Supported Employment

Supported Employment Outcomes

Braddock, D., Rizzolo, M. C., & Hemp, R. (2004). Trends & milestones: Most employment services growth in developmental disabilities during 1988–2002 was in segregated settings. Mental Retardation, 42(4), 317–320.
Aggregate of information from the State of the States in Developmental Disabilities Project to identify trends and milestones in the employment of people with intellectual disabilities and developmental Disabilities. Between the years 1988 and 2002, people living with either diagnosis who were participating in supported employment programs financed by state agencies grew from 9%-24%. Since then, the grown in percentage of participation in supported employment has been "substantially lower" to 3% annually.
Cimera, R. E. (2006). The future of supported employment: Don’t panic! Journal of Vocational Rehabilitation, 24(3), 129–136.
Author explores the validity of other literature’s proposed ways to improve supported employment by analyzing the state of supported employment from both the perspective of cost efficiency to provide services and the need to better research how employers benefit from hiring people participating in supported employment programs.
Cimera, R. E. (2011). Does being in sheltered workshops improve the employment outcomes of supported employees with intellectual disabilities? Journal of Vocational Rehabilitation, 35(1), 21–27.
Explores the differences of two groups of 4,904 people with intellectual disabilities. One group worked in sheltered workshops before their placement in a supported employment program and the other group only participated in sheltered workshops. People in both groups were compared to someone with a similar primary/secondary disability and gender. Researcher discovered that there were no significant differences in the rate of employment within the community—refuting that people with who are first trained through a sheltered workshop are more capable of obtaining work than those who do not participate in sheltered workshops. Non-sheltered workers earned an average of $18.65/week more than those who were first trained in sheltered workshops. People who did not work in sheltered workshops first worked more hours per week than those who first participated in sheltered workshops and required nearly more than $3,000 less training per placement than those who first participated in sheltered workshops.
Cimera, R. E. (2014). Agency setting as a factor in the effectiveness of supported employment programs. Journal of Rehabilitation, 80(2), 41–46.
This study investigated whether being affiliated with a sheltered workshop had an effect on an agency's ability to provide effective and efficient supported employment services. Two groups of supported employees were compared. Preliminary data indicate that supported employees from agencies with sheltered workshops maintained their employment in the community 2.5 months longer (10.84 v. 8.32 months) and incurred 41.6% fewer costs ($399.43 v. $684.38 per month) than matched peers from supported employment-only agencies. However, these results may have been influenced by factors other than the presence of pre-vocational programs.
Cimera, R. E. (2014a). Agency setting as a factor in the effectiveness of supported employment programs. Journal of Rehabilitation, 80(2), 41–46.
Researchers explored whether the type of agency setting (sheltered vs supported) influenced participants’ employment outcomes. Compared 31 supported employees from agencies without sheltered workshops with 31 employees receiving supported employment services through a facility-based agency with a sheltered workshop using 10 variables to ensure a proper match (disability, severity, demographics, etc). Discovered that people who received supported employment through a facility-based agency have a greater likelihood (55.6%) to be placed in a sheltered workshop than those who received services from an independent agency (7.7%). Researcher hypothesizes that job coaches from facility-based supported employment agencies are less motivated to help clients obtain competitive employment because they can rely on the sheltered workshop if competitive employment does not initially work or is too difficult. Services provided by sheltered facility-based agencies are more expensive because although the services provided last approximately 2.5 months longer, the employee placements are shorter, they earned less money, worked less hours and cost more to provide services than receiving services from an independent agency. Explores possible explanations for the differences between type of agencies.
Dague, B. (2012). Sheltered employment, sheltered lives: Family perspectives of conversion to community-based employment. Journal of Vocational Rehabilitation, 37(1), 1–11.
This qualitative study takes a look at the perspectives of family members and people living with disabilities through the process of converting the person from a sheltered workshop facility into community-based, supported employment. It explores the correlation between the attitudes of closing the sheltered workshops and the history a person has with the sheltered workshop culture. It identifies notable strategies for success and discusses what (in some cases) was an evolution of thought for parents and family members who initially feared the unknown and gradually saw positive differences in the lives of their loved ones due to being integrated in society.
Diallo, A., Chen, R. K., & Barrera, M. M. (2014). Barriers to Using Evidence-Based Practice among Supported Employment Staff Serving Individuals with Intellectual Disabilities. Journal of Rehabilitation Administration, 38(1), 35–44.
The primary purpose of this study was to shed light on the attitudes of supported employment staff toward the use of evidence-based practice in serving clients with intellectual disabilities. The secondary goals were to identify perceived barriers to using evidence-based practice and how to overcome them. The results revealed that White supported employment staff were more open to incorporating evidence-based practice into their work than their non-White counterparts. In addition, level of education was found to correlate with a willingness of supported employment staff to use evidence-based practice.
Griffin, D., Rosenberg, H., Cheyney, W. & Greenberg, B. (1996). A comparison of self-esteem and job satisfaction of adults with mild mental retardation in sheltered workshops and supported employment. Education and Training in Mental Retardation and Developmental Disabilities. 31(2), 142-150.
Discusses role of work setting and living situation in the development of self-esteem and job satisfaction for those living with Intellectual Disabilities. Researchers compared two groups of 100 people with mild intellectual disabilities and discovered that those who lived in a semi-independent living situation and worked in a supported employment setting had higher self esteems and job satisfaction than those who lived with family and attended a sheltered workshop.
Mueser, K. T. & Cook, J. (2016). Why can't we fund supported employment?. Psychiatric Rehabilitation Journal, 39(2), 85-89. View Source
Report which provides history of sheltered work environments and subminimum wage. Provides various case studies in which people living with disabilities were exploited as workers in sheltered environments and people living with disabilities who are succeeding in competitive employment. Outlines why working in a sheltered workshop is harmful. Discusses customized employment programs through Employment First programs. Explores myths, facts and success stories of individuals living with severe disabilities in the integrated workplace. Discusses the sheltered workshop model and the perpetuation of the status quo.
Wehman, P. (Ed.). (2001). Supported Employment in Business: Expanding the Capacity of Workers With Disabilities (1st ed.). St. Augustine: Training Resource Network Inc.
This book is a collaborative effort of 31 leaders in supported employment who wrote 19 chapters addressing issues specific to supported employment and can be used as a reference book covering topics like implementation, funding, transition, economics of running a supported employment program, policy, job development and intervention techniques. (We will include several of these articles specific to policy and procedure as separate items in this literature review).

Cost-Efficiency and Supported Employment

Cimera, R. E. (2007a). The cost of supported employment and sheltered workshops in Wisconsin (FY 2002-FY 2005). Journal of Vocational Rehabilitation, 26, 153–159.
Researcher analyzed three fiscal years of Wisconsin’s VR services and determined that although initial costs are greater than non-supported employment options, the cost of continued services drops after four years of operation. Provides information on how to access cost efficiency of successful closures. Explores possible explanations for increasing expenses. Breaks down cost of supported employment by nature and severity of disability.
Cimera, R. E. (2007b). The cumulative cost-effectiveness of supported and sheltered employees with mental retardation.Research & Practice for Persons with Severe Disabilities, 32(4), 247–252.
Examines and compares cumulative costs of the full "employment cycle" (referral, assessment, placement, follow-along, graduation/job-termination) of 56 supported employees and 171 people participating in a sheltered workshop. Both groups of employees were diagnosed with intellectual disorders and deemed “most significantly disabled.” Determined that not only was supported employment 64.5% more cost effective than sheltered workshops, sheltered workers receive services for a longer duration than supported employees. Discusses the possible reasons supported employment is more cost-effective than sheltered workshops. Discusses how to keep cost-effective analysis in context with findings.
Cimera, R. E. (2007c). Utilizing natural supports to lower the cost of supported employment. Research and Practice for Persons with Severe Disabilities, 32(3), 184–189.
Study to determine whether using natural supports can decrease overall cost of providing supported employment in Wisconsin based on three cost analyses: looking at data collected before and after the Natural Supports Initiative (NSI) was passed, comparing per capita costs of supported employment from NSI agencies to costs generated by every other agency in Wisconsin and determining whether NSI agencies incurred greater costs than non NSI agencies. NSI agencies were more cost efficient than non-NSI agencies. Proposes reasons as to why NSI agencies were more cost efficient.
Cimera, R. E. (2008a). The costs of providing supported employment services to individuals with psychiatric disabilities. Psychiatric Rehabilitation Journal, 32(2), 110–116.
This longitudinal study is the first which compares the costs of providing supported employment services to people with psychiatric disabilities based on four years of programmatic expenditures in data gathered from Wisconsin to that of people living with other conditions. This study also took into consideration the severity of the disorders and compared them with non-psychiatric disorders of comparable severity. People living with psychiatric disorders are the least costly population to serve, yet they have low rates of participation possibly because providers focus on employment history when determining referrals.
Cimera, R. E. (2008b). The cost-trends of supported employment versus sheltered employment. Journal of Vocational Rehabilitation, 28(1), 15–20. Retrieved from this source
Explores cumulative cost trends of a "full employment cycle" for clients in sheltered workshops compared to supported employment agencies for people with intellectual disorders. For every one sheltered employee, three supported employees could have been funded. Researcher concludes that over time, supported employment is a better investment for tax payers because supported employment costs gradually decline over the course of the employment cycle while sheltered workshop employees have a slight increase in cost over time—two intertwining reasons for the increase could be because a sheltered worker has a longer "employment cycle" and the person has the same amount of supervision at the beginning of the employment cycle as they do at the end.

Cimera, R. E. (2009b). Supported employment's cost efficiency to taxpayers: 2002 to 2007. Research & Practice for Persons with Severe Disabilities, 34(2), 13–20.
Studied gross monthly benefits vs gross monthly costs to calculate cost efficiency of VR clients from 2002-2007. Also compared nine categories of disabilities to determine which type of disability was most cost-efficient to tax payers. Researcher concluded supported employment is cost effective to tax payers, regardless of the disability. Secondary conditions did not significantly increase cost. Both clients with and without secondary conditions achieved similar outcomes.
Cimera, R. E. (2010a). Can community-based high school transition programs improve the cost-efficiency of supported employment?. Career Development for Exceptional Individuals, 33(1), 4–12.
Researchers compared the data of 254 transition age youth living with a variety of disabilities to see which employment model (no transition services, school-based transition services, community-based transition services offered at school and students not interested in services) was most cost effective for taxpayers. Researchers matched individuals based on primary disability, presence of secondary disability, length of employment, and cost of supported employment services received. Cost of vocational services forgone, taxes paid, changes in governmental subsidies and tax credits. 85% of students who received community-based services through their school were more cost effective than their peers who did not receive transitional services. 88.2% of students who received community-based services during high school were more cost-efficient than their school-based transitional services. The cause for greater cost-efficiency is because students who participated in the community-based services stayed at their job double the length of time (averaged) than their peers receiving school-based transitional services. However, because participants made so little money, only 6 of the participants actually made enough money to pay taxes, rendering every employment model not cost-effective for taxpayers. This study did not explore the non-monetary benefits (improved quality of life, happiness, independence, etc). Supported employment programs need to explore ways to become more cost-effective.
Cimera, R. E. (2010b). National cost efficiency of supported employees with intellectual disabilities: 2002 to 2007. American Journal on Intellectual and Developmental Disabilities, 115(1), 19–29. View Source
Defines cost efficiency (monetary benefits vs monetary costs) and explains different ways to measure cost efficiency. Explores weaknesses in cost-efficiency analysis (age of literature, economic variables, funding sources, localized data, variations in economic achievement outcomes and small sample sizes). Looks at how to best determine if supported employment is cost-efficient from a taxpayer’s perspective. Explores whether secondary conditions impact cost-efficiency of supported employment model, discusses changes in cost efficiency and delineates which states, territories are most cost efficient. Explores possible reasons behind effectiveness.
Cimera, R. E. (2012). The economics of supported employment: What new data tell us. Journal of Vocational Rehabilitation, 37(2), 109–117.
Comparative literature review juxtaposing pre-2000 research on supported employment with research conducted post 2000. Continuous analysis is required because economic data is highly fluid over time. Concluded that regardless of the type of disability, people who participate in supported employment programs have better outcomes than those who participate in sheltered workshops. Working in the community makes greater economic sense. Sheltered workshops are not as cost effective as supported employment. During an "employment cycle," returns a net benefit to tax payers. Rise in cost-efficiency over sheltered workshops is likely due to increased wages. Relative value of what sheltered workshop employees earned decreased by 40.6%. Acknowledged that even with the increased wages, supported employees do not have income sufficient to mitigate poverty which makes supported employment fall short of expectations. Supported employment costs are contingent upon location and vary dramatically. Supported employment costs fluctuate monthly - especially during the first several months of a newly enrolled participant. Researchers must base cost-efficiency analysis on entire "employment cycle" (enrollment, pre-employment support, postemployment support, disenrollment) to obtain accurate cost efficiency data. When other researcher do not take the entire employment cycle into account, it can skew cost-efficiency data. Individuals served in a community-based model are more cost effective longitudinally than segregated workers. Explores ways to reduce costs of supported employment including using transition programs, proving training for natural supports and involving coworkers in the training of supported employees. Because cost-effective programs are more likely receive long-term funding, it is vital to learn strategies to drive down costs.
Cimera, R. E. (2014b). Reducing the cost of providing supported employment services: A preliminary study.Journal of Rehabilitation, 80(3), 4–10.
Wisconsin's supported employment "follow along" services analyzed for cost efficiency, comparing "follow along" supported employment services for 19 individuals provided by "individual-provided" (non-Job coaches/natural supports) and 19 individuals receiving supported employment services from agency trained job coaches. Both groups were matched based on six variables. Proposes arguments for and against individual-provided follow-along services. In addition to exploring how to reduce the cost of supported employment, author explores service quality provided by cheaper service options. Findings reveal that people who received individual-provided supported employment services were nearly twice as likely to keep community-based jobs. Individual service providers were more effective a providing follow along services. Hypothesized that success rates also increased because individual-provided supported employment services are more effective because the person is vested in the person receiving services, knows their interests better and has a better understanding of the person's capacity and how to better relate and motivate them. Concludes that agency provided supported employment services are more likely to allow the individual to simply return to a sheltered workshop when things become challenging.
Nazarov, Z. E., Golden, T. P., & Schrader, S. Von. (2012). Prevocational services and supported employment wages. Journal of Vocational Rehabilitation, 37(2), 119–129.
Using an observational approach, we investigate the relationship between the receipt of prevocational services and subsequent hourly wages of consumers participating in supported employment programs. To evaluate the potential impact of these services on wages of consumers, we use six years (2005–2010) of data from of the New York Integrated Supported Employment Report (NYISER) data management system. Results indicate that receipt of prevocational services has a negative correlation with hourly wages of consumers. This finding suggests that prevocational services may have detrimental effects on providers' and consumers' expectations on consumers' work ability and productivity resulting in reduced hourly wages. Furthermore, participation in prevocational services may serve as a signal to employers about consumer's productivity.
Wehman, P. (Ed.). (2001). Supported Employment in Business: Expanding the Capacity of Workers With Disabilities (1st ed.). St. Augustine: Training Resource Network Inc.
This book is a collaborative effort of 31 leaders in supported employment who wrote 19 chapters addressing issues specific to supported employment and can be used as a reference book covering topics like implementation, funding, transition, economics of running a supported employment program, policy, job development and intervention techniques. (We will include several of these articles specific to policy and procedure as separate items in this literature review).
Wehman, P., Kregel, J., Keyser-Marcus, L., Sherron-Targett, P., Campbell, L., West, M., & Cifu, D. X. (2003). Supported employment for persons with traumatic brain injury: A preliminary investigation of long-term follow-up costs and program efficiency. Archives of Physical Medicine and Rehabilitation, 84(2), 192–196. View Source
Researchers evaluated longitudinal follow-up costs (1985-1999) of providing supported employment services to 59 individuals living with a traumatic brain injury (TBI) who had at least one integrated job placement. Discusses employment rates of people with TBI and factors contributing to obtaining work post-TBI. Participant income averaged $17,515 greater than the costs of providing follow-up services. Follow- up services decrease over the length of time a person is employed. Researchers discuss why costs might decrease over time.