Recipients of Supported Employment services are never a homogeneous group. There may be variability with respect to disability type, gender, race, culture, socio-economic status and environment, etc. Consequently, the various aspects of each person with a disability must be respected and attended to. Specifically, the suitability of services for persons with a disability as a whole and for the individual must be focused.

Occasionally, the expectations of the worker with a disability may be in opposition to those of their employer, their family and their funding and/or referral source. This can lead to uncertainty over who is the primary person and whose best interests must take precedence. The focus of the Supported Employment methodology is integrating persons with severe disabilities into integrated work settings. Consequently, individuals requiring support to acquire and sustain employment in integrated work settings are the primary persons of Supported Employment services.

In summary, the Supported Employment methodology is intended to be an individual process dependent on constant, open communication between service providers and persons with a disability being served. It is not enough to ask how services can be designed to meet the needs of a person with a disability – consumers must be looked to regularly for insight into how existing services can be improved upon. The person with a disability determines what is and not an effective, quality service.

Points for attention:

In a discussion with the person with a disability it must become clear what he/she wants and what his/her possibilities are. Specific attention must be given at:

1. what the person with a disability thinks by himself/herself which support is needed;

2. in what way he/she likes to be trained;

3. how he/she likes to be supported;

4. what information is important for the support provision;

5. where information can be collected;

6. which information must be given to the employer;

7. how the information en by whom shall be given.

Information related to the possibilities and wishes of a person with a disability can also be collected from the direct environment (family, friends, etc.) of the person with a disability. This information van be based on:

1. interest for specific subjects or matters;

2. hobbies and activities in leisure time;

3. specific attention for certain activities;

4. the things a person with a disability likes to do.

For each person with a disability Supported Employment activities are carried out an individual file must be kept up. In the file must – beside background information of the person – also be expressed in what way the service/activities are focused on the person with a disability. His can be done for example by:

1. report of meetings;

2. record of appointments;

3. the way in which information is gathered and recorded etc.;

4. the use of specific methods, etc.

Together with the person with a disability must be examined on which aspects attention must be given and/or which specific measures must be carried out. This can be for example be related to:

1. accessibility of public transport;

2. mobility training;

3. individual adaptations related to the type of disability (for example adaptations for persons with a visual disability).

2.  The Supported Employment process is an individual process.

Explanation:

The Supported Employment process is an individual process whose outcomes must include:

	From the Person’s point of view:
	the individual is actively involved in his or her planning;
	the individual is free to express his/her desires and needs;
	the development of a supportive environment;
	the individual defines his/her life directions;
	the individual establishes the outcomes and how they will be measured.

It is crucial that persons with a disability are not positioned as passive recipients of Supported Employment services. From the onset, he or she must be an active participant in identifying and prioritizing goals, determining who will assist them in attaining these goals as well as how they will be assisted. Persons with a disability must also be involved in planning services and determining how the Supported Employment process will be implemented. Whenever possible, persons with a disability are to be included in meetings of which they are the subject matter. They must also have a say in who will attend these meetings. Most importantly, persons interest, desires and strengths dictate the employment placements to be realized.

Persons with a disability too often have a history of not being listened to. Thus, quality Supported Employment organizations provide persons with a disability with assurance that there are rewards, not penalties, for expressing their expectations and opinions. Even if persons with a disability are willing to share their points of view, due to their lack of experience, they must receive assistance in learning how to do so. Furthermore, there are persons with a disability who express themselves in modalities other than words (e.g. body language, drawings and sigh language). Thus, more than the verbal expression of needs and desires must be attended to during the Supported Employment process.

Architectural, attitudinal, transportation and communication barriers are not present in quality Supported Employment services since they significantly hinder participation of persons with a disability. Thus, for service recipients to be truly involved in the Supported Employment process, he or she is not confronted with handicapping conditions. For example, service providers must provide:

	Necessary technical aid and related equipment
	Encouragement and support
	Accessible environments
	Necessary transportation
	Accessible and understandable information.

Being accurately informed is key to meaningful involvement in the Supported Employment process. In other words, for persons with a disability to engage in informed decision-making information must be communicated to them in a language and/or modality they are able to understand. For example, service providers must abstain from using technical jargon. In addition, information must be available in alternate format (e.g. Braille; pictorial representations) and alternate modes of communicating (e.g. Sign language) should be utilized when necessary. An effective means of communicating – one that reduces ambiguity and generates more comments on the part of the consumer – is a necessary component of quality Supported Employment services.

The success of the Supported Employment methodology depends, to a large extent, on whether the person with a disability is situated in a supportive environment. Not only must service providers treat persons with a disability with dignity and respect, they must ensure that persons with a disability are in work placements where they are treated with dignity and respect.

There are different opinions with respect to what constitutes a supportive environment. The guiding principle is: If persons with a disability do not consider themselves to be in supportive environments, they are not. It must be taken into account that persons with a disability often have little exposure to supportive respectful environments. Hence, they may be unable to identify unsatisfactory environments. For this reason, it is the responsibility of service providers to ensure that persons with a disability are in supportive environments.

It is the person with a disability who determines the desired outcomes of Supported Employment services as well as how they contribute to overall life goals. Thus, service providers must take the persons’ life goals into account if they are to provide appropriate services. Furthermore, persons with a disability have a strong role in measuring the outcomes of support services. Each person with a disability has a unique lived world, thus he or she is the best person to define life goals as well as what is needed for them to be attained. Furthermore, persons with a disability must have a leading role in measuring outcomes since they are an authority on whether they are consistent with their identified goals.

	From the family’s and friends point of view.
	The process includes input from significant “players” in the individual’s life.
	The significant “players” have important and contributing roles in the process.
	The significant “players” are listened to and respected.

Family and friends typically are able to provide insight into the life goals and needs of persons with a disability. Thus, these significant persons offer a more complete picture of workers with disabilities, in turn enhancing the quality and appropriateness of Supported Employment services. Furthermore, they can work with support service personnel in supporting the employee with a disability and in gauging the appropriateness of services.

While family members and other significant individuals in the life of a person with a disability can provide support, they must not be the primary, paid support workers.

	From the staff’s point of view.
	Gain a better understanding of the person.
	Changing the perception of the needs and desires of the individual.

The process puts the focal person in charge of his or her services. 

When the views of service providers dominate the Supported Employment process, services are less likely to reflect the values of service recipients. The reason being that service providers’ assumptions about individuals needs more often reflect their values than those of the clientele being served. By listening to and interacting with persons with a disability, service providers are better able to move past their own world view and see persons with a disability on their own terms. Agency personnel are strongly encouraged to recognize their personal values and world view in an effort to not impose them om clientele. Furthermore, putting persons with a disability in charge of the service they receive demonstrates respect for their decision making capabilities. 

Points for attention 

1. The organization must prove that persons with a disability are involved in the planning process.

2. The organization must prove that the needs, desires and possibilities of the individual person is taken into account.

3. The organization must prove that necessary facilities/equipment related to the individual’s needs are present/available and that these are used.

4. The organization must prove that all relevant information is recorded and discussed with the person with disability. Furthermore the organization must prove that the steps in the process are based on the agreement and knowledge of the person with a disability.

5. The organization consult/includes, with permission of the person with a disability, family and friends in the Supported Employment process.

6. The organization must prove that the work culture, including the attitude of the employees, is related to offering support and guidance based on individual needs, desires and possibilities of the person with a disability.

3. The organization must provide individual support plans based on individual input. 

Explanation

The organization must develop its individual tailored plans to meet the needs and objectives of persons served. Thus, coordinated, individualized service plans are formulated with the persons served and are based on their strengths, abilities, needs and preferences. While service plans are influenced by community employment needs, the standards of referral and funding sources (local, provincial, state, federal, or managed care) as well as those the organization sets for itself, consumer needs must take precendence and must never be compromised. 

Individual service plans are valid only after they have been communicated to the person with a disability and those individuals responsible for its implementation. The plan must be communicated in a manner they are able to understand 

Many of the following are typically included in a plan:

	Documentation of the decisions made by the person served.
	Goals and objectives that address the person’s preferences and choices.
	Measures and procedures to assess outcomes individuals responsible for implementing the plan.
	Specific supportive services.
	A schedule for a periodic review of the plan.

Clearly, an array of services can be included in support plans.

Support plans must be reviewed and modified on a regular base since consumer needs and expectations are not static, but fluctuate continuously. In other words, a regular review of outcomes provides data for improving and modifying individual services. Without exemption, consumers must be actively involved in decision making and the review of service plans.

Examples of areas in which consumers must engage in informed decision-making are:

	The scope, duration and expected outcomes of services.
	Employment choices, plans and options.
	Work settings.
	Career development and/or training activities.
	Career advancement opportunities.

Points of attention

1. The organization must prove that there is an individual work plan related to the situation of the person with a disability.

2. The organization  must prove that the work plan is based on individual input of the person with a disability.

3. The organization must record discussion/appointments etc. in a written report. This report is part of the individual’s file.

4. The organization must discuss the follow up of the work plan periodically with the person with a disability. Decisions related to changes, adaptations etc. can only take place based on desires and preferences of the person with a disability.

5. The organization must prove that appointments related to objectives and outcomes are time limited. The evaluation of the time table is an important part of the follow up of the work plan.

6. The individual support from the service organization to the person with a disability is focussed on:
    

	Encouraging the person in the process of choosing a job to inspire him/her as much as possible to look after points and possibilities in his/her environment.
	Helping to find a job or planning a career based on his/her interests, skills and gifts.
	Encouraging the person to take self-initiative in planning a career.
	As early as possible in the education of the person with a disability to start with planning a career.

4. The Supported Employment activities must lead to a paid job.

Explanation

Preparation activities are focused on the realization of paid jobs based on interests, desires and possibilities of persons with a disability. The person with a disability is actively involved in the job seeking process and lead this as much as possible. The choice for workplaces must mainly be based on career developments options and not so much on available vacancies.

When it is still unclear what the possibilities and preferences for a job are it is important to offer a person with a disability job orientation possibilities. Based on these experiences the person can make by himself/herself a better choice. Related to the choice further steps can be made.

During the 4 placement process on a (future) work place the offered job will be examined first to the extent in which the job contributes to career development of the person with a disability and the possibilities for social integration and interaction.

A part of the preparation activities can be a training in social and basic skills. A practical training can be combined with the training in social and basic skills.

Prior to the training plan it is important to have an analysis of the job, divided in tasks which the person with a disability have to fulfill. Furthermore it is necessary to verify which tasks the person with a disability can fulfill after additional training and which not. When there are some tasks of which it is clear that the person cannot fulfill these than examination is needed to see if these tasks can be deleted from the job. Other tasks the person can fulfill could be added. In fact the job is (re) designed for the person with a disability. Companies can have assistance in the design of workplaces which are linked with the interests, abilities and possibilities of the persons with a disability.

Depending on the type of disability training on the job side might be necessary. Before starting with the training the employer receives a detailed overview of the training program, the support and adaptations the person with a disability needs.

Part of the training can be an introduction program. This program can be focussed on orientation at the (future) work environment (where do I work, where can I leave my coat, where is the toilet etc., where are my colleagues, where is the canteen, where are the materials etc.). Immediate the actual training focussed on the activities starts. The employer is obliged to give the agreed training and support. When co-workers shall fulfil a supporting role than they will be appointed by the employer. The Supported Employment service organization shall give also support and guidance to the co-workers. The co-workers shall have entrance to information they need to fulfil their supporting tasks adequately.

In the job seeking process it is important to look after a workplace where he/she can function optimal. In any case the workplace must be related to the skills and possibilities of the person with a disability.

Before realizing the workplace it might be necessary to fulfil prior conditions. These prior conditions can be related to technical aids/materials the person with a disability need to be able to function on the job.

It might be necessary to deliver other forms of support outside the workplace as on the workplace. Support outside of the workplace can be a training in using public transport, the availability of transport, the realization of a support network (for example for persons with a psychiatric disability). On the workplace specific adaptations can be needed such as adaptive work circumstances (extra breaks, a less stress environment etc.). The support depends on the individual needs of the person with a disability.

Practical training as well as outside on the workplace must be limited in time. With the (future) employer training appointments and/or trial periods can be agreed. These appointments are also limited in time. The goal is, and that must be clear on forehand, to realize paid jobs in the company of the employer.

It is possible that different organizations are involved in the job placement process. The training can be provided by one organization and the placement by another organization. When an organization which is responsible for the preparatory work likes to receive a Supported Employment accreditation than it is needed that binding appointments are made with a placement organization. The organization must prove that the persons for which the preparatory work is carried out have paid jobs. Information about the job must be present in the file of the person with a disability, as well as information about the appointments between the organizations.

Points of attention

1. The organization must prove that the job preparatory activities are focussed on realizing paid jobs.

2. The organization must prove that the person with a disability is actively involved in the job seeking process. This includes the delivery of all relevant information, the provision of support to the person with a disability so that he/she is able to make a choice.

3. The organization takes care of job orientation possibilities in the situation when it is not clear what the possibilities and preferences for a paid job are.

4. The organization takes care of all for the person with a disability relevant preparatory activities. Depending on the disability and the individual situation of the person with a disability for example a training in basic skills and social skills can be necessary

5. The organization must show that Supported Employment instruments are used, such as:

	job description;
	job analysis;
	job (re)design;
	introduction program;
	job coaching;
	support outside of the workplace;
	support/training of co-workers.

6. The organization takes care that the (future) employer receive a detailed overview of the training, support and adaptations the person with a disability needs.

7. The organization takes care that the appointments with the (future) employer related to training on the job are limited in time. Appointments with the (future) employer are recorded in written.

8.  When the organization, which takes care of the job preparatory work is not in charge of the work placement than the organization must have binding appointments with the organization which is responsible for this part. The appointments are recorded in written. A copy of the job contract must be present in the file of the person with a disability.

5. The organization must prove and/or organize on-going support, which is not time limited, but is focussed on individuals needs and the needs of the employer.

Explanation

Support is based on individual needs, thus the level of support provided by Supported Employment organizations fluctuates from person to person. Without exception, the least restrictive supports are to be utilized. For this reason, natural supports are to be called upon whenever possible. In summary, Supported Employment organizations must only provide person with a disability with the level of support they require – nothing more, yet nothing less. Specifically, as a worker becomes more familiar with job tasks and the work environment, the level of support is gradually reduced so that it is consistent with the needs.

It must stressed that support is always on-going and is never time limited. Thus, the Supported Employment organization must continuously assess the needs of a person with a disability to ensure that, throughout the Supported Employment process, the person receive the amount of support that is necessary. The guiding principle is that resource(s) must be sufficient to meet the needs of a person with a disability. To ensure a successful job placement, support must also be available to employers. For example, the service provider can assist an employer in understanding what the support needs are of an employee with a disability so that he is able to function in his job.

The purpose of the support person is to be a resource for the employee and the employer. Hence, the services and resource(s) they provide must make sense for the individual person with a disability and the work setting.

All on-going support does not have to come form the same provider. In other words, persons with a disability can acquire support from various sources so that all of their on-going support needs are met.

For example, social security work incentives can be used to purchase  job coaching services and a case management system can assist persons with a disability with money management. Whenever possible, natural supports are to be called upon. Supported Employment organizations are responsible for ensuring that there is a smooth transition when different providers are used for on-going support. 

For the employer it is important to know which organization he can contact when problems or questions arise for which specific support is needed. The Supported Employment organization takes care of clear written appointments for this with the employer.

Points of attention

1. The organization must prove that the Supported Employment services are based on the desires and possibilities of the individual person with a disability.

2. The organization must prove that the Supported Employment services are also focussed  on the desires of the employer.

3. The organization must show that the service to the person with a disability and the employer is a match of the results of 1. and  2 here above.

4. The organization mediates and give advise in the further consolidation of the workplace.

5.  The organization must prove that on-going support appointments with the employee and the employer are written on paper.

6. The organization looks after periodic meetings between the employee and the employer related to the desires and possibilities. The organization must have a report of these meetings.

7. The organization takes care of additional training and/or support

8. The organization takes care of training and support related to skills and other points of attention which are a condition to be able to function in a job.

9. The organization takes care of training and support in for example daily living skills which are relevant for participation in the work setting.

10. The organizations keep an eye on the social setting at the workplace and intervene when there arise relational problems between the employee and co-workers, management staff or the employer.

11. The organization keep an eye on the developments of the job performance and assists, mediate and intervene when the person is loosing his/her job.

12. The organization must show these activities through written reports.

13. When there is a cooperation with another organization appointments must be on paper and results must be demonstrated. The information must be available in the file of the person with a disability.

6. The organization must have an internal evaluation system

Explanation

The importance of an internal evaluation system is that the Supported Employment service providing organization must have a clear view of the way activities are carried out. Furthermore it is important that the internal evaluation shall be used as a quality measurement instrument of the activities. The intent is ensuring appropriateness of existing services and determining how they can be continuously improved upon. To accomplish these necessary objectives, a system must be in place for determining the degree to which service outcomes meet the expectations of clientele. Specifically, the objective is to extend services incorporating the needs, values, goals and environment of consumers. 

Services are assessed using an outcome measurement system developed by individual organizations.

Examples of outcome measures are:

	trace if all relevant information is recorded in files;
	trace if periodic meetings take place with the person with a disability;
	trace if periodic meetings take place with the employer;
	trace if periodic meetings take place within the organization with all involved persons related to the follow up of the activities;
	trace if individual plans are modified;
	trace if the person with a disability give directions to the decision making process;
	trace if written plans are also carried out;
	trace if the quality of the services still meet the expectations of the person with a disability and the employer.
	trace if periodic meetings take place with other organizations about the follow up and quality of the cooperation activities and/or appointments are recorded and carried out;
	trace if on-going support activities are adequately;
	trace if career development options of the person with a disability are sufficient taken into account.

Part of the internal evaluation is also to find out if the organization in general is developing activities which are focussed on improving expertise of the employees of the organization.

Recording of information is not only necessary to get insight in the development of the activities (knowing what the organization is doing), but also necessary to provide adequate information to for example funding organizations.

The organization is also bound to all relevant laws and regulations related to subsidy conditions.

Many instruments are available for internal evaluation. The use and choice of instruments is a responsibility of the organization itself. The organization must make transparent and clearly the way in which evaluation takes place. Periodic evaluation reports must be available. Through written reports must be showed what is done by responsible persons with the evaluation outcomes/conclusions.

Points of attention

1. The organization must make clear that internal evaluation related to the Supported Employment activities takes place.

2. The organization must demonstrate that internal evaluation is also focussed on the development of the activities for individual persons with a disability and that they are actively involved in this. Furthermore the organization must demonstrate that based on the evaluation outcomes individual plans are modified.

3. The organization must demonstrate that activities focussed on the employer are evaluated periodical.

4. The organization must demonstrate that on-going support is evaluated periodical.

5. The organization must have written records of evaluation information.

6. The organization must demonstrate that overall evaluation reports are made and that these are discussed periodical. Furthermore it must be demonstrated what is done with these evaluation reports.

7. The organization must demonstrate that information for Supported Employment funding organizations is appropriate.

8. The organization must demonstrate that activities are recorded and that laws and regulations are taken into account.

7. The organization must demonstrate outcomes

Explanation

Supported Employment activities are outcomes and result oriented.

The results of all activities which are carried out by the organization must be recorded. The organization must give insight in the range and composition of the group of persons with a disability the services are carried out. The type of disability and the complexity of the disability must be explained. When in services for persons with learning disabilities (mental retardation) an existing system is used, this system must be mentioned.

The organization must give insight in the average duration of an individual project/stage. The results for each participant must be registered. Information must be available about the dates when participants are coming involved in a Supported Employment process, the duration of the different stages till the moment of getting a contract for a job. Information about the type of the contract of a job, the length of the contract must be available. Furthermore information about the number of persons and the intensity of the on-going support when persons have a paid job. All information must be available in a data-system.

From this information it shall become clear for how many persons Supported Employment activities have started and how many in a foreseeable time get a paid job.

Other information of importance is:

	Effectiveness: measures the results of the activities.
	Efficiency: includes such things as length of service, costs per unit of service, costs benefits and utilization capacity .
	Satisfaction: outcome measures are the results generated form measuring the satisfaction of the persons served with the individual outcomes of their individual service plans.
	Progress: measures of intensity and results of follow up activities.

The organization must deliver the information clearly structured. The information is needed to get insight n the range of the outcomes and results of the Supported Employment method. The information is also needed for a follow up accreditation survey (3 years later) to compare these with the new information form that moment. Information shall also can be processed nationally so that more information becomes available about the results of the method of Supported Employment.

Points of attention

1. The organization must deliver information about the number of persons for which Supported Employment activities are carried out, the type, the level ad complexity of the disability.

2. The organization must give insight in the average time of an individual project. From the start of Supported Employment activities till the moment of a paid contract.

3. The organization must demonstrate for how many persons a paid job is realized, the type of the contract and the hours per week.

4. The organization must demonstrate the number of persons for which on-going support activities are carried out, the intensity and the duration of these activities.

5. The organization must deliver the information clearly structured.

6. The information can give information about other aspects related to the effectiveness and efficiency, such as information related to costs-benefits and client satisfaction evaluation.