March, 2011 David Mank, Ph.D. Director Indiana Institute on Disability and Community Professor

1. A Synthesis of a ResearchSeries on Typicalness Coworker Supports and Quality Outcomes in Supported Employment scarson@insource.org March, 2011 David Mank, Ph.D. Director Indiana Institute on Disability and Community Professor Indiana University dmank@indiana.edu www.iidc.indiana.edu

2. QUESTIONS ABOUT QUALITY • Relationship between features of employment and outcomes? • Is the employment of people with disabilities "typical" when compared to employees without disabilities in the same work places? • Does coworker involvement make a measurable difference?

3. QUESTIONS ABOUT QUALITY • Relationship between typical employment status and outcomes? • Relationship between level of intellectual disability and outcomes? • Outcomes for people with more severe disabilities or behavior issues? • Relationship between patterns of support and outcomes?

4. COLLABORATORS • Indiana University • University of Oregon • University of Salamanca • Practitioners in: • USA • Germany • Australia • United Kingdom

5. RESEARCH SCOPE AND DESIGN • Individualized jobs or very small group placements • 462 people with developmental disabilities in 13 programs across 8 states • Plus 448 people from England, Germany, and Australia • 243 people with mental illness • 304 people with brain injuries

6. RESEARCH SCOPE AND DESIGN • Disability levels comparable to U.S. national data on 140,000 in supported employment • 85 items about individuals, employers, outcomes, and job features • Developmental disabilities data • Mental illness data - • Brain injury data -

7. FEATURES OF EMPLOYMENT • Job Acquisition and Hiring • Compensation Package • Similarity in Work Roles • Orientation and Initial Training

8. ASSESSMENT OF INDIVIDUAL’S EMPLOYMENT FEATURES • Rated on a scale of 1 2 3 4 5 6 7 (not typical) (somewhat) (quite typical) • How "Typical" is this person's conditions and features of employment when compared to other employees without disabilities in the same work setting?

9. MEASURES OFWORK SITE INTEGRATION • Number of employeeswithoutdisabilities in immediate work environment • Number of employees with disabilities in immediate work environment • Pattern of interactions - rarely, if ever, interacts with others - exchanges only greetings and small talk - interacts with others about work related duties - engages in substantial and frequent interactions

10. LIMITATIONS • Participants not randomly chosen (Representativeness?) • Data collected from local employment support personnel (Bias?)

11. Hourly Wage ($) 7 6 5 4 3 2 1 0 Rarely Small Talk Work Related Substantial 11 HOURLY WAGE ANDLEVEL OF INTEGRATION

12. Monthly Wage ($) 800 700 600 500 400 300 200 100 0 Rarely Small Talk Work Related Substantial 12 MONTHLY WAGE ANDLEVEL OF INTEGRATION

13. 800 700 600 500 400 300 200 100 0 Rarely Small Talk Work Related Substant'l Severe Mild and Borderline Moderate * 13 RELATIONSHIP BETWEEN INTEGRATION, WAGES, AND LEVEL OF DISABILITY

14. 14 LEVEL OF INTERACTION AND SIMILARITY IN WORK ROLES

15. Length of Time Employed is Not Related to Typical Job FeaturesLevel of Social Interaction is Not Related to Type of Work

16. INITIAL FINDINGS • Employees with disabilities are more likely to be well integrated in the work place AND earn more IF, the - • - job acquisition process, - compensation package, - work roles, and - initial orientation and training, are more typical when compared to people without disabilities in the same work place

17. IMPACT OFSUPPORT TO COWORKERS • Employees with disabilities who have had information and support from coworkers are more likely to have: • more typical job acquisition • more typical work roles • higher wages • participate in work social activities • participate in social activities outside of work • positive relationships with coworkers

18. 18 COWORKER TRAININGAND WAGES

19. THE VALUE OFSUPPORT TO COWORKERS • Information and support provided to coworkers and immediate supervisors is positively related to higher wages, benefits, and integration

20. TRAINING SPECIFIC TO THE INDIVIDUAL WITH A DISABILITY IS: • positively related to • wages • benefits • integration • typicalness over time • job satisfaction

21. RELATIONSHIP BETWEEN SUPPORT PATTERNS AND OUTCOMES? • People who receive four or more hours of direct support weekly on the job have: • lower wages, • and less typical • job acquisition process • compensation package • similarity in work roles • orientation and training • Hours of support is not related to level of disability and NOT related to months employed

22. Greater direct support is related to poor outcomes except when coworker involvement is higher

23. EXCEPTIONS TO THE TRENDS • A small number of people with the most severe disabilities with very high wage and integration outcomes, and a small number of people with mild disabilities with very low wage and integration outcomes

24. EXCEPTIONS TO THE TRENDS • No difference between these two groups in job types, features, types of work, companies, etc. EXCEPT, • Those with low outcomes (and mild disability) receive four or more hours of direct support weekly and are more likely to have socially inappropriate behaviors

25. WHAT ABOUT COMPANIES THAT PROVIDE DISABILITY AND DIVERSITY TRAINING TO THEIR EMPLOYEES? • People with disabilities who work in companies that provide training to employees about diversity and disability in the work place: • earn higher wages • have positive coworker relationships • are more likely to participate in company social activities • have more typical job acquisition, compensation packages, and more typical orientation and training

26. THE IMPACT OFBEHAVIORAL ISSUES • People with any kind of behavioral issue - • have lower wages • work fewer hours • have less typical job acquisition, work roles, and initial orientation and training • are more likely to be segregated • typically work in grounds keeping or recycling, and • receive four or more hours of direct and indirect support weekly

27. ANOTHER EXCEPTIONTO THE TRENDS • There are a small number of people (n = 26) with behavioral issues who have high wage and integration outcomes, and • There are a small number of people (n = 35) with no behavioral issues who have low wage and integration outcomes

28. ANOTHER EXCEPTIONTO THE TRENDS • No difference between these two groups in the type of job, features, accommodations, hours of support, months employed, etc. EXCEPT, • Those with behavior issues and high outcomes had coworkers trained by the supported employment program • Those with no behavior issues and low outcomes did not have their coworkers trained

29. RELATIONSHIP BETWEEN LIVING ARRANGEMENT AND EMPLOYMENT OUTCOMES • People who live in group homes - • work fewer hours • earn less money • have less typical work roles • are less well integrated than people who live with their family, are in supported living or more independent living arrangements, even when controlling for level of mental disability

30. Monthly Wages 1000 900 800 700 600 500 400 300 200 100 0 Group Homes Parents Supervised Apartment Independent Living 30 WAGES AND RESIDENCE

31. Hours 35 30 25 20 15 10 5 0 Group Homes Parents Supervised Apartment Independent Living 31 HOURS WORKED WEEKLY

32. GENDER DIFFERENCES • Women in supported employment work fewer hours and earn less than men • Women are more likely to voluntarily leave jobs than men

33. SCOPE OF THE STUDY FOR PEOPLE WITH MI • Data collected on 243 individuals in 10 programs across 8 states • Individualized jobs • 85 items about individuals, disability information, employment features, employers, and community connections

34. DESCRIPTIVE DATA FOR PEOPLE WITH MI • Diagnostic categories • 48% were reported to have schizophrenia and other psychotic disorders • 34% were reported to have mood disorders • 17% were reported to have other disabilities (PTSD, personality disorders, anxiety disorders, etc.) • Most jobs were in food service, clerical work, and custodial services

35. LEVEL OF INTEGRATION ANDMONTHLY WAGES FOR PEOPLE WITH MI

36. SUPPORT FROM STAFF AND OVERALL JOB ADJUSTMENT • Staff support to work place personnel is positively related to: • Work rate, work quality, coworker relationships, typical employment conditions, and employee satisfaction

37. JOB ADJUSTMENT • Individuals tend to have higher overall job adjustment when their preferences and characteristics were matched to the work place environment (noise level, physical space, lighting, number of coworkers, etc.) and …

38. QUESTIONS ABOUT SUPPORTS AND OUTCOMES FOR PEOPLEWITH BRAIN INJURIES • How does type of BI affect outcomes? • What factors influence wage and integration outcomes? • How do typical employment conditions affect employment outcomes? • How do symptoms and behavioral changes affect work place functioning?

39. SCOPE OF STUDYAND DATA COLLECTION • Data was collected on 304 individuals served in 26 programs in 21 states

40. TYPICALNESS AND OUTCOMES FOR PEOPLE WITH BI • Individuals with more typical processes in job acquisition and orientation have better outcomes related to: • compensation, work roles, salary, work site integration, and better overall job adjustment

41. TYPICALNESS AND OUTCOMES FOR PEOPLE WITH BI • Individuals with more typical supervision and support from employers, supervisors, and coworkers have better outcomes related to: • compensation, work roles, social adjustment, work site integration, and better overall job adjustment

42. $6.40 $6.30 $6.20 $6.10 $6.00 $5.90 $5.80 $5.70 $5.60 $5.50 $5.40 Little Interaction Frequent and Interact Ongoing Substantially Interaction HOURLY WAGES AND INTEGRATION FOR PEOPLE WITH BRAIN INJURIES

43. INTERNATIONAL CONTEXT • Germany, UK, Australia • 350 total participants • Concept of job adjustment developed and measured

44. Higher ‘Job Adjustment’ is Related to Better Outcomes in Wages, Integration, and Typicalness

45. COMMON THEMESACROSS COUNTRIES • Positive relationship between wages, integration, and typicalness • Coworker involvement is related to better outcomes

46. IMPLICATIONS • Investment in how jobs are developed and negotiated appears to be even more important than anticipated • Integration and wages cannot be expected to improve as a function of time • Good job matching is critical

47. IMPLICATIONS • Early involvement of coworkers is essential • Look for companies that provide diversity and disability training to their employees • When compromises are necessary, the tradeoffs should be carefully considered

48. IMPLICATIONS • Involve coworkers in the supported employment process; • Ask which coworkers should be involved? • Ask how will the information be provided? • Ask what information should be provided?

49. Articles in the Series 49 Articles in the Series 1. Mank, D., Cioffi, A., & Yovanoff, P. (1997a). Analysis of the typicalness of supported employment jobs, natural supports, and wage and integration outcomes. Mental Retardation, 35(3), 185-197. 2. Mank, D., Cioffi, A., & Yovanoff, P. (1997b). Patterns of support for employees with severe disabilities. Mental Retardation, 35(6), 433-447. 3. Mank, D., Cioffi, A., & Yovanoff, P. (1998). Employment outcomes for people with more severe disabilities. Mental Retardation, 36(3), 205-216. 4. Mank, D. M., Cioffi, A. R., & Yovanoff, P. (1999). The impact of coworker involvement with supported employees on wage and integration outcomes. Mental Retardation, 37(5), 383-394. 5. Mank, D., Cioffi, A., and Yovanoff, P. (2000). Direct support in supported employment and its relation to job typicalness, coworker involvement, and employment outcomes. Mental Retardation, 38(6), 506-516. 6. Olson, D., Cioffi, A., Yovanoff, P., and Mank, D. (2000). Gender differences in supported employment. Mental Retardation, 38(2), 89-96. 7. Rogan, P., Banks, B., & Howard, M. (2000). Workplace supports in practice: As little as possible, as much as necessary. Focus on Autism and Other Developmental Disabilities, 15(1), 2-11. 8. Banks, B., Charleston, S., Grossi, T., and Mank, D. (2001). Workplace supports, job performance and integration outcomes for people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 24(4), 389-396. 9. Jenaro Rio, C., Mank, D., Doose, S., Butterley, J., and Tuckerman, P. (2002). Supported employment in the international context: An analysis of processes and outcomes. Journal of Vocational Rehabilitation, 17(1), 5-21. 10. Mank, D., Cioffi, A., and Yovanoff, P. (in press). Supported employment outcomes across a decade: Is there evidence of improvement in the quality of implementation? Mental Retardation. 11. Grossi, T., Jenaro Rio, C., Mank, D., & Banks, B. (in preparation). Natural supports and brain injuries.