Customized employment as a pathway to competitive integrated employment: An analysis of RSA 911 data of state vocational rehabilitation agencies with the highest use of this intervention

1Introduction

Early Office Disability Employment Policy (ODEP) demonstration and system change projects in the mid-2000 s suggested that customized employment (CE) produced valued employment outcomes for individuals with disabilities (Citron et al., 2008; Elinson et al., 2008; Fesko et al., 2008). These projects highlighted the promise of CE as a vocational rehabilitation intervention and demonstrated that CE had the potential to mitigate the disparity in employment opportunities and outcomes that exist for people with significant disabilities. In 2014, CE was outlined in statute when the Rehabilitation Act was amended in the Workforce Innovation and Opportunity Act (WIOA, 2014). Specifically, CE was defined as: “competitive integrated employment, for an individual with a significant disability that is based on an individualized determination of the strengths, needs, and interests of the individual with a significant disability, and is designed to meet the specific abilities of the individual with a significant disability and the business needs of the employer” (29 U.S.C §705(7), p. 1634). The statute also outlined specific strategies for implementing CE including: (a) exploring jobs with the individual; (b) working with employers to facilitate placement, including customizing a job description based on current employer needs or on previously unidentified and unmet employer needs; (c) developing a set of job duties, a work schedule, and job arrangement, along with specifics of supervision (including a performance evaluation review), and determining a job location; (d) representing a professional chosen by the individual, or self-representation of the individual in working with an employer to facilitate placement; and (e) providing services and supports at the job placement (29 U.S.C §705 et seq.).

Customized employment (CE) represents a significant shift in the way employment support services are developed and provided for people with the most significant disabilities. CE is a sequential, cumulative process that includes three interconnected phases: discovery, customized job development, and ongoing support. Discovery is the first CE phase used to determine an individual’s strengths, interests, skills, and support needs to obtain and maintain CE. The discovery process includes interviews, observations, interactions with the employment seeker, and documentation review (Inge et al., 2018; Workforce Innovation Technical Assistance Center [WINTAC], 2017). Interviews are conducted with family members and other influential people in the employment seeker’s life. Observations take place in settings where the job seeker participates in familiar and less familiar activities. The information obtained from task-based discovery activities is used to inform how best to support a job seeker in a customized job.

Discovery is the foundation for the second phase, customized job development, and is used to identify businesses that represent the job seeker’s vocational themes. Informational interviews provide the framework to learn more about businesses’ needs, working conditions, and potential employers who engage in similar work. Customized job development assumes that jobs are negotiated based on an employment proposal that accounts for the job seeker’s unique skills and interests. The job developer, also known as an employment specialist, completes a job site analysis and plan (Hall & Keeton, 2021) that can be used to develop the employment proposal. The final phase includes providing individually tailored ongoing support to the customized employee and employer.

Providing CE to assist people with the most significant disabilities is critical, because they remain chronically unemployed. In fact, only 21.1% of people with intellectual and developmental disabilities work in competitive integrated employment settings, while the remaining 78.9% receive services in facility-based work and non-work settings (Winsor et al., 2021). There is ongoing research that supports the utility of CE as a rehabilitation service that can be used to improve the poor employment outcomes for individuals with the significant disabilities (Inge et al., 2022; Riesen et al., 2021a; Riesen et al., 2021b).

Although CE is a promising rehabilitation practice (Riesen et al., under review), there appears to be inconsistent CE implementation and utilization across the country and poor overall CE outcomes (Kim et al., in press). Kim and colleagues reported on preliminary data extracted from the Rehabilitation Services Administration Case Service Report (RSA-911) for program years (PY) 2017–2020 to determine outcomes for individuals receiving CE as a Vocational Rehabilitation (VR) service. RSA’s Case Service Report is the administrative data collected by each State Vocational Rehabilitation Agency (SRVA) on consumers exiting in a program year. Their results showed that 10 state vocational rehabilitation agencies (SVRAs) were associated with 78% of the 2,280 individuals that received CE who exited after being served under an Individualized Plan for Employment (IPE). Of these 2,280 individuals, only 692 (30.4%) successfully exited to competitive integrated employment (CIE). These individuals worked a median of 15 hours per week and received a median wage of $11.24 an hour.

The low utilization of CE is concerning because rehabilitation professionals generally view CE as a highly relevant strategy for individuals with significant disabilities (Inge et al., 2022; Leahy et al., 2018). Therefore, it is important to more fully examine how SVRAs are utilizing CE as a service and identify the systemic and practitioner barriers to effective implementation and successful CIE closures (Bishop et al., 2021). The purpose of this study is to expand the analysis of RSA PY 2017 through PY 2020 to determine SRVRA customized employment service patterns and outcomes. The following research questions were examined for this study:

RQ1. What are the characteristics of SRVAs in terms of CE service provisions/patterns?

RQ2. Are there differences in the services used in conjunction with CE services among the 10 state SRVAs with 78% of the individuals who exited services after an IPE and received CE services?

RQ3. Are individuals more likely to exit VR services in CIE when the SVRA utilizes CE with co-occurring services?

RQ4. What is the median wage for individuals exiting services in CIE for SVRAs that utilize CE as co-occurring services?

2Method

3Results

4Discussion

The number of VR recipients exiting SVRAs during 2017 to 2020 who received CE services is concerning. In 77 SVRAs, only 2,280 individuals exited services after receiving CE. Ten states were responsible for 78% of this number, while the other 22% utilization of CE was accounted for by 67 agencies. The number of recipients in the 10 states who exited in CIE after receiving customized employment services was low (n = 538, 30.2%; while over twice as many, 1,241 (69.8%) did not exit in employment after receiving SVRA services.

Limited diversity in terms of race and ethnicity was observed among VR recipients who received CE. The majority of the individuals were white (n = 1,370, 77%) followed by Black/African American (n = 264, 14.8%). This same limited diversity is seen in the overall sample of VR recipients exiting SRVAs during this time period who achieved a CIE outcome. For comparison, 74.8% of all VR participants with an employment outcome in 2020 identified as White; while 22% identified as Black; and 7.7% as Hispanic (Revell et al., in press). Efforts are needed to reach individuals from diverse racial and ethnic backgrounds to ensure that they have equitable access to services. This includes identifying and remediating barriers that potentially bias their access to VR services including CE.

The low numbers of VR recipients exiting in CIE after receiving CE services raise questions regarding the capacity of SVRAs to provide CE to individuals with the most significant disabilities. Although RSA 911 data does not indicate why the number of VR recipients receiving CE services is low, there may be several factors associated with this outcome. Approximately 58% of the states in the United States have a CE state policy; 18% have a CE fee schedule; and 8% are using the Discovery Fidelity Scale developed by Hall, et al., 2016 (D. Crandell, personal communication, October 6, 2022). A lack of clear state policy, absence of a CE fee schedule, limited system for wide adoption of validated CE procedures, and limited published research can all contribute to underutilization of CE services. To authorize and vend for CE as service, VR counselors must have a cadre of agencies who understand how to provide substantive CE services. In addition, they must be able to effectively oversee providers, review documentation, and assess whether fidelity CE standards have been met.

Although there is overlap in the two services, there are clear distinctions in SE and CE service delivery. VR counselors may need guidance on who to refer for CE services versus supported employment. A question that has been asked by states receiving technical assistance (TA) from the Vocational Rehabilitation Technical Assistance Center on Quality Employment (VRTAC-QE) is who should be referred for CE.

Another concern is the implementation of services by the agencies that are vendors of CE for the SVRAs. Riesen et al. (in press) found that only 27 SVRAs have separate internal or external training requirements for SE and CE vendors. The Association of Community Rehabilitation Educators (ACRE) approves training curriculum based on competencies for customized employment, and some states are requiring service providers to complete an approved training curriculum. Nationally, there are only nine curricula approved by the ACRE to issue the Basic Certificate with an emphasis in Customized Employment (D. Wilkerson, personal communication, July 28, 2022). These nine agencies with approved training have issued 3,026 certificates to service providers (e.g., employment specialists/job coaches) according to the certificate registry on the ACRE website (Association of Community Rehabilitation Educators, 2022). In comparison, there are 16,621 listed as holding the Basic Employment Certificate. As more states are requiring the Basic Certificate in Customized Employment for vendors to bill for this service or considering doing so, it is concerning that the demand for providers outweighs the supply. This disparity may account for the low numbers of VR recipients who are receiving CE services. States must begin to determine how they can increase the capacity of their vendors to provide CE with fidelity. This may include allowing agencies to provide CE by service providers who hold the Basic Employment Certificate while setting a timeline for their obtaining the Basic Certificate in Customized Employment. During this time, SVRAs should ensure that technical assistance (TA) is available for service providers to ensure fidelity of the intervention. In other words, service providers must be able to demonstrate knowledge of CE services as well as demonstrate skills to implement the services. Currently, VRTAC-QE is one source of technical assistance for states to work towards their goals of improving their capacity in CE. It may also be beneficial for SVRAs to establish a stipend or provide financial support to agencies in order for them to meet their requirements for providing CE services.

The median hours worked by the individuals in this sample who received CE services and exited in competitive integrated employment were 13 hours per week, which is less than those for all VR recipients exiting in CIE. The average hours worked per week at closure for all VR recipients exiting in CIE were 29.7 hours in program year (PY) 2018, 29.9 hours in PY 2019, and 29.1 hours in PY 2020. The median hourly wage for those who exited in CIE was $11.5 (mean = $11.25, SD = 5.81), and the median weekly wage was $150 (mean = $191.54, SD = 197.95). Although this hourly wage is more than the $7.25 federal minimum wage, it is less than the hourly wage achieved at closure for all VR recipients exiting in CIE. As a comparison, the average earnings per hour at closure for all VR recipients exiting in CIE was $13.00 per hour in PY 2018; $14.00 in 2019; and $13.10 per hour in PY 2020. Associated with the low hourly minimum wages is the low weekly wage for this sample. VR recipients who received CE services and exited in CIE earned a median weekly wage of $150 (mean = $191.54, SD = 197.95) per week. This is less per week than other VR recipients who exited in CIE during this same time period. In 2018, the average earnings per week at closure for all VR recipients exiting in CIE were $392.04 in 2018; $418.60 in 2019; and $419.19 in 2020 (Revell et al., in press). The low number of hours worked and wages earned are concerning for a number of reasons. First, working so few hours raises the concern of what workers with disabilities will do the remainder of their week. Likewise, a median weekly wage of $150 is clearly below the poverty level. As such, there is a concern that individuals obtaining employment through CE interventions are experiencing underemployment relative to comparable peers being served by SVRAs.

Negotiation and customization are two primary features of CE, and agencies providing these services need to negotiate for more hours and greater wages that, at a minimum, reflect the hours and wages of other VR recipients who exit services in CIE. Individuals who receive CE services are, by federal definition, individuals with significant disabilities. Typically, these individuals will have greater barriers to employment than other VR recipients, which may include lower expectations for their employment outcomes. However, VR service providers should not expect that individuals with significant disabilities can only work a minimum number of hours per week or that they cannot earn commensurate wages to employees without disabilities for the same work. One issue may be that when negotiating positions, not enough work is identified under the proposed job description. Ongoing negotiation to ensure that additional job duties, hours, and increased wages must occur as the worker with disabilities develops new skills just as it would be negotiated for any employee of the business.

In the final analysis, the differences in employment status were examined between the SVRAs in Group A and those in Group B. VR recipients served in Group B (i.e., higher percentage referred for SE) were more likely to exit in competitive integrated employment (59.4%) than individuals served in Group A (15.1%). This is an important finding as the Essential Elements of Customized Employment for Universal Application does not include on the job support as a component of CE (WINTAC, 2017). According to this document, individuals who need ongoing supports should be referred to SE for these services. Recognizing that the individuals in this sample who were referred for supported employment were more likely to exit in CIE after receiving services is important to ensure that VR recipients receive these needed services after placement in a negotiated position.

5Conclusion

This study highlighted several important findings related to CE service patterns and utilization. Based on these findings, several recommendations to improve CE service delivery and utilization can be made. First, a comprehensive assessment of SVRA policy should be conducted. This policy assessment will help researchers and policy makers determine how states are defining a provision of CE and to determine if SRVA policy reflects operationalized procedures needed to implement the distinct phases of CE to fidelity. Specific policy should then be cross-referenced with validated CE practices to ensure that SVRA CE policies and procedures align with CE validate practices for discovery, customized job development, and ongoing support. Second, RSA’s case service report should be revised to ensure consistent language and reporting for CE cases. For example, discovery is considered an essential element of the CE process; however, there is no mention of discovery in the RSA case services report and the only data element for vocational rehabilitation counselors to report is “Assessment, service provided by agency staff” or “Assessment, provided through VR agency purchase.” As assessment is a relatively broad service domain used for numerous activities in support of providing vocational rehabilitation services (e.g., eligibility determination, career counseling, individual plan for employment development), the capacity to distinguish Discovery in the data will allow for increased scrutiny of the utilization and efficacy of this initial step in CE. Further, vocational rehabilitation counselors must be provided with ongoing and reliable training about how more accurately enter RSA case service data to reflect the CE services being provided (Bishop, et al., 2021).