An evidence based approach to supporting people with learning

disabilities into jobs

Stephen Beyer

Welsh Centre for Learning Disabilities

Cardiff University

Wales, UK

Percentage of people with a learning disability in paid work Estimates of people in paid work

Scotland- 12.1% 2007 17% - English National Survey 2003/04 7.5% - English Local Authorities, Commission for

Social Care Inspection 2007/08 WORKSTEP - about a third of people placed 2008 Pathway to Work pilots- about 2% New Deal- about 3% Access to Work- about 4%

We do not know what hours people are working

Problems of awareness and definition There is little shared definition across social care

and employment services of: Learning disabilities “Mild, moderate or severe”

Awareness of their work potential, and support needs, is low among: Families People with learning disabilities DEAs Some employment providers Some social workers and social care staff

Key problems of moderate and severe learning disabilities Majority of people will have problems with:

speech and language memory cognitive processing

More people with severe learning disabilities are are likely to experience additional: sensory and physical impairments poor vision measurable hearing loss epilepsy

Key problems of moderate and severe learning disabilities Ability to understand verbal instruction and to provide

information Cue dependency creates difficulty transferring tasks

learned here (training) to there (job) Small changes can lead to the person being unable to

do a well known task : Changes in task sequence Changes in work machinery Changes in work materials Changes in a co-worker role Changes in workplace environment

All this weakens the relevance of pre-training

Why supported employment for people with learning disabilities? Effective task training research going back into 1970s

Complex & dangerous tasks1,2,3,4,5,6,7,8

Systematic training in a specific workplace crucial to this client group9,10

Matching “ecology” of workplace to person’s wishes, talents and specific strengths researched in 1980/90s11

“Zero reject” vocational profiling in use since the mid 1980s instead of “work/can’t work” testing

Put together, these techniques were called “supported employment” and success with people with learning disabilities demonstrated in US University evaluations in 1980 and 90s12.13,14,15,16,17,18

What works for people with a learning disability learning jobs?

Job coach support on-site Training on the job- Systematic Instruction

Breaking tasks into steps “Chaining” tasks together Hierarchy of cues

Physical guidance Gestures Verbal prompts

Managing praise and reinforcement more closely

Proactive problem solving (natural 7-phase cycle)

Job adaptation Natural support focus Work-based accreditation of skills

demonstrated

Pre-employment training is possible Verbal instruction & demonstration Simple language Greater time to learn Use of naturally occurring praise and

re-inforcement through: Supervisors, work-mates Ordinary pay incentives

Managing work pressure/ productivity demands

Shaping social contact through co-workers

Qualifications for job and career development

Severe Moderate Mild

What works in finding jobs?

Greater use of support to find & plan Families Job coaches

Extended Vocational Profiling/ Discovery 20+ hours in various environs? Interests and what good at Relevant experiences Work types and environments Days and schedules Welfare benefit planning

Use of practical job tryouts to aid decision-making

Aided CV and support planning Proactive and specific job finding and

matching jobs to people Employer presentation and negotiation Adaptation of interview and induction

Greater independent action More use of generic help to

identifying strengths, interests and experience

Use of more generic sources for vacancies

Greater use of courses, “job clubs” CV development Job search Writing applications

More use of mainstream job application & interviewing and induction processes

Severe Moderate Mild

Supported Employment 19,20,21

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Research findings- What works in transition?

US studies have identified factors that increase the likelihood of employment upon completion of school successful graduation from a high school can lead to higher

employment rates22,23

being male24

having had a summer or part-time supported job experience while at school25,26,27,28,29

receiving vocational-technical training, rather than an academic, curriculum30

duration of community based training and age appropriate integration with non-disabled peers31

use of a job coach32

Elements of work experience for young people that work33,34,35

Clear program goals Clear roles and responsibilities for worksite staff Clear, individualized training plans Good links between students, schools, and employers On-the-job learning A range of work-based learning opportunities Mentoring available in the workplace Clear expectations and feedback Assessments to identify skills, interests, and support needs Reinforcement of work-based learning outside of work Appropriate academic, social, and administrative support all

partners

Number of young people entering jobs after transition 36

At 6 months

At 18 months

Number of Jobs

% employment

Number of Jobs

% employment

% Retention

First Cohort 18 21.2% 11

+10

25.3%

61.1%

Second Cohort

7 11.7%

Total Jobs 25 17.2%

Number of young people entering jobs after transition

At 6 months

At 18 months

Number of Jobs

% employment

Number of Jobs

% employment

% Retention

First Cohort 18 21.2% 11

+10

25.3%

61.1%

Second Cohort

7 11.7%

Total Jobs 25 17.2% • Carers were 2.7 times more likely to get a college place for their young person if they wanted it, than to get a job if they wanted it

Number of young people entering jobs after transition

At 6 months

At 18 months

Number of Jobs

% employment

Number of Jobs

% employment

% Retention

First Cohort 18 21.2% 11

+10

25.3%

61.1%

Second Cohort

7 11.7%

Total Jobs 25 17.2% • Employment levels increased over the next 12 months and jobs retention was moderately stable

Differences in key factors between those with/without job

Job at 6 months

No job at 6 months

Mean total vocational input (Hours) from : 1. Schools 2. Employment Services

228.7**100.1**

105.345.5

Mean work experience (Hours) organised by : 3. Schools 4. Employment Services

17.771.8**

28.831.2

% of carer’s who view prospects of job for YP as : 5. Positive 6. Negative

75.0%++25.0%

49.0%51.0%

% of carer’s who have concern about YP getting a job : 7. Have concerns 8. Do not have concerns

44.0%56.0%

78.0%++22.0%

** Sign. at p > 0.01 on t-test

++ Sign. at p > 0.01 on Chi-square test

“Logistic Regression” What influences the probability that a young

person will get a job after transition? Not one overall “model” They will have had:

more hours delivered in qualification-based courses by their school/college

more hours delivered in obtaining work experience placement by an employment organisation

carer’s who have fewer concerns about the young person getting a job

Who helped to find a job? 64% of jobs at 6 months had some help of the

employment organisation (EO) involved at transition Six young people had found their job through family

with some help of the EO Five young people found their job as an extension of

a work experience started at school or college, with the help of the EO that originally placed them

Five young people found new jobs through the additional actions of the EO they worked at school or college.

Carers- Improvements needed 40% of carers wanted to be kept more informed about

transition activities 11% felt that son or daughter would benefit from more

work experiences or tasters during the transition time Many were upset by the lack of any follow-through after

the person had left school or college and wanted continuity- a follow-on plan

North Lanarkshire 37

Generated significant interest because of reported high levels of employment of people with learning disabilities for 16 hours per week or more

Significant financial benefits to the people reported Noted for challenging the view that the 'benefits trap' is the biggest

problem restricting movement into employment An opportunity arose to examine in detail the North Lanarkshire

experience and to analyse their data.

NLSE Process Referral visit (7 days)

An assessment to ensure that the agency’s criteria are met Home visit (within 6 weeks)

Explain the service Check on Welfare Benefits with Welfare Rights Officer if needed

Vocational profiling (8-12 weeks) Agree person’s preferences and conditions the person wants, jobs and specific

employers Twice per week for 2-3 hours per session Meeting 1:1 in a variety of settings, at different times, and involving different

activities, including social outings Information also sought from family, professionals and relevant others Period includes 2 short job tasters, supported by a job coach

NLSE Process Job finding (Meet 1-2 hours per week)

Registering person with Job Centre Plus Pursuing employers Assisting person in job search Interview preparation Further work placements as needed

Job coaching (as long as needed) Providing training at work and fading support

Mentoring and evaluation (agreed with person/employer) Agreeing criteria and monitoring success of placement from employer and

employee perspectives Career development (No timescale)

Updating Vocational Profile Taking action to improve current, or change, job

NLSE Process Validation

0 2 4 6 8 10121416Referral

Leavers review at school/collegeVP Meeting/Home Visit

VP Social VisitVisit JCP+, Professionals etc.

Visit EmployersInductionJob taster

Progress review

Stage in SE process

Mean hours of input per person

Average hours provided to a sample of young people with learning disabilities in transition

Jobs 2007-143 jobs (138 people, 5 with 2 jobs)- 114 people

with learning disabilities; 21 with mental health issues; and 3 with brain injury

All people with a learning disability “either came from day centres or had an eligibility to attend the same”

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Jobs Unemployment was 6.9% in the area compared with 4.7% for

Scotland and 5.4% for the UK (ILO definition) Full data existed for 104 people in work at 2007 (96%), of which:

88 were people with learning disabilities 15 mental health issues 1 person with brain injury

Data presented relates to 88 people with learning disabilities

Hours

Hours Workers with LD

%

6.5-15 9 10.2%

16-25 56 63.6%

26-35 9 10.2%

Above 35 14 15.9%

Total 88 100.0%

Mean Hours= 24.2 hours per week>16 hours= 89.8% LD)

Welfare Benefit Before (LD)

The mean total income from Welfare Benefits before people entered employment was £139.51 per person

S o urce o f i n c o m e

Pr i or to

e m p l o ym e n t

(% o f a l l

w o rkers)

A f t er “ i n c o m e

m a x imi sa t i o n ”

a n d pr i or to

e m p l o ym e n t

(% o f a l l

w o rkers)

D LA (Care)+D L A (M o b )* 1.1% -

D LA (Care)+D L A (M o b )+ IS 47.7% 73.9%

D LA (Care)+D L A (M o b )+ IB/SD A 30.7% 14.8%

D LA (Care)+D LA (M o b ) +

IS+IB/SD A

11.4% 5.7%

IB/SD A o n ly 1.1% -

D LA (Care o n l y ) 1.1% -

D LA (Care)+IS - 1.1%

D LA (Care)+ IB/SD A 1.1% -

D LA (M o b )+IS 2.3% 3.4%

IS o n ly - 1.1%

JS A 2.3% -

Tra i n i n g A ll o wa n ce 1.1% -

T o t a l 99.9%+

100.0%

Impact of benefits advice There was a small increase in take-up of DLA at this point from 93%

to 98%. Mean total income from Welfare Benefits after maximisation was

£141.93 per person, an average increase of 3% on the pre-employment income.

Income actually increased only for 7 people with LD Average increase in income from Welfare Benefits being 94%

and £50.83 Range of individual increases being from 6% to 306%

Welfare Benefit After (LD)S o urce o f i n c o m e Wh e n i n

e m p l o ym e n t

(% o f a l l

w o rkers)

Ta x Cred i t o n ly 1.1%

D LA (Care)+D L A (M o b )+ Ta x Cred i t 83.5%

D LA (Care)+ Ta x Cred i t 3.4%

D LA (M o b )+ Ta x Cred i t 2.3%

D LA (Care)+D L A (M o b )+IB/SD A 9.1%

T ot a l 99.4%

+

Benefit changes Overall, Welfare Benefits represented:

98.7% of income before employment 100% after maximisation 49.7% when in employment Reduction in Welfare Benefits from:

a mean of £139.51 per person before to a mean of £122.65 per person a fall of 12.1%

This represents a total saving to the taxpayer of per year £77,168 for the total group of LD clients

Wage income The average salary earned in employment was £129.60 The average hourly rate was £6.09 per hour, 14% above the adult

National Minimum Wage of £5.35 in place for 2006/07 On its own, salary was slightly lower than both the average pre-

employment and the maximised Welfare Benefit incomes before employment

However, 34.1% of the workers had a higher gross income from salary alone, than their maximised Welfare Benefit income before employment

“Better off” Overall, average total gross income from all

sources after employment was £252.25 per week per person

Better off by +94.8% for 88 people with LD Most common increase 51% and 75% People with learning disabilities showed the full

range of better off outcomes

Costs to LA The annual costs of SE in North Lanarkshire, based on 2007/2008

budget was £4,304 per person per year, based on “actual capacity”- 202 people

Equivalent Locality Support Service, which catered for 295 people on a full- and part-time basis with an annual cost of £14,998

Using the average number of people in jobs 122 (ranging from 109 Jan. to 129 Dec. 2007) the cost per employed person of SE rises to £7,126 per job.

This still represents 47.5% of the cost of a LSS place SE’s share of clients has risen from 25.7% in 2005/06, to 41.6% in

2007/08

Conclusions Not all people with learning disabilities are

able to benefit from training of a full range of skills before they enter a job

This does not mean that they cannot be employed

It means that they are more likely to need a skilled person to help them find, learn and keep a job

Transition

Conclusions Ultimately we need to inform and reassure families

about employment, tackling: post-school and college options for employment specific support arrangements within options

whether help and monitoring would be on-hand or at arms length

How concerns will be addressed : safety exploitation and abuse appropriateness of jobs to person’s interests and skills travel arrangements

Deal with Welfare benefit expectation early and as a family

Transition

Conclusions Start early in discussing employment (year 8 or 9?) Consider a central focus for information- a transition Worker Provide information to families on employment

What it entails for a young person with learning disabilities- individual job match

What prospects their son or daughter may have for supported employment

What implication might be for income blending welfare benefits, tax credits and earned income

Involve experienced employment organisations Dispel notions of people needing to be “job ready”

Transition

Conclusions It is important to offer young people with learning disabilities work

experience that : suits their individual needs is based in ordinary community jobs has an appropriate level of support is structured to generate the information needed by all parties to help them move

on to employment if they wish Teachers, and tutors find it difficult to do this given their

commitments and distance from the jobs market Generic work experience organisations struggle to cope with

additional needs and to provide 1:1 support Partnership with supported employment (job coaching) agencies

has been recognised as successful

Transition

Conclusions Success can be achieved in placing people from the general Social Work

Services population of people with learning disabilities in employment of 16 hours per week or more using supported employment

This has been with relatively unfavourable unemployment levels locally. It is likely that this can only be achieved with this client group if the key

approaches of supported employment are replicated, particularly the focus on 16+ hours per week.

Any reduction of cost:benefit ratios is cumulative and must be assessed across the body of people shifted from day service to employment

Year 1 costs are much higher than year 9 costs Any “saving” in costs related to day service can only be redeemed if there is

a strategy of shifting resources from day service to employment outcomes

Supported

Employment

Conclusions Skilled job coaching and investment in a staff group of sufficient size

is important, and it is likely that replication would require: Investment at a significant level to provide enough job coach

and Welfare Rights Advice and management resources effective training in the process

Replication of the intensive SE process, and including expert Welfare Rights Advice

Monitoring to ensure the process is delivered to an adequate level of intensity

There to be significant cost:benefits on offer for LAs There remain some uncertainties in the cost analysis that would

benefit from a more detailed costing of the full package of support for supported employees and day service alternatives for future workers

Supported

Employment