Consumer Choice and Satisfaction in Supported Employment
by Wendy Parent, Outreach Director
The Rural Institute
This article was originally published in the Journal of Vocational Rehabilitation, Vol. 6 (1996) and is reprinted here with the permission of the author and that publication.
The development of this paper was supported by Grant # H133B30071 from the National Institute of Disability and Rehabilitation Research (NIDRR), U.S. Department of Education. The opinions expressed are those of the author and no endorsement by NIDRR is implied.
Abstract
Supported employment has proven to be a successful service option in terms of outcomes and participant satisfaction. Most studies to date have focused upon the attitudes of employers, rehabilitation counselors, parents, and advocates with little information available as to the opinions of the consumers who are the primary customers. This article summarizes the views of 110 consumers of supported employment who share information about their experiences and their feelings about their jobs and the services they receive. Practical strategies and a Consumer Satisfaction Survey tool are presented to assist practitioners, consumers, and advocates with enhancing consumer choice and satisfaction in supported employment.
Few persons would disagree that supported employment has been and continues to be an overwhelming success. Today, more than 100,000 individuals with severe disabilities are working in community businesses alongside their coworkers (Revell, Wehman, Rayfield, & Kregel, 1994; Wehman, Revell, & Kregel, 1995). Persons, previously unemployed, underemployed, and with sporadic work histories are now earning regular wages (Thompson, et. al., 1992) and receiving other benefits associated with employment (West, Kregel, & Banks, 1990; West, Revell, & Wehman, 1992). These wages reflect dramatic improvements over participants' presupported employment placements in segregated adult day programs (Drake, Becker, Biesanz, Torrey, McHugo, & Wyzik, 1994; Kregel, Banks, & Wehman, 1989). Employers also are receiving a valuable contribution to their workforce and view supported employment as a positive source of assistance (Kregel & Unger, 1993, Shafer, Hill, Seyfarth, & Wehman, 1987). Rehabilitation professionals are experiencing the rewards of an effective support service which expands the opportunities available to the large numbers of persons on their caseloads who desire competitive employment (Cook & Pickett, 1994; Molinaro & Walls 1987). Parents and advocates are expressing favorable opinions about a much needed support option that allows friends and family members with a disability to achieve their career goals (Ferguson, Ferguson, & Jones, 1988; Hanley-Maxwell, Whitney-Thomas, & Pogoloff, 1995; Stineman, Morningstar, Bishop, & Turnbull, 1993; Irvin, Thorin, & Singer, 1993).
Despite the positive feedback from participants of supported employment, little information is known about the attitudes of the primary customer of those services, namely the individuals with disabilities who use supported employment services. For example, are people obtaining the jobs of their choice? Is supported employment assisting consumers in the manner they would like? Do individuals have recommendations for changing or improving service delivery practices? Anecdotal evidence suggests that consumers like their jobs and the services they receive. However, to truly assess the success and impact of supported employment, it is imperative that the viewpoints of this very important group be determined (Kregel, 1992). Presenting and gathering information in a way that is meaningful to supported employment consumers is the critical first step in accomplishing this goal. Listening and responding to what they say is the essential element that will insure the quality and integrity of this approach.
The purpose of this article is threefold. First, a tool to assist practitioners, consumers, and advocates with assessing supported employment jobs and services and advantages of its use will be described. Second, the opinions of individuals with disabilities who use supported employment services and what they feel about their experiences will be presented. Finally, specific strategies for use by program managers, employment specialists, and consumers to enhance participant satisfaction with supported employment will be discussed.
The Consumer Satisfaction Survey
The Consumer Satisfaction Survey (CSS) was developed with assistance from persons with disabilities who shared ideas about the content, decided the format of the questions, and determined the best procedures for its administration. The resulting instrument contains 60 items that are divided into several categories including: consumer/job demographics, pay and benefits, supervision, relationships/teamwork, job conditions, job satisfaction, job coach satisfaction, and service satisfaction. The CSS is designed to be completed during a personal interview that takes approximately 30 minutes to conduct.
The instrument was pilot-tested and field-tested with individuals with a variety of disability labels who functioned as consumers and interviewers. The CSS was found to be a valid, reliable, and useable tool by all participants regardless of the severity of their disability and level of communication (Parent, 1994). This tool is useful in supported employment programs for the purposes of promoting high quality services, monitoring an individual's employment situation, and providing a vehicle for the consumer's voice. Specific advantages of including the CSS are highlighted in Table 1.
| Table 1 Advantages of Using the Consumer Satisfaction Survey
(This table was co-developed by Karen Gibson, an Employment Specialist at the Virginia Commonwealth University-Rehabilitation Research and Training Center) |
What Consumers Have to Say
The opinions of 110 individuals with a disability who were working in supported employment were obtained during a study conducted in Virginia by the Rehabilitation Research and Training Center on Supported Employment at Virginia Commonwealth University (Parent, 1994). A summary of the key findings describing what consumers of supported employment services are telling us is located in Table 2.
| Table 2 Key Findings: What Consumers of Supported Employment Services are Telling Us
|
What are the characteristics of the consumers who participated in the study and the jobs where they work? Sixty percent of the participants were male and 40% were female with the average age being 32 years old. Individuals reported a disability label of cerebral palsy and other physical disabilities (34%), mental retardation (33%), traumatic brain injury (22%), and mental illness (21%). Participants were primarily employed in commercial (e.g., retail, store, or shop), food (e.g., restaurant, fast food), or service provider (e.g., church, park, agency) types of businesses in clerk/office worker (27%), dishwasher/food prep (19%), and stockclerk/warehouse (17%) positions. Average hours and wages were reported to be 28 and $159.38 per week respectively. Participants were employed between one month and six years with the average length of employment being 2.3 years.
How satisfied are consumers with their jobs?
The majority of consumers (90%) like their jobs. Not unlike the general workforce, participants indicated that they like some aspects of their job and dislike others. Things they like about their jobs include: the people (coworkers, public), the job duties (washing dishes, physical labor, stocking), the work conditions (atmosphere, breaks, hours, no pressure), having a job (just working), and the pay. Similarly, what people don't like about their jobs are: the people (talk down, petty fighting, customers complain, coworkers take too many breaks, they talk too much), the work conditions (indoors, interruptions, dirty, slow periods, stressful), their work schedule (weekends, not enough hours, evenings, overtime), the pay and benefits (not enough, no benefits), and the job is boring (routine, monotonous).
What do consumers have to say about their jobs? More than half (56%) of the consumers say they earn enough money from their jobs with the remainder saying they earn more than enough or not enough. Approximately half (54%) of the individuals have received a raise and another third expect one in the near future. Two thirds (67%) of the consumers do not receive company medical benefits while others need Medicaid or Medicare subsidies and a few have benefits that meet all of their health care needs. More than one third (41%) have opportunities for career mobility within the company and more than half feel that there are no opportunities for advancement for either themselves or themselves and other coworkers.
Most (82%) feel that their boss is always available when needed and that they can ask him or her for help if they have a question or problem. Characteristics that individuals like about their bosses are their management style and how they treat their employees. Similarly, most (82%) feel that their coworkers treat them the same as everyone else and that they get along great or O.K. Close to two thirds (62%) say that they like their job duties a lot and most of the others feel they are O.K. Approximately one half (49%) think that their job is sometimes boring and sometimes fun while close to half feel that their job is a lot of fun.
How satisfied are consumers with their job coaches? The majority of participants say that their job coach has been very helpful (85%) or sometimes helpful (16%). The areas where consumers most often receive help from their job coaches include: learning how to do the job, getting a job, dealing with work-related issues, providing support, and handling problems at the job site. Most consumers would like their job coach to visit them at the job site about the same as they are (74%), while some would like visits more (18%) or less (8%) often. Consumers generally like their job coach and say that if given the choice, they would like to keep their same job coach (87%), have one of the job coaches they used to work with (11%), or get a different job coach (2%).
How satisfied are consumers with supported employment services? The majority (96%) of consumers are satisfied with supported employment and many feel that they would not be working without its help. Many (80%) think supported employment assisted them as much as could be expected. Overwhelmingly, participants say they would use supported employment again if they lost their job or decided to change jobs (93%) and would recommend supported employment to a friend (92%).
How has supported employment affected the lives of consumers? Consumers feel that their lives have gotten better (73%), stayed about the same (24%), or become worse (3%) since starting to work at their job. The ways consumers feel their lives are better now that they are working include: more money, more productive (busy, doing something, less bored), personal benefits (more confidence, self-esteem, coping better), major life changes (savings account, major purchases, dating relationships, cruise), more independent (more responsibilities, more decisive, mom allows to do things) and like the people (friends).
How do consumers feel about their jobs? Close to one half (45%) of the consumers are earning less money than they would like and others are getting paid as much as they would like. Approximately three fourths (73%) work together with their coworkers as much as they would like and many are satisfied with the amount of time they spend together at break and lunch. More than half (56%) feel this job is O.K. for now but not the job they would like to do the rest of their life. Similarly, more than half (55%) would like to be able to learn more new things at work while others are learning as many new things as they would like. More than one third (44%) of the consumers would like to work more, less, or different hours and most feel that the time of day that they work is fine. More than half (56%) would like to keep their job just the way it is while some (26%) would like to change their job to make it better and others (19%) would like to have a different job.
Strategies to Enhance Consumer Satisfaction
Numerous suggestions for increasing consumer choice and satisfaction emerge from the comments and ideas offered by participants. Often, bureaucratic red tape, agency restrictions, funding limitations, and staff shortages are identified as factors prohibiting attempts to establish a consumer-directed approach to the delivery of supported employment. However, many of the recommendations presented only take the initiative of one person with one consumer to lay the foundation for large-scale change.
What can program managers do to increase consumer involvement and enhance the quality of supported employment services? Table 3 lists specific strategies for program managers interested in making changes in the way supported employment services are provided through their agency or program. The critical first step is to set the standard that consumer choice is a priority and everything else will fall into place. For example, establish policies that facilitate consumer choice, model practices that are guided by consumer input, and ask consumers what they want and respect what they have to say. Simply identifying individual preferences is not enough; following-through with the services and supports that will make choices is vital to success. While the provision of assistance that the consumer wants may at times appear costly, it is likely to save money in the long run due to increased satisfaction and ultimately job retention.
| Table
3 Strategies to Assist Program Managers with Increasing Consumer Involvement and Enhancing the Quality of Supported Employment Services
|
Consumer involvement needs to be a major part of all program operations in order to insure that policies, procedures, and practices are compatible with what people really want. For example, have consumers participate on the program Advisory Committee, in planning meetings, staffing sessions, staff and community trainings, and program development activities. Be proactive and include assessment of consumer satisfaction as a critical piece of service delivery that is conducted regularly over time. In addition, plan staffing and other resources to be available to respond to changes in preferences that arise as consumers change their mind.
The best policies are meaningless if not implemented through the day-to-day operations of service delivery. One method for promoting consumer involvement is to support the job coaches who are trying to make this happen. For example, get involved in what they are doing, trust their judgement, and visit job sites to find out what is going on. It is imperative that those individuals who are making consumer choice a reality be given the encouragement and backing to provide quality services that are driven by the people they serve.
What can employment specialists do to enhance choice and satisfaction for supported employment consumers? Employment specialists are in the unique position of being on the front line where consumer choice can be translated into outcomes even if program support is minimal. A few guiding principles can lead the way to insure that consumer preference is the motivating factor behind the way decisions are made and services are delivered. First, it is imperative to spend time initially, truly getting to know the individual (Parent, Unger, Gibson, & Clements, 1994). For example, spend time together, get involved with the individual's world, and find out what he or she would really like. Second, provide detailed information about available services, share all of the information that is known, and be open to explore new possibilities that may not have been tried before. A major criticism expressed by consumers is that professionals often make important decisions for them through the screening of information as to what they feel is appropriate, a lack of knowledge on their part, or close-mindedness to another way of doing things (Brooke, Barcus, & Inge, 1992).
Third, help consumers explore options by arranging practical concrete experiences related to jobs and supports of interest. For example, if someone desires to bag groceries, take him or her to visit a grocery store, arrange a situational assessment to try it out (Moon, Inge, Wehman, Brooke, & Barcus, 1990), or coordinate a time for him or her to talk with someone who is employed as a bagger. Fourth, make sure communication is frequent and use a variety of means to give the individual ample opportunities to share ideas as they occur to him or her. It is unlikely that most people will remember a passing thought months down the road if conversations are few and far between. Finally, assess satisfaction on a consistent basis and intervene to make those areas that are not liked a little more desirable. For example, an individual may say he or she doesn't like the job and wants another, however, looking at the specific aspects of the job may reveal that he or she really does like the job but wants different hours. Responding to a specific request is far less time consuming or costly than finding another job should the individual quit out of frustration or be terminated and then re-enter the system. Specific recommendations to aid employment specialists who really want to make a difference are located in Table 4.
Table
4
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What can consumers do to insure that their choices and preferences are heard and responded to? The bottom line in obtaining the job and supports one desires is to know what is available and let others know what can and should be. Contact agencies and organizations in the community, find out what they have to offer, determine the eligibility process, and initiate the referral procedures to insure that services are readily available when needed. Similarly, explore types of employment opportunities, find out the different requirements expected of particular businesses, generate job leads through friends and informal networks, and share information with professionals to facilitate the job development process. In addition, look at the supports that are currently available, think about who typically provides help, investigate other types of assistance that persons may be willing to provide, and be prepared to make suggestions to professionals to expand limited and dwindling resources.
It is important to communicate frequently with the providers of supported employment services, even if that means initiating the telephone calls and requesting meetings to share pertinent information. Ask questions and persevere until the information presented is understandable and an acceptable resolution to the issue has been determined. Critical to making sure that one's choices become a reality is to proactively arrange a blanket of support to utilize when assistance is needed during the present as well as in the future for both existing and anticipated needs, such as career advancement, independent living, or job changes. Experience suggests that no issue should be overlooked. Instead, brainstorm potential issues and supports, document procedures for accessing assistance that is readily available (e.g., names, telephone numbers, key information), and make the provisions now to get what may be desired later. Table 5 offers specific tips for consumers to help them achieve their chosen career goals.
| Table
5 Strategies to Assist Consumers with Insuring that Their Choices and Preferences are Heard and Responded To
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Summary
There is no doubt that we have done a good job with supported employment but we can do better. Yes, people are out working and most probably would not be without assistance from supported employment. However, many are not employed in their careers and desire to change jobs at some point in the future. We simply must acknowledge and support opportunities for job mobility and career advancement for every person working in supported employment so the question no longer is "should I work at this job or no job at all" but rather "what job do I want to pursue next?"
Do consumers like their jobs? Yes, but as with the general labor force, certain aspects of the job are typically more desirable than others. Asking global questions is just not enough. We must break these questions down and ask about everything, if we are going to determine what specific aspects of the job and/or services could be improved. Eventually employees will leave their jobs if these areas are not addressed or if other things occur so that the benefits of the job no longer outweigh the disadvantages. Adequate provisions for assessing and responding to individual preferences and concerns must be implemented if a truly consumer-driven service delivery approach is to be achieved.
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