Supported Employment: What Have We Learned After 30 Years? Paul Wehman, Ph.D., Virginia Commonwealth University Professor of Physical Medicine and Rehabiliaion Director VCU-RRTC European Union on Supported Employment 20th Anniversary Conference Dublin Ireland, June 12, 2013

Supported Employment: What Have We Learned After 30 Years?

Persons with significant intellectual disabilities can work in open/competitive employment (eg. Mank, D. 1997; Mank, D. 2000; Wehman, P. 1981; Wehman, P., Parent, W. et. al 1987) 1980’s

Persons with severe mental illness can work in competitive employment (eg. Bond, G. et. al. 2008; Bond, G. 2004; Drake, R. & Bond, G. 2008) 1990’s

Persons with classic autism can work in competitive employment (eg. Howlin ,P. et. al. 2005; Wehman, P., Lau, S. et. al. 2012, Wehman, P., Schall, C. et. al. 2013) 2003-2013

Persons with severe traumatic brain injury can work in competitive employment (eg. Wehman, P. et. al. 1990; Wehman et. al. 2005; Wehman, Chen et. al. 2013; Chesnut, R. et. al. 1999; & Hart T. et. al. 2010) 1990’s

Persons with spinal cord injury can work in competitive employment (eg. Inge, K. et. al. 1998; Ottomanelli, L. et. al. 2009; Ottomanelli, L et. al 2012) Late 1990’s To Mid 2000’s

Segregated day programs & extended prevocational services are not necessary for open/competitive employment (eg. Wehman,P. & Kregel, J. 1998; Brown, L. et. al. 2006)

Effective job coaches/employment specialists are a critical bridge for long term successful open/competitive employment

Supported employment is more cost effective than day program services (eg. Cimera, R. 2007; Cimera, R. 2010)

Internships can be significant enhancers for long term open/competitive employment (eg. Daston, M. et. al. 2012; Luecking, R. 2009; Luecking, R. 2011; Symonds,P. & Luecking, R. 2013)

Paid work while in school before graduation greatly facilitates open/competitive employment (eg. Carter, E. et. al. 2011; Wehman, P., McDonough, J. et. al. 2013)

Quality of life & independence is greatly improved through supported employment (eg. Garcia-Villamisar, D. et. al. 2002; Jahoda, A. et. al. 2008; Verdugo, M. A. et. al. 2009; Wehman, P., Sima, A., et. al. 2013)

Parents support of individuals with significant disabilities capacity to work greatly increases likelihood of successful open/supported employment (eg. Wehman , P. 2013)

What’s going on in the world of supported employment?

Supported Employment: A World Wide Phenomena The Current Gold Standard for Individuals with Disabilities & their Families People with disabilities say: (Migliore, A. et. al. 2007) A “Slot” in sheltered workshop is not enough “Let us work in business” Real Work with Supports - Now! Pre = Never

Spain Providing SE for over 20 years SE initiatives up from 24 (1995) to 57 (2004) Since start of SE program (2005) up to 207 (2010) International leaders in Quality of Life research (Jordán de Urries F.B., & Verdugo, M 2010;Verdugo, M et al 2009)

Ireland Government support Ireland’s Presidency of the Council of the EU Job Shadow Day & National Supported Employment Week Open Door Project Innovation and dedication

United Kingdom Youth SE initiatives show improved work rates Project SEARCH pilot study Growing body of SE research (eg. quality of job, services, inclusion, cost benefit) Calls for investment in intensity & type of support in relation to needs; policies to improve availability & flexibility of jobs (Beyer, S. 2012)

Australia Data driven approach to analyze and monitor performance Services “uncapped”(2010) individuals no longer need to be placed on waiting list & can receive immediate access to service they require

Challenges for the Future 1. Close all Sheltered facilities and Segregated Day Programs and Re-Direct Funds for Open/Competitive Employment 2. Make Open/Competitive Employment the First Choice for all 3. Make Funds Available to persons with Disabilities to Spend on their own Job Coach and Provider

Challenges (cont) 4. Set Goals for Placement of Persons with Disabilities Each Year between Now and 2018 5.Create Training Institutes for Employment Specialists to Establish Supported Employment Competencies 6. Create country Wide Business Disability Networks

References Beyer, S. (2012). The progress towards integrated employment in the UK. Journal of Vocational Rehabilitation, 37(3), 185-194. Bond, G. R. (2004). Supported employment: Evidence for an evidence-based practice. . Psychiatirc Rehabilitation Journal, 27, 345-359. Bond, G., Drake, R. & Becker, D. (2008). An update of randomized controlled trials of evidence-based supported employment, 31(4), 280-290.  Brown, L., Shiraga, B. & Kessler, K. (2006). The quest for ordinary lives: the integrated post-school vocational functioning of 50 workers with significant disabilities. Research and Practice for Persons with Severe Disabilities, 31(2):93-121.  Carter, E.W., Austin, D.& Trainor, A. (2011). Factors associated with the early work experiences of adolescents with severe disabilities. American Journal of Intellectual and Developmental Disabilities,49(4), 233-247.

References Cimera, R.E. (2007). The cumulative cost-effectiveness of supported and sheltered employees with mental retardation. . Research and Practice for Persons with Severe Disabilities, 32(4),247-252. Cimera, R.E. (2010). National cost efficiency of supported employees with intellectual disabilities: 2002-2007. American Journal of Intellectual and Developmental Disabilities, 115, 19-29. Chesnut, R.M., Carney, N., Maynard, H., Mann, N.C., Patterson, P. & Helfan, M. (1999). Summary report: evidence for the effectiveness of rehabilitation for persons with traumatic brain injury. Journal of Head Trauma Rehabilitation, 4(2), 176-188. Daston, M., Riehle, E. & Rutkowski, S. (2012) High School Transition that Works: Lessons Learned from Project Search. Baltimore, MD, Paul H. Brookes Publishing Co. Drake, R. & Bond G. (2008). The future of supported employment for persons with severe mental illness. Psychiatric Rehabilitation Journal 1(4),367-376. 

References Garcia-Villamisar, D., Wehman, P. & Navarro, M.D. (2002). Changes in the quality of autistic people’s life that work in supported and sheltered employment: a 5-year follow-up study. . Journal of Vocational Rehabilitation, 17(4),309-312.  Hart, T., Dijkers, M., Whyte, J., Braden, C., Trott, C. & Fraser, R. (2010). Vocational interventions and supports following job placement for persons with traumatic brain injury. Journal of Vocational Rehabilitation, 32 (3),135-150.  Howlin, P. , Alcock, J. & Burkin, C. (2005). An 8 year follow-up of a specialist supported employment service for high-ability adults with autism or Asperger syndrome. Autism. 9(5), 533–549. Inge, K., Wehman, P., Strobel, W., Powell, D., & Todd, J. (1998). Supported employment and assistive technology for persons with spinal cord injury: Three illustrations of successful work supports. Journal of Vocational Rehabilitation, 10, 141-152.

References Jahoda, A., Kemp, J., Riddel, S. & Banks, P. (2008). Feelings about work: a review of the socio-emotional impact of supported employment on people with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 21(1), 1- 18. Luecking, R.G. (2009). The way to work: how to facilitate work experiences for youth in transition. Baltimore, MD, Paul H. Brookes Publishing Co. Luecking, R.G. (2011). Connecting employers with people who have intellectual disabilities. American Journal of Intellectual and Developmental Disabilities 49(4),261-273. Mank,D., Cioffi, A. & Yovanoff, P. (1997, June). Analysis of the Typicalness of Supported Employment Jobs, Natural Supports, and Wage and Integration Outcomes. Mental Retardation. 35, 3, 185-197. 

References Mank,D., Cioffi, a. & Yovanoff, P. (2000, December). Direct Support in Supported Employment and Its Relation to Job Typicalness, Coworker Involvement, and Employment Outcomes. Mental Retardation: 38,(6) 506-516. Migliore, A., Mank, D. , Grossi , T. & Rogan, P. (2007). Integrated employment or sheltered workshops: preferences of adults with intellectual disabilities, their families, and staff. Journal of Vocational Rehabilitation, 26(1) 5-19. Ottomanelli, L., Goetz, L., McGeough, C. , Suris , A., Sippel, J., Sinnott, P., et al. (2009). Methods of a multisite randomized clinical trial of supported employment among veterans with spinal cord injury. Journal of Rehabilitation Research & Development, 46(7), 919-30. Ottomanelli, L. , Goetz, L., Suris, A., McGeough, C., Sinnot, P., Toscano, R.,et al. (2012). The effectiveness of supported employment for veterans with spinal cord injuries: results from a randomized multi-site study. Archives of Physical Medicine and Rehabilitation, 930(5),740–747.

References Symonds, P. & Luecking, R.G. (2013) Open employment in Australia. Journal of Vocational Rehabilitation, 38(3),215-222. Wehman, P. (2013). Transition from School to Work: Where are we and where do we need to go? Career Development for Exceptional Individuals-35th Anniversary issue, 36(1), 58 – 66. Wehman, P., Chen, C., Targett, P., West, M., & Cifu, G. (in press, 2013). Transition planning and postsecondary educational outcomes for youth with TBI. NeuroRehabilitation. Wehman, P. & Hill, J. (1981, February). Competitive employment for moderately and severely handicapped individuals. Exceptional Children, 338-346.

References Wehman, P., Hill, J.W., Wood, W., & Parent, W. (1987). A report on competitive employment histories of persons labeled severely mentally retarded. Journal of the Association of Persons with Severe Handicaps, 12(1), 11-17. Wehman, P., Inge, K. J., Revell, G., & Brooke, V. A. (2007). Real Work for Real Pay: Inclusive Employment for People with Disabilities. Baltimore: Paul Brookes Publishing Co. Wehman, P., Lau, S., Molinelli, A., Brooke, V., Thompson, K., Moore, C., et al. (2012). Supported employment for young adults with autism spectrum disorder: Preliminary data. Research and Practice for Persons with Severe Disabilities, 37(3), 1-10. Wehman, P. & Kregel, J. (1998). More than a Job: Securing satisfying careers for people with disabilities. Baltimore: Paul Brookes Publishers.

References Wehman, P., Kreutzer, J., West, M., Sherron, P., Zasler, N., et al. Return to work for persons with traumatic brain injury: A supported employment approach. (1990) Archives of Physical Medicine and Rehabilitation, 71, 1047-1052. Wehman, P. McDonough, J. , Schall, C., Molinelli, A.& Riehle,E. (in press). Project SEARCH implementation at high school level for youth with autism . Teaching Exceptional Children. Wehman, P., Schall,C., McDonough, J., Kregel, J., Brooke, V., Molinelli, A., et al. (2013). Competitive employment for youth with autism spectrum disorders: Early results from a randomized clinical trial. Manuscript submitted for publication.

References Wehman, P., Sima, A., Ketchum, J.M., West, M.D., Chan, F., & Luecking, R. (2013). Predictors of successful transition from school to competitive employment for youth with disabilities. Manuscript submitted for publication. Wehman, P., Targett, P., West, M. & Kregel, J. (2005). Productive work and employment for persons with TBI: What have we learned after 20 years? Journal of Head Trauma Rehabilitation 20(2), 115-127.