobs and it struck the author that many people with disabilities "have dreams of which many of us professionals are totally unaware". Furthermore, their job preferences were found to be "not in synch" with the types of supported employment jobs on offer, which for the most part were in fast food and other catering related posts.

Career-based approach

2.40 While models of career development for the general population assume changing jobs to be an integral part of the employment process, this is not always the case for supported employees (Pumpian et al, 1997). Factors such as the status of jobs and advancement opportunities have not always been taken sufficiently into account when determining suitable job matches (Sowers et al, 1996; 2002).

2.41 Racino and Whittico (1998) assert that self advocates now demand 'good jobs' with good pay and benefits, enjoyable work that enables a contribution, and 'quality' education, career planning and the possibility of advancement. A recent qualitative study of users' views on supported employment in England (Wistow and Schneider, 2003) found that getting and keeping a job was "not enough" and that people with learning disabilities sought career progression. Recognition of these needs has resulted in an important shift in thinking for supported employment (DiLeo, 1999).

2.42 Demonstration projects such as Pathways to Independence in Wisconsin are pioneering innovative ways of supporting people with disabilities to find satisfying careers using person centred planning methods, setting up 'career planning teams' and by developing better partnerships between everyone involved in an individual's life alongside supported employment providers (Mills & Fentress, 2002). 'Career planning teams' are similar to 'circles of support' in that they are a group of people who care about the person and work together to help him or her find a career. The individual with disabilities is the 'team leader' and the team includes amongst others, the employment specialist or job coach and a benefits specialist. Menchetti and Garcia (2003) have pioneered the use of a 'personal career plan' as a viable method for finding out about individuals' careers choices.

2.43 Another initiative, piloted in several states in the US was 'career services vouchers' (DiLeo, 1999). These vouchers were given to people with disabilities to be spent on "pursuing mutually agreed-on career goals from exploration and job development to accommodations and additional on-the-job support". Such initiatives arise out of recognising the importance of putting control of resources in the hands of disabled people and thereby increasing their self-determination (Mank, 1994; 2001). Although not directly comparable, Direct Payments have rarely been used in this country to support individuals in employment (Ritchie and Stalker, 1999).

Marketing & job development

"Employers' satisfaction with quality supported employment services is critical for ongoing support, integration and future placements. Job developers must be knowledgeable and skilful in balancing the needs of employers and consumers with disabilities. Employers who experience quality supported employment services may serve as advocates and communicate the benefits to other potential employers." (Grossi et al, 1998)

2.44 Finding the right job not only relies on a thorough understanding of an individual's interests, preferences and goals, but also on understanding the needs of employers. Focus group research in the USA found that while supported employment specialists looked for employers who were aware and understanding, employers on the other hand emphasised competence and quality (Luecking, 1996).

2.45 Employers have identified both benefits and concerns regarding employing individuals with disabilities (Unger, 2002). Research finds that employers with previous experience of employing disabled people report more favourable perceptions and a willingness to hire other persons with disabilities. Luecking et al (2004) asserted that such employers develop more positive views even when these workers have severe disabilities. Unger concluded that to an extent employers were willing to sacrifice work performance or work quality in exchange for dependable employees. Similarly, research by Petty & Fussell (1997) found employers viewed people with learning disabilities as reliable, hard-working and effective employees.

2.46 Hagner & Daning (1996) found that having experienced job developers who had developed relationships with a network of employers and were more attuned to employers' needs was important. Company-centred negotiations that focused on the needs of the company and the employer's plans were found to be the most effective especially in getting employers to create jobs when no position was open. This approach also led more often to natural supports being developed in the workplace. Most job developers in their study highlighted two critical success factors: presenting a businesslike approach to employers and second, establishing open and personal communication.

2.47 Some writers assert that employment specialists could do more to market supported employment to employers (Leucking et al, 2004). Further, the language and culture of disability services has "not jibed with those of the business world". DiLeo (1999) urged employment services to avoid marketing messages that focused on disability as well as project names, logos, business cards and other materials "relating to human services, charity, hope or pity".

2.48 Pierce (1999) identified backgrounds in healthcare or human services as a distinct disadvantage for supported employment staff, as this did nothing to equip them with the skills necessary to communicate effectively with employers. It has been suggested that the roles of job developer and job coach require different sets of skills and should ideally be separate roles. Studies where this has happened report positive findings (Mank et al, 1998a). The advantages for job developers include having the time to invest in relationships, recruiting managers' interest and becoming an expert in the human resource system. Long-term support agencies can invest more in job analysis, job matching and natural supports.

Importance of awareness raising/training in the workplace

2.49 Research into employment for disabled people in the UK concluded that awareness raising and training for employers was a "vital part of any equality strategy" (Smyth & Maynard Campbell, 1997). This finding is supported by the work of researchers in the US ( e.g. Mank et al, in press). These researchers found better outcomes for those working in companies where training was provided about diversity or disability awareness. Further, providing information and support to co-workers and supervisors in the workplace was linked to better wage and integration outcomes, as was less contact with supported employment personnel (Mank et al, 1999). Better outcomes were also associated with the provision of specific information about the support needs of the individual and providing information to co-workers and supervisors just as the individual started in the job rather than later.

Job coach issues

2.50 The role of employment specialist continues to evolve. At the same time, research shows gaps between what is expected, and the responsibilities of employment specialists and their levels pay and training (Agosta et al, 1996; Grossi et al, 1998). Having trained employment specialists has been shown to positively affect the quality of supported employment services (Grossi et al, 1998; Beyer, 2001). There are better financial outcomes for supported employees in services that have dedicated job finders and staff with qualifications (Beyer, 2001). Conley's research (2003) recommended several enhancements to supported employment including recruiting and retaining qualified vocational workers and providing them with improved training.

'Natural supports'

2.51 A body of writing during the 1990s criticised traditional paid supports as intrusive and as hindering successful outcomes, in particular social integration, and instead advocated for the use of 'natural supports' in the workplace or greater involvement of employers in facilitating supported employment (Butterworth et al, 1996). DiLeo and Langton (1996) asserted that natural supports were an "inevitable outcome in the evolution of services" and the Rehabilitation Act Amendments (1992) formalised natural supports in the US as an "extended service option". Developments in the area of natural supports have been perceived as the beginning of a shift in control and in encouraging the involvement of people with disabilities and their families in the process of supported employment (Wehman & Kregel, 1998).

2.52 Nevertheless, there can be great diversity in the way natural supports are defined and implemented. From their survey, Murphy et al (1996) concluded that the term was "neither self-evident nor well understood". Some have argued ( e.g. Test and Wood, 1996) that there is little or no convincing empirical evidence about natural supports or their effectiveness in the workplace for employees with disabilities. Even so, the use of natural supports has increased. Mank, (1996; 2003) suggested that natural supports had become "axiomatic" with the implementation of supported employment in that supported employment services assert that they make use of natural supports even though there are differences of opinion about definition, measurement and assessment of the impact of natural supports.

2.53 Recent research by Mank et al (2003) found better outcomes when employers and co-workers were involved in the support process from the start. In one study (Mank et al, 1999), where co-workers received training and information on how to support individuals with disabilities, supported employees earned 22% more and were significantly better socially integrated in the workplace. Weston (2002) established that the use of natural supports overcame employers' fears around employing people with complex needs over time. Also when job coaches trained co-workers to provide ongoing support, supervisors were found to be more satisfied with accuracy and levels of productivity.

'Typicalness'

2.54 The focus on natural supports and better understanding workplace cultures has led to further advances in thinking about best practices in supported employment through natural or 'typical' processes. The so-called 'typicalness' of the job acquisition process, conditions of the job, similarity of work roles with colleagues, and initial training and orientation has been positively and strongly correlated with positive wage and integration outcomes (Mank, 2001; 2003). In other words, if employment is 'typical', outcomes such as wages, hours worked, and the degree of integration and interaction are better. However, in some cases, atypical features of employment may be needed and should still be considered valuable (Mank, 1997).

2.55 International research comparisons using data from Germany, the UK and Australia (Jenaro Rio et al, 2002) confirm a relationship between providing more typical interventions during the job development process and the social, economic and performance outcomes of supported employment. Weston (2002) found that although experiences of work were not 'typical' in every respect for people with severe disabilities or complex needs, 'typical' practice in terms of inclusion in the workforce was very important as it ensured people felt part of the team, and this was one of the most successful ways of retaining people in jobs. Other UK research (Beyer, 2001) similarly finds higher wages for supported employees whose jobs were similar to others in the same workplace, and where they had similar terms and conditions.

Enhancing social integration outcomes

2.56 While social integration is recognised as the "centrepiece" of supported employment (Mank, 1988), the process of facilitating social integration has been an ongoing critical development issue. There are mixed findings and many different views about what constitutes social integration (Chadsey-Rusch et al, 1997). Most research commenting on social integration outcomes has examined opportunities for vocational integration and it is often assumed that levels and quality of social interactions at work are synonymous with social integration (Hughes et al, 1998). In this respect, the social integration outcomes of supported employment have been largely positive. Traustadottir (1999) found the social relationships people developed at work could be the most important factor in whether or not people kept or lost their jobs.

2.57 Taking a broader quality of life perspective suggests that for some, having a job does not automatically result in broadening of social relationships and networks beyond the workplace and that facilitating social integration is a complex issue (Bass & Drewett, 1997). Riddell et al (2001) found that supported employment did not always provide sufficient opportunities for individuals to enhance their social networks. Similarly, Wistow and Schneider (2003) found variable social integration outcomes among the 30 supported employees they interviewed.

2.58 Disappointing social integration outcomes have been associated with jobs that are socially isolated and/or untypical of other jobs in the same workplace, and with unpaid or low paid positions (Ridley, 2001). Meeting people at work was a positive benefit for some individuals in this Scottish study and such relationships were highly valued. Further, mixing with others at work had indirect benefits such as increasing individuals' self confidence, which encouraged at least one person to be "more sociable and talkative" in other social situations.

2.59 Research findings therefore point to a need to focus on the quality of jobs, the social atmosphere and connections at work, and to use intentional strategies to promote social integration. The importance of better support for relationship development including "getting better at spotting workplaces conducive to social inclusion" was one of the conclusions reached by Beyer (2001). Employment specialists could evaluate the strengths and weaknesses of different workplaces using one of the many measures designed for this purpose, such as those devised by the Virginia Commonwealth University (Parent et al, 1992).

Self directed employment/self employment

2.60 The prospect of self-employment (sometimes referred to as 'micro-enterprise') for people with disabilities is a more recent phenomenon associated with the concept and promotion of self-determination, person centred planning approaches placing the individuals' dreams and aspirations at the centre, and the development of personalised funding systems such as Direct Payments. Self-directed employment has been defined as an array of models where people taking responsibility for the work also have a significant say in how it is organised and managed (Rizzo and Van Houtte, 2000).

2.61 A nationwide demonstration project in the USA in 1993 on ways to improve consumer choice within vocational rehabilitation services, unexpectedly found that 13% of participants who became employed chose self-employment over regular employment (Callahan et al, 2002). They concluded that self-employment and participant choice/control were closely related concepts. Since then, the 1998 United States Rehabilitation Act Amendments officially recognised the importance of self-employment as an employment option within the US Vocational Rehabilitation system (Hagner & Davies, 2002).

2.62 Proponents of this option argue that it presents a "tremendous opportunity" especially for individuals who are challenged by the competitive labour market and although "not for everyone", self-employment is hailed as "the next logical step in the evolution of supported employment" (Griffin and Hammis, 2003). In summary, the advantages are that it:

• Closely matches individual preferences, gifts, and unique contributions and allows for the creation of work opportunities when someone does not fit standard job descriptions
• Encompasses some types of work not found in existing job opportunities
• Offers another avenue for supported employment and is a viable alternative to day programmes
• Offers control and self-reliance, which is appealing to some
• Offers an opportunity to schedule the working day and week to accommodate personal productivity levels, personal goals, support needs, lifestyle choices etc

(Newman, 2001; Hagner and Davis, 2002; Griffin and Hammis, 2003).

2.63 Self-employed individuals with disabilities may need access to business training, business plan development, skills training and education, assistance with obtaining financial resources and specialist benefits advice, and mentoring. Griffin and Hammis (2003), alongside other authors such as Rizzo (2002) emphasise the importance of providing a wide range of supports, systems for supported decision making, supportive business structures and innovative business coaching.

2.64 The literature also identifies one of the biggest barriers to developing self-employment options as the attitudes and approach of services supporting individuals with disabilities (Allen and Granger, 1997; Griffin and Hammis, 2003). Although other outcomes were positive, the businesses studied by Hagner and Davies (2002) were what they called "shoestring operations" in that they were not economically viable by traditional criteria. Shelley et al (1999) also found the income from self-employment was supplemented by other earned and unearned income.

Importance of post employment services

2.65 The Montana/Wyoming Careers through Partnerships demonstration project illustrated the importance of post employment services to job retention and career advancement (Griffin & Hammis, 2003). Many participants in this project used funds for post employment services such as job coaching and financial support services (Newman, 2001). Reid and Bray (1997) concluded that individuals who kept their jobs for some time had at least one important source of support, which could be their job coach or someone at the workplace.

2.66 "Extended services" or ongoing support has rarely been researched although it is claimed as one of the "unique features" of supported employment, which has contributed to its success with individuals with severe disabilities (West et al, 2002). These researchers found that most people required very little support once stabilised in a job even when problems arose and that strategies involving natural supports in the workplace and other people such as family members, went some way to resolve the shortfall in funding for extended services.

GAPS IN INFORMATION

2.67 Scant literature was found relating to adults with ASD and employment and, what there was predominantly focused on employment strategies with adults with Aspergers Syndrome. Nevertheless, a recent report published by the National Autistic Society (Barnard et al, 2001), suggested employment was the single biggest issue or barrier facing more able adults with ASD. Furthermore, Fast (2004) claimed that 90% of those with Aspergers Syndrome who are in jobs are what the author describes as "under-employed" in these jobs, that is, not working to their full capacity.

2.68 The main barriers to employment recognised in the literature were professionals' lack of understanding of ASD in the employment context; confusing recruitment processes; interviewing techniques which disadvantaged people with ASD; adjustments in the workplace that tended to be physical rather than procedural; and the often high technical and knowledge skills of people with Aspergers Syndrome. Supported employment and person-centred planning can be the key to facilitating employment for people with ASD (Leach, 2002).

2.69 In examining what makes a successful job for people with ASD, Grandin (1999), herself a person with ASD, argued that jobs need to be chosen that make use of the strengths of people with ASD and in summary, that successful transitions into jobs or careers can be achieved through:

• Gradual transitions - work started for short periods while the person is still in school
• Jobs that have a well-defined goal or endpoint
• Capitalising on the person's work not personality, and making a portfolio of work
• Supportive employers who recognise the person's social limitations
• Having mentors - people who have common interests with the person with ASD
• Educating employers and employees about ASD
• Undertaking freelance or self-employed work

(Grandin T, 1999)

BEST PRACTICE FEATURES

2.70 In summary, the literature review has identified several best practice features, which can be summarised as:

• A values based approach is taken to implementing supported employment;
• A user-led approach is adopted promoting self-determination, person centred services, choice and a career-based approach;
• Employers' needs are taken into account when marketing supported employment and job development;
• Employment specialists adopt a business like approach to marketing and job development, avoiding the language and culture of human service systems
• There is awareness raising and training for employers, co-workers and supervisors
• Employment specialists become consultants and facilitators rather than experts
• There is training for, and proper support given to employment specialists, including training in new approaches
• Employment specialists use 'natural supports' within the workplace and support jobs in ways that are as 'typical' as possible for each setting;
• Intentional and systematic ways are found to enhance social integration;
• Self employment opportunities are considered and supported by supported employment agencies;
• There are post employment or follow up services;
• Services use strategies to ensure people with severe disabilities are included;
• Systemic barriers such as the lack of strategic development and financial disincentives within the benefits system are tackled.

CHAPTER TWO: SUMMARY OF KEY FINDINGS

• • There is a gap in the literature regarding employment and people with ASD
• A value-based approach based on the support model has been found to be the most effective at promoting employment
• Given the variability in practice, revisiting the values and definition of supported employment is called for
• Implementation of supported employment across Europe has been disappointing with many countries found to invest more in segregated provision
• Although there is no consensus about the definition of supported employment, 3 elements are common - 1) paid jobs; 2) integrated settings; and 3) ongoing support
• Individuals with more severe disabilities are underrepresented in supported employment although studies show high quality outcomes are possible
• Research supports tackling systemic barriers as these define the extent to which supported employment can deliver improvements over time
• While aspects of the social security system are recognised as unhelpful, effective welfare rights advice has guaranteed positive financial outcomes for many people
• The changeover and conversion envisaged at the start has not been achieved - instead supported employment has become part of a continuum of services
• Supported employment is often developed in isolation, leading to fragmentation and fragility of the sector. A need for strategic development is emphasised
• Writers emphasise the importance of a user-led perspective and of individuals controlling their vocational destinies through self determination and self advocacy
• Ensuring a more user-driven approach includes promoting person centred planning methods, emphasising individual choice, and adopting a career-based approach
• Examples exist of local authorities promoting employment through flexible recruitment policies and procedures, promoting in-house opportunities, setting targets, and working in close partnerships with other agencies
• Finding the 'right job' relies on a proper understanding of both the individual's needs and the employer's needs
• Employment specialists could do more to market supported employment to employers and should avoid the language and culture of human services systems
• Employers with experience report more favourable perceptions and willingness to hire other disabled persons
• Awareness raising and training for employers, co-workers and supervisors is associated with better outcomes
• Training for employment specialists is critical for quality supported employment and is associated with better outcomes for individuals
• There is a gap between what is expected of employment specialists and their current levels of pay and training
• While 'natural supports' have been variously interpreted, better outcomes are associated with involving employers and co-workers in the support process
• When employment is 'typical' outcomes such as wages, hours worked and social interaction are better
• To enhance social integration, research suggests focusing on the quality of jobs, the social atmosphere at work and adopting intentional strategies
• Self employment opportunities were perceived as "the next logical step in the evolution of supported employment", with potential to offer individualised options
• Post employment or follow-up services to those established in jobs are critical