The impact of competitive integrated employment on economic, psychological, and physical health outcomes for individuals with intellectual and developmental disabilities

The State of Employment for People With IDD: Implications for Practice, Policy, and Equity

Meaningful progress in improving employment outcomes for people with intellectual and developmental disabilities continues to be elusive, despite 40 years of investment in research, policy, and supports. This article reviews the current state of employment for individuals with intellectual and developmental disabilities (IDD) and describes policy, practice, and individual factors that influence employment outcomes. Research suggests the need for a holistic approach to change that addresses systems-level strategy, policy, and fiscal investment while strengthening individual experiences with employment and related day services. Recommendations address strengthening the implementation of employment policy, developing pathways to employment, and engaging individuals with IDD and, in particular, individuals with diverse social characteristics in reflecting on the quality of their experiences and supports.

An observational investigation of unemployment, underemployment, and competitive integrated employment of people with intellectual and developmental disabilities in 2021-2022

BACKGROUND

Employment is an important component of community living, and a precursor to economic stability and independence. Despite this, research consistently demonstrates people with intellectual and developmental disabilities (IDD) have low rates of community-based employment. However, little research has been conducted to quantify competitive integrated employment, and which individuals have better employment outcomes as it relates to competitive integrated employment.

OBJECTIVE

This study aims to explore the ways in which key service-related and demographic characteristics of individuals with IDD are associated with participation in competitive integrated employment.

METHODS

We used the 2021-2022 National Core Indicators Intellectual and Developmental Disabilities In-Person Survey dataset. We conducted bivariate and multivariate analyses, using chi-square and generalized linear models, to examine the cross-sectional relationship between employment and demographic and service-related characteristics for 4629 individuals with IDD.

RESULTS

Overall, 42% of the sample was unemployed but wanted a job, while 39% were underemployed and just 21% have competitive integrated employment. Several demographic and service-related characteristics were significantly associated with employment. After controlling for demographic and service-related correlates of employment, having an employment-related goal in one's service plan was associated with 4.5 (95% CI: 3.6-5.5) times higher odds of competitive integrated employment relative to unemployment.

CONCLUSIONS

This study underscores the value of person-centered planning for improved employment outcomes. Further research is needed to fully understand potential inequities in employment and system-level factors that are associated with competitive, integrated employment, as well as solutions to improve access to customized individual employment supports for all people with IDD.

Employment Interventions for People With Intellectual and Developmental Disabilities: A Delphi Study of Stakeholder Perspectives

The purpose of this study was to examine the social validity of five different evidence-based and emerging pathways to employment (i.e., supported employment, customized employment, internships, apprenticeships, and postsecondary education) from the perspective of multiple stakeholders. A Delphi method was used to determine whether stakeholders are in consensus regarding the accessibility, affordability, acceptability, efficacy, and the cost-benefit ratio of these interventions. Findings indicated that all pathways were deemed socially valid via stakeholder consensus except for apprenticeships, which could not be determined as a result of limited stakeholder knowledge and experience with the pathway. Future efforts to improve employment outcomes for people with intellectual and developmental disabilities (IDD) should focus on better training for service providers and increased access to services.

The impact of customized employment on the competitive integrated employment outcomes of transition age youth with intellectual and developmental disabilities: A randomized controlled trial study

BACKGROUND

Customized employment (CE) is recognized in the Workforce Innovation and Opportunity Act (2014) as a strategy for promoting competitive integrated employment. However, the existing body of evidence supporting CE is mainly descriptive rather than experimental research.

OBJECTIVE

This study examined the impact of CE on the employment outcomes, hours worked per week, and wages of transition-age youth with intellectual and developmental disabilities.

METHOD

The outcomes of transition-age youth participating in a CE intervention were compared to those receiving treatment-as-usual using a randomized controlled trial design.

RESULTS

Participants receiving CE were significantly more likely to secure competitive integrated employment than controls who received treatment-as-usual. Participants in the intervention and control conditions earned similar wages. Participants in the control condition worked more hours per week than those in CE.

CONCLUSION

The findings from this study demonstrate the effectiveness of CE to assist transition-age youth with intellectual and developmental disabilities in obtaining competitive integrated employment, but future research is needed to examine factors impacting weekly hours and wages of participants in CE.

Promoting Quality of Life: Suggestions for Mental Health Care Providers Working with Young Autistic Adults

There is a growing population of autistic adults in need of supports from a service delivery system that, at present, fails to accommodate their needs adequately and equitably. Unfortunately, there is a shortage of trained behavioral health service providers to meet the needs of young autistic adults. Quality of life (QoL), or one's perception of, and satisfaction with, life in relation to held goals and expectations, has been identified as a key outcome of interest by autistic self-advocates. By supporting autistic clients to hone their strengths and interests, integrate various aspects of their identity, identify goals, and connect to appropriate resources, providers can promote clients' self-knowledge and self-determination, in the service of improving QoL. In this Perspectives article, we offer concrete recommendations to mental health providers, including those who do not specialize in autism, with the goal of supporting implementation of evidence-based strategies that improve QoL and promote self-determination among young autistic clients.

Effects of Customized Employment on the Independence of Youth With Intellectual and Developmental Disabilities

Participation in work during school is a known predictor of postsecondary employment for transition-age youth with intellectual and developmental disabilities (IDD). Recent research has demonstrated the benefits of work on skill development in major life domains. The purpose of this study was to examine the impact of customized employment on the support needs of youth with IDD with a significant disability compared to those receiving treatment as usual. Findings indicated significant increases in independence in three specific domains for the treatment group versus control on the Supports Intensity Scale-Adult Version, including Home Living, Employment, and Protection and Advocacy. Findings suggest a therapeutic effect of work activities on growth and development in important life domains. Implications for future research, policy, and practice are discussed.

Young adults with intellectual and other developmental disabilities acquire vocational skills with video prompting

Students with intellectual and other developmental disabilities often require substantial support to acquire the skills needed to secure work experience and paid employment. Prior findings suggest that video prompting is likely to be an effective and feasible strategy for establishing such skills. To evaluate this possibility in a special education transition program, we examined the effectiveness of a video prompting procedure in teaching 8 young adults with developmental disabilities to perform job-related tasks (doing laundry, checking in to work, vacuuming, stripping bed). The intervention was effective with all participants. The skills maintained over 3 months, and the participants performed the tasks accurately in a new setting with different materials. Participants were reportedly satisfied with the intervention and deemed it easy to use.

Effects of supported employment on the competitive integrated employment outcomes of transition age and young adults with intellectual disabilities: A non-experimental causal comparative study

BACKGROUND: Supported employment has long been recognized as one of the most effective services for individuals with the most significant disabilities in achieving competitive integrated employment (CIE) outcomes. OBJECTIVE: This study examined the effect of supported employment interventions on the employment outcomes of transition-age youth and young adults with intellectual disabilities served by state vocational rehabilitation agencies using a propensity score matching (PSM) approach. METHODS: We conducted a non-experimental causal comparative study with PSM to create a treatment (n = 2162) and a comparison group (n = 2191) using the Rehabilitation Services Administration Case Service Report database (Program Year 2018). Chi-square and t-test were used to analyze the differences between the treatment and control groups on employment outcomes, hourly wage and hours worked per week. RESULTS: Results demonstrated that transition-age youth and young adults with intellectual disabilities who received supported employment were more likely to achieve CIE, earn higher wages, and work longer hours weekly than were the control group. CONCLUSION: These findings suggest that supported employment is an effective service for enhancing the vocational rehabilitation outcomes of transition-age youth and young adults with intellectual disabilities and provides valuable information for policy makers, health care providers, rehabilitation counselors, and educators.

Linking Process and Outcome Measures to Improve Employment Support Programs for Individuals With the Most Significant Disabilities

Employment agencies and funding systems commonly use distal outcome measures such as employed or not employed, full-time or part-time, and continuous measures such as wage, hours worked, and type of job to document the employment status of individuals with disabilities. These measures continue to demonstrate that individuals with disabilities fall behind individuals without disabilities in all employment outcomes. While there is utility in distal outcome measures, it is difficult to determine what intervention or program variables were responsible for a specific outcome. Moreover, outcome measures do not provide sufficient information about the quality of employment supports and services an individual with disabilities receives. One way to improve accountability in employment support programs is to link outcomes to specific processes for obtaining and maintaining employment. The purpose of this manuscript is to describe how employment programs can link short-term (proximal) and long term (distal) outcomes measures to specific processes for employment. A customized employment framework is used to illustrate how systematically linking outcomes and processes improves accountability in programs that support job seekers with most significant disabilities.