Feature Issue on Employment and IDD

Extensive literature describes best practices in supported and customized employment. The implementation of these practices is lagging, however, placing job seekers with disabilities at a higher risk of not receiving the quality services they need to achieve their career goals.

Training is the solution most often recommended to improve implementation of best practices. For example, several state funding agencies require that employment programs’ staff either have received training or credentials like the Association of Community Rehabilitation Educators (ACRE) certified training or the Association of People Supporting Employment First (APSE) Certified Employment Support Professional (CESP) credential.

However, adult learning theory argues that adult learners typically remember and apply only a fraction of the content delivered through training. Some of the reasons include that abstract concepts taught through training are not always directly applicable to everyday complex realities.

Instead, learning can be significantly enhanced when embedded in the workflow. This involves discussing best practices in supported and customized employment with peers, addressing specific implementation challenges, and setting goals for improvement.

Consistent with this approach, employment services that serve job seekers with primary mental health disabilities have adopted the Supported Employment Fidelity Scale. More recently, the Discovery and the Job Development fidelity scales have been developed to support employment consultants who assist job seekers with intellectual and developmental disabilities.

Fidelity scales require authorized professionals to conduct interviews, observations, and document analysis to evaluate the implementation of best practices and then provide recommendations for quality improvement. However, because this process is labor-intensive and requires the involvement of external authorized professionals, fidelity scale reviews are completed periodically, making it more challenging to address issues promptly and provide rapid support within the workflow.

Recognizing the need for tools to support employment consultants in their workflow and taking advantage of the increasing availability of mobile technology, our team set out in 2015 to develop ES-Coach (Employment Support Coach) and we launched it in 2016 with 61 employment support professionals across 37 programs in 17 states.

ES-Coach is a smart-phone based application that enables employment consultants to visualize their service delivery both individually and as a team, and use that information to reflect, set goals, and take action for better aligning their services to supported and customized employment best practices.

Every day, at a different random time, employment consultants receive a text on their phones with three quick questions about their primary employment support activities. Responding takes less than one minute. The closing screen features daily microlearning tips about best practices in supported and customized employment.

Managers and employment consultants are encouraged to review team data during their staff meetings, as a catalyst for conversation. Does the amount of time dedicated to supports leading to hire vs. support after hire correspond with their individual caseloads? Does getting to know job seekers include discovery activities in community settings? Are networking and job negotiation part of the job search strategies? To which extent are family members involved? Are co-workers involved in providing natural support after hire? How does the amount of time dedicated to these best practices compare with previous months, other team members, and other employment programs across the United States?

This snapshot of real-time information enables the evaluation of best practices in supported and customized employment, allowing for reflection, goal-setting, and informed adjustments so that job seekers receive the quality services they need to achieve their career goals.

ES-Coach experts assist participants by highlighting a best practice each month through various activities, including coaching calls with managers, “Let’s Talk” calls with employment consultants, emails, and microlearning tips linked to resource focused on best practices.

Results

While the project is still in progress, we are excited to share some preliminary results about how managers and employment consultants used ES-Coach.

For example, a manager was surprised to find that her team dedicated less time to support leading to hire (i.e. getting to know a job seeker, finding jobs, and any other support leading to hire) compared to the national average. After discussing the ES-Coach data with her team, it became clear that they felt pressured to place job seekers quickly. The manager emphasized the importance of taking time to get to know the person well to ensure a better job match, job satisfaction, and job retention. This conversation reassured the team about their priorities. As a result, the team significantly increased their investment in supports leading to hiring, surpassing the national average.

Another manager noticed that her team spent more time than the national average on administrative tasks at the expense of supporting job seekers to achieve their career goals. This manager used the ES-Coach data to advocate with her organization’s leadership for resources to hire administrative support, so employment consultants could focus on supporting job seekers to find employment.

Below are a few quotes from managers and employment consultants that illustrate how ES-Coach helped their teams.

“ES-Coach can assist in assessing the organization's performance in real-time, providing valuable insights into areas of strength and areas that require improvement. ES-Coach has been highly beneficial for the employment team at Summerhouse Houston. I highly recommend this tool for organizations looking to enhance their quality of services provided and maximize productivity.”

“So after we first started the system, I actually went into a team meeting and I pulled it up on a share screen and I showed everyone the dashboard and what it looks like and what their responses are producing. And that did motivate a lot of the team…I kind of just told them. I said, you know we do really well here; we should improve here.”

“I absolutely love the ES-Coach. I do review a lot of things that you guys send us as supervisors in the email, especially the tips. I know my staff absolutely love the tips. They're very relevant and pertinent to what they're doing. Some of them, they've actually implemented themselves. So I really, you know, I don't have anything negative to say.”

Challenges

A key goal of this project was to enroll 48 employment programs nationwide over 12 months. While we quickly enrolled a third of the organizations, it took over a year to enroll the remaining two-thirds, despite extensive outreach efforts, including several ES-Coach open house events, Lunch & Learn presentations, webinars, direct emails, social media campaigns, and meetings with key stakeholders. As of June 2024, thirteen organizations have dropped out, and we are continuing to replace them as new ones join.

These challenges led us to question why employment programs were hesitant to adopt ES-Coach, despite its ease of use, value in quality improvement efforts, and the fact that it is free.

An initial reflection is that while most employment programs are committed to delivering high quality supported and customized employment services, they are often stretched thin with staffing and pressured by state and other initiatives.

Historically, this workforce has experienced high turnover rates, a situation exacerbated by the post-COVID workforce crisis affecting the entire U.S. economy. While mainstream businesses have raised salaries to attract staff, reimbursement rates for employment services have not always kept pace with these new economic conditions, putting employment programs at a disadvantage in hiring and retaining staff. As a result, employment programs often lack the capacity to think beyond their daily challenges, which may lead them to overlook a tool like ES-Coach.

Finally, employment programs are often funded through fee-for-service or milestone payment models that emphasize service delivery but do not necessarily address service quality. As a result, these programs may lack the financial incentive to adopt new tools for quality improvement.

Future direction

The fact that it took more than a year to enroll 48 employment programs in ES-Coach, despite its value and being free, prompts us to pause and reflect: Is ES-Coach addressing a real pain point? Whose pain point is it? Can the messaging be improved? In the coming months, we will engage with ES-Coach participants and key stakeholders to address these questions.

Initial thoughts suggest a need for a mindset shift: while training is often proposed as the solution for improving the implementation of best practices in supported and customized employment, training alone is insufficient without performance support integrated into the workflow. High turnover among employment consultants is a challenge that must be addressed as a precondition to ensuring the quality of employment services. Finally, it is crucial that state and federal agencies that fund employment programs be involved in the conversation, given the influence that funding models have on service delivery.

We are excited to contribute to ensuring that job seekers with disabilities have access to services aligned with best practices in supported and customized employment, helping them achieve their career goals.