Transcript Document

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**
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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
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FY 1988
FY 1993
FY 1999
FY 2001
FY 2004
FY 2007
FY 2010
FY 2011
12%
20%
24%
25%
21%
21%
19%
19%
33,500
74,200
108,600
117,300
104,700
108,800
108,600
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 Beyer
Cardiff 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
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The Work Choice programme
– Module 1: Work entry support (<6 months)
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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)
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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)
Skin conditions
Diabetes
Heart or circulatory
Chest or breathing
Digestive
Hearing
Arms or hands
Progressive illnesses
Back or neck
Legs or feet
71.9%
61.5%
57.8%
56.7%
55.7%
53.6%
44.5%
44.1%
41.8%
39.7%
Condition
(% in jobs)
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 √
• 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 Urríes
University of Salamanca
[email protected]
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.
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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 employment
219.781.416 263.185.183 231.034.650
Open employment:
Ordinary companies / SE / 76.612.857 78.649.098 79.247.840
Enclaves
Suggestions for change
General
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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 change
Sheltered Employment
• 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 change
Supported 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.
Conclusion and response
Where do we spend the necessary refocusing?
• 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 response
Where 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.