An evidence based approach to supporting people with learning disabilities into jobs

1. An evidence based approach to supporting people with learning disabilities into jobs Stephen Beyer Welsh Centre for Learning Disabilities Cardiff University Wales, UK

2. Percentage of people with a learning disability in paid work • Estimates of people in paid work • Scotland- 12.1% 2007 • 17% - English National Survey 2003/04 • 7.5% - English Local Authorities, Commission for Social Care Inspection 2007/08 • WORKSTEP - about a third of people placed 2008 • Pathway to Work pilots- about 2% • New Deal- about 3% • Access to Work- about 4% • We do not know what hours people are working

3. Problems of awareness and definition • There is little shared definition across social care and employment services of: • Learning disabilities • “Mild, moderate or severe” • Awareness of their work potential, and support needs, is low among: • Families • People with learning disabilities • DEAs • Some employment providers • Some social workers and social care staff

4. Key problems of moderate and severe learning disabilities • Majority of people will have problems with: • speech and language • memory • cognitive processing • More people with severe learning disabilities are are likely to experience additional: • sensory and physical impairments • poor vision • measurable hearing loss • epilepsy

5. Key problems of moderate and severe learning disabilities • Ability to understand verbal instruction and to provide information • Cue dependency creates difficulty transferring tasks learned here (training) to there (job) • Small changes can lead to the person being unable to do a well known task : • Changes in task sequence • Changes in work machinery • Changes in work materials • Changes in a co-worker role • Changes in workplace environment • All this weakens the relevance of pre-training

6. Why supported employment for people with learning disabilities? • Effective task training research going back into 1970s • Complex & dangerous tasks1,2,3,4,5,6,7,8 • Systematic training in a specific workplace crucial to this client group9,10 • Matching “ecology” of workplace to person’s wishes, talents and specific strengths researched in 1980/90s11 • “Zero reject” vocational profiling in use since the mid 1980s instead of “work/can’t work” testing • Put together, these techniques were called “supported employment” and success with people with learning disabilities demonstrated in US University evaluations in 1980 and 90s12.13,14,15,16,17,18

7. Job coach support on-site Training on the job- Systematic Instruction Breaking tasks into steps “Chaining” tasks together Hierarchy of cues Physical guidance Gestures Verbal prompts Managing praise and reinforcement more closely Proactive problem solving (natural 7-phase cycle) Job adaptation Natural support focus Work-based accreditation of skills demonstrated Pre-employment training is possible Verbal instruction & demonstration Simple language Greater time to learn Use of naturally occurring praise and re-inforcement through: Supervisors, work-mates Ordinary pay incentives Managing work pressure/ productivity demands Shaping social contact through co-workers Qualifications for job and career development What works for people with a learning disability learning jobs? Severe Moderate Mild

8. Greater use of support to find & plan Families Job coaches Extended Vocational Profiling/ Discovery 20+ hours in various environs? Interests and what good at Relevant experiences Work types and environments Days and schedules Welfare benefit planning Use of practical job tryouts to aid decision-making Aided CV and support planning Proactive and specific job finding and matching jobs to people Employer presentation and negotiation Adaptation of interview and induction Greater independent action More use of generic help to identifying strengths, interests and experience Use of more generic sources for vacancies Greater use of courses, “job clubs” CV development Job search Writing applications More use of mainstream job application & interviewing and induction processes What works in finding jobs? Severe Moderate Mild

9. Supported Employment 19,20,21

10. Research findings- What works in transition? • US studies have identified factors that increase the likelihood of employment upon completion of school • successful graduation from a high school can lead to higher employment rates22,23 • being male24 • having had a summer or part-time supported job experience while at school25,26,27,28,29 • receiving vocational-technical training, rather than an academic, curriculum30 • duration of community based training and age appropriate integration with non-disabled peers31 • use of a job coach32

11. Elements of work experience for young people that work33,34,35 • Clear program goals • Clear roles and responsibilities for worksite staff • Clear, individualized training plans • Good links between students, schools, and employers • On-the-job learning • A range of work-based learning opportunities • Mentoring available in the workplace • Clear expectations and feedback • Assessments to identify skills, interests, and support needs • Reinforcement of work-based learning outside of work • Appropriate academic, social, and administrative support all partners

12. Number of young people entering jobs after transition 36

13. Number of young people entering jobs after transition • Carers were 2.7 times more likely to get a college place for their young • person if they wanted it, than to get a job if they wanted it

14. Number of young people entering jobs after transition • Employment levels increased over the next 12 months and jobs retention • was moderately stable

15. Differences in key factors between those with/without job ** Sign. at p > 0.01 on t-test ++ Sign. at p > 0.01 on Chi-square test

16. “Logistic Regression” • What influences the probability that a young person will get a job after transition? • Not one overall “model” • They will have had: • more hours delivered in qualification-based courses by their school/college • more hours delivered in obtaining work experience placement by an employment organisation • carer’s who have fewer concerns about the young person getting a job

17. Who helped to find a job? • 64% of jobs at 6 months had some help of the employment organisation (EO) involved at transition • Six young people had found their job through family with some help of the EO • Five young people found their job as an extension of a work experience started at school or college, with the help of the EO that originally placed them • Five young people found new jobs through the additional actions of the EO they worked at school or college.

18. Carers- Improvements needed • 40% of carers wanted to be kept more informed about transition activities • 11% felt that son or daughter would benefit from more work experiences or tasters during the transition time • Many were upset by the lack of any follow-through after the person had left school or college and wanted continuity- a follow-on plan

19. North Lanarkshire 37 • Generated significant interest because of reported high levels of employment of people with learning disabilities for 16 hours per week or more • Significant financial benefits to the people reported • Noted for challenging the view that the 'benefits trap' is the biggest problem restricting movement into employment • An opportunity arose to examine in detail the North Lanarkshire experience and to analyse their data.

20. NLSE Process • Referral visit (7 days) • An assessment to ensure that the agency’s criteria are met • Home visit (within 6 weeks) • Explain the service • Check on Welfare Benefits with Welfare Rights Officer if needed • Vocational profiling (8-12 weeks) • Agree person’s preferences and conditions the person wants, jobs and specific employers • Twice per week for 2-3 hours per session • Meeting 1:1 in a variety of settings, at different times, and involving different activities, including social outings • Information also sought from family, professionals and relevant others • Period includes 2 short job tasters, supported by a job coach

21. NLSE Process • Job finding (Meet 1-2 hours per week) • Registering person with Job Centre Plus • Pursuing employers • Assisting person in job search • Interview preparation • Further work placements as needed • Job coaching (as long as needed) • Providing training at work and fading support • Mentoring and evaluation (agreed with person/employer) • Agreeing criteria and monitoring success of placement from employer and employee perspectives • Career development (No timescale) • Updating Vocational Profile • Taking action to improve current, or change, job

22. NLSE Process Validation Average hours provided to a sample of young people with learning disabilities in transition

23. Jobs • 2007-143 jobs (138 people, 5 with 2 jobs)- 114 people with learning disabilities; 21 with mental health issues; and 3 with brain injury • All people with a learning disability “either came from day centres or had an eligibility to attend the same”

24. Jobs • Unemployment was 6.9% in the area compared with 4.7% for Scotland and 5.4% for the UK (ILO definition) • Full data existed for 104 people in work at 2007 (96%), of which: • 88 were people with learning disabilities • 15 mental health issues • 1 person with brain injury • Data presented relates to 88 people with learning disabilities

25. Hours Mean Hours= 24.2 hours per week >16 hours= 89.8% LD)

26. Welfare Benefit Before (LD) The mean total income from Welfare Benefits before people entered employment was £139.51 per person

27. Impact of benefits advice • There was a small increase in take-up of DLA at this point from 93% to 98%. • Mean total income from Welfare Benefits after maximisation was £141.93 per person, an average increase of 3% on the pre-employment income. • Income actually increased only for 7 people with LD • Average increase in income from Welfare Benefits being 94% and £50.83 • Range of individual increases being from 6% to 306%

28. Welfare Benefit After (LD)

29. Benefit changes • Overall, Welfare Benefits represented: • 98.7% of income before employment • 100% after maximisation • 49.7% when in employment • Reduction in Welfare Benefits from: • a mean of £139.51 per person before • to a mean of £122.65 per person • a fall of 12.1% • This represents a total saving to the taxpayer of per year £77,168 for the total group of LD clients

30. Wage income • The average salary earned in employment was £129.60 • The average hourly rate was £6.09 per hour, 14% above the adult National Minimum Wage of £5.35 in place for 2006/07 • On its own, salary was slightly lower than both the average pre-employment and the maximised Welfare Benefit incomes before employment • However, 34.1% of the workers had a higher gross income from salary alone, than their maximised Welfare Benefit income before employment

31. “Better off” • Overall, average total gross income from all sources after employment was £252.25 per week per person • Better off by +94.8% for 88 people with LD • Most common increase 51% and 75% • People with learning disabilities showed the full range of better off outcomes

32. Costs to LA • The annual costs of SE in North Lanarkshire, based on 2007/2008 budget was £4,304 per person per year, based on “actual capacity”- 202 people • Equivalent Locality Support Service, which catered for 295 people on a full- and part-time basis with an annual cost of £14,998 • Using the average number of people in jobs 122 (ranging from 109 Jan. to 129 Dec. 2007) the cost per employed person of SE rises to £7,126 per job. • This still represents 47.5% of the cost of a LSS place • SE’s share of clients has risen from 25.7% in 2005/06, to 41.6% in 2007/08

33. Transition Conclusions • Not all people with learning disabilities are able to benefit from training of a full range of skills before they enter a job • This does not mean that they cannot be employed • It means that they are more likely to need a skilled person to help them find, learn and keep a job

34. Transition Conclusions • Ultimately we need to inform and reassure families about employment, tackling: • post-school and college options for employment • specific support arrangements within options • whether help and monitoring would be on-hand or at arms length • How concerns will be addressed : • safety • exploitation and abuse • appropriateness of jobs to person’s interests and skills • travel arrangements • Deal with Welfare benefit expectation early and as a family

35. Transition Conclusions • Start early in discussing employment (year 8 or 9?) • Consider a central focus for information- a transition Worker • Provide information to families on employment • What it entails for a young person with learning disabilities- individual job match • What prospects their son or daughter may have for supported employment • What implication might be for income blending welfare benefits, tax credits and earned income • Involve experienced employment organisations • Dispel notions of people needing to be “job ready”

36. Transition Conclusions • It is important to offer young people with learning disabilities work experience that : • suits their individual needs • is based in ordinary community jobs • has an appropriate level of support • is structured to generate the information needed by all parties to help them move on to employment if they wish • Teachers, and tutors find it difficult to do this given their commitments and distance from the jobs market • Generic work experience organisations struggle to cope with additional needs and to provide 1:1 support • Partnership with supported employment (job coaching) agencies has been recognised as successful

37. Conclusions Supported Employment • Success can be achieved in placing people from the general Social Work Services population of people with learning disabilities in employment of 16 hours per week or more using supported employment • This has been with relatively unfavourable unemployment levels locally. • It is likely that this can only be achieved with this client group if the key approaches of supported employment are replicated, particularly the focus on 16+ hours per week. • Any reduction of cost:benefit ratios is cumulative and must be assessed across the body of people shifted from day service to employment • Year 1 costs are much higher than year 9 costs • Any “saving” in costs related to day service can only be redeemed if there is a strategy of shifting resources from day service to employment outcomes

38. Conclusions Supported Employment • Skilled job coaching and investment in a staff group of sufficient size is important, and it is likely that replication would require: • Investment at a significant level to provide enough job coach and Welfare Rights Advice and management resources effective training in the process • Replication of the intensive SE process, and including expert Welfare Rights Advice • Monitoring to ensure the process is delivered to an adequate level of intensity • There to be significant cost:benefits on offer for LAs • There remain some uncertainties in the cost analysis that would benefit from a more detailed costing of the full package of support for supported employees and day service alternatives for future workers