1. What are the outcomes of open employment for people with intellectual disability?

What is open employment

Open employment is a term used in Australia. Autism Spectrum Australia define it as:

doing a job which can be done by any person. You do the same job as your co-workers and are paid the same wages (http://www.autismlaunchpad.org.au/work/open-employment/).

The Australian government defines it as follows:

‘Open’ employment refers to employment where the jobs are open to all people, with or without disability. People with disability who wish to receive assistance to find employment in the open labour market can register with a DES provider (Australian Government, 2017, p.8).

Other terms are used for this in different countries and contexts including ‘competitive employment’ or ‘competitive integrated employment’ (CIE). In CIE, ‘employers compensate their employees with ID at or above minimum wage and provide work opportunities within a body of co-workers who mostly consist of persons without a disability’ (Blick et al., 2016, p.359).

What are the benefits of having a job?

Many studies have provided evidence on life outcomes related to open employment experienced by people with intellectual disability. Outcomes of open employment that are widely evidenced in the research literature are:

• economic benefits (increased income and better standard of living)
• increased quality of life or wellbeing
• improved mental health
• improved physical health
• reduced risk of poverty
• increased social participation, including opportunities for friendships
• increased social support
• increased skill development
• increased sense of social worth, feeling valued and increased social status
• provision of purpose, structure and meaning to daily living (Holwerda et al., 2013; Honey et al., 2014; Blick et al., 2016; Simplican et al., 2014, Emerson et al., 2018; Carter et al. 2017; Meltzer et al. 2016; Riesen et al. 2015; Nevala et al. 2019).

Speaking about young people with intellectual disability in the USA, Carter et al. (2017) note:

… a good job contributes to a sense of accomplishment, self-worth, and independence; it gives young people a place to share their strengths and gifts in valued ways; it fosters new friendships and access to social supports; and it provides resources and connections that increase community involvement and contributions (p.365).

In Australia, researchers reviewing the evidence on outcomes of employment for people with disability generally, note:

There is abundant evidence on the social and economic benefits of work for people with disability and their families. People who work contribute to society, gain financial independence, enjoy a better standard of living, experience improved physical and mental wellbeing, have expanded social networks and have opportunities to develop their career, demonstrate and expand their skills and knowledge (ARTD Consultants, 2016, p.2).

People with intellectual disability in Australia have also been asked to report on the outcomes they get from employment, and report all of the outcomes listed above, including:

It’s like everything had changed since – like when I was a kid I didn’t know anything about [my Disability Employment Service] and about anything, but now I’m man … It’s like being a kid changing to be a man. It’s like being changed a lot in a different life. It’s really good for me … now I’m a man. I have changed now. It feels really good now (23-year-old man, urban, working in open employment in fast food) (Meltzer et al., 2016, p.40).

[I work] because I want to get out of my home, I want to do something … I just wanted to do something and mix in with other people… Just to earn some money … and just live (34-year-old woman, urban, working in an ADE) (Meltzer et al., 2016, p.42).

Working is about, you get up, and you belong in the community, and get more confidence, like all the people at my job now treat me like the same, like equal (47-year-old woman, regional, working in open employment in a hotel) (Meltzer et al., 2016, p.41).

Research suggests that having a job in young adulthood is linked to improved socioeconomic status 6-7 years later (Honey et al, 2014).

Interestingly, working even a small amount of hours per week can generate significant outcomes. A recent large-scale study of people with and without disability in the UK (16-65 year olds) found that working 8 hours a week ‘generates significant mental health and well-being benefits for previously unemployed or economically inactive individuals’ (Kamerade et al., 2019, p.1). This study found that people do not require full time employment to achieve these benefits.

While there is evidence that having a job leads to positive outcomes, there is also evidence that not having one leads to negative outcomes. There is strong evidence that a lack of employment greatly increases and contributes to the high relative poverty risk for people in Australia (Honey et al., 2014). The relationship between unemployment and poor health is also well established in the literature (Emerson et al., 2018; Kavanagh et al., 2013).

What are the benefits of having a job in open employment settings vs having a job in a segregated setting?

Many people with disability work in settings that are not open competitive employment. In Australia these include Australian Disability Enterprises and the term ‘supported employment’ is used in Australia to refer to this kind of work. (It should be noted that ‘supported employment’ has different meanings in different countries). The Australian government describes supported employment as follows:

‘Supported’ employment generally refers to employment in enterprises that have as their primary purpose employment of people with disability, and where the majority of employees have disability. There are often mixed industries within enterprises to cater for their employees, and there are higher levels of job customization (Australian Government, 2017, p.8).

Research has identified that outcomes from open employment compared to supported employment (i.e. sheltered or segregated) settings include:

• increased earnings
• increased quality of life
• increased opportunities for skill development.

A range of international research shows that people with intellectual disability can be successfully employed in competitive, integrated positions and substantially increase earnings in comparison to segregated work or day support programs (Butterworth, Christensen, & Flippo, 2017; Migliore et al., 2012; Wehman, Chan, Ditchman, & Kang, 2014, in Wehman et al., 2018).There is also some evidence that people with disability working in non segregated settings achieve higher self-reported quality of life than those working in sheltered employment (Beyer et al., 2010). In addition, one Australian study of people with intellectual disability found that while there are skill development opportunities in both open employment and ADEs, those working in open employment had greater access to skill development opportunities in the mainstream community (Meltzer et al., 2016).

There is also evidence that people with intellectual disability prefer employment in non-segregated settings (Wehman et al., 2018) and that open employment and social enterprises are viewed as less segregated than ADE settings by Australians with intellectual disability (Meltzer et al., 2016). People with intellectual disability have reported that the main motivation for moving from an ADE to open employment was better pay, to work with people without disability and increased opportunities for social interaction (Meltzer et al., 2016).

While there is evidence that open employment leads to a wide range of outcomes for employees with disability, there is also evidence that some individuals prefer different settings including those of Australian Disability Enterprises.  People with disability report that the relationships they form at work are the main factor that attaches them to their ADE and is the primary reason they want to stay (Meltzer et al., 2016). People with intellectual disability report enjoyment of ‘sheltered workshop’ settings with a range of fun activities and friendships that are more likely to extend beyond the workplace (Lysaght et al., 2017). Similarly, a proportion of young people with intellectual disability using Individualised Placement and Support became disengaged from this program due to concern over the loss of their social networks in sheltered employment settings (Noel et al., 2017). In addition, there is evidence that some people have had negative experiences in open employment and therefore prefer different settings (Simplican et al., 2014, citing Hall, 2009; Meltzer et al., 2016), though negative experiences are also reported in ADE settings (Meltzer et al., 2016). One Australian study of people with intellectual disability found that ADEs and social enterprises were felt to be more supportive of workers with intellectual disability and offer greater job stability than open employment (Meltzer et al., 2016). Finally, this study also identified that a small number of research participants employed in ADEs held more skilled and supervisory roles whereas those in open employment did not (Meltzer et al., 2016).

Moving from segregated to open employment

The problem

Employment in Australian Disability Enterprises (ADEs) is a common experience for Australian’s with intellectual disability. People with intellectual disability who are National Disability Insurance Scheme (NDIS) participants are more likely to be employed in Australian Disability Enterprises (ADEs) than other participants of the NDIS.  A large majority of NDIS participants with an intellectual disability who are aged 25 years and over and are employed, have employment in ADEs (70%), with 15% having a job in open employment on a full wage, and a further 13% having a job in open employment on a part wage (NDIA, 2019). Younger NDIS participants with intellectual disability (aged 15-24) are far more likely to be in open employment (on part or full wages) than employed by an ADE (NDIA, 2019, p.35).

Segregated employment settings such as ADEs have traditionally not had good outcomes as a pathway to open employment, and were not initially designed for this purpose. Indeed, previously, the procedures governing Disability Employment Services (DES) prevented them from supporting ADE employees to find work in open employment, though these have now been changed (Meltzer et al., 2016).

There is evidence that early placement of young people with intellectual disability into segregated day programs and sheltered employment options reduces their later economic participation (Cocks & Harvey, 2008). There is strong evidence that once in segregated employment settings, such as ADEs, few transition out into open employment. In 2014, less than 1% of those employed in an ADE transitioned to employment in the mainstream labour market (Australian Government, 2015; AFDO, 2018). Similarly, the National Disability Services suggests that less than 5% of people with disability transition to open employment from day services or supported employment settings in Australia (NDS, 2017).

Some studies have demonstrated that there are few structured skill development opportunities within sheltered and segregated employment settings and that time spent working in such settings does not promote later employment in open employment (Akkerman et al., 2016; Cimera, Wehman, West, & Burgess, 2011; Dague, 2012; Hemphill & Kulik, 2017; Soeker et al., 2018). Similar issues have been found with day services or community access programs (Thoresen et al., 2018).

However, there is evidence that some people with intellectual disability have been supported via their ADE employers to transition into open employment (Meltzer et al., 2016). An Australian study found that ADEs did frequently offer opportunities for vocational training as part of employment, but that skill development opportunities in mainstream settings were more available in open employment (Meltzer et al., 2016).

The solution

A suite of research in the United States has highlighted the importance of a system-wide prioritization of employment as a primary outcome for adults with intellectual disability, which then fosters a consistent set of expectations and supports across services, families and individuals (Hall et al., 2018).

Moving into open employment can occur from any location and is aided by a set of supportive practices (which research has also identified as being often present in social enterprises) (Smith, McVilly, McGillivray, & Chan, 2018). Ways to support people with intellectual disability to move out of segregated employment or day service settings and into open employment include:

• Focus on the vocational aspirations and the potential strengths of people with disability, based on what people with disability want (Smith, McVilly, McGillivray, & Chan, 2018; Soeker et al. 2018). This might utilize a Discovery approach that is an in-depth exploration of the interests and capabilities of the job seeker with disability. This process is based on building trust and getting to know job-seekers with intellectual disability (Hall et al. 2018).
• Provide opportunities to explore and move to, and between, higher skilled and better paid work (Smith, McVilly, McGillivray, & Chan, 2018).
• Provide opportunities to explore vocational options, including those that have a relatively higher social value/status than those commonly inherent in ADEs (Smith, McVilly, McGillivray, & Chan, 2018). Expanding options can include looking for task and interest matches with employers, rather than waiting on job openings (Hall et al., 2018).
• Make available work tasks that foster skills development relevant to open employment (Soeker et al., 2018).
• Support development of relevant social skills including spending time planning for transportation to and from work (Hall et al., 2018).
• Plan the supports that will be needed in the workplace, such as communication and technology supports (Hall et al., 2018).
• Utilise individualized and tailored person centred approaches including Customised Employment practices, within ADEs and day services (Smith, McVilly, McGillivray, & Chan, 2018; Thoresen et al. 2018).
• Utilise opportunities in Social Enterprises to explore the vocational aspirations of people with intellectual disability. Components could include a range of entry level positions, job rotation options and opportunities for promotion and career paths (Smith, McVilly, McGillivray, & Chan 2018).
• Support parents and families to gain knowledge of the employment service system, approaches that support employment, along with the influence of their own expectations and the value of their own social networks (Hall et al., 2018).

References

The authors would like to acknowledge the usefulness of Crosbie, J.: Murfitt, K.; Hayward, S. & Wilson, E. (2019), NDIS Participant Employment Taskforce. Literature review: Employment and economic participation of people with disability, Burwood, Deakin University, as a review of similar literature that provided initial guidance.