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Customized Employment as an Evidence-based Practice to Improve the Employment Outcomes of Transition-age Youth with Physical Disabilities: Case Study 5

by Dr. Katherine Inge and Michaela Lemieux

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A key feature of customized employment is getting to know and building rapport with the individual who wants to achieve competitive integrated employment.  This includes mindfully listening to the person, conducting interviews, and observing the person in both familiar and unfamiliar places.  The goal is to identify the person’s interests, skills, and work preferences that will result in a customized position of choice.  This case study illustrates how getting to know and building rapport with one young woman with a physical disability resulted in her customized job. 

Who is Erin? What are her strengths, interests, and job preferences?

Erin is a young woman with a physical disability who was referred to the VCU-RRTC by her physician, because she wanted a job and needed assistance in achieving this goal. When the employment specialist first met her, she visited Erin at home to learn more about her personal needs and interests.  She learned that Erin uses an adaptive scooter for mobility outside of her home and a ventilator to support her respiratory health.  At home, she uses a stationary ventilator and is able to walk for brief periods of time without being connected to the device.  When in the community, she uses a portable ventilator that is housed in a backpack. However, she is unable to carry the backpack due to the weight of the respirator and her limited strength and stamina.  An aide was with her for safety at all times when in the community to assist with the management of the ventilator. 

During initial meetings at her home, Erin reported enjoying crafting, collecting coins with her father, and volunteering at her church making bulletins and other flyers.  She talked about attending a local community college reporting that she initially was enrolled in an IT course of study.  She had dropped this due to difficulty with the subject matter and dislike of the courses.  After dropping the IT course of study, Erin pursued her associates degree in general studies. However, she was unable to discuss what she wanted to do for employment that was related to her associates degree and how her studies might transfer to a job.  Some professionals may interpret this inability to describe what the person wants to do as a lack of motivation or disinterest in employment.  This was not the case for Erin. She did not have any work experiences, and Erin simply did not have any knowledge on which to base a decision of what she wanted to do.

When asked about what she enjoyed doing in her free time, Erin became much more animated.  She talked about volunteering at her church and coin collecting with her father.  She described keeping a spreadsheet of the coins that she owned, their value, and coins that she wished to purchase.  Her ability to manage the spreadsheet as well as use the computer to develop church flyers and bulletins were things that she seemed to enjoy as well as skills that she could bring to a competitive integrated job.

Discovery and Work Experiences

After the initial home visits, Erin participated in a number of discovery activities in familiar and unfamiliar settings.  This included her community college campus, a museum, a regional nonprofit organization, and a historical society. These various experiences were completed to learn more about her employment goals, interests, and skills that she could bring to a business.  In addition, the work experiences were organized to learn more about her work preferences to determine how to best customize a job for her.  These activities were selected based on her expressed interests and vocational themes that emerged from her participation in discovery activities. Her primary interest appeared to include administrative tasks such as computer work and organizing. All of the activities were limited to several hours and never any longer than a morning or afternoon, since these were non-paid work experiences.

During the initial discovery activities, it was clear that Erin needed access to transportation and a way to manage her respirator as independently as possible.  Erin’s mother provided transportation, and the aide assisted with her respirator.  In order to help her become more independent, the employment specialist talked with her and her family to consider accessible transportation.  The employment specialist assisted in the process by obtaining a letter from her physician for the accessible transportation service.  The letter specifically included the need for the aide to ride the bus with her in case there was a malfunction of the device.  It was also determined that the aide could accompany her to the job and the support was funded by Medicaid Waiver. This was a major step towards facilitating Erin’s independence, and she expressed her satisfaction with being able to access the service without having to rely on her mother for transportation.

Library Work Experience: One of Erin’s work experiences took place at a local library based on her interest in books and research. During the work experience, Erin organized returned books on carts for re-shelving and then took the cart of books to the various shelves in the library.  Due to the small size of the library and the work tasks, she was unable to use her scooter.  This meant that her aide had to carry the ventilator behind her as she completed the work tasks.  This dependence on the aide could potentially limit the types of jobs that she would be able to apply for unless a way for her to be more independent was identified.

After the work experience, the employment specialist discussed with Erin ways that she could be more independent. Since the backpack used for the ventilator was specially designed to make sure the ventilator did not become overheated, a cart needed to be identified that could be used with the backpack.  A carry-on tote was tried, but the young woman did not like the design.  Erin and her employment specialist then looked at various options online to get an idea of what she might like instead.  The employment specialist purchased a luggage cart that the young woman could pull with one hand with the backpack attached. After an initial trail, Erin told her employment specialist that it was very helpful and that she liked using it.  This was a simple, low cost, “low tech” solution that increased her independence and helped on her path to employment.

Home Goods Store: The young woman also completed a work experience at a retail store that sold home goods. At this business, she used a scanner to do markdowns including applying new barcode prints to the items. The department that the young woman worked in was picture displays. The area had a large range of items that were big and small. During this experience, she independently used the cart to maneuver her ventilator around the store making her independent of her aide for mobility!

Job Development/Informational Interviews

Keeping her job themes in mind, the employment specialist reached out to businesses that matched the participant’s goals. Informational interviews were conducted at salons, hotels, stores and businesses where administrative tasks would be done. An effort was made to set up informational interview or work experience at several small coin and gold shops that matched her interest in coin collecting but this was unsuccessful. The response given was that there was not enough work to merit an additional employee, and in most cases the owner served as the store operator completing all the tasks at the coin shops approached.  An employment proposal was submitted on her behalf at a local technical center but that too was not successful.  The employment specialist encouraged Erin to reach out to friends and family members for job leads.  This included the employment specialist meeting with representatives from her church.  Erin also was encouraged to talk with church members for job leads.  

Customized Job

The young woman contacted her employment specialist to let her know that she had heard about a possible job through another church member.  The opportunity was at a day care as a part-time administrative assistant. The position did not have an established job description, but Erin set up a meeting at the day care for the following week.

At the interview, the job duties were negotiated including answering the phone, making copies, organizing files, monitoring the doors, and answering them when needed. She also would watch children from the daycare if they needed to leave early or needed time out of the classroom. She was hired to work Monday, Wednesday and Friday from 9:15 am to 12:45 pm making $9.00 an hour.  Since her hire, she has expanded her work hours to five days a week for approximately 17 hours a week.  Her employment specialist provided initial job site supports but this was quickly faded to the natural supports of her supervisor.  Due to the continued health considerations related to the use of the ventilator, the aide is on the job site; however, she does not provide any workplace supports.  Her time is supported through the Virginia Medicaid Waiver and the aide simply is “on call” should an emergency arise with the ventilator.  Follow-along services are being provided as additional supports need to be identified or provided.

CONCLUSIONS

Solutions to Erin’s support needs to obtain and maintain competitive integrated employment were solved with customized employment.  By observing and participating with her in familiar and non-familiar environments, her accessibility needs were identified, and solutions found.   It is important to note that she found her job by networking within her church community much like any young adult might network to obtain a first job. 

RESOURCES

Inge, K., Graham, C., Brookes-Lane, N., Wehman, P. & Griffin, C. (2018). Defining customized employment as an evidence-based practice: The results of a focus group study.  Journal of Vocational Rehabilitation, 48(2), 155-166.

https://drrp.vcurrtc.org/resources/content.cfm/1301

https://doi.org/10.3233/JVR-180928

See Erin at Work:

ACKNOWLEDGEMENT

The VCU-RRTC would like to thank Erin for giving us permission to share her story.  The authors of this case study are Dr. Katherine Inge and Michaela Lemieux at Virginia Commonwealth University’s Rehabilitation Research and Training Center on Employment of People with Physical Disabilities.  If you have questions on this case study and on the VCU-RRTC, you may contact Dr. Inge at [kinge@vcu.edu] or (804) 828-5956. For more information on the VCU-RRTC, please visit [https://vcurrtc.org/index.cfm].

VCU-RRTC is an equal opportunity/affirmative action institution providing access to education and employment without regard to age, race, color, national origin, gender, religion, sexual orientation, veteran's status, political affiliation, or disability. The VCU-RRTC on Employment of People with Physical Disabilities is funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number #90RT503502). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). However, these contents do not necessarily represent the policy of NIDILRR, and you should not assume endorsement by the Federal Government.