by Katherine J. Inge, Carolyn W. Graham, Nancy Brooks-Lane, Paul Wehman, and Cary Griffin
Defining customized employment as an evidence-based practice: The results of a focus group study.
Journal of Vocational Rehabilitation,
Customized employment has generated support at the national, state, and individual participant levels to expand employment for people with significant disabilities. The next step is movement from practitioner-based descriptions to evidenced-based practices that can be consistently replicated.
The objective of this qualitative research study was to begin the development of a research-based description that agencies can use to replicate customized employment when supporting individuals with significant disabilities.
Twenty-eight professionals representing national experts and implementers of customized employment participated in five phone-administered focus groups. The calls were recorded, transcribed, and analyzed to identify themes associated with customized employment implementation.
Twelve key components or practices emerged as comprising customized employment.
This research provides insight into the practices that are associated with customized employment that facilitate integrated employment outcomes for individuals with disabilities. Additional research is needed including random control trial studies to further the development of a replicable set of evidence-based practices.
Customized employment was initially defined in the Federal Register as a blending of services and supports and may include — job development or restructuring strategies that result in job responsibilities being customized and individually negotiated to fit the needs of individuals with a disability. Customized employment assumes the provision of reasonable accommodations and supports necessary for the individual to perform the functions of a job that is individually negotiated and developed (Federal Register, June 26, 2002, Vol. 67, No. 123 pp. 43154-43149). In 2014, customized employment was added to the definition of supported employment in the Workforce Innovation and Opportunity Act (WIOA), which was signed into law on July 22, 2014. WIOA defines customized employment as competitive integrated employment for an individual with a significant disability that is based on the strengths, needs, and interests of the individual with a significant disability.......designed to meet the specific abilities of the individual with a significant disability and the business needs of the employer....carried out through flexible strategies (WIOA, 2014). Flexible strategies include job exploration; customizing a job description based on current employer needs or on previously unidentified and unmet employer needs; developing a set of job, duties, a work schedule, work arrangement and the specifics of supervision, and determining a job location; and providing services and supports at the job location (WIOA, 2014). WIOA also defined the term competitive integrated employment as, full-time or part-time work at minimum wage or higher, with wages and benefits similar to those without disabilities performing the same work, and fully integrated with co-workers without disabilities.
Current literature supports customized employment as a promising practice; however, there is limited evidence of its efficacy as an evidence-based employment practice. Callahan and Griffin (2011) described the Office of Disability Employment Policy’s (ODEP) efforts beginning in 2001 to provide a foundation for the concept of customized employment. Elinson and colleagues evaluated the outcomes of ODEP’s demonstration program that included 31 demonstration sites within Workforce Investment Act One-Stop Centers (Elinson, Frey, Li, Palin, & Horne, 2008). They reported that 44.8% of program participants with disabilities achieved competitive employment using the model. For those participants in round one of data collection with a two-year follow-along, 44.5% retained their employment for 12 months or longer; for those in round two with a one-year follow-along, the 12-month retention rate was 73.6%. A review of the project descriptions indicates that they did not include research methodology where the results of control and experimental groups were compared, a critical component of evidenced-based research.
Citron and colleagues (2008) presented outcomes from a seven-year systems change effort that emphasized the customized employment model. The project served 198 participants across a range of disabilities, with 141 (71%) achieving an employment outcome. Of the 141 individuals with employment outcomes, 73 (52%) were placed into positions where negotiation was critical to successful placement. This data was descriptive in nature and not experimental or quasi-experimental. Similarly, Rogers, Lavin, Tran, Gantenbein, and Sharp (2008) reported findings from a five-year demonstration project for transitioning youth and young adults with various disabilities emphasizing customized employment. They reported that among 475 participants from 7 school districts, 62% of all enrolled students and 72% of out-of-school participants had individualized job placements in the workforce at competitive wages.
Riesen, Morgan, and Griffin (2015), conducted an extensive review of customized employment literature. These authors identified 15 non-databased and 10 databased articles on customized employment published between 2006 and 2013; five of which described how customized employment could be implemented with transition-age youth. While the databased articles did not use experimental, quasi-experimental, or single subject methodologies, positive outcomes associated with customized employment were consistent among studies in the review. Reported outcomes included increased quality of life, wages higher than minimum wage, attainment of part-time or fulltime employment and consistency in wage earnings and hours worked up to a 2-year follow-up period.
The most recent peer reviewed article on customized employment, not included in the Riesen et al. review, is a retrospective study conducted on employment for adults with autism spectrum disorder (Wehman, et al., 2016). Sixty-four individuals with autism spectrum disorder, many with intellectual disabilities, were assisted in achieving community-integrated employment representing 72 unique positions. It is significant to note that the retrospective review found that 55 (72.2%) of these positions were customized. There were no existing job descriptions at the time of the job search or there were significant job task reassignment and/or modifications. These findings support customized employment as an intervention to improve employment outcomes.
Although there is limited research on customized employment as an evidence-based practice, a body of work has emerged describing customized employment. Supporters of the approach agree that customized employment is based on the match between the unique strengths, needs, and interests of the job candidate and the identified needs of the employer (Callahan, 2004; Griffin, Hammis, & Geary, 2007; Inge, 2007; Wehman, Inge, Revell, & Brooke, 2007). Another important component of customized employment is Discovery or the identification of the individual’s needs, strengths, and interests (Griffin & Keeton, 2009; Harvey, Szoc, Dela Rosa, Pohl, & Jenkins, 2013; Inge, 2008; Inge & Graham, 2015; Szoc & Harvey, 2009). The objective of this qualitative research study is to begin the development of a research-based description that agencies can use to replicate customized employment when supporting individuals with significant disabilities.
Twenty-eight professionals representing national experts and implementers of customized employment participated in five phone-administered focus groups. Individuals who were known to the research team as nationally recognized “experts” on customized employment were invited to participate in the focus groups. These professionals have produced “how to” resources as well as delivered presentations and technical assistance nationally on customized employment. A total of 19 individuals responded to the e-mail invitation and consented to participate using an online consent process. Of the 19 individuals who consented to participate as national experts, 14 called in during three scheduled focus group phone calls. Once the focus groups were conducted with the national experts, they were asked to recommend individuals known to them as “exemplary” implementers of customized employment for a second round of focus groups. These professionals were invited to participate by the research team through email contacts. Criteria for participating included that they were implementing or supporting staff that provided the service. Nineteen implementers consented to participate, and 14 of these implementers called in during the two scheduled focus group calls.
Two sets of open-ended questions guided the focus group discussions: one for the national experts and one for the implementers. The first set of questions for the national experts was developed by the research team. The team brought their initial ideas for questions to a group meeting, which were then combined, refined, and ordered to arrive at the initial version of the protocol. The lead researcher then pilot tested the questions with two customized employment consultants. The questions were revised based on their feedback resulting in eight questions that guided the focus groups with the national experts. The questions for the implementers were developed after the national expert focus groups had been conducted and were based on the information provided by the expert participants. This included 12 questions on the strategies identified including discovery, community-action teams or individual support teams, informational interviews, and job negotiation, and job shadowing. Table One includes the questions that were used for the focus groups.
Focus group administration
In order to include a national sample of participants, telephone administration of the focus groups was selected. Although telephone-based focus groups have the drawback of limiting contextual information that can be collected from participants (Novick, 2008), the telephone method has been shown to have advantages. For instance, participants may be more comfortable when participating from the convenience and comfort of their own locations (McCoyd & Kerson, 2006; Novick, 2008; Sturges & Hanrahan, 2004). After Institutional Review Board approval was obtained, the team leader contacted potential focus group participants by email. Experts and implementers were provided times that the focus groups could take place, and participant time preferences were used to schedule the focus group calls. Each telephonic focus group was scheduled for one hour.
The same research team member served as the facilitator for all of the focus groups. At the beginning of the call, the facilitator asked participants for permission to record the conversation. She then told the group that the recordings would be transcribed and any mention of a person’s name or personal information would be removed from the transcripts. Participants were told that they did not have to respond to all questions. The recording was started and the facilitator proceeded through each of the core questions, asking related follow-up probes as needed. The facilitator confirmed with participants that they did not have any other information to share when they stopped discussing a specific question. Most of the focus groups lasted for approximately one hour.
Contents of the audio-recordings were transcribed verbatim by a professional transcription service, and the transcripts were used as the texts for analysis. Each audio file was checked against the transcript to verify accuracy, with no discrepancies noted. The final files used for analysis contained the full content of the focus groups absent any potentially identifying personal information. One member of the research team who has experience in conducting qualitative research analyzed all the study data. Another team member checked the first team member’s findings and reviewed the first analyst’s coding of the data. When agreement was not present, the two researchers discussed until consensus was obtained ultimately arriving at a shared meaning for the data.
Focus questions for the customized employment
|•What are the underlying values of customized employment?
|•Could one person give us a case study example?
|•What are the specific strategies used in customized employment?
| •Probe: Are there any more strategies?
| •Probe: I would like for you to describe each of these strategies.
| •Probe: Be as specific and concrete as you can.
| •Probe: Can you give more detail?
|•Do you want to add anything related to the process of working with an individual when using a customized employment approach?
|•Do you want to add anything related to the process of working with business/employers when using a customized employment approach?
|•What would you like to tell me that I haven’t asked?
|•Can one person give us a customized employment case study to frame our discussion for today?
|•One key strategy that is aligned with customized employment is the concept of “discovery.” One national expert defined discovery in the following way: “The short version is getting to know a person, their likes, interests, preferences and bringing those things into what they want to do and where their future might go.” Please describe how you or your agency gets to know a person, his/her likes, interests, and preferences.
|•Discovery was also described as: “Getting input from other people and seeing the person in other settings.” Describe how you obtain information from other people. Describe how you observe the person in other settings.
|•The national experts identified community Action Teams and Individual Support Teams as a customized employment strategy. Are they different or the same? Describe how you have used a Community Action Team. Describe how you have used an Individual Support Team.
|•Informational Interviews is another customized employment strategy. Please describe how you conduct an informational interview.
|•The national experts mentioned Job Shadowing as a customized employment strategy. Please give us an example of a job shadow experience.
|•Please describe how you negotiate a customized employment position with an employer.
|•Can someone give us an example of a video portfolio or use of other technology such as a smart phone to represent the person to an employer?
|•Describe how you have used an employment proposal to represent a job seeker to an employer.
|•Describe how resource ownership has been used to negotiate a job for an individual.
|•What would you like to tell me that I haven’t asked?
Findings and discussion
Twelve themes, or core practices, were identified from the analysis. While the practices are listed from one to 12 in Table 2, this is not meant to imply that they should be completed in sequence. Practices may occur simultaneously, or one practice may occur naturally before another based on a specific job seeker’s needs. For instance, while meeting at a location of the individual’s choice, the person supporting the job seeker should be mindfully listening to the individual while working to build rapport. One participant in a focus group of expert participants discussed that the practices in a conventional vocational rehabilitation process is linear and episodic. While the practices in customized employment are interrelated.
Customized employment practices
||Physically meet at a location of the individual’s choice.
||Build rapport and get to know the individual.
||Mindfully listen to the person.
||Identify the individual’s interests, skills, and abilities.
||Conduct in-depth interviews with family and friends concerning the person’s interests, skills, and abilities.
||Observe the person in daily activities in a number of different community settings.
||Arrange for the job seeker to observe at local businesses that potentially match job seeker’s interests, skills, and abilities.
||Conduct informational interviews with employers at local businesses that are representative of the job seeker’s interests, skills, and abilities.
||Observe the job seeker engaging in job related tasks.
||Assist the job seeker in identifying a work experience(s) to refine/identify job interests, skills, and abilities.
||Collaborate with the job seeker, family, and friends in confirming the job seeker’s interests, job interests, skills and abilities.
||Negotiate a customized job description.
I think this is part of what’s important about customized employment, is that in the conventional vocational rehabilitation process....is linear and episodic......Whereas in the discovery methodology that we use, it’s absolutely connected....because the discovery profile, conditions of employment, and vocational theme, skills, and interests, tell you where to go in the community and which businesses.
Although the focus group questions were intended to gather information about the entire customized employment process, much of the dialogue focused on “discovery.” The experts and implementers who participated in the focus groups agreed that discovery is the foundation of customized employment and is one of the elements that differentiates it from other employment interventions. Discovery is capacity-based, not deficit-based and is person directed. The goal of discovery is to build rapport and get to know the job seeker. Discovery is an essential step before job negotiation and subsequent employment. One participant said that I really don’t think you can assist a person... by not knowing who they are. Participants also discussed that discovery differs from more traditional approaches to assisting job seekers in finding employment. One participant expressed this by saying the following:
[Discovery is not].........spending time on a laptop computer, administering assessments, taking notes, using checklists, ranking competencies, or comparing. Discovery does not include predicting or guessing what a person can do or identifying jobs that are available in the labor market.
Practice: Physically meet at a location of the individual’s choice
Often, people with disabilities are observed in special programs or segregated settings where there are limited opportunities for them to demonstrate personal interests and skills. The resulting perception is that they are unable to achieve integrated employment. These preconceived views or expectations can be changed when a person is seen where he or she is most comfortable and participates in typical community activities. Participants in the focus groups were clear that customized employment practices must occur in the community and not at agencies that support people with disabilities: It’s not in the job coach office. It’s in the community. Another implementer of customized employment expressed it this way: It’s different to sit in my office and ask those questions. Go to their home and say show me what you do.
One participant in an implementer focus group discussed going to an individual’s home at length. His example demonstrates how seeing people in their natural environments can provide a wealth of information as well as dispelling myths about the abilities of individuals with disabilities. Meeting people in their homes and environments of choice sets customized employment apart from other approaches to providing employment services.
I’m thinking back to a guy that had pretty significant, very significant physical disabilities....and I’m in their home. There were some puzzles that obviously were...homemade and some other kind of wooden toys.... They were good quality stuff. So, I said, tell me about that stuff, do you collect it? He said, no, I make it. This is a guy that uses a communicator and a wheelchair and I’m thinking, you make it?...He said well I use the jigsaw in the garage. OK, can you show me the jigsaw in the garage, and he said sure. He was safe with it, he knew what he was doing, and that’s something that nobody ever brought up when we were talking about the guy’s skill set. In my opinion, it’s not customized employment unless you go to their houses, and I know that people get into a lot of discussions about whether that’s ok. I’m not talking about people that say they don’t want you in their house, but that’s about 1 out of a 100, and another 1 out of a 100 where it’s a little scary. Other than that, the other 98 or so, I think you got to spend time with people in their own environments and see what they really do when they’re not being bugged by somebody else that’s telling them[what] to do.
There are a number of reasons why going to the job seeker’s home is important during the initial phases of discovery. The employment specialist needs to see where the person lives to learn about resources that are available such as local businesses as well as transportation options. Going to the home provides information on family supports to get buy-in or if supports will be needed from other sources. Some community settings may be noisy and distracting limiting the amount of information that can be discovered about the job seeker.
Practice: Build rapport and get to know the individual
Building rapport with job seekers is not a stand-alone practice but occurs across all the other customized practices that emerged from this research. Rapport develops as an employment specialist or other representative spends time learning about the job seeker’s goals for employment. This begins when meeting at a location of the individual’s choice and develops over time while observing, interviewing, and engaging in other practices that lead to the identification of a customized job. One expert focus group participant discussed meeting the person in a location of choice that also illustrates the importance of mindfully listening to the individual and building rapport.
.....I would ask [her] where she wanted to meet. As opposed to spend the whole time on my laptop or taking notes about the person, I would spend time listening and asking them questions, what they like to do. I would ask if they were interested in having me at their home. I would ask if they didn’t want to have me at their home. I would observe them wherever they are most comfortable.
Practice: Mindfully listen to the individual
Listening to the job seeker also is important during customized employment implementation. One panel of experts discussed the importance of the mindset that professionals must have during discovery as being open and mindfully listening to the individual. One expert stated that [it is] keeping your assumptions at bay and really learning who the person is, and really utilizing observation and not making assumptions. Another expert also discussed the importance of being open and not making assumptions.
I just finished working with a woman who painted with her mouth, and everybody in her life thought she should be an artist, and that wasn’t what she wanted to do. But, it was a really natural place to jump to. So holding your assumptions at bay is incredibly important.
To hold assumptions at bay, the person must be heard while actively asking questions to understand the person. The questions arise from listening to what the person is saying. It is important to seek out confirming information, to mindfully listening to the person, and to observe.
Practice: Identify the individual’s interests, skills, and abilities
Getting to know a person’s interests, skills, and abilities requires engaging in many of the different practices of customized employment identified during this research to include interviewing, mindfully listening, observing the individual in familiar and unfamiliar community environments, observing and participating in workplaces that reflect what is learned about the individual during discovery. One participant in an expert focus group expressed concerns about how superficial getting to know a person’s interests, skills, and abilities can be.
I think [interests] is the trickiest. I think it is the one that we often do mostly at a surface level by just kind of asking people either what kind of work they want to do or what’s their favorite activity and stuff like that. And really trying to get an intrinsic interest, those things that people do that really bring them personal satisfaction is terribly important, terribly complex, and so discovery obviously has to spend some time figuring that out at a deep enough level that it makes sense.
Many of the participants discussed ways that interests could be explored to help the individual identify a job of choice.
Some people are verbal and know what they want to do and will immediately tell you, “I want to work with the plants.” This is good but it may be problematic if the person does not have the corresponding skills. For many job seekers, in which customized employment will be the most effective intervention, will have no idea what he/she may want to do. The only experience this person may have is adult day training or less - nothing. Therefore, beginning with What do you like to do? provides a good place to begin the discussion.
Another expert discussed the importance of identifying if a person’s interests are related to what the individual wants to do for work. Some job seekers may not necessarily want to have a job that is based on their interests. However, the participants did not provide any advice on how to make this distinction.
You need to be incredibly careful, because some people have interests that they don’t want to do for pay, and some people have interests that they do want to do for pay. So insuring that you make the distinction of whether a person’s interests relate to the tasks they want to do for pay is incredibly important.
Practice: Conduct in-depth interviews with family and friends concerning the individual’s interests, skills, and abilities
Professionals may assume that a person with a significant disability may not have any interests or skills that can facilitate integrated employment. Interviewing family and friends can uncover interests and skills that may not be apparent on first meeting with or observing the job seeker. During one focus group, an expert provided an example of the importance of interviewing people who know the job seeker well.
I worked with a woman who was 50 years old, had multiple physical and cognitive disabilities, and all she wanted in her life was a job. She had been put into numerous volunteer positions, but never a job. In the discovery, I observed her in her volunteer position; I observed her in the community; I interviewed a whole host of people who knew her well; and two threads came out from the interviews. One thread was that she was extremely religious, and then another thread came out that she had helped her sister-in-law design her wedding invitation, which nobody knew that she had any kind of artistic ability or any kind of computer knowledge at all.
Practice: Observe the person in daily activities in a number of different community settings
Some people with disabilities are not going to be able to tell others what it is that they like or want to do. An implementer provided the following explanation as to why it is important to observe people in their daily activities in a number of different community settings. So, being able to go and see them in other settings, whether it is at home, at church, at other kinds of activities, you get to see a lot more about what people really like to do. One focus group participant cautioned against identifying a job for the individual if the person is unable to verbally describe job preferences.
You can’t just ask some people what do you want to do, and they sit there and look at you, and then it’s like you go back to the old bad practice of let me go see if I can figure out some job that I can put you into, because you say you don’t want to or you don’t know what you want to do.
In these instances, observing an individual can be a critical part of discovery and customized employment: up front, it’s just spending time kind of hanging out in their home, whatever they’re doing in their life.
Practice: Arrange for the job seeker to observe at local businesses that potentially match the job seeker’s interests, skills, and abilities
For some job seekers, additional discovery is needed beyond interviewing family and friends and observing the job seeker in daily activities to develop employment themes or profiles. The job seeker may benefit from observing at local businesses that potentially match the person’s interests, skills, and abilities. Businesses are identified based on the information gathered during discovery activities that have taken place to this point. One focus group participant’s example demonstrates the importance of actively engaging with the job seeker in community businesses.
I had someone who wanted to do small engine repair...I found a business and said can you at least visit with us for 20 minutes, and during this 20 minutes, come to find out this kid [had] never picked up a screwdriver in his life. He talked and talked until you asked him to pick up [a screwdriver], to do something, and that’s when you discover that [he had no experience]. He watches television of people doing it. It’s not the actual doing it, and it looked like fun to him, and that’s ok, that’s good, but it wasn’t anything that we were going to build a job off of.
Practice: Conduct informational interviews with employers at local businesses that are representative of the job seeker’s interests, skills, and abilities
A number of the participants in the experts’ and implementers’ focus groups discussed conducting informational interviews. One focus group participant described an informational interview in this way:
....so we found an employer where we were able to do an informational interview, and the employer was highly responsive. So we went in, and we spent about an hour getting advice and hearing about the industry and hearing what was new.
Another participant expressed concern that many individuals with disabilities are excluded from employment, because we try to guess or predict what work is available in our communities, and we’re really not in the community. We don’t know our communities very well. Informational interviewing focuses on getting to know the business in a similar way that discovery focuses on getting to know the individual. It allows the employment specialist or representatives to learn more about how the job seeker’s interests and skills can meet the needs of business. One focus group of implementers discussed how informational interviewing can guide professionals to focus on a specific individual’s interests as opposed to a more traditional job development approach that requires the job seeker to consider existing jobs. In other words, a traditional approach locates the job first for the job seeker to consider. Discover considers who the individual is first.
[Information interviews are] really focused on [a specific] person and their interests. Because what we’ve found when we used traditional job development was that, you know.....they would then pick the person at the top of their list that they viewed as having the most skills, and that person always getting the job.....So by using this process, it’s really about that person and gathering information that’s going to benefit that individual job-seeker versus did I find a job here that I can plug somebody into.
In addition to learning more about businesses in the community, informational interviewing may also lead to the identification of a customized job. One expert described a case study in which during an informational interview, the business owner identified unmet business needs that matched well the interests, skills, and abilities of the job seeker. As a result, a job was customized and the business owner’s problems solved when the job seeker was hired. Her example describes how the interests and needs of the job seeker were met as well as the needs of the business.
[I] went to several different churches. I went to one church I happened to know the pastor, started talking about this woman’s interest....talking about what she can do, very slow, data entry...She drove her electric chair by joy stick but not very well so she kind of needed very large halls and to not bump into people and things. Anyhow, the pastor identified that they were in the process of transferring all the information onto the computer of their history. He didn’t care how quickly it went, but he needed it done....unbeknownst to me, she went to that church and the pastor remembered her. She got hired. She started at 10 hours a week, this was a couple of years ago, and I believe now she’s working 20 hours a week.
Practice: Observe the job seeker engaging in job related tasks
Observing the jobseeker engaging in job related tasks that fit his/her employment themes or profile is another important practice in customized employment. Observation of the job seeking engaging in work related tasks provides information that may not be uncovered when meeting with a job seeker at locations of his or her choice or interviewing friends and family members. Engagement is different from a job seeker observing employees doing a job. One expert panel member described engagement this way: I think it’s more than just observation. I think its participation...... You’re not going to know if you like something until you’ve tried it.
There are two reasons for having the jobseeker engage in job related tasks. One is to determine whether the person has skills that can guide job identification, and the other is to determine whether the job seeker wants to do this type of work. Another participant illustrated the importance of observation to learn about a person’s skills as well as connecting to businesses that can provide feedback on the job seeker’s abilities:
We had a gentleman who had an interest in doing things, mechanical things, and he takes apart computers, and we were able to observe him taking apart computers at his house and putting them back together, but I don’t have the knowledge of whether he did that correctly... [W]e had someone that was a computer technology guy who built computers for people, he had him come in for a couple of hours in the afternoon and had him work alongside of him and was able to give us that professional feedback that he indeed does have some skills there.
Practice: Assist the job seeker in identifying a work experience(s) to refine/identify job interests, skills, and abilities
For some job seekers more discovery work is needed than just interviewing family and friends and observing the job seeker in daily activities and job related tasks to develop employment themes or profiles. Knowing a person’s skills is critical for presenting a person to an employer specifically to be able to represent the value that hiring the job seeker brings to the business. Completing a work experience in a business can also validate whether a person’s interests is a marketable skill. One participant in an implementer focus group provided the following example:
[One man] liked to work with his hands and use tools and has no transportation....He wished he had a bike, so we tried to figure out a way for him to go to a business. We just asked somebody who knew somebody who owned a bike store and allowed him to come in and work alongside a person who was fine-tuning a bike where he spent several hours...We’ve learned a lot about him, way more than what by just him telling us what he knows how to do.
Participants in the expert and implementer focus groups discussed engaging people who are not paid to support the job seeker. This was referred to as having community action teams to assist with discovery. The community action team may assist by finding settings where the job seeke