Human Service - Supported Employment - Essay Example

?Running head: HUMAN SERVICE . Human Service . Insert Insert Grade Insert 27 April Human Service The evolution of Supported Employment (SE) concept as an Evidence Based Practice (EBR) was aimed at helping people with significant disabilities segregated in competitive employment to search, find, and remain in the competitive job. The Rehabilitation Act Amendment of 1986 introduced Supported Employment as a program option of the federal state Vocational Rehabilitation (VR) program with definite mandate of aiding persons with significant disabilities to work successfully in competitive work setting (Novak, Mank, Revell, & Zemaitis, n.d, P.1). Supported Employment is defined as integrated work environment offering competitive work to people with significant disabilities together with the support to enable them perform their functions (Anthony, 2005, Pg.2). Before the introduction of supported employment, people with significant disabilities had very few options for work such as special segregated workshops and work activity programs. Moreover, supported employment programs have enabled the disabled to access personalized and continuing support in competitive work setting, thus integrating the community workforce and presenting the disabled with opportunity to work in competitive employment. The introduction and development of the SE was very innovative and ambitious in that, first, placement into jobs was achieved faster without much job preparation found in sheltered workshops; secondly, support was assured for all the time needed in the competitive job; thirdly, there was general assumption that all people regardless of their disabilities can perform important and productive work in a normal work environment (Anthony, 2005, P.2). With these approaches, the SE introduced a rapid departure from the conservative services for the state VR agencies and permanent support agencies supporting persons with severe disabilities. The SE was a hybrid of the two systems aimed at supporting the severely disabled in community jobs. Moreover, the SE transformed the funding system of the VR agencies and the permanent services agencies, with the former starting to fund extensive work setting supports to more needy groups than previously catered for and the later started funding work related services in competitive work environments. The SE was originally crafted for people with developmental disabilities and later was incorporated into psychiatric rehabilitation program (Anthony, 2005. P.3). Research on early psychiatric vocational rehabilitation facilities implied need to establish vocational rehabilitation services, with the fundamental principles of psychiatric rehabilitation (PR) and those of SE sharing many similarities. With the research recommendations, the Center for Mental Services (CMHS) sponsored the SE implementation resource kit structured to support the implementation of SE as evidence based practice in psychiatric rehabilitation program (Anthony, 2005, P.4). The SE works through state agencies dealing with VR disabilities and mental health, utilizing several of purchase of service (POS) programs to secure employment from provider agencies. Many of the POS programs share similarities in their defined services, a purchasable unit for each service and a unit cost for each defined service (Novak, Mank, Revell & Zemaitis, n.d, P.3). The POS program has enabled the growth of hour-based POS agreement, based on personalized program information with defined units of services received by each customer. This has improved the number of VR agencies utilizing the result based funding strategies to access SE services from the community. The impact that supported employment has had in the rehabilitation field The SE has impacted very much on the rehabilitation field especially in terms of cost effectiveness, societal integration and health benefits. Cost effectiveness Implementation of SE in rehabilitation programmes has proved to be more cost effective compared to other VR programmes. According to Latimer, analysis of research carried on seven SE sites in the U.S. “individual placement and support (IPS) emerges as much cheaper than day treatment centers or about as costly as other vocational rehabilitation programs; therefore, replacing existing vocational rehabilitation programs with IPS may well make it possible to introduce IPS into a service delivery system without any increase in budget – while, as we have seen, yielding better employment outcomes” (Latimer, 2008, P.7). SE tends to lower the cost of inpatient and outpatient service costs for people in rehabilitation field. According to 2 randomized controlled trails (RCTs) and 2 non-RCTs studies for hospitalization costs “the costs of case management and other outpatient services, although the differences are either not significant or not tested, in five out of five studies the costs are somewhat lower for IPS – the difference varying from 9% to 27% across the studies” (Latimer, 2008, P.8). The above benefits of SE in terms of cost effectiveness are subject to be altered by the following factors: client characteristics, rules concerning benefits, and the unemployment rate. Clients who show social inattention and active avoidance use more time on vocational advisory services, working fewer hours hence costing more (Latimer, 2008, P.8). The regulations on the effects of income earned on disability payments and health benefits can influence the cost effectiveness of an IPS program. On unemployment rate “more recent studies tend rather to the conclusion that client employment rates tend to be lower where the overall unemployment rate is higher; thus, cost-effectiveness of supported employment would be expected to be higher in settings where the unemployment rate is lower’ (Latimer, 2008, P.12). Societal benefits People on SE are more likely to be on higher self-esteem and more positive in their attitudes compared with people on other VR programmes. Recent studies have indicated that people on SE enjoy a higher level of job satisfaction, higher self esteem, report numerous employment related benefits, and are more positive in their outcomes (Foeman, 2009, P.17). Health benefits People on SE fall sick less often and exhibit less symptomatology especially those with mental illnesses compared to people on other VR programmes. According to Latimer, analysis on report relating to hospital use by people on SE carried out in four RCTs found out that, Among the long-term studies, one reports that, among the 52% of clients they were able to trace about ten years after their entry into an IPS program, 39% reported that they went to the hospital less because of working; the other that a large majority” of the 49% of original study participants they were able to interview reported that they went to the Hospital less when they were working (Latimer, 2008, P.7). The impact of Supported Employment on the future of rehabilitation programs in terms of: changing philosophy; mission, changing direction from a facility based model to community based options; and, the downsizing and potential closure of these programs. Changing philosophy Implementation of SE has opened up the opportunity for the community and government to realize the significance of accepting people with severe disabilities in competitive employment. These transformations have enlightened the community to understand that people with severe disabilities have needs that are mainly person-centered, can develop meaningful relationships with community, can work in paying jobs and/or participate in their community through meaningful activities, and are able to live on homes of their own. With this understanding in future, addressing the issues of people with severe disabilities in terms of employment will be based on the philosophy of self-determination based on the use of supported employment, supported education, and supported living (Wehman, Revell, & Brooke, 2003, P.2). Mission The mission will be to increase opportunities to enhance competitive employment to the individuals with a significant disability. This is due to growth of competitive employment over the years fuelled by use of supported employment, leading to movement towards complete community integration of people with disability at work and other areas of community life. Changing direction from a facility based model to community based options. Evolution of SE point towards shift from facility based model to community based rehabilitation due to benefits achieved with the SE. For example, “supported employment has made significant advances over the past 13 years of implementation; the impact of supported employment services is particularly apparent within the Vocational Rehabilitation system” (Novak, Mank, Revell, & Zemaitis, n.d, P.1). Due to growth witnessed by the SE program, the government and the community is currently focusing on creating more community based rehabilitation programs. The downsizing and potential closure of these programs With the government and community policies on rehabilitation being changed to increase community based model due to the impact of SE, the facility based models are being reduced in terms of the number of people they are supporting who are eventually enrolled in community based models. This events are leading to some facility based rehabilitation programs to close, with many others reducing in terms of staff employed and people they support. This trend is expected to continue, though at no time the two models will cease to exist due to complexity of disability cases; thus, some people with disabilities cannot be enrolled in SE. The future of rehabilitation programs in 10 years from now. In 10 years from now, based on the changing philosophy, majority of the rehabilitation programs will be community based, with much emphasis on people with severe disability to engage in SE. in this case, community will be more helpful and appreciative of people with disabilities. References Anthony, W.A. (2005). Supported Employment for People in Contact with the Criminal Justice System. MD: Bethesda. Foeman, G. (2009). A Review of 21st Century Research into the Development of Supported Employment (SE) Programs: Major Findings, Debates, and Dilemmas. Department of Behavioral Health and Mental Retardation Services. Latimer, E. (2008). Economic impacts and cost-effectiveness of evidence-based supported employment for people with severe mental illness: A review of the literature. Montreal: McGill University. Novak, J., Mank, D., Revell, G. & Zemaitis, N. (1998). Initiatives Influencing the Emergence of Results-Based Funding of Supported Employment Services. U.S. Journal of Disability Policy Studies, 9 (1) 119-133 Wehman, P., Revell, G. & Brooke, V. (2003). Competitive Employment Has It Become the "First Choice" Yet? Journal of Disability Policy Studies. Vol. 14/No.163-173. Virginia Commonwealth University. Read More