Transitional Employment Training for SSI Recipients With Mental Retardation

Transcription

1 Transitiona Empoyment Training for SSI Recipients With Menta Retardation by Aaron J. Prero and Craig Thornton* Transitiona empoyment training is a promising method for assisting persons with menta retardation to gain and hod reguar marketpace jobs. The Socia Security Administration (SSA) has concuded a arge scae demonstration project in which this training was provided to recipients of Suppementa Security Income (SSI) with menta retardation. This artice introduces the concepts and practices of transitiona empoyment and presents findings of the SSA demonstration derived from observation of demonstration operations. A foowup artice wi discuss the effects of the demonstration services on the empoyment, earnings, and SSI payments of the trainees, as derived from anaysis of SSI administrative records and other quantitative data. Prero is with the Division of Statistics Anaysis, Office of Research and Statistics, Socia Security Administration. He was a project officer of the Transitiona Empoyment Training Demonstration. Thornton, who was the project director, is a Senior Economist at Mathematics Poicy Research, Inc., Princeton, New Jersey. 2 Socia Security Buetin, November 1991/Vo. 54, No. 11

2 There has been an exposion of interest in the concept of transitiona empoyment trainirig for heping persons with menta retardation increase their economic and socia sef-sufficiency. Fifteen years ago, the idea that this program mode, which paces and trains workers on marketpace jobs, woud be appropriate for moderatey or severey mentay retarded persons was a nove one about which there was considerabe skepticism. Today, transitiona empoyment programs around the country are providing this bridge to reguar empoyment. Successfu efforts to pace persons with menta retardation in reguar jobs have ed to the recognition that the primary barrier to such empoyment is often inadequate training and support rather than a ack of abiity. Three trends have fueed this growing interest. First, enhanced pubic awareness about the rights and abiities of persons with disabiities in genera and persons with menta retardation in particuar has ed to greater socia pressures to assimiate such persons into the mainstream of society. Second, rapid progress in the deveopment and appication of new training techniques has made empoyment in the marketpace feasibe for a greater number of persons with retardation. Finay, budgetary pressures on Federa, State, and oca governments have encouraged the search for effective ways to increase the sef-sufficiency of otherwise dependent persons. The Socia Security Administration (SSA) has a particuar interest in methods of fostering empoyment and greater sef-sufficiency among persons with menta retardation, because of the disabiity programs that it administers. Menta retardation is the most frequent impairment among disabed recipients of Suppementa Security Income (SSI), accounting for 29 percent of the cases in 1988 (Kochhar, 1991). Since experience has made it cear that pacing and training mentay retarded persons on the job is feasibe, the primary focus of research in this area has moved toward determining the costs and ong-term effects of these programs, which program variations are most cost effective, how empoyment outcomes can be improved through improvements in training techniques, how services can be targeted to persons who wi benefit from them, and whether programs can be operated on a poicy reevant scae. This artice examines these issues, drawing, in particuar, on an anaysis of the Transitiona Empoyment Training Demonstration. The demonstration was conducted by SSA, which funded eight training organizations to provide transitiona empoyment services to SSI recipients with menta retardation as we as an independent evauation conducted by Mathematics Poicy Research. The demonstration operated in 13 cities from May 1985 unti June The artice is organized in four sections. The first provides background on transitiona empoyment training for persons with menta retardation. The second section describes the Transitiona Empoymerit Training Demonstration. The third section examines issues that must be addressed in designing transitiona empoyment programs and describes how the issues were resoved in the demonstration. The ast section presents findings of the demonstration with respect to these and other issues. Transitiona Training Popuation Empoyment Characteristics Menta retardation is characterized by two conditions (Grossman, 1983). The first is evidence of a significant inteectua imitation. This condition is generay defined by a measured IQ score beow 70. The other condition is an inabiity to engage in activities that are age appropriate. This condition is harder to measure since it pertains to how we persons can function in their respective socia environments and how toerant or demanding those environments are. The distribution of IQ scores in the genera popuation can be described approximatey by the be shaped curve of the norma distribution. The average IQ score for the genera popuation is 100 and the standard deviation is 15 or 16, depending on the IQ test used. This distribution Socia Security Buetin, November 1991iVo. 54, No. 11 3

3 impies that fewer than 3 percent of the popuation woud be cassified as mentay retarded on the basis of an IQ score. Furthermore, among those cassified as mentay retarded, more than 90 percent of their IQ s woud fa between 55 and 70, indicating mid menta retardation. The distribution of adaptive behavior is ess we known. Many persons whose IQ scores are ess than 70 are empoyed and ead essentiay norma ives. Others are ess sef-sufficient and depend on a variety of services for support. Kiernan and Bruininks (1986) review the avaiabe evidence on the prevaence of menta retardation in the popuation and concude that 1 percent of the adut popuation, or approximatey 2 miion persons, have substantia adaptive behavior imitations due to menta retardation. Unempoyment and dependence on support programs that are consequences of these imitations are costy to society and the individuas. Society, and the unempoyed individuas, forego the goods, services, and income that coud be produced if more persons with menta retardation were empoyed. There are aso psychoogica costs, incuding those due to a ack of socia integration and to absence of the sef-esteem that can be derived by working and contributing to society. Rates of empoyment and program participation of persons with menta retardation are not we known except in terms of genera magnitudes. The notion that persons with menta retardation generay cannot work is a misconception. A arge fraction, probaby haf, were empoyed even decades ago, when speciaized empoyment services were not as widey avaiabe as today. On the other hand, many others do not find empoyment, despite their desire to work. Persons with menta retardation may be eigibe for SS.2 The program provides Federa income support payments to aged, bind, and disabed persons witn imited income and resources. The benefit rate, definitions of disabiity, and the other eements of the program are uniform nationay. States have the option to suppement the Federa SSI benefit rate for a or seected categories of recipients. The SSI statistics suggest that roughy 679,000 working-age aduts receive approximatey $2.9 biion per year in SSI payments on the basis of a primary diagnosis of menta retardation.3 Other assistance and service programs in which aduts with menta retardation may participate incude the Socia Security disabiity program, Medicare, Medicaid, Food Stamps, shetered workshops and work activity centers, and residentia and transportation programs. The promise that transitiona empoyment has shown for reducing dependence on these programs by increasing empoyment and sefsufficiency is a primary source of support for this program mode. Eements of Transitiona Empoyment Transitiona empoyment, as expressed we in its name, is temporary training provided on a rea job to faciitate the transition to reguar, marketpace empoyment. Athough the concepts are sti evoving, there is consensus on certain basic characteristics: Training services are avaiabe for a imited time, and pacement in a potentiay permanent, competitive-eve job is an integra part of program services. Training takes pace on a rea job, that is, a paid job that consists of tasks that another worker woud otherwise perform for the empoyer and in which the worker has an opportunity interact with nonhandicapped coworkers or the pubic. Specia training is provided by job coaches. Training support is reduced over time to promote independence. The first key eement, competitive empoyment within a imited time, refects the intention of transitiona empoyment to provide a bridge to empoyment rather than ongoing support. The duration of transitiona empoyment services varies (generay between haf a year and 1% years), but the goas of the program are aways to phase out services and promote independent empoyment. The second key eement of transitiona empoyment specifies a rea job for training. This can be a job that has the potentia to be permanent or it can be a temporary job from which the worker wi be transferred once he or she has mastered the necessary job and socia skis. (The advantages and disadvantages of each training venue are discussed on page 22.) However, when the training is conducted on a temporary job, the mode requires that additiona job coaching be provided after pacement in the potentiay permanent job. That is, transitiona empoyment programs may foow a pace-train or train-pace-train sequence, but not simpy a trainpace sequence. In an integrated environment, the exampes and expectations of coworkers infuence trainees behavior. Trainees frequenty respond to the demands that are impicit in the workpace with regard to both socia behavior and eve of productivity. In contrast, a segregated, shetered environment may convey a ess demanding message, since workshops and activity centers are invoved in to 4 Socia Security Buetin, November 1991/Vo. 54, No. 11

4 evauation, socia activities, and genera ski deveopment, as we as the production of goods and services. The third eement, job coaching, distinguishes transitiona empoyment programs from other types of on-thejob training programs. Athough the job-specific training that the job coach provides is, in other circumstances, frequenty provided by supervisors or coworkers, the coach must use speciaized training techniques appropriate to the specific earning abiities of the cient. Coaches aso dea with behaviora, communication, transportation, and other nonvocationa aspects of a job, which are not typicay part of ordinary on-the-job training. Finay, the job coach s time is fuy dedicated to training, and can be devoted in the amounts necessitated by the individua situation. Supported Empoyment Aternative An aternative service mode, when competitive empoyment appears unachievabe, is supported empoyment. This -newer mode seeks to serve persons who woud be unabe to hod a job in the reguar abor market without ong-term support. It provides the same types of services as transitiona empoyment and differs primariy in that support and training are expected to ast indefinitey. There is no consensus as yet on the precise program features or on the characteristics of the target popuation of supported empoyment. However, the U.S. Department of Education has defined supported empoyment for the purpose of its rehabiitation programs to incude the foowing features (Code of Federa Reguations, tite 34, part 363, section 7): Paid empoyment of a east 20 hours per week. An integrated setting in which coworkers are predominanty persons without disabiities. Ongoing support services that must incude training provided at the worksite at east twice a month, and may aso incude transportation, counseing, and simiar services. Individuas eigibe to be served must require these ongoing support services for the duration of their empoyment (U.S. Department of Education, 1987; page 30546). Supported empoyment is thus inappropriate for persons who can be served adequatey in time-imited preparation programs eading to independent empoyment. The costs of supported empoyment are of different magnitudes, and the benefits generay of a different nature, than the costs and benefits of transitiona empoyment. Specificay, the costs of time-unimited services are greater, and benefits may be reaized mainy in terms of persona advantages to the cient, rather than savings in government and private program expenditures. The goas of supported empoyment, therefore, are frequenty different from those of transitiona empoyment. Supported empoyment paces greater emphasis on integrating persons with disabiities in the workpace, particuary persons with more severe disabiities, and ess emphasis on economic independence than does transitiona empoyment. As a resut, pubic expenditures on supported empoyment programs are justified argey in terms of promoting equity and socia integration whie transitiona empoyment programs are justified as a means of fostering economic sef-sufficiency. Despite the differences in their orientations, however, these two programs provide simiar types of services. Moreover, because it is often quite difficut to determine the ikeihood of a person s achieving competitive empoyment, particuary within a imited time, the two programs often enro simiar cients. As the methodoogies of both modes deveop, further and more precise distinctions may be drawn for programmatic and funding purposes, and more wi be earned about the types of individuas for which each mode is most appropriate. In any event, both types of programs wi need to remain fexibe since the abor market is dynamic, and cients of either program are ikey to need different types and eves of service under different abor market and persona circumstances (Kiernan and Stark, 1986). Job Retention Services Athough transitiona empoyment services are by definition time bound, it is often necessary to provide certain imited ongoing services in order to hep the person remain on the job. Job retention services are needed because many persons with menta retardation experience difficuty coping with nonroutine or crisis situations ike substantia changes in the responsibiities of a job, breakdowns of transportation arrangements, personaity conficts with a supervisor or coworker, or famiy probems. These situations arise in the work and persona ives of everyone, regardess of cognitive abiities, and the resoution of such probems ordinariy demands an extra measure of anaytic abiity and resourcefuness. Job retention services assist cients to overcome these kinds of probems and remain on their jobs. The incusion of ongoing job retention services burs the distinction between transitiona empoyment and supported empoyment. In fact, some practitioners view the combination of short-term job coaching foowed by Socia Security Buetin, November 1991/Vo. 54, No. 11 5

5 periodic checks and occasiona retraining services as a form of supported empoyment. Other Empoyment Assistance Programs Other government and private programs are aso avaiabe to assist mentay retarded persons with training and empoyment. These incude, among others, the Federa- State vocationa rehabiitation program, the vocationa education component of specia education programs, Targeted Jobs Tax Credits, the on-the-job training program of the Association for Retarded Citizens, and the system of shetered workshops and day activity centers. Despite the frequent ack of coordination and integration of these programs with each other, their services are used as adjuncts by some transitiona empoyment programs. Vocationa rehabiitation agencies pay for evauation services and prepacement training that can be hepfu to transitiona empoyment programs. These agencies aso fund transitiona empoyment services directy. The specia education system provides prevocationa training to which transitiona empoyment can be a seque. Sometimes vocationa education incudes work-study programs that offer pacement and training services to students. However, these services may end abrupty when the student finishes forma schooing. Transitiona empoyment can provide continuity of programming for these students. Shetered workshops have traditionay paced ony a sma proportion of their cients in reguar jobs (Beamy et a., 1986). However, increasing numbers of workshops have initiated transitiona empoyment programs or have begun to refer cients to such programs. Kiernan, McGaughey, and Schaock (1988) found that in fisca year 1985 approximatey 20 percent of cients of shetered workshops were paced into rea work settings, which incuded transitiona and supported empoyment programs as we as direct pacements onto jobs. The Targeted Jobs Tax Credit program provides no direct services but rather an incentive to empoyers to hire and train specific categories of workers, incuding handicapped persons and eight other groups (U.S. Congress, 1989). Under this program, empoyers who hire a worker from one of the targeted groups can take a tax credit equa to a fraction of the wages paid to that worker during the first year of his or her empoyment. This tax credit has specia reevance to transitiona empoyment because many provider agencies promote the tax credit when deveoping jobs for cients. Agencies aso hep empoyers fie for the credit. The nationa on-the-job training program of the Association for Retarded Citizens is funded by the U.S. Department of Labor. Like the Targeted Jobs Tax Credit program, this program provides incentives to empoyers. In this case, the incentive is a wage subsidy for newy hired workers with menta retardation. The subsidy can ast up to 8 fu-time weeks, and is widey used by transitiona empoyment programs in conjunction with their other services. Brief History of Transitiona Empoyment Programs Service Vocationa Training Program at the University of Washington (Moss, 1980), the University of Iinois Food Service Training Programs (Rusch and Mithaug, 1980), Project Empoyabiity at Virginia Commonweath University (Wehman, 1981), and Project Earn at Southern Iinois University (Bates, 1986). These programs were typicay sma, generay serving fewer than 15 persons at a time, and they usuay empoyed staff with backgrounds in specia education, rehabiitation, and training. The university-based programs coected substantia information about the services deivered to cients and the resuting outcomes. The data provided a basis for research as we as a means to measure with accuracy the deveoping skis of cients. Interest in understanding ong-term outcomes ed these programs to provide essentiay open-ended services. Programs woud continue to monitor cients and woud resume providing appropriate services whenever needed. Not ong after these universitybased programs began, some foundations and private organizations aso started transitiona empoyment programs for persons with menta! retardation. Exampes of eary efforts are the Job Path program in New York City (Vera Institute of Justice, 1983), the Menninger Foundation transitiona empoyment program in Topeka, Kansas, and Transitiona Empoyment Enterprises in Boston (Krauss and MacEachron, 1982). The inception of transitiona and Large programs in Massachusetts supported empoyment programs for and Virginia were among the first persons with menta retardation estabished by State governments. dates back more than 15 years. The programs of both the private Transitiona empoyment programs organizations and the States tended designed for persons with menta to be arger than the university-based iness have existed since 1958 programs and to serve ess severey (Fountain House, 1980, page 1).4 disabed individuas. They aso The first programs described in the tended to imit the duration of iterature were a few university-based services to a greater extent than did programs. Among them are the Food the university-based programs. 6 Socia Security Buetin, November 1991/Vo. 54, No. 11

6 Further, these programs aso generay coected ess detaied data about the services provided to cients and the resuting outcomes. Beginning in 1985, the U.S. Department of Education has encouraged State vocationa rehabiitation departments to impement supported empoyment programs. This effort was made permanent by the Rehabiitation Act Amendments of 1986 (Pubic Law ) which authorized supported empoyment as a vocationa rehabiitation activity for the States. Since 1986, over 2,000 new supported empoyment programs have been estabished and operate in a 50 States (Krege, 1991). Assessments of Transitiona Empoyment Foowing the eary evauation efforts of the prototype programs, a arge-scae demonstration was undertaken in 1981 to measure the costs and benefits of transitiona empoyment for persons with menta retardation. This demonstration, the Structured Training and Empoyment Transitiona Services (STETS) demonstration, was funded by the U.S. Department of Labor and administered by the Manpower Demonstration Research Corporation (Riccio and Price, 1984). The STETS enroed 284 trainees and 211 contro group members aged in five cities. The STETS projects provided the participants with up to 18 months of pacement, training, and foowup services in 1981 through The evauation, performed by Mathematics Poicy Research (Kerachsky et a., 1985) was designed to detect the net impact of the services, that is, the difference between actua empoyment, earnings, and other outcomes and the situation that woud have prevaied absent the services. The evauation found that this transitiona empoyment program successfuy moved many young aduts with menta retardation into competitive empoyment. Twenty-two months after enroment, 19 percent of the contro group members were in competitive jobs whie 31 percent of the treatment group were in such jobs, an increase of 62 percent. Thus, athough the program was ceary not successfu for a enroees, it nevertheess produced dramatic increases in post-program competitive empoyment. A benefit-cost study done as part of the STETS evauation indicated that this mode of transitiona empoyment had the potentia to generate benefits that were greater than the program costs. The benefits incuded increased participant earnings and empoyment and reductions in the use of aternative services, particuary reductions in the use of shetered workshops. The costs were primariy those associated with operating the program. The findings aso indicated that within the range of persons served in STETS, whose measured IQ scores ranged from 40 to 80, the program.had the greatest net effect in the ower end of this IQ range. These effects were greatest argey because the most impaired members of the contro group achieved so itte. The net benefits to the east impaired trainees were smaer because, as observation of the contro group showed, many of those trainees woud have become empoyed even without the demonstration services. This finding is simiar to that of experiments with other hard-toempoy groups. The Nationa Supported Work Demonstration, in 1975 to 1979, provided transitionaempoyment-type services to persons who were not disabed but were disadvantaged in other respects. The net effect was the greatest for the most disadvantaged participants (Hoister, Kemper, and Maynard, 1984). The STETS demonstration and other transitiona empoyment projects for persons with menta retardation have provided important information, but other essentia information is sti missing. In particuar, there has been no rigorous evauation of the impact on persons with moderate and severe menta retardation. Athough there were some such individuas in the STETS demonstration, the number was inadequate for a focus on that group. Aso, evauations have acked the necessary foowup data to assess ong-term effects. The STETS demonstration foowed the treatment and contro groups for ony 22 months after their appication to the program. This time period enabed the evauation to capture virtuay a operating costs, but excuded ong-run benefits. At the end of the 22-month observation period, the evauation estimated that continued benefits coud entirey repay the investment in training. This outcome seemed ikey, but coud not be confirmed for ack of data. More information is needed about the service-deivery approaches, within the broad definition of transitiona empoyment, that are most effective and the characteristics of staff necessary to deiver those services. The Socia Security Administration s Transitiona Empoyment Training Demonstration has attempted to further carify the issues and provide additiona answers about training methods and ong-term outcomes for persons with more severe retardation. The SSA Demonstration The Socia Security Administration s Transitiona Empoyment Training Demonstration studied the experiences of 745 SSI Socia Security Buetin, November 1991iVo. 54, No. 11 7

7 recipients with menta retardation. Haf (375 persons) were randomy assigned to a treatment group and were offered transitiona empoyment services, The other haf (370 persons) were assigned to a contro group whose experiences woud form the standard for judging the effect of the services. Persons in the contro group were precuded from receiving demonstration services, but were free to seek other services avaiabe in their communities. This SSI demonstration was conducted under authority of section 111 O(b) of the Socia Security Act. Section 111 O(b) authorizes the conduct of experimenta, piot, or demonstration projects which... are ikey to assist in promoting the objectives of the SSI program. One program objective is to encourage work by SSI recipients. This objective is furthered by provisions of the aw that provide work incentives to recipients and reduce barriers to becoming empoyed. The outcomes of the demonstration are described in two evauative reports. The process report (Thornton, Dunstan, and Schore, 1988) anayzes issues in the impementation and operation of the demonstration, incuding the design of training programs. The process anaysis and report are the main basis for the findings presented here. The second report (Thornton and Decker, 1989) compares the earnings and empoyment of the training group with those of the contro group to determine the net impact of the training over the 3% years of the evauation. A foowup artice wi summarize the net impacts. Organization of the Demonstration The project was conducted scae adequate to produce statisticay vaid resuts on on a transitiona empoyment training, especiay for SSI recipients. The research contractor, Mathematics Poicy Research, Inc., designed the demonstration in detai, based on requirements specified by SSA. The contractor was aso responsibe for: 0 Deveoping the requirements for appications for grants to operate demonstration sites and reviewing the appications, Deveoping the data coection instruments and procedures, 0 Monitoring the training operations and coecting the data from the program operators, Conducting a post-program survey of participants, and Evauating the resuts. The training was provided by eight nonprofit organizations seected from 80 appicants in a competitive process. The Socia Security Administration awarded grants totaing $2,624,000 to these eight organizations. The U.S. Department of Education, Office of Specia Education and Rehabiitative Services contributed $110,000 of the funding through an interagency agreement. The eight organizations matched their grants with a tota of $1,022,000 from other sources, so that overa resources for demonstration site operations were $3,646,000. The grantees were three universities and university affiiates, three oca units of the Association for Retarded Citizens and Goodwi Industries, and two independent rehabiitation organizations. Four of the sites-as the grantee organizations are referred to in this artice-aso operate shetered workshops. The grantees were: Chidren s Hospita, Boston, Massachusetts. University of Washington, Seatte, Washington-serving Portand, Oregon, in cooperation with Portand Community Coege. The University of Wisconsin- Stout, Menomonie, Wisconsinserving a rura area in west centra Wisconsin. Association for Retarded Citizens-Monmouth Unit, Monmouth County, New Jersey. 0 Exceptiona Chidren s Foundation, Los Angees, Caifornia (a unit of the Association for Retarded Citizens). Goodwi Industries-Miwaukee Area, Miwaukee, Wisconsin. AHEDD, Inc., Lemoyne, Pennsyvania-serving Harrisburg, Lancaster, Phiadephia, Pittsburgh, and York, Pennsyvania, and Dover, Deaware. The Center for the Rehabiitation and Training of the Disabed, Chicago, Iinois. Grant appication guideines specified certain features of the operations and eft other features to the discretion of the grantees. As a resut, the styes of the sites differed in some important respects. Observation of differences among the sites in methods and outcomes, together with anaysis of other site data, are a main source of information for the process anaysis of the demonstration and for the anaytic concusions of this artice. A sites provided job deveopment, pacement, and job coaching services. The intensity and duration of each of these services varied among providers. At some sites cients were generay provided ess than a month of fu-time, one-on-one job coaching, whie other sites averaged severa months of services per cient. Pacement in a potentiay permanent job was a responsibiity of 8 Socia Security Buetin, November 1991iVo. 54, No. 11

8 the sites. At east some of the training had to be provided on that job. However, grantees were permitted, if they chose, to provide the greater part of the necessary training before the permanent pacement, on another rea job that was for training ony and had no potentia for permanence. A urban sites provided trave training for participants who were not abe to trave by bus independenty. Some sites provided transportation. Sites varied in the extent to which they provided other socia services and case management of these services. Sites were required, under the terms of the grants, to provide or arrange for foowup job retention services for permanenty paced trainees. Job retention services generay incude periodic monitoring of a worker s job performance and the provision of training, counseing, and other supports necessary to enabe the worker to remain empoyed. In order to ensure the provision of these ong-term services after a worker s year of eigibiity for demonstration services expired, sites were expected to arrange for referra to nondemonstration programs that woud provide these services. Experimenta Design and Data Coection Participants were enroed before they or the sites knew whether or not the participant woud be assigned to the training or contro group. After enroment, the site submitted the participant s identifying information to the research contractor, which recorded an assignment of the individua based on a random number seection procedure with a 50 percent probabiity of either assignment. Members of the contro group were often referred to the oca vocationa rehabiitation agency, but they received no services under the demonstration. The site interviewed each participant before the assignment to the training or contro group. The same questionnaire was administered at a sites, permitting aggregation of the data. Information was coected on househod composition, heath, vocationa experience and training, education, and the interviewer s observations of the participant. Detaied records on staff hours of direct services provided to a subsampe of the training group were kept by a sites in a uniform manner prescribed by the contractor. These data were used to assess the eve and costs of services. Data on earnings and SSI payments were coected for both the training and contro groups. The data are derived from periodic review of SSI administrative records and from a reinterview of the participants conducted in ate These data cover up to 40 months foowing enroment in the demonstration. Longitudina data are usuay beyond the reach of training projects because of the expense of tracking sampe members and ow response rates to surveys. This project, however, can draw on SSI records and records based on the Socia Security tax reports of empoyers over the ong term. Cient Recruitment Enroment in the demonstration took pace in May 1985 through June 1986, and was vountary. The Socia Security Administration sent approximatey 12,000 etters with informationa materia to mentay retarded SSI recipients who ived in the ocaities served by the sites. Foowup etters from the providers were aso sent to most individuas who did not respond to the initia maiing. In about 80 percent of the cases, the recipient s SSI benefit was being paid to a representative payee, usuay a parent or other reative, because of the recipient s inabiity to manage his or her own funds. In these cases, the information about the demonstration was sent to the representative payee. A poo of names for the maiing ist was drawn from SSI computerized administrative records and consisted of recipients aged who ived in the ZiP Code areas served by the sites. Diagnosis is shown on the computer record ony for recipients whose appications were fied or whose cases were reviewed since Therefore, to imit the maiing ist to persons with menta retardation, the case foders of over 30,000 recipients whose names were seected from the computer record were checked for the nature of the impairment. When the primary or secondary diagnosis was retardation, the name was added to the maiing ist. An SSI recipient who received an informationa etter coud contact the respective training provider by maiing a postage-paid postcard that was encosed with the etter. The recipient s name, address, and Socia Security number had been pre-entered on the back of the postcard, and no additiona information had to be entered by the recipient except for corrections. The recipient coud aso contact the site by teephone or in person. One reason for recruiting participants from the maiing ist was to ensure representation of a SSI recipients with menta retardation in the sampe, not just those persons who were aready known to the service system. In particuar, the demonstration sought to serve at east some recipients who had not previousy been receiving vocationa services. However, when it appeared that enroment woud be insufficient to meet sampe size requirements based on this method of recruitment Socia Security Buetin, November 199iVo. 54, No. 11 9

9 aone, sites were permitted to soicit referras of SSI recipients from other agencies. These individuas were randomy assigned in the same way as the earier enroees. Foowing the initia contact, the training site arranged one or more interviews with the recipient on the basis of which the recipient decided if he or she was interested in the program and the site decided if the individua appeared appropriate. The concept of the contro group and the process of assigning participants to the training and contro groups were expained. Parents, guardians, and representative payees were invoved in the entire process. Written consent was required for participation. The rues of the demonstration imited the amount of pre-enroment testing and evauation to ess than haf a day in order to imit the degree of persona invovement of participants so ong as they were sti subject to assignment to the contro group. One purpose of this imitation was to assure that the intervention woud be as neutra as practica with regard to the contro group s desire to seek training and empoyment. Another purpose was to reduce the possibe disappointment to participants who were subsequenty assigned to contro status. Sites varied within the imitation in the extent to which they evauated the abiities and needs of potentia participants. In addition to testing, where cients were known to other agencies in the community, sites had the opportunity to obtain coatera information. The outreach and recruitment process produced a sampe of 745 persons representing approximatey 5 percent of a eigibe SSI recipients iving in the catchment areas. This sampe is statisticay sufficient for testing hypotheses about the overa effect of the demonstration and supports anaysis of program effectiveness for key subgroups defined by demographic characteristics, prior empoyment, iving arrangements, and eve of retardation. A key eement of the recruitment process was the admonition to the sites that they try to make enroment as open as possibe, given the capacities of their training operations. It appears that sites successfuy impemented this suggestion and enroed many persons with severe handicapping conditions. However, most sampe members have mid to moderate impairments, refecting the genera distribution of handicapping conditions in the popuation. Characteristics of Sampe As shown in tabe 1, over 40 percent of the sampe was concentrated in two sites, AHEDD and Exceptiona Chidren s Foundation. The remainder of the sampe was distributed fairy eveny across the other sites. Maes constituted amost 60 percent of the sampe. The average age at enroment was 26 years, 22 percent were younger than 22 (and hence eigibe for specia education services) and 11 percent oder than 3.5. Thirty percent of the sampe was back. The IQ data indicate that sampe members had a wide range of measured inteectua capacities. The IQ scores were obtained from SSA case foders, where the evidence used to determine SSI eigibiity resides. The scores, generay from the Wechser or Stanford-Binet tests, averaged 57. Six percent had scores that cassified them in the severey retarded group, 35 percent were cassified in the moderate range, and 49 percent cassified as having mid menta retardation. It is ikey that the 10 percent of the sampe members who had an IQ score of 70 or greater aso had other handicapping conditions that were considered in SSA s determination of disabiity.5 When individuas appied to the sites, the staff recorded any conditions other than menta retardation that woud seriousy imit the individua s abiities to work. Because intake staff had ony a imited opportunity to meet with the appicants prior to enroment, they coud record ony those conditions that were reported by appicants or referra agencies or those that became obvious during the intake process. This information suggests that at east 83 percent of the sampe members had a physica or psychoogica imitation in addition to their menta retardation. Data coected at enroment indicate that sampe members received income support from a number of sources. A of them were SSI recipients as required by the eigibiity criteria. In approximatey one-third of the cases, the sampe member was aso a Socia Security beneficiary. Virtuay a sampe members received Medicaid benefits and 14 percent of them received other wefare supports. Most sampe members appeared to be dependent on other individuas for assistance. Over 80 percent of a the sampe members ived in a supervised type of setting, with approximatey 60 percent iving with their parents. In addition, 77 percent of the sampe members had a representative payee to hande their SSI payments. Not surprisingy, very few of the recipients who enroed in the demonstration had recent work experience in the reguar unsubsidized abor market. Amost 70 percent of the sampe members had engaged in some type of vocationa activity during the year prior to enroment, but ony 11 percent had hed a reguar jobthat is, paid empoyment that entaied working without specia supervision, with nonhandicapped 10 Socia Security Buetin, November 1991iVo. 54, No. 11

10 coworkers, and performing work that is typicay done by nonhandicapped workers. The predominant vocationa activity was shetered empoyment. One-third of the sampe members worked in shetered workshops in the prior year. In addition, at the time of enroment, 15 percent of the sampe members were attending schoo or participating in an educationa program. Waivers Trainees in the project were granted waivers that protected their SSI status whie in training. Section 1619 of the Socia Security Act, as revised in Juy 1987, protects SSI status more comprehensivey by the reguar aw than did the waivers, so the waivers may now be considered an approximation of, rather than a departure from, the rea-word situation. The waivers did not ater the provision of the Socia Security Act that reduces the SSI payment because of earnings (section 1612). None of the waivers in the demonstration appied to benefits under the Socia Security insurance programs for those who were concurrenty entited under both the SSI and insurance programs. Other Features The structure and organization of the demonstration as a whoe ent uniformity to the operations of the sites. This uniformity was furthered by the requirement that a sites provide certain services. Nevertheess, the sites had the freedom to design many other eements of their programs. Features and Issues in Program Design Transitiona empoyment training can be impemented in a wide variety of ways whie sti exhibiting its essentia characteristics of timeimited training by a job coach in a rea job. Some of the most interesting findings of the demonstration invove comparisons across sites of design features and empoyment outcomes. This section describes the key features of the demonstration: the ocation and intensity of job coaching, the duration of training, the provision of transportation and other supports, competencies of provider staff, training techniques, and types of jobs deveoped. Athough the immediate focus of the discussion is the design of the demonstration, this section aims to highight severa key design decisions that must be made in the operation of any transitiona empoyment program. Such decisions can substantiay affect the cost and effectiveness of the training. The design of a transitiona empoyment program invoves a compex baancing of services and the provider s target popuation. Programs that intend to serve a wide range of persons must be abe to provide a correspondingy wide range of services. For exampe, a decision to enro persons who cannot trave independenty obigates the program to provide (or arrange the provision of) trave training. Simiary, if persons with disruptive behaviors are enroed, it is incumbent on the program to suppy appropriate behaviora training. Thus, the demonstration providers tended to design their service packages and enroment criteria simutaneousy. Location of Training and Intensity of Job Coaching The amount of job coaching time that the agency is prepared to provide a cient varies widey among agencies and is a key issue in the design of a transitiona empoyment program. A cosey reated issue is the context in which the training occurs. A transitiona empoyment position is a rea job. The job may be a permanent one or it may be temporary and arranged specificay to be a setting for training. In the atter case the cient, if and when successfuy trained, is paced and receives additiona training in a position that is permanent. (Of course, jobs hed by persons with disabiities, ike a other jobs, are subject to the vicissitudes of the market and may not continue indefinitey. Retraining wi ikey be necessary on any future job the cient enters.) The training organization stations a job coach at the transitiona workpace for as itte as a few days to a number of months. The responsibiities of the job coach, in addition to teaching the cient, incude working with the empoyer, particuary the first ine supervisor, and providing advice on issues that arise in supervising an empoyee with menta retardation. The job coach may aso hep coworkers reate appropriatey to the empoyee with retardation and may perform a variety of other functions as described beow in the discussion of staff competencies. Four prototypica contexts of training are discussed here. The most intensive (and expensive) is a coach responsibe for ony one cient for severa months. If the training is successfu, at some point the job coach wi begin to withdraw graduay over a period of some additiona weeks to the eve of visiting the job site ony once every week or two. This was the method Socia Security Buetin, November 1991iVo. 54, No. 11

11 used most often by the Tabe 1.-Sampe characteristics at enroment, by randomization status demonstration sites. [Entries are percent of sampe with characteristics uness otherwise specified] A second service mode trains as many as six to eight cients in various positions with a singe empoyer, with one job coach responsibe for a of them. In a hote, hospita, or nursing home, for exampe, the trainees of a singe job coach may be distributed among the aundry, food service, housekeeping, janitoria, and grounds maintenance departments. These groups of jobs are sometimes dedicated to training ony, such that cients, once trained, are paced on simiar, potentiay permanent jobs with other empoyers. Empoyers are usuay induced to aocate positions to training-ony jobs by, among other things, a guarantee that the agreed upon production eves wi be maintained, even if it requires the job coach s doing the work. Wages based on productivity can be ess than the norma ega minimum. The costs of training are ower than for one-on-one job coaching, yet this mode can frequenty serve cients who need as much ski or behavior training as those served one on one. Typicay, pacement of the trainees is staggered over time so that a newy paced cient can initiay receive more of the job coach s attention. However, this approach does reduce the provider s fexibiity in matching jobs and cients and requires a cients in the group to be abe to trave to the common job site. In addition, some one-onone training must be avaiabe if cients must be paced subsequenty on permanent jobs with a different empoyer. One demonstration site had two such training ocations with three to five cients active at any one time at a ocation. A third context in which the job coaching can take pace is in one or more departments within the training organization s own faciities. Most commony, a coege (or other Characteristic Grantee AHEDD, Inc.... ARC/MU... The CENTER... Chidren s Hospita ECF... Goodwi Industries UWashiPCC... UWisiStout... Age Under or oder... Average (in years) Sex Femae Mae _... Race Back White and other Measured IQ score Greater than Beow 40 Average score Income per person Tota Suppementa Security Income 2 Other unearned Earned _ Average years of SSI receipt Benefit Transfer payments: 3 Food stamps Medicaid Other 4 receipt Concurrent receipt of SSI and Socia Security benefits Vocationa activity during year prior to enroment Some activity 5 Reguar job. Mainstream job training or vounteer Shetered workshop or encave Other No activity t Tota Treatment Contro sampe group group a a a $5,058 $5,113 $5,004 3,638 3,691 3, a o a.3 a.3 a Socia Security Buetin, November 1991iVo. 54, No. 11

12 Tabe 1.-Sampe characteristics at enroment, by randomization status- Continued [Entries are percent of sampe with characteristics uness otherwise specified] Characteristic Schoo attendance at enroment Attending... Not attending... Living arrangement In a supervised or semi-supervised setting... With parents... Independent... Unassisted use of transportation Used reguary... Not used reguary... Physica, socia, emotiona status 3 Has been institutionaized... Receiving psychiatric treatment... Disabiities that imit empoyment: Physica 6... Emotiona 7... Socia behavior inadequate for interview 8... Cannot speak ceary in sentences... Exhibits at east one of above characteristics... Intake worker opinion Success in competitive job: High probabiity... Medium probabiity... Low probabiity... Tota Treatment Contro sampe group group Sampe size (number of persons) n For the fu names of the grantees and the project ocation, see page 8. 2 The SSI payment incudes an imputation of the State suppementa payment for sampe members at The CENTER and UWash/PCC because individua-eve data on the State suppementation were not avaiabe for Iinois and Oregon. 3 Categories are not mutuay excusive. 4 Wefare incudes Aid to Famiies with Dependent Chidren and Genera Assistance. 5 For persons with a job, the cassifications are hierarchica and mutuay excusive. Thus, some persons who hed reguar jobs may aso have been in a workshop for part of the year. 6 Incudes severe visua or hearing impairment, seizure disorders, cerebra pasy, genera heath probems, arm/head mobiity probems, whoe body range-of-motion imitations, and ambuatory imitations. 7 Incudes menta iness, chemica or drug dependency or abuse, and maadaptive, anti-socia, or disruptive behavior. 8 Incudes inattention to interview, inabiity to respond appropriatey to questions and conversation; inabiity to make eye contact with interviewer; inabiity to dispay appropriate greetings, postures, or gestures; inadequate grooming or attire; physica appearance and characteristics that are not norma; and exhibition of unusua behavior or gestures. Source: Intake data coection form and SSA records data. institution) that conducts a transitiona empoyment training program trains its cients in the institution s cafeteria. Trainees may work in the dishroom--cearing trays, washing pots, and/or operating a dishwashing machine-or they may work in positions in which there is contact with the pubic, such as bussing tabes or serving on a counter ine. When a dishroom is staffed primariy by program trainees the setting is ess integrated than other modes of transitiona empoyment training, but the reationship to the arger environment of the cafeteria staff and customers compensates to an extent. Two sites used this type of training venue extensivey. This mode has the advantage of accommodating cients whose initia behavior or ow eve of production woud be unacceptabe to a private empoyer even during training. A reated advantage is that the job is fexibe enough to be used to evauate the strengths and weaknesses of the cient, thereby reducing the risk of a subsequent inappropriate job pacement. One site initiay paced its cients with the most pronounced disabiities in jobs in its own cafeteria for evauation. The east intensive form of job coaching is assisting the reguar supervisor in the empoying firm to train the cient. The job coach may spend a few fu days with the cient, but quicky reduces persona contact to daiy or weeky visits with the supervisor and/or cient. This mode ony marginay meets the definition of transitiona empoyment and is ceary suitabe ony for the highest functioning cients. This mode was not adopted as a primary approach by any of the demonstration sites, athough there were some cients who needed ony this eve of training in order to become empoyed. Socia Security Buetin, November 1991iVo. 54, No

13 Duration of Training Another eement in the design of a mode for transitiona empoyment training is the duration of training services the provider wi offer. Athough some existing programs have a time-reguated curricuum, generay based on a schoo semester, most programs adjust training time to the needs of the cient. However, to ensure that the services be transitiona and not permanent, a transitiona empoyment program wi usuay impose a time maximum for the provision of services. Programs aso exercise impicit contro over the duration of services provided by rejecting appicants whom they fee they cannot train within some maximum amount of time. Typicay the transitiona period is imited to between haf a year and a year and a haf. The amount of time a program aows wi vary not ony with the type of popuation it intends to serve but aso with the mode of training it empoys, especiay the type of job coaching. Thus, the design of a service mode must resove simutaneousy the issues of the intensity and ocation of job coaching, the duration of service, and the type of cient to be served. The costs of job coaching in its various forms and the other services provided over time are ceary an important eement in this set of decisions. The time imit on services generay does not appy to ongoing monitoring for probem situations. This monitoring and retraining function may be performed by the initia provider of transitiona empoyment training or by some other agency. The monitoring agency woud typicay ca the empoyer and/ or the empoyee every 2 to 6 months to ascertain that there are no probems that need attention and to remind the empoyee and empoyer that service remains avaiabe. One mode currenty in use accompishes most of the necessary monitoring through famiy or other nonprofessionas who vounteer as mentors. The mentor keeps in constant contact with the worker, brings probems to the agency s attention, and offers the individua guidance in many other areas as we. Transportation and Other Necessary Services An organization operating a transitiona empoyment program may be an agency that provides a fu range of services for persons with menta retardation or some of those services. Or it may be stricty an empoyment and training agency. Thus, the training organization may or may not provide a trainee with counseing, group home or other residentia services, recreationa activities, and case management within the agency. A cient who has achieved the abiity to work independenty may sti need such services and may even need some services not required before becoming empoyed. Transportation is a service that deserves particuar attention because of its cose connection with working and its sometimes high cost. The demonstration found transportation issues to be of overwheming infuence on the success or faiure of the efforts to habiitate cients (see page 21). The training sites often faced tradeoffs between pacing the cient on the job site that best matched that cient s interests and abiities and pacing that cient on the job for which transportation coud be most easiy arranged. The oca mass transit system may be sufficient for the purpose but frequenty is not. First, the system may not serve both the cient s residence and the pace of empoyment, or may impose an unreasonaby ong commuting time because of indirect routes or infrequent schedues. Second, the trainee or empoyee may have difficuty negotiating the system, such as in reaching or eaving transit stops, identifying the correct bus, knowing where to get off, or paying the correct fare. Third, the cient or his or her famiy or other caregivers may fee that the cient s physica security is too vunerabe to risk his or her using pubic transportation. Some of these probems can be overcome through measures ike trave training and finding jobs at convenient times and paces. Aternative forms of transportation may be deveoped, such as ride sharing, contract taxis, speciaized transportation services, or the cient s famiy. Staff Competencies Professiona quaification of staff for transitiona empoyment services is a current subject of debate. A convenient focus for the discussion of this issue is the roe and training of the job coach. The job coach can have a broad range of responsibiities, incuding deveoping jobs, evauation of cients and matching them with jobs, counseing cients and their famiies, case managing the socia services cients may need, and trave training. The job coach can be responsibe for anayzing the tasks of a job as an industria engineer might, so as to be abe to design appropriate training protocos. Aternativey, the job coach s roe may be confined to impementing a prescribed training pan and resoving immediate on-the-job probems. In this case, the other responsibiities may be assigned to speciaists within the agency or deegated to other agencies. If the job coach s responsibiities are broad, the coach may need extensive education and/or experience in socia services, as we 14 Socia Security Buetin, November 1991iVo. 54, No. 11

14 as in training techniques and business practices. Some universities are beginning to offer this type of curricuum in their specia education degree programs with the expicit purpose of quaifying graduates to provide job coaching or simiar services. At the other extreme, it is common for agencies to empoy job coaches with itte or no reated education, preferring, instead, cose supervision of the job coaching by supervisors with the requisite background. Since the training eement of the job coach s duties is quite time-intensive, it may be economica for job coaches without professiona skis, working at commensuratey ower saaries, to perform that eement of the work. The demonstration sites varied consideraby with respect to this design feature. In the section beow, the variation is described in greater detai, aong with the demonstration s finding that adequate services can be provided in the ess costy format, empoying coaches with ess forma education. Training Technique Cients very often require substantia training in socia and ife skis besides job tasks. Common focuses of attention are understanding the roe of the workpace supervisor and the meaning of supervisory instruction, respect for the job as manifested in attendance, appropriate socia behavior with coworkers and supervisors, grooming and persona hygiene, avoiding behavior that is disruptive to the workpace or disconcerting to coworkers, attending to tasks without becoming distracted, teing time or otherwise recognizing when to move from task to task or return from breaks, and, as mentioned earier, traveing to and from the job. Curricua and methodoogies have been deveoped for training in many of these areas and, as experience accumuates, wi be further deveoped and refined. Techniques characterized as behavior modification are adapted to some of these training needs. In the area of job-ski training, a system of task anaysis can be empoyed to break a task down into an extended series of steps. This permits a detaied reckoning of the cients strengths, weaknesses, and progress. It aso faciitates training in sma increments. Six of the sites used standardized forms and charts for this purpose. Another possibe feature of a training program that can be cassified as a training technique is peer support. Some of the eary practitioners of transitiona empoyment training for persons with menta retardation regarded this eement of their programs as essentia. Peers with simiar disabiities share experiences through working together or at weeky meetings of cients who work at separate ocations. The benefits derived from these forms of peer support resembe the benefits that support groups in genera provide their participants, particuary the confidence that comes with knowing that others face and cope with difficuties simiar to one s own. Types and Characteristics of Jobs The focus of transitiona empoyment is the job. The type of job is a transitiona empoyment design issue: Some programs speciaize in certain kinds of jobs, such as food service, and programs may require a job to have certain characteristics, such as heath coverage, to be acceptabe for pacement of cients. Programs ordinariy require that a training job be fexibe. Fexibiity may incude the empoyer s aowing the job to be done in nonstandard ways and at an atered pace and schedue. Frequenty the training organization guarantees production during the training period by having the job coach make up any shortfa. Fexibiity can be important on a permanent job, as we. However, whie ower production standards may be permitted during training, just as they are frequenty permitted in the training period of a nondisabed worker, over a onger period of time either norma production rates must be maintained or wages may be reduced to refect productivity. Job modification is another aspect of fexibiity. A worker with menta retardation may be abe to perform most but not a of the tasks of a given job. A minor redistribution or restructuring of tasks among jobs in a workpace can resut in a job whose responsibiities can be met by the cient. Persons who aso have physica disabiities can be accommodated by modifying equipment or methods. Another approach to ensuring the compatabiity of the worker and the job is job matching. Cients can be matched to jobs based on both abiities and interests. Standardized evauation tests are avaiabe for testing cients abiities to perform specific tasks, athough the demonstration sites generay found these tests to have ow predictive power with respect to the persons in this project. Important evauative information can aso be derived from a job tria, which can ast as ong as 1 or 2 months. Cients interests may be more difficut to discover, since many persons are unfamiiar with the range of jobs that exist in the economy and how these jobs are performed, and any interests cients express may be based on a very imited exposure to and understanding of the aternatives. Socia Security Buetin, November 1991/Vo. 54, No

15 Wages and fringe benefits are an area in which existing programs design their services in differing ways. The training agency may consider a job at minimum wage with no fringe benefits to be better than shetered or no empoyment. Or the agency s poicy may be that heath insurance coverage, paid vacation, and other benefits are necessary for the cients we being and a job shoud not be accepted without them. The jobs for which transitiona empoyment cients are presenty trained most frequenty are in food service, janitoria services, groundskeeping, and aundry. However, smaer numbers of cients are working in cerica, microfiming, ight assemby, and other such jobs. Tabe 2 shows the occupationa categories of the 127 trainees who competed the Transitiona Empoyment Training Demonstration with a permanent job. Some of these jobs, such as dishwasher or janitor, seem to be seected not because they are simpe to perform but rather because they are the most avaiabe in the job market. For exampe, dishwasher jobs are generay avaiabe due to reativey high staff turnover in these positions. However, a dishwasher may have a broad set of responsibiities that make the job ess than idea for a new worker with menta retardation. A dishwasher s tasks frequenty incude oading and unoading the dishwashing machine; sorting dishes, gassware, and fatware; checking that they are cean; deivering them to the appropriate paces in the cafeteria or restaurant; reguating the dishwashing machine, ceaning its fiters, and stocking it with detergent; and keeping the dishroom generay cean. When more than one task is waiting to be done the dishwasher may have to estabish priorities that depend on the circumstances of the moment. Tabe 2.-Occupationa categories of cients successfuy paced on permanent jobs Number of Type of job cients Percent Tota Food service Janitoria Light assemby Cerica Persona service Source: Thornton, (1988, tabe V.2). Dunstan, and Schore In contrast, the job duties of a person doing ight assemby work may be reativey straightforward, making the job idea for transitiona empoyment programs. However, ight assemby jobs are more difficut for transitiona empoyment programs to deveop, in part because they are characterized by ess turnover. These are some of the design variations that are possibe in a transitiona empoyment program. The variations identified as having been incorporated in the demonstration form the context for the findings presented in the next section. Findings of the Process Anaysis The anayses and findings of the Transitiona Empoyment Training Demonstration fa into two genera categories. The impact anaysis is based on measured differences in outcomes between the training and contro groups. The process or impementation anaysis is based on observation of and information about the manner in which the demonstration was conducted. This artice is in the atter category. A report on the impact anaysis (Thornton and Decker, 1989) deas primariy with earnings and empoyment of participants and costs and benefits of the project. Outcomes for subgroups of the sampe are anayzed and correated with various characteristics of the participants. Because the evauation was fieded as an experiment, with participants randomy assigned to the treatment and contro groups, the estimated impacts can be attributed to the transitiona empoyment with a known degree of precision. The process anaysis is party descriptive and party inferentia. The findings presented in the process report (Thornton, Dunstan, and Schore, 1988) and in this artice are argey based on the site monitors cose observation of demonstration operations. Site monitors periodicay reviewed the poicies and procedures of the sites, interviewed the sites administrators and staff, reviewed sites budgets and expenditures, conducted joint meetings of personne from a sites to discuss operations, observed cient intake interviews, and observed cients being trained on jobs. The anaysis aso considered data on the oca economies, the avaiabiity of shetered workshop and other services in the respective ocaities, and statistics by site on pacement of trainees in training jobs and potentiay permanent jobs. The reiabiity of the concusions drawn from this information is enhanced by the muti-site structure of the demonstration. On the one hand, the differences among the eight sites permitted comparisons on severa interesting points. On the other hand, the operations of a sites had very much in common, and they were a monitored from a uniform perspective by a singe evauation team. Nevertheess, by its nature the process anaysis does not have the same degree of scientific vaidity as the impact anaysis. The findings presented in this section are thus suggested, rather than ceary demonstrated, by the anaysis. 16 Socia Security Buetin, November 1991iVo. 54, No. 11

16 Outcomes Three short-term outcomes for the 375 persons who were enroed in the training group and associated programmatic concusions are as foows. A tota of 127 participants, 34 percent of the 375 trainees, were hoding potentiay permanent jobs when they competed the project. Another 57 participants (15 percent) were paced in one or more potentiay permanent jobs but faied to retain those jobs. An additiona 70 participants (19 percent) were paced in training jobs but coud not be subsequenty paced in potentiay permanent jobs. The remaining 121 participants (32 percent) were not paced even in a training job. The average hoder of a permanent job was earning $111 per week for 27 hours work as of the end of his or her enroment in the program. In an average month in which the worker had no unpaid time off, earnings woud be approximatey $480. This amount of earned income woud ead to a reduction in the individua s monthy SSI payment of amost $200 for a person who woud have had no income in the absence of the training program. However, this information aone is not an adequate basis for projecting future reduced SSI payments based on earnings. Even the most optimistic expectations of job retention aow for some decine over time in the number of persons empoyed. If earnings from permanent jobs at exit from the demonstration are averaged over a members of the training group, rather than just over those in permanent jobs, average earnings woud be $38 per week. This does not incude earnings of trainees who were in training jobs at exit. Hours of empoyment, amount of earnings, and reduced SSI payments based on earnings are being foowed over time through the reinterview of participants in ate 1988 and periodic review of SSI administrative records. Demonstration services cost about $7,650 per participant6 and woud cost about $5,600 per cient in a simiar but ongoing program. Of the $7,650 cost, somewhat more than $2,000 per person is attributabe to the resources used in starting up and terminating the demonstration program. It is estimated that the same service coud have been provided for about $5,600 per cient by simiar organizations operating in a steady state over the ong run. This amount incudes expenditures for job coaching, job deveopment, outreach, and other tasks performed by direct service personne, as we as program administration and an aocated portion of agency overhead. These figures are a weighted average of the experiences of the demonstration sites. Cost per participant can be much ower or higher, depending on the resources that an agency devotes to job coaching and job deveopment, the efficiency of management, success in pacing cients for training, and simiar considerations. Findings and Impications Eight findings of the process anaysis are presented as suggestions for future research and as considerations for providers and panners of transitiona empoyment services. Cients needs are diverse and wide ranging. The experience of the demonstration confirmed the diversity of persons with menta retardation. Participants entered the program with a wide range of needs, interests, and abiities. Of particuar reevance to the demonstration and its focus on empoyment is that they came with different eves of work experience, prior education and training, famiy support, orientation toward work, desire for socia integration, genera heath status, and presence of secondary impairments. Some of the persons enroed were abe to earn their jobs in a day or two. Others required months of training. Sti others were abe to earn the production aspects of their job quicky, but needed extended training in interpersona and other skis. For exampe, many of the trainees acked the skis to communicate or work appropriatey with supervisors, coworkers, and customers. Some participants were inappropriatey friendy to their coworkers whie others were overy distant or hostie. There were probems in accepting criticism from supervisors and distinguishing between the reative authority of supervisors and coworkers. Some stayed on their work breaks onger than schedued whie others enjoyed working so much they faied to take their schedued breaks. Training was needed in areas such as persona hygiene and attendance. Behavior probems, which caused tensions between the participant, supervisors, and other workers, needed to be addressed. Behavior probems posed some of the strongest chaenges, particuary when these probems were due to menta iness. For exampe, sites enroed severa persons with schizophrenia in addition to menta retardation. These cients coud earn the production aspects of the job, but had recurring episodes of disruptive behavior. Such cients generay Socia Security Buetin, November 1991/Vo. 54, No

17 required a disproportionate amount of service. Providers had to decide whether to devote extra resources to serving a person with menta iness considering, among other things, whether the individua coud be stabiized on a job within the 1 year imit on services. After the experiences of working with severa eary enroees with difficut behavior probems, a few sites determined that they acked the necessary service structure, and they began to screen out appicants with menta iness. Besides the training needs, sites aso faced cients needs for case management services. These services, when needed, were considered directy reated to the empoyment and training responsibiities of the sites, because it is unikey that any job pacement woud be viabe if a cient has nonvocationa probems that are not being addressed. Staff devoted considerabe time to providing case management services. Coordination and management of services was often necessary even among participants whose needs for other services were adequatey met before enroment. A new job coud potentiay disrupt an existing support network invoving parents, friends, and the staff of various service agencies. These networks may have heped participants with virtuay a aspects of their ives: decision making, trave, money management, homemaking, interpersona reations, hygiene, and grooming. The participant and the persons who provided assistance had to adapt to new schedues and adjust to new demands and expectations in order to accommodate to a new job. Case management services were needed to maintain this network intact or to effectivey repace it so that the overa needs of the participant woud continue to be met. For exampe, the rues of many group homes precuded residents from remaining in the home during the day. These homes were unsupervised during the day when residents were expected to be in daytime activities such as shetered workshops or activity centers. Uness specia arrangements coud be negotiated with the home, a resident coud be constrained from accepting an otherwise suitabe job whose hours did not coincide with the standard business day. Coordination was aso necessary with group homes over issues such as the timing of meas and the extent to which the home s staff woud reinforce the work behaviors that job coaches were trying to teach participants. Getting a job aso created needs for new services as cients began to trave to and from their jobs, to interact with a wider range of persons on and off the job, and to earn and spend money. Programs that are more fexibe in responding to cient needs are more successfu in pacing cients. The counterpart of such diversity in cient needs and abiities is that programs must be quite fexibe in provision of services. Thus, it is not surprising that the demonstration sites that paced cients in a wide variety of jobs were more successfu than sites that restricted cients to food service and janitoria jobs. Agencies that routiney put a trainees through a food service or simiar curricuum forecose the possibiity of successfuy serving some cients. Programs with fixed curricuums were at a decided disadvantage in the demonstration. In essence, the recruitment process presented each of the eight programs with a crosssection of those SSI recipients with menta retardation who were interested in jobs. Programs with rigid structure were hard pressed to serve this cross-section and generay either had to seect ony those persons for whom the program s specific structure was appropriate or had to enro persons who might have been better served with a different approach. For exampe, two of the programs initiay paced a of their participants in training positions avaiabe at ony a few job sites. These programs coud not we serve participants who found trave to those training-job sites difficut or whose interest or aptitude was in other jobs. This finding suggests that uness a program can screen appicants carefuy to assess aptitudes, interests, and abiities, the program is ikey to have greater success if it adopts a more fexibe curricuum than if it focuses on providing training for specific jobs or in specific ocations. Programs that enro a diverse mix of persons, as the demonstration sites did, need to have the capacity to find jobs that interest and suit their diverse caseoad and the capacity to provide a wider rage of training intensities and durations. Programs with this capacity wi pace a higher fraction of their participants on jobs and are ikey to make onger asting pacements. Job deveopment is a major chaenge for transitiona empoyment programs. Acceptance of transitiona empoyment by empoyers is not widespread in any industry, as this demonstration confirmed. Reativey speaking, however, the food service and hote industries appear to be the most open to transitiona empoyment pacements. Comments and observations of empoyers of demonstration cients indicate that those hospitaity industries commony hire workers who do not fit the fu-time, ong-term, prior-work- 18 Socia Security Buetin, November 1991No. 54, No. 11

18 experience mod. It appears that firms in these industries are, therefore, aso more amenabe to hiring workers who are atypica in other respects, such as transitiona empoyment workers with menta retardation. Athough pacement in nonhospitaity jobs was difficut, it was not impossibe. Over a third of the demonstration s participants who got and hed potentiay permanent jobs were working in ight manufacturing, cerica, and simiar jobs. Cients showed that they coud perform such jobs successfuy, as we. The chaenge facing job deveopers is to find a job that matches the participant s interests and abiities with the characteristics of the job and the capacities of the program. The match must consider the cient s trave needs, vocationa interests and aptitude, and socia functioning and the job s hours, wages, fringe benefits, eve of supervision, and ski requirements. The success of a training program depends on its abiity to make good job matches and its capacity to support those matches with the services that the cients need in those jobs. Referras of cients may be difficut to obtain. Ony about 5 percent of individuas eigibe to participate in the demonstration enroed either as trainees or members of the contro group. This fraction is more than adequate from the perspective of the size of a demonstration project. But considering that virtuay a eigibe persons were invited to enro, it seems to show a ess than enthusiastic attitude toward transitiona empoyment within the cient community. The demonstration encountered reuctance on the part of some parents and socia workers of persons with menta retardation to permit and encourage participation. This was unexpected, since advocacy groups had expressed the conviction that persons with menta retardation and their parents and advisers were eager to use transitiona empoyment services. The proportion of enroees at some sites who were not receiving services from any agency was a surprise to those sites and ed to the surmise that parents who were more active and successfu in arranging services for their chidren were satisfied with the status quo and were not receptive to considering a quick change to transitiona empoyment. Schutz (1986) has pointed out that many parents are confused about the appropriateness of competitive empoyment for persons with more severe retardation. Many had accepted that the best that their son or daughter coud hope for was a shetered workshop job. Their present service provider may be _ reinforcing that beief. Furthermore, over the past 10 years parents have seen changes in professiona and nonprofessiona opinion about the feasibiity and desirabiity of community integration and competitive empoyment and may have been skeptica about this atest round of new service. Even parents who are sure that they want competitive empoyment for their chidren may have doubts about the abiity of the service system to deiver a the appropriate services. In particuar, they are ikey to fear that individuas woud be paced on jobs without a ong-term support system necessary to maintain those jobs. They may fear that the system has not reay changed from what Rusch (1983) described as pace and pray to a pace, train, and maintain approach to empoyment. Famiies may have aso been concerned about the circumstances of the demonstration, which was schedued to run for ony 30 months. In addition, SSA s sponsorship of the demonstration may have raised doubts. The demonstration began shorty after a period of substantia adverse pubicity about the disabiity review process. Athough specia waivers were instituted to protect participants SSI eigibiity and a nationa moratorium on disabiity reviews was announced just prior to the demonstration, SSI recipients may have been worried that enroing in an SSA-sponsored program might ead to a finding that they were no onger disabed. The esson from this experience is that there are many SSI recipients who at this time are uninterested in transitiona empoyment services provided by SSA. Athough it is impossibe to identify the separate effects of genera concerns about transitiona empoyment from specific concerns about the demonstration or SSA, it nevertheess seems wise to incude specific pans for addressing these types of concerns in panning future transitiona empoyment programs. Changes in SSI rues in 1987 protect persons who work despite a severe impairment and shoud hep address these concerns. Program operators can aso pan for and emphasize the avaiabiity of ongterm support, and they can incude parents and other interested parties in the service-panning process. Finay, additiona evidence about the success of transitiona empoyment training wi hep to encourage individuas to earn about the services and the advantages of competitive empoyment. Athough cients enroed in the demonstration argey in response to the informationa materia maied to them by the Socia Security Administration, sites aso soicited referras from other agencies serving persons with menta retardation, Socia Security Buetin, November 1991/Vo. 54, No

19 Reationships among agencies vary from pace to pace and over time, so it is difficut to generaize about them. But it can be said, at the very east, that most of the demonstration s sites did not gain the fu cooperation of the shetered workshops in their areas, despite strong attempts. This may have been due to a variety of reasons, incuding, possiby, simpe competition for cients. Or it may be, as sometimes aeged, that workshops are more pessimistic about what their cients might achieve through transitiona empoyment services. Changes are taking pace, however, in this area of socia service, so this situation is ikey to improve. 0 Training can be provided effectivey by job coaches without professiona education. The professiona background needed by job coaches is, among other things, a cost issue. Some practitioners of transitiona empoyment for mentay retarded persons advocate that job coaches have graduate or undergraduate degrees in reevant discipines and broad responsibiities for task anaysis, job deveopment, counseing, and other services, as we as coaching. Because such personne generay command higher saaries, and because job coaching is a particuary time-intensive part of transitiona empoyment services, the issue of the forma training needed by job coaches has significant cost impications. The demonstration sites adopted a variety of staffing configurations to provide the needed services. The major differences pertained to the educationa backgrounds of the staff, the extent to which direct service staff were supervised, and the degree of speciaization among the staff. Some job coaches had masters degrees in specia education or rehabiitation whie others had not attended coege or were undergraduate students. Most job coaches had experience in education, training, or rehabiitation, but some coaches were hired because of their experience with business or industry or simpy because they seemed sufficienty mature and enthusiastic to provide the training. Except for staff at agencies that had previousy operated transitiona empoyment programs, very few staff came to the demonstration with experience in transitiona empoyment. The modes of job coach supervision aso differed substantiay. A coaches were required to make reguar reports on cient progress to their supervisors, but the content and expected eve of detai of those reports varied. Some supervisors monitored cients progress by taking directy with the cients and empoyers. Supervisors aso required different degrees of recordkeeping and direct monitoring. The records generay deat with the participant s job progress. Record formats ranged from ogs maintained by the job coaches to detaied quantitative records of participants performance of a of the tasks and subtasks of their job. Finay, sites differed with respect to the degree to which their staff speciaized. One staffing approach had the job coaches responsibe for virtuay a services to the participants. These coaches, who were often given more genera job tites such as empoyment speciaist, deveoped jobs, provided a of the necessary training (incuding trave training and training in socia skis, if necessary), and provided any necessary case management of community services. Under another staffing approach, staff members speciaized in specific services. In this mode a participant may be provided services from an intake worker, an evauator, a job deveoper, a counseor, and a job coach. Demonstration sites deivered effective services using a variety of staffing and supervisory structures. The key design eement was to match the eve and content of staff supervision to the staffs abiities. Thus, the demonstration found that transitiona empoyment services can be deivered effectivey even if job coaches have itte forma training in rehabiitation and education, so ong as a professionay prepared and effective service coordinator designs the training pan and monitors the coaches. One site that had empoyed ony coaches with masters-eve education changed its poicy whie the project was in progress. The quaities that the sites vaued most in a prospective job coach were experience with business and industry, maturity, enthusiasm, patience, communication skis, and a good attitude toward persons with menta retardation. It is difficut to identify the cients who are ikey to succeed in achieving permanent empoyment. Good methods to screen participants woud make it possibe to target transitiona empoyment training ony to persons who are ikey to benefit from it. This woud reduce expenditures on cients for whom the service is not appropriate. Better assessment toos woud aso encourage referras to transitiona empoyment because the referring agency woud have more confidence in the appropriateness of transitiona empoyment for the person being referred. The demonstration did not attempt extensive screening, in part to determine specificay what sort of cients are best served. That is, one goa was to discover strong correations between particuar characteristics of the individuas and 20 Socia Security Buetin. November 1991iVo. 54, No. 11

20 success or faiure in the program, so that screening methods coud be recommended for use in future programs. The finding of the demonstration in this regard was that success in achieving permanent empoyment was not we correated with IQ score, secondary handicaps (except behaviora, as noted), or any other singe characteristic measured. However, a subjective prediction by the intake worker of the ikeihood of success in the program was recorded at the time of enroment. This prediction was significanty correated with the probabiity that a participant woud be paced successfuy on a job. One interpretation of the intake worker s abiity to predict success is that the intake worker forms his or her opinion on the basis of many potentiay compensating cient abiities and behaviors, some of which are not readiy quantified. Thus, an intake worker may be abe to correcty assess the person s motivation to work or the support that wi be provided by the person s famiy and other service providers. In addition, intake workers may be abe to judge that a cient who is weak in some few areas can sti succeed, because the individua has some compensating strengths. Further research might deveop an index for weighting the strengths and weaknesses of cients and produce more objective and accurate evauations of success potentia. A characteristic that appeared to be reated to cient faiure was emotiona disturbance or menta iness. As the demonstration progressed, sites discovered they coud work with most persons regardess of the eve of functioning presented if the trainee was abe to get to the job. However, sites aso found that behaviora probems were difficut to resove and that these probems coud not aways be addressed fuy within the timeframes of transitiona empoyment. The extent to which the behavior was subject to improvement was difficut to predict. Inappropriate workpace behavior exhibited in a shetered, segregated environment did not appear to indicate reiaby that the cient coud not be trained to conform to the requirements of an integrated workpace. One of the principa advantages of transitiona empoyment training in a rea job is the infuence of the environment on the behavior of the trainee. Site personne have expressed the beief that their predictions woud have gained in accuracy over the first 4-8 weeks of service to the point of being quite reiabe by that time. This assertion is as yet not verified, but it suggests that transitiona empoyment programs shoud afford appicants a tria period of training on a job, even when the prospective cient appears somewhat ess than ideay suited for the service. Such a tria woud give cients a better understanding about work and woud provide the programs a more compete picture of the strengths and weaknesses of the cients (particuary with respect to motivation, famiy support, behavior, and other characteristics that are difficut to measure). Transportation probems severey imit the success of transitiona empoyment programs. Limitations on the avaiabiity of transportation between cients homes and jobs made the process of job deveopment and training difficut. Transportation issues pervaded a aspects of pacement and training. Program operators reported that there were cients who coud have been integrated successfuy into avaiabe fu-time jobs that matched their abiities, but were instead reegated to part-time work, jobs for which they were not as we suited, or no pacement at a, because of transportation probems. It is notabe that transportation was a critica issue at the arge-city sites, where there are extensive mass transit systems, in the medium size cities, and in the more rura areas. Bus routes and schedues that did not accommodate a prospective job, or the cient s inabiity to trave by bus, were the main imitations. In genera, sites found it easier to arrange for transportation the more extensive was the oca pubic transit system. However, the avaiabiity of such a system did not aways eiminate transportation probems. In severa arge cities, participants refused to use the pubic transportation system because of fears of crime. Participants who ived in sections of cities where there were few jobs often faced ong commutes to work. Some participants had bus rides exceeding an hour and a haf and had to make one or more transfers. In these instances, the presence of a pubic transportation system made getting to a job feasibe, but not easy. When sites trained a participant to trave, they used a variety of approaches. When the route was difficut or the participant had difficuty earning, the trainer might meet the trainee reguary at the bus stop to ensure that the trainee got on the correct bus or might foow the bus to ensure that the trainee got off at the right stop. Aids to trave training incuded bus passes so that the trainee woud not have to figure and carry the exact fare and pictures of the route sign carried by the right bus. Bus service is simpy unavaiabe at worksites in some suburban and rura areas. Where pubic transportation was unavaiabe or participants coud not be trained to get to their jobs by themseves Socia Security Buetin, November 1991/Vo. 54, No