Journal of Vocational Rehabilitation

This article provides a primer on the emerging field of benefits planning, assistance and outreach as outlined in the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA). Detailed is an overview of the TWWIIA and a theoretical construct for the delivery of benefits planning and assistance services and supports. A review and description of the major practice domains within the construct are provided as is an operational definition of benefits planning and assistance. In conclusion, a summary of needed developments and critical next steps for the emerging field are presented.

Cost efficiency research is reviewed. This literature is followed by discussion on the state variation in the costs of supported employment with an analysis of ``high'' cost vs. ``low'' cost states funding patterns. An examination of the preliminary impact of the Home and Community Based Waiver on costs of supported employment is also provided on a state-by-state basis.

This paper examines the changes that one southern state made to improve the quality of employment services for individuals with significant disabilities. A new supported employment payment system is shared that compensates the employment service providers based upon the outcomes achieved by the employee in competitive employment. In addition, a newly developed personnel training certificate program will be shared that integrates the new payment system with best practices in supported employment using an employee-directed approach. Participant training data and preliminary outcomes will demonstrate the supported employment quality improvements.

Cost effectiveness of supported employment can only be meaningful studied in the context of how meaningful the actual outcomes are. This paper examines how to assess outcomes, how funding agencies purchase services, and describes how two states, Massachusetts and Oklahoma, provide funding for supported employment. A summary of cost effectiveness recommendations is provided as well.

Federal funding for supported employment programs continues to be an essential part of the national implementation efforts. There are five major federal funding sources which include Title I and Title VI of the Rehabilitation Act, Developmental Disabilities funds, Title XIX of the Social Security Act and the Ticket to Work and Work Incentive Improvement Act. Each of these sources is described.

The purpose of this study was to investigate the differences in clinical syntomatology between two groups of adults with autism who participated in two modalities of employment: supported vs sheltered. This study was part of a larger study designed to analyze the variables that predict the success of people with autism in employment settings. The results suggested that a possible relationship existed between clinical evolution of people with autism and modality of employment. Specifically, the sheltered group scored higher than the supported group in total CARS scores in 1999, and the total score of the sheltered group in 1999 was higher than total score in 1996 for the same group. The total score of the supported group, on the other hand, was the same in 1996 and 1999.

We examined the effectiveness of a problem-solving intervention to teach social skills to two workers with traumatic brain injuries. Both individuals demonstrated deficits in social skills which jeopardized their current job placements. Two of the most problematic social skills were selected for intervention with each participant. The intervention was evaluated using a multiple baseline design across social skills for each of the participants. All targeted social skills increased in the training setting when the intervention was implemented. The social skills also generalized to the work sites. Additionally, participants continued to perform the targeted social skills in the training setting for up to six weeks following the removal of the intervention.

We describe a 33-item interviewer-rated checklist, the Quality of Supported Employment Implementation Scale (QSEIS), designed to measure implementation of supported employment (SE) programs for people with severe mental illness (SMI). We used a 1.5-hour semi-structured interview with program directors in 32 SE programs in Kansas (KS) and New Jersey (NJ). Interviewers averaged 84% in item ratings. The internal consistency for the total scale was low (Cronbach's alpha = 0.51), but higher for four subscales: Teamwork (0.74), Planning and Support (0.60), Rapid Job Search (0.74), and Integration with Mental Health (0.62). In these programs we found substantial implementation of SE standards, with mean ratings exceeding 4.0 on a 5-point scale, for 18 of 33 items. Mean overall implementation was similar in both states, with somewhat different patterns, with NJ rating higher on Planning and Support, and KS rating higher on Integration of Mental Health and Rapid Job Search. The QSEIS total scale and the 4 subscales were correlated with 9 indicators of employment outcomes, obtained from a retrospective survey completed by program directors in 24 of the programs. The total QSEIS score was not significantly correlated with any of the outcome measures. Planning and Support correlated positively with job tenure (r = 0.62), but was not related to annual VR closure rate (r = -0.15). Conversely, Rapid Job Search was negatively correlated with job tenure (r = -0.56), while positively correlated with annual VR closure rate (r = 0.46). Thus, supported employment interventions may be multidimensional, with one set of interventions fostering job acquisition and a second set fostering job retention. We conclude that the QSEIS is a pragmatic tool for describing SE programs for people with SMI, although more work on psychometric precision and predictive validity is needed. The survey provides norms by which other providers and other states can compare their achievement of the principles of supported employment.