An updated review of the customized employment literature

3.1Model descriptions and project evaluation

Nine articles published between 2006 and 2019 described or evaluated CE project models. Luecking and colleagues provided outcome data for two CE demonstration projects funded by the Office of Disability Employment Policy (ODEP). First, Luecking and Luecking (2006) provided information on outcomes for the Tennessee Customized Employment Partnership (TCEP), a model demonstration project. One hundred and thirty-five individuals received CE services from the TCEP project between 2001 and 2005; participant ages ranged between 16 and 56 or older and the majority (54.8%) had a cognitive/intellectual disability. At intake, none of the participants were working a full-time, competitive integrated job and less than 10% were working part-time in a competitive integrated job. Approximately 14.1% of individuals were working in a non-competitive job, such as sheltered employment. Those who were working in either a competitive or non-competitive job were paid an average of $5.54 per hour. Seventy-one individuals receiving services through the project reported having a customized job. Average time from intake to job placement was 128 days. The average hourly wage at time of employment was $6.65 per hour, the federal minimum wage was $5.15 at the time, and average hours worked were 19 hours per week. Luecking and Luecking also provided case studies related to the discovery process, job negotiations, and accommodations. As a follow-up to the TCEP project, Luecking and Gumpman et al. (2006) assessed the quality of life outcomes for 30 individuals who received CE services through the project. Of these 30 participants, 39.3% of the participants had not worked previously and 50% were not currently working. The authors also examined the relationship between CE services and specific quality of life indicators. Participants who were working at the beginning of the study and continued for the duration of the study earned an average of $6.36 per hour and worked an average of 16.45 hours per week. Luecking used a one-way ANOVA to determine quality of life changes and found that participants’ ratings on 12 of the 13 quality of life indicators increased significantly across time.

In another study, Luecking et al. (2008) described an ODEP-funded demonstration project in Maryland. The project focused on providing CE services to individuals who were: (a) on the waitlist for employment services, (b) students in secondary education programs who will likely be put on the waitlist for employment services, or (c) currently receiving employment services in a segregated setting and would like to obtain integrated employment. The project braided resources to deliver CE services to participants. Sixty-two individuals participated in the project, 55 of whom obtained employment. The authors provided a case study example from the project and suggested that One-Stops present an opportunity for CE methodology adoption in systems change efforts.

Citron et al. (2008) described Project Exceed, an ODEP-funded systems change initiative that focused on securing customized employment for individuals with disabilities through collaboration with rehabilitation providers. The primary goal of the project was to shift from traditional services such as day programs and sheltered workshops to integrated employment opportunities. The project provided services for 198 individuals with disabilities including those with mental illness, developmental disabilities, and physical disabilities. One hundred and forty-one participants obtained employment working an average of 15–20 hours per week with a mean wage of $8.00 per hour. Of the 141 participants, 59 were self-employed, 73 were employed in a position that was negotiated with the employer, and 9 were employed in a position where job duties were not negotiated in detail with the employer. The authors identified six key organizational change factors essential to successful CE facilitation: staff development, community partnerships and diversified funding, sustainability, shift in managerial approaches and supervision, changes in human resource processes, and expanding customized employment to diverse populations. Additionally, Citron and colleagues (2008) identified barriers that were encountered during the process.

Fesko et al. (2008) provided information on ODEP-funded CE partnership and collaboration models that provided a substantive provision of CE service. The authors examined 26 grantee reports to identify common themes related to developing partnerships. Results showed that grantees formed partnerships with a wide variety of diverse organizations. Common themes identified as strategies for effective partnerships included: (a) understanding partners, (b) building on preexisting partnerships, (c) identifying shared values and a common vision, (d) creating partnerships enhanced through collaborative service delivery, (e) developing multilevel partnerships, (f) creating collaborative opportunities, (g) developing customized support teams, and (h) systematizing service delivery collaboration. The authors concluded that collaboration was the foundation of systems change efforts and a primary innovation of the grant sites and recommended that disability providers engage with One-Stop Career Centers (One-Stops) to create interagency work groups.

Rogers et al. (2008) described a five-year ODEP-funded transition project that trained staff to implement CE. Four hundred seventy-five transition-aged youth across seven school districts participated in the project. The primary goals of the project included: (a) encouraging students to work through a customized employment approach, (b) engaging students and families on competitive integrated employment, (c) promoting choice making, self-determination, and self-reliance skills, and (d) providing services without regard to students’ race, culture, national origin, ethnicity, religion, gender, age, sexual-preference, or nature of disability. At the conclusion of the project, 287 individuals obtained competitive integrated employment with 232 individuals retaining employment for at least 90 days. Participants worked an average of 28 hours per week with a mean wage of $8.17 per hour.

Elinson et al. (2008) evaluated 31 ODEP-funded demonstration projects that implemented CE as part of One-Stop services for individuals with disabilities. Qualitative and quantitative outcome data that included information on site visits, quarterly reports, and interviews with key informants was collected. Data on employment outcomes, including wages, hours worked, and type of supports received, was collected in three rounds over a two-year period. The results of the evaluation showed 6,555 participants were served through ODEP demonstration projects and of these participants, 2,936 (44.8%) obtained employment. Although CE service implementation was inconsistent across programs, data indicated that participants enrolled in CE services maintained consistent hours and wages. The authors noted that individualization services were implemented frequently, while negotiation and job carving were not. In addition, they noted that while project sites were successful at assisting persons with disabilities develop job leads and prepare for interviews, only a few project sites successfully negotiated or carved new employment positions. The authors also indicated that while programs were successful at implementing components of CE, the programs had a difficult time sustaining CE practices after demonstration funding ended.

Heath et al. (2013) described a four-year self-employment CE project in Alaska that examined the association between successful entrepreneurial business launches and the process of discovery. The study included seventy-one individuals with non-cognitive mental impairments or physical impairments who pursued microenterprises that involved selling a product and/or selling a service. Participants also contributed to the development of a self-employment CE model, emphasizing four essential components including a dedicated self-employment facilitator, discovery, access to virtual business incubator, and business plan development. The authors distributed a survey to participating facilitators and virtual incubators that asked specific information about participant and program characteristics and outcomes. The authors established criterion variables for the study including business launch outcomes. Predictor variables included gender, age, disability, education level, wage, and access to discovery, among others. The authors used a chi-square analysis to determine if there was an association between participating in the CE process and launching a business. Results suggested that the CE discovery process was associated with successful self-employment.

Shogren et al. (2017) described a capacity-building model and preliminary outcomes of a model of employment systems change in three rural project sites in a midwestern state. The project model combined CE, the discovery process, and the Self-Determined Career Development Model (SDCDM) to train various local community partners including one special education cooperative and two community support providers. Each site received several rounds of training on the discovery process and SDCDM. Further, each site received funding to create an Active Employer Council (AEC) that allowed sites to better partner with local employers, local Chambers of Commerce, and other business networks. Each site was encouraged to collaborate with multiple employment stakeholders within their communities. Twenty-five participants were enrolled across the three project sites and at the end of the project year, seven participants obtained employment. The authors noted several important findings and implications for successful service implementation, including taking sufficient time to build community relationships, assessing, and structuring professional development and systems change initiatives on improving integrated employment, establishing earlier referrals to vocational rehabilitation, and the need to create meaningful partnerships with workforce development activities.

3.2Perceptions and knowledge about CE

Three of the articles examined perceptions of CE. Luecking, Cuozzo, and Buchanan (2006) surveyed nine employers from a range of industries who had hired individuals with significant disabilities with customized job descriptions. Employers were selected from a CE demonstration project in Maryland between 2004 and 2005. Survey responses were independently reviewed and summarized. All employers indicated that their experiences with the career specialists were positive and that they would recommend a CE approach to other employers. Employers reported that having a specific job description and systematic approach was important. Some of the employers indicated that their perspectives on hiring people with disabilities had become more positive because of the experience. Several employers expressed interest in further collaboration with the career specialists. Authors provided recommendations for CE strategies and service values to create a work environment that is beneficial to employers and welcoming to people with disabilities.

Riesen & Morgan (2018) conducted a study using standardized open-ended focus group interviews using semi-structured questions to assess employer perceptions of CE. Ten employers representing small to large businesses who had no previous experience with CE participated in the study. Five key themes were identified from the analysis of focus group questions, including: identifying business needs, networking, communicating, training, and examining financial implications. Study results suggest that employment specialists build meaningful relationships and take time to adequately get to know business operations before negotiating a job. Riesen and Morgan also recommend that employment specialists use value proposition to make the business case for CE. Value propositions require an employment specialist to explain to the potential employer how the person with a disability can contribute to the overall needs of the business and improve the business’ financial position through personalized job description.

Jones et al. (2020) conducted a survey among state vocational rehabilitation counselors (VRCs) to assess their knowledge of the discovery process of CE. The authors distributed a 55-item survey that collected demographic information, items asking participants to rate the importance of various discovery activities, items regarding CE perceptions, and open-ended questions regarding barriers and supports to the CE process. Quantitative analysis indicated that participants considered themselves knowledgeable of both the overall CE process and various components of CE. Analysis revealed no significant difference in CE knowledge or perceptions based on VRC training in CE. However, the results indicate that number of years worked in the field had a statistically significant impact on opinions regarding the length of time that should be spent on the discovery process; those with more years of experience placed greater emphasis on the length of time to be spent on the discovery process than those with fewer years of experience. Qualitative analysis of open-ended questions resulted in the identification of collaboration and training as promoters of the CE discovery process. Lack of organizational support, limited training, and limited resources were identified as barriers to the CE discovery process.

3.3Essential structure and competency

Six articles included in the review examined the essential structure of CE. Harvey et al. (2013) conducted a series of panel reviews with 26 subject matter experts (SMEs) to develop and refine a competency model for the knowledge, skills, abilities, and other characteristics (KSAOs) and tasks essential for CE service provisions. The authors identified 31 task items divided into discovery, job search planning, job development and negotiation, and post-employment support components. A total of nine competencies and 83 KSAOs for each competency were outlined. Competencies included: (a) positive and open approach to life; (b) customized job development; (c) CE components and process; (d) demonstration of respect and willingness to relate to others; (e) business and employment practices; (f) business networking; (g) information collection, interpretation, and use; (h) communication with others; and (i) development of plans and organizations. The authors discussed implications for the CE competency model and suggested it be a tool for setting and implementing standards for CE services.

Inge et al. (2018) conducted focus groups with 28 national experts and implementers of CE to develop research-based descriptions of CE that agencies can use to replicate CE when supporting individuals with significant disabilities. The authors used open-ended questions to solicit feedback from participants about underlying values and strategies for customized employment implementation. After reviewing the focus group data, Inge and colleagues outlined 12 themes/core CE practices. These themes/core practices included: meeting at a location of the individual’s choice, building rapport and getting to know the individual, identifying the interests, skills, and abilities of the individual, conducting interviews with family and friends, observing the person in daily activities in different community settings, arranging opportunities for the job seeker to observe a local business, conducting informational interviews, observing the job seeker engaging in job related tasks, assisting the job seeker in identifying a work experience to refine/identify job interests, collaborating with the job seeker and others to confirm job seekers interests, and negotiating a customized job.

Riesen and colleagues conducted three studies on customized employment fidelity scales. The first two studies represent an effort to validate the discovery fidelity scale (DFS) developed by Hall et al. (2018). In the first study, Riesen et al. (2019) used a modified online Delphi process to generate consensus among CE experts regarding what they believe to be acceptable and unacceptable indicators for CE discovery systems and services constructs. The expert panel reviewed and rated a total of 60 systems and service items. While the authors indicated that there appeared to be some subtle differences in what experts believe are acceptable and acceptable practices, almost all the acceptable and unacceptable systems and services level tenet indicators met criteria for consensus. In a follow-up study, Riesen et al. (2021a) sought to determine the internal consistency of the DFS and the respective systems and services constructs. The authors examined completed DFS for customized job seekers and used Cronbach’s alpha to determine the internal consistency of the systems and service level tenets. A total of 17 DFS were completed and the results indicated moderately acceptable internal consistency for both service and systems constructs. However, the analysis indicated that three items in the service construct should be revised or removed to increase internal consistency. The authors also collected 90-day outcome data on the customized job seeker engaged in discovery and reported preliminary data. However, the small sample size constrained the authors’ ability to conduct a robust analysis of the outcome data. Finally, Riesen et al. (2021b) conducted a three round Delphi study to build consensus among CE experts regarding 52 customized job development fidelity scale (JDFS) descriptors developed by Hall and Keeton (2019). Like the DFS, the JDFS has systems and service level constructs. After three Delphi rounds, consensus was obtained for most CE job development systems fidelity descriptors and all the CE job development services fidelity descriptors.

Finally, Smith et al. (2019) described Phase I, open trials of the Achieving Competitive, Customized Employment through Specialized Services (ACCESS) intervention. The ACCESS intervention protocolizes the CE process into a package of tools, templates, and logs. Phase I consisted of the research team conducting an open trial to test the feasibility and acceptability of the ACCESS recruitment, intervention, and data collection benchmarks. The authors recruited 13 participants to participate in the Phase 1 trial and the research team was able to meet initial feasibility benchmarks. However, acceptability benchmarks were unable to be met as only four of these participants completed the open trial due to barriers with service providers and benefits analyses. The authors noted five of the participants were randomly assigned to one service provider who was unsuccessful in carrying out the intervention for any participant, leading the research team to attribute the failure to the provider rather than the intervention.