Thursday, March 27, 2014

Thoughts on Group Service Models for People with Disabilities

In my speaking and writing, I often tout the need for services to be individualized, and take issue with the congregate models we generally see from agencies and schools in the forms of group homes, day programs, and classrooms. Often, there is pushback from families and providers. I frequently hear:
- “What’s wrong with letting people socialize with each other?”
- “It’s their choice to be with each other.”
- “I’m [Jewish, Italian, African-American, etc.] and [live, work, play] with people with my same label.”

Good points, but these arguments miss the mark. They represent a kind of binary thinking (disability groups are bad/good) that is all too common. They oversimplify social grouping, which is a sophisticated sociological phenomena. Understanding how groups function is a key to successful individual community life as well as personal self-worth. 

Groups can provide important social cohesion. This can be very positive for when an individual wants to validate his or her social identity, or share experiences with people who have some commonality. For a repressed minority group, it can be particularly important. A person can establish self-identity and take pride in it. In-group members relate with others who have shared experiences and cultural expression. Group members can form a basis for friendship, and advocacy of the shared commonality. Indeed, many people who are deaf, or who have dwarfism, for example, express strong preferences about living among others with the same life situation for a variety of reasons. And peer support groups for persons with mental illness have been shown to be helpful for group members.

But the difference on making an educated decision to voluntarily join a group for social cohesion, support, or advocacy, versus having a group experience imposed on you is huge, especially in regards to individuals with disabilities. People benefit from having a range of social experiences and participating in groups defined by different gathering reasons, and then being able to make educated choices about how they want to experience their communities. 

There is also an important social perception issue related to disenfranchised groups in which the group members are subject to negative stereotypes. What happens is that when an individual is seen as part of a group, the group commonality becomes prominent and defining. This leads to sociological issues when the commonality is not particularly valued, including prejudice and bias, intergroup hostility, and discrimination.

Group definition plays out in the context of how providers organize services. If you have a certain “functioning level,” or a label such as autism, behavior problem, intellectual disability, etc., your service experience will likely be more defined by that characteristic, rather than by your personal life needs (job, home, etc.). While a "treating-the-problem approach" is common in a medical model, it produces a severely limiting life experience for someone with a disability. They become "boxed in" by perceived and potentially misunderstood disability and support needs in terms of employment, housing, recreation, and more. Not only that, but individuals with disabilities often find themselves surrounded by others with the same disability or "level of function," limiting access to others who might mentor, model, or perform at a higher level.

Fully understanding how to make good decisions about what groups to be a part of, in what context, and for how much of one’s life is a big decision people must make. Whom do I live with, what kind of work do I do, whom do I have fun with are major questions for us all. What professionals shouldn’t do, though, is track people into pre-made groups as answers to these questions based on their disability label. This ultimately limits the answers to those models that disability professionals have artificially created. 

So, consider the kinds of questions we ask:
  • It’s not: What disability work crew you want to join?; It’s: What kind of job do you prefer?
  • It’s not: What group home you want?; It’s: How do you want to live and with whom? 
  • It’s not: Do you want to go to the mall with other people from your residential placement?; It’s: What do you want to do for fun and with whom?
And remember, if all your previous experiences have been defined by group homes, workshops, crews and enclaves, and all your friendships have developed from group home co-residents placed by others, then saying your current situation is your "preference" is really not choosing at all. When someone understandably selects the only thing they have known, then we have failed to support him or her in understanding all the possibilities.

Thursday, February 27, 2014

Overcoming the Multi-Tasking Bias of Employers in Hiring

In my previous post, commenters noted the benefits of my proposed supported employment process of Plan-Match-Support, but worried about a commonly reported hiring issue - the preference of employers to hire a person who can do multiple tasks. This perception can throw a roadblock into hiring a worker with a disability who might be considered capable of completing fewer kinds of tasks than others.

Let’s analyze the situation closely. First, it’s important to acknowledge that we have no research evidence on employer hiring preferences when workers with disabilities are in the equation. We have only studies of general employer attitudes toward hiring people with disabilities, and the anecdotal reports of job developers.

Unfortunately, this means that our understanding of employer thinking here is weak. It also means that if a job developer hears an employer say, “No thanks, I have a candidate who can perform more tasks,” we have no way of knowing how that actual job development process was performed to that point. Nor do we know how the job developer reacted. We also don’t know whether the employer has been educated about a specific job applicant with a disability, or whether the employer has had previous experience with workers with disabilities.

Why are these factors so important? Simply saying employers prefer multi-task-capable applicants oversimplifies the issue. Everyone would prefer Superman over Clark Kent in theory, unless you happen to just need a good reporter. For example, several research articles have found that employers who had previous positive experiences with workers with severe disabilities actually reported more favorable attitudes toward hiring individuals with severe disabilities in the workplace, despite any comparisons to multi-tasking candidates.

The comfort level with the job developer, and his or her credibility, also can influence decision-making. And most importantly, the employer personally meeting and assessing the skills of the job applicant with the disability can be crucial in overcoming bias, rather than considering a pitch about a “theoretical” applicant with a disability (thus increasing the probability of a discriminatory stereotype). And finally, the notion that workers with disabilities can’t expand their skill repertoire with training, accommodation, and support is wrong.

Further, the notion of multi-tasking actually can be detrimental to business performance. Recent studies of workers performing numerous tasks found that all performance suffers when trying to do too many things, not to mention increasing everyone’s stress level.

So, yes, the multi-task hiring preference can present job development issues, depending on the employers’ experiences (or lack of) and bias. But it can be mitigated by how the job development process occurs, and how well we educate employers about real productivity, the benefits of a diverse workforce, and the process of talent matching, a concept I will talk about in a future post.

The reality is that when workers with disabilities are well-matched to tasks that need completing, those tasks are completed reliably and productively. This is the most salient factor in hiring, whether those tasks represent all the business tasks or not. And there are many other non-task contributions workers with disabilities make to the workplace as well. How well we develop our employer engagement so that we overcome any multi-task hiring bias is key.

Wednesday, January 29, 2014

Moving Beyond “Place, then Train"

When supported employment first challenged the status quo of sheltered work over 25 years ago, the mantra was that it represented a shift in thinking. It was a movement away from Train and Place to its opposite, Place, then Train. That pithy quote helped to convey and crystallize the philosophical evolution taking place. Waiting to place someone until he or she is ready, based on training in a sheltered workshop, was just not working. For one thing, it took way too long for those few that managed to even get jobs. Researcher Tom Bellamy estimated that, based on average placement rates at the time, it would take over 55 years for someone to have a real job opportunity.

But in today’s world, Place, then Train has its own shortcomings. For too long, employment professionals have worked to find any available job opening, put job seekers in there, and then try to train for all expected tasks. This approach is not only over-simplified, it causes poor quality work outcomes. While getting any job was an improvement over a life of segregated work, it still too often missed the mark for good wages, social inclusion, longevity, and personal satisfaction.

So where should we go from Place, then Train? Something more like Plan, Match and Support. Still simplified, to be sure, but this is a more sophisticated take on job success. Jobs for people with employment challenges need to be customized to fit their skills, interests, and needs. And employers need workers who meet their task needs, fit in socially, and are motivated. Simply put, this requires individualization that includes all three components. 

Plan has two elements. It refers to the preparation required for a good job match that focuses on the two key customers, job seekers and employers. Career Planning for a job seeker means vocational assessment, using situational and and natural environments, and developing such things as self-representation skills, job experiences, portfolios, visual resumes, and interview skills. Employer Planning begins with employer research, and involves various strategies of employer engagement, leading to networking, and then very specialized job development for customized tasks and settings.

Match and Support take the place of Placement and Training. Placement implies something we do to people, rather than assisting workers with disabilities to be hired successfully. Matching is a more facilitative approach. Like a good headhunter or dating service, you want to bring together people and workplaces where there is a good fit, then help make the magic happen by negotiating a Job Match. This includes job analysis, customization of tasks, and helping arrange accommodations and other needs. Once a job has been brokered, workplace Support and training strategies focuses on natural supports and building co-worker relationships to facilitate learning and assistance from within the work environment. This is quite different from traditional job coaching. Instead, it involves utilizing employment specialists to facilitate training, rather than being the sole source of instruction.

When presenting this approach, there are often a range of worries from staff, including the time required to do the planning. And yes, in the real world, shortcuts and priorities often must happen. But the level of planning accomplished relates to both the probability of success and level of quality. In a future blog post, I will discuss the ways to prioritize and build teamwork such that we don’t sacrifice quality and revert back to Place and Train, because that too often turns into Place and Pray, which is no way to ensure high rates of job success.

Monday, December 2, 2013

The Two Sides of the Employment First Coin

Like a two-sided coin, the advocacy movement of Employment First has two core linked components. 

The first side is about ending obsolete practices – to phase out the needless segregation, less-than-minimum wages, and limited work tasks given to people with disabilities that make up much of sheltered work. 

The second side is to provide a system that supports, for every individual with a disability, a preference for quality employment services that are individualized. These are services that lead to well-matched jobs to enhance productivity, social success, and wages in community integrated businesses.

The success of both goals are interdependent. Moving people with disabilities out of sheltered workshops does not achieve the goal of a quality life if, after leaving, they remain excluded from typical community life, and instead sit home doing nothing, or be relegated to day programs focusing on non-vocational activities, or fail in poorly-matched and weakly-supported jobs.

And this is what might happen if states close workshops without investing in supported employment services. If states just maintain their supported employment for the small percentage of people receiving those services (about 22% nationally in the US), this will only perpetuate a serious bottleneck to employment people with significant disabilities have faced for the last 30 years. New services must be expanded or incubated to be able to serve more people. 

In addition, the level of quality of such services varies widely from place to place. Far too few agencies are well versed in marketing planning, job analysis and customization, or naturally sustainable job support strategies. A commitment to cutting edge service is a needed investment.

But, as well, ending a segregated approach with demonstrably poor outcomes must be part of the discussion of what needs to change. We cannot just ignore this half of the goal. Many of the large disability service agencies take the position that segregated facilities will just “fade away on their own” (to quote one such position paper) once better employment services are offered. But that is overly simplistic and has proven untrue over time. It will take proactive steps to end the current reliance on sheltered employment as a solution to work for people with disabilities.

If we consider both sides of Employment First, then we must acknowledge three basic conclusions. 
  1. First, change won’t occur until we freeze referrals to sheltered workshops, as is finally now being done in several states. Then there must be an active process to downsize the census over time.
  2. Two, offering quality employment services to many more people requires a large investment in capacity-building. This includes not only core basic training for the new staff that must be hired, but also in-service development to greatly increase the quality of career planning, job development, and job support. Many agencies still only provide rudimentary levels of these skill sets.
  3. And, finally, if established agencies are to successful change their missions and services, they must have access to technical assistance on organizational restructuring. Agency conversion can be complex and fraught with land mines, from family resistance, management restructuring, and the changing of agency mission and staff organization. Agencies taking this leap must be offered support, guidance and the resources necessary for them to succeed.