Supported Employment, Demographic Covariates, and Adjunctive Vocational Rehabilitation Services as Predictors of Competitive Integrated Employment for Young Adults with Intellectual and Developmental Disabilities: A Hierarchical Logistic Regression Analysis

doi:10.21203/rs.3.rs-3335575/v1

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Research Article

Supported Employment, Demographic Covariates, and Adjunctive Vocational Rehabilitation Services as Predictors of Competitive Integrated Employment for Young Adults with Intellectual and Developmental Disabilities: A Hierarchical Logistic Regression Analysis

https://doi.org/10.21203/rs.3.rs-3335575/v1

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Purpose

Compelling evidence strongly supports competitive integrated employment (CIE) as a driving force for improving the economic well-being, as well as the physical and mental health, and overall quality of life for individuals with Intellectual and Developmental Disabilities (IDD). However, the employment participation rate for those with IDD remains notably lower than those without IDD. Supported Employment (SE) is evidence based vocational rehabilitation intervention, which offers personalized workplace support necessary for successful performance within CIE settings. This study aims to predict CIE outcome for youth and young adults with IDD by evaluating demographic variables, SE, and adjunctive state vocational rehabilitation agency (SVRA) services.

Methods

This study sample included 67,884 youth and young adults with IDD extracted from the U.S. Department of Education's Rehabilitation Services Administration Case Service Report dataset. Our analytical approach was logistic regression analysis.

Results

The findings indicated that SE had a highly significant association with positive CIE outcomes. Participants who received SE were considerably more likely to achieve CIE compared to those who didn't. Adjunctive SVRA services also played a crucial role, with notable differences in CIE odds between those who received workplace support, job placement assistance, and job search assistance and who didn’t. The final model explained 27% variance in a CIE outcome.

Conclusions

These findings underscore the efficacy of SE in supporting youth and young adults with IDD in achieving CIE. Consequently, this study's insights hold potential to guide vocational rehabilitation professionals in optimizing SE delivery alongside adjunctive SVRA services.

supported employment

intellectual and developmental disabilities

vocational rehabilitation services

competitive integrated employment

hierarchical logistic regression analysis

The Workforce Innovation and Opportunity Act of 2014 (WIOA) and the Rehabilitation Act of 1973, as amended, emphasized competitive integrated employment (CIE) as the preferred employment outcome for people with disabilities receiving services from state vocational rehabilitation agencies (SVRAs). WIOA [1] defined CIE as full or part-time work at minimum wage or higher, with wages and benefits similar to those without disabilities performing the same work, and fully integrated with coworkers without disabilities. Taylor and his colleagues [2] conducted a systematic review to examine the association between CIE, and economic well-being, physical health, and mental health outcomes for individuals with intellectual and developmental disabilities (IDD). They found strong evidence to support CIE as a pathway to improve the economic well-being, physical and mental health, and overall quality of life of people with IDD. Although CIE is essential for people with and without disabilities, a significant disparity in employment rates persists between individuals with disabilities and those without. According to the 2020 American Community Survey, approximately 38% of working-age adults with disabilities are engaged in employment, in contrast to the 74% employment rate among individuals without disabilities [3]. When considering employed individuals with disabilities, a higher proportion of them tend to have part-time positions (26%) compared to those without disabilities (15%) [4]. This inequality in employment participation is even more pronounced for individuals with IDD. Notably, data from the National Core Indicators project reveals that during 2018–2019, merely 18% of working-age adults supported by state IDD agencies were able to secure paid jobs within the community [5]. Furthermore, those who manage to secure employment usually work with restricted hours and low wages [5]. While more individuals with IDD are in integrated employment, the number of individuals with IDD participating in facility-based and non-work services has grown more rapidly. The expansion of community-based non-work services has eclipsed competitive integrated employment as the prevailing option for individuals with IDD [6]. Specifically, in 2018, only 21.5% of individuals with IDD were receiving day support services in integrated employment from IDD agencies while those receiving non-work services grew more rapidly than those receiving CIE [3]. This implies that employment services are still supplementary rather than constituting a comprehensive systemic change [3, 7–9].

Supported Employment (SE) is an evidence-based intervention for individuals with the most significant disabilities that provides individualized workplace supports needed for successful job performance in competitive integrated employment settings [10, 11]. Since the early 1980s, support employment has been implemented as the employment intervention of choice for individuals with IDD in the US and internationally. A key aspect of SE is the “place then train” approach, a process of first securing CIE for an individual and then providing needed workplace support [12]. SE was manualized in 1997 by describing the components of SE [13]. The manual details the core features of SE services including four distinct phases presented in Table 1[14].With SE, everyone, regardless of the level or the type of disability, is deemed capable of CIE. Further, the implementation of SE is a comprehensive approach that requires trained employment specialists to implement an array of interventions at each of the four phases presented in Table 1 [14, 15].

In addition to the desirability of CIE to increase the financial, physical, and mental health and well-being of individuals with IDD, it is also an efficacious outcome. Cost-benefit analyses of employment services for individuals with IDD clearly showed that employment service models that were integrated into the community provided greater cost-benefit than those which did not [16, 17]. Iwanaga and her colleagues [18] found that transition-age youth and young adults with ID who received SE service from SVRA had their cases closed in CIE at a rate of 71%, a significantly higher rate of successful employment than the 43% rate of their peers who did not receive SE service. Wehman et al. [19] found that transition-age youth with ID who received special education in secondary school and were Supplemental Security Income (SSI) recipients (N = 3687) had the highest propensity to receive SE (62%). Of the individuals who received SE as a vocational rehabilitation intervention, 58% were employed at case closure which was significantly higher than the employment rate of those who did not receive SE (37%), a 21% difference. Although less impressive results were found for other subgroups, the propensity-adjusted estimate of the overall effect of SE on employment outcomes demonstrated that individuals with IDD who received SE services had, on average, a 12.49% higher employment rate than individuals who did not receive SE.

The main disconnect between research findings on CIE outcomes for individuals with IDD receiving SE compared to those observed in real-world settings is largely due to a lack of training among service providers. This hypothesis is corroborated by the findings from a recent national Delphi Study. Schall et al. [20] surveyed 67 key stakeholders across the U.S. including adults with IDD, their family members, researchers, employment service providers, and transition-age educators, and found that stakeholders agreed that SE was a socially valid intervention, however, it was not easy to obtain in their communities, and not delivered by trained service providers [20]. The lack of trained providers to deliver SE is a significant problem depressing access to SE for individuals with IDD.

Some of this confusion may stem from the funding agency, the U.S. Department of Education, Rehabilitation Services Administration’s (RSA) definition of SE services. RSA defines SE services as “ongoing support services, including customized employment, and other appropriate services needed to support an individual with a most significant disability in maintaining supported employment” (Policy Directive RSA-PD-19-03) [21]. The actual four phases of the SE model presented in table 1 are included as adjunctive SVRA servicesin the funding formula (Policy Directive RSA-PD-19-03) [21]. Thus, the definition of SE services is vague, while the actual SE process that has been validated by research is considered “adjunctive”. Finally, despite the existence of SE competencies and training, there is no industry requirement that community rehabilitation providers deliver services meeting any standard of fidelity [15]. To truly evaluate the success of SE for individuals with IDD, it is necessary to examine the effectiveness of SE plus the adjunctive SVRA services titled job search assistance, job placement assistance, and workplace support. These three adjunctive services account for the four phases of SE as it was developed and researched [11]. Finally, there is evidence that the income limits placed on individuals who receive federal disability benefits such as Supplemental Security Disability Income may act as a disincentive for CIE [22–24]. Thus, we also elected to examine the impact of an adjunctive SVRA service called work incentives planning and assistance.

Purpose of the Study

This study aimed to evaluate demographic variables, SE, and adjunctive SVRA services as predictors of CIE outcomes for youth and young adults with IDD. The specific research questions that guided this study were:

What demographic variables contribute to predicting CIE outcomes for youth and young adults with IDD?
How much does SE predict CIE outcome beyond the variance already explained by demographic covariates of youth and young adults with IDD?
What adjunctive SVRA services contribute to the prediction of CIE outcome beyond the variance already explained by demographic covariates and SE of youth and young adults with IDD?
How much do demographic variables, SE, and adjunctive SVRA services together predict CIE outcomes for youth and young adults with IDD?

Study Cohort

The U.S. Department of Education, Rehabilitation Services Administration Case Service Report (RSA-911) dataset is the administrative data collected by each SVRA on individuals who exited services in a program year (PY) [21]. The RSA-911 data includes information on demographics, disability, service interventions, and employment status when recipients exit services. The data set from the RSA-911 for PY 2021 was used for the present analyses as it is the most current dataset available at the time of this study. The inclusion criteria for this study were: (a) ages of 18 and 35 (i.e., transition age youth and young adults), (b) a primary diagnosis of IDD at intake, and (c) case closed as successfully employed or not employed after receiving SVRA services. IDD were identified if RSA-911 data’s primary disability sources are Attention-Deficit Hyperactivity Disorder (ADHD), Autism, Cerebral Palsy, Congenital Condition or Birth Injury, Epilepsy, Intellectual Disability, or Specific Learning Disabilities. The sample in this study included 67,884 transition age youth and young adults who met the inclusion criteria and whose cases were closed in PY 2021. The sample included 43,529 (64.1%) males and 24,355 (35.9%) females. The largest number of SVRA recipients were European Americans (n = 38,896, 57.3%, followed by African American (n = 14,009, 20.6%), Hispanic (n = 11,730, 17.3%) and other (n = 3,249, 4.8%). The mean age of the samples at intake was 21.92 years (SD = 4.71). Approximately 41,140 participants (n = 60.6%) held a high school diploma or special education certificate, while 7,138 participants had not completed high school (10.5%). Around five percent of the participants (n = 3,593, 5.3%) completed a 4-year college or higher. About forty percent were referred by an educational institution (n = 27,776, 40.9%), while 32.3% (n = 21,896) referred by themselves, friends, or family. Almost half were low income (n = 32,488, 47.9%).

<< Insert Table 2 Here>>

Table 2

*Participant Characteristics (*N *= 67884)*
	n	%
Dependent variable Competitive Integrated Employment (Yes)	30,740	45.3%
Demographic variable Gender
Male	43,529	64.1%
Female	24,355	35.9%
Race
White	38,896	57.3%
Black	14,009	20.6%
Hispanic	11,730	17.3%
Other	3,249	4.8%
Education
Less than High School	7,138	10.5%
High School or Special Education diploma	41,140	60.6%
Associate degree	2,058	3.0%
4 year college or higher	3,593	5.3%
No information	13,955	20.6%
Referral sources
Self/friends/family	21,896	32.3%
Educational institution	27,776	40.9%
Community-based rehabilitation organization	2,476	3.6%
Medical and mental health provider	2,294	3.4%
Other	13,442	19.8%
Low income (Yes)	32,488	47.9%
SE (Yes)	9,294	13.7%
Job search assistance (Yes)	11,351	16.7%
Job placement assistance (Yes)	13,152	19.4%
Workplace support (Yes)	7,883	11.6%
Work incentives planning assistance (Yes)	3,724	5.5%

Independent Variables

The demographic characteristics of study participants, SE and adjunctive SVRA services were considered predictors for this study. Demographic variables included ages (with ages from 18 to 21 as the reference group), gender (with male as the reference group), race/ethnicity (with White as the reference group), education (with less than high school as the reference group), referral source (with self/family/friends as the reference group), low income (with not low income as the reference group). Adjunctive SVRA services included job search assistance, job placement assistance, workplace support, and work incentives planning and assistance (see Table 2 for a description of each service variable). The reference category for all SVRA services was participants who did not receive the specific service (No) compared to participants who had received the specific service (Yes). The demographic characteristics and the number of participants who received each of the SVRA services is presented in Table 1.

Table 1

*Four Phases of Supported Employment* [14]
Phase	Description
Phase 1: Strengths-Based Assessment	The job seeker works with an employment specialist to complete person-centered planning, undergo disability benefits counseling, complete observations, and community-based assessments to develop a profile of employment strengths, interests, and preferences.
Phase 2: Marketing and Individualized Job Development	The job seeker and employment specialist engage in a job search to find the best employment match. This phase includes all activities associated with job searching, job on-boarding, job negotiation, job analysis, workstation modification and design.
Phase 3: On-the-Job Training and Supports	The employment specialist partners with the business and the new employee to ensure the employee performs their job independently. This phase includes direct instruction to ensure the new employee meets the employer’s expectations with minimal direct support. It also includes facilitating the natural supports of the workplace allowing the business to assume supervision and support of the worker. Once the employee completes 80% or more of their job independently, they move to the final phase of SE.
Phase 4: Ongoing (Long-Term) Supports	During this phase, employment supports are provided sporadically to address the employee or employer’s training needs including retraining new business protocols, adjusting to changes in job responsibilities or requirements, adjusting to new managers or co-workers, providing disability awareness training to managers and co-workers.

<< Insert Table 3 Here >>

Table 3

*Description of Vocational Rehabilitation Services*
Type of Service	Description
Supported employment	Supported Employment services are ongoing support services, including customized employment, and other appropriate services needed to support an individual with a most significant disability in maintaining supported employment.
Job search assistance	Job search activities support and assist an individual in searching for an appropriate job. Job search assistance may include help in resume preparation, identifying appropriate job opportunities, developing interview skills, and making contacts with companies on behalf of the consumer.
Job placement assistance	Job placement assistance is a referral to a specific job resulting in an interview, regardless of whether or not the individual obtained the job.
Workplace support	Support services provided to an individual who has been placed in employment in order to stabilize the placement and enhance job retention.
Work incentives planning and assistance	Assistance provided to an individual who is interested in becoming employed, but is uncertain of the impact work income may have on any disability benefits and entitlements being received, and/or is not aware of benefits, such as access to healthcare, that might be available to support employment efforts.

Table 4

*Hierarchical Logistic Regression Analysis for Prediction of Employment Outcome (*N *= 67884)*
		Each step					Final model
	R²	Beta (B)	S.E.	Wald ꭓ²	p level	Odds Ratio	Beta (B)	S.E.	Wald ꭓ²	p level	Odds Ratio
Step1 Demographic variable	.06
Age (Ages 18–21)		0.29	0.02	207.25	< .001	1.33	0.18	0.02	70.27	< .001	1.20
Gender (Male)		-0.15	0.02	77.77	< .001	0.86	-0.11	0.02	35.05	< .001	0.90
Race (White)				327.96	< .001				213.78	< .001
Black		-0.29	0.02	202.37	< .001	0.75	-0.33	0.02	211.20	< .001	0.72
Hispanic		-0.31	0.02	200.12	< .001	0.73	-0.07	0.02	7.73	0.005	0.94
Other		-0.20	0.04	26.67	< .001	0.82	-0.14	0.04	10.94	< .001	0.87
Education (Less than HS)				1457.31	0.00				1822.68	0.00
HS diploma or equivalent		0.63	0.03	483.33	< .001	1.87	0.55	0.03	313.39	< .001	1.74
Associate degree		1.20	0.05	508.81	< .001	3.32	1.37	0.06	587.76	< .001	3.95
4 years or higher		1.68	0.05	1303.11	< .001	5.37	1.94	0.05	1557.27	< .001	6.98
No information		0.69	0.03	463.99	< .001	2.00	0.61	0.04	294.11	< .001	1.84
Referral (Self-family Friends)				92.88	< .001				43.52	< .001
Educational institution		-0.19	0.02	77.16	< .001	0.83	-0.04	0.02	2.85	0.09	0.96
CBRO		0.07	0.04	2.38	0.12	1.07	0.01	0.05	0.09	0.77	1.01
Medical/Mental health providers		-0.13	0.05	8.58	0.00	0.88	-0.05	0.05	1.15	0.28	0.95
Other		-0.11	0.02	23.28	< .001	0.90	-0.16	0.03	40.33	< .001	0.85
Low income (No)		-0.14	0.02	74.03	< .001	0.87	-0.19	0.02	114.04	< .001	0.83
Step2 SE	.15
SE (No)		1.76	0.03	4126.97	0.00	5.82	1.72	0.03	3619.21	< .001	5.58
Step3 Adjunctive VR services	.27
Job search assistance (No)		0.44	0.03	315.70	< .001	1.55	0.44	0.03	315.70	< .001	1.55
Job placement assistance (No)		0.99	0.02	1776.19	0.00	2.70	0.99	0.02	1776.19	< .001	2.70
Workplace support (No)		1.56	0.03	2310.07	0.00	4.77	1.56	0.03	2310.07	< .001	4.77
WIPA (No)		-0.08	0.04	4.20	0.04	0.92	-0.08	0.04	4.20	0.04	0.92
Constant							-1.24	0.04	1110.79	< .001	0.29
CBRO = Community-based rehabilitation organization, WIPA = Work Incentives Planning and Assistance
Parenthesis in variables indicate reference group

Outcome Variable

The outcome variable in this study was competitive integrated employment after receiving and exiting SVRA services (CIE vs unemployment at SVRA services closure).

Data Analysis

The IBM SPSS Statistics Version 27.0 for Mac was used for all analyses. Descriptive statistics were computed to report frequencies and mean values for the independent and outcome variables. Missing values were replaced by using means of nearby points. The primary analysis was conducted using hierarchical logistic regression analysis (HLRA) to determine the incremental variance in CIE outcome accounted for by each predictor set. In this study, the variable sets were entered sequentially: Step 1– demographic covariates (age, gender, race, education, referral sources, low income), Step 2– SE, Step 3– adjunctive SVRA services (i.e., job search assistance, job placement assistance, workplace support, and work incentives planning and assistance).

First Step

In the first step of the HLRA, demographic variables were entered, including age, gender, race, education, referral sources, and low income. The HLRA results are presented in Table 3. The omnibus test for the logistic regression model was found to be statistically significant, χ²(14, N = 67,884) = 3257.07, p < .001. The prediction accuracy of the model is 60% higher than 50%. The Nagelkerke R² was computed to be .06, indicating weak association between the predictors and the outcome variable. The results showed all variables to be significant predictors of CIE. There was a significant difference in the odds of achieving CIE between White Americans with IDD and Black Americans with IDD (odds ratio [OR] = 0.75, 95% CI [0.72, 0.78]) and White Americans with IDD and Hispanic/Latinx Americans with IDD (OR = 0.73, 95% CI [0.70, 0.77]). Compared to participants with IDD with less than high school diploma, there was a significant difference in the odds of achieving CIE for participants who completed 4-years college or higher (OR = 5.37, 95% CI [4.90, 5.88]), for participants with an associate degree (OR = 3.32, 95% CI [2.99, 3.69]), and for participants with high school diploma or equivalent (OR = 1.87, 95% CI [1.77, 1.98]). For referral sources, compared to participants referred by self, family or friends, there was a significant difference in the odds of achieving CIE for participants referred by educational institution (OR = 0.83, 95% CI [0.79, 0.86]) and for participants referred by medical or mental health providers (OR = 0.88, 95% CI [0.80, 0.96]). There was a significant difference in the odds of achieving CIE between low-income participants and higher-income participants (OR = 0.87, 95% CI [0.84, 0.90]).

Second Step

In the second step, SE (with not receiving SE as the reference group) was entered. The omnibus test for the logistic regression model was found to be statistically significant, χ²(15, N = 67884) = 8228.72, p < .001. The prediction accuracy of the model is 65%. The Nagelkerke R² was computed to be .15, indicating weak association between the predictors and the outcome variable. Although it was still weak association, SE explained an additional 9.3% variance in a CIE outcome after controlling for the effect of demographic covariates. There was a significant difference in the odds of achieving CIE between participants who received SE and participants who did not receive SE (OR = 5.82, 95% CI [5.52, 6.14]).

Final Step

In the final step, job search assistance, job placement assistance, workplace support, and work incentives planning assistance (with not receiving each service as the reference group) were entered. The omnibus test for the logistic regression model was found to be statistically significant, χ²(19, N = 67884) = 15314.68, p < .001. The prediction accuracy of the model is 73%. The Nagelkerke R² was computed to be .27, indicating a robust association between the predictors and the outcome variable. These adjunctive SVRA services explained an additional 12% variance in CIE outcome after controlling for the effect of demographic covariates and SE. There were significant differences in the odds of achieving CIE between participants who received workplace support and participants who did not receive workplace support (OR = 4.77, 95% CI [4.48, 5.09]); between participants who received job placement assistance and participants who did not receive job placement assistance (OR = 2.70, 95% CI [2.57, 2.82]); between participants who received job search assistance and participants who did not receive job search assistance (OR = 1.55, 95% CI [1.48, 1.63]).

In the final model, all demographic variables were still significantly predicted a CIE outcome. Among demographic variables, education attainment variables (i.e., completing 4-years college or higher and completing associate degree) were the most significant predictors for CIE. Compared to participants with IDD without high school diploma, participants with IDD completing 4-years college or higher (OR = 6.98, 95% CI [6.34, 7.68]); and participants with IDD with an associate degree (OR = 3.95, 95% CI [3.54, 4.42]); were more likely to achieve CIE. SE was still a significant and the second strongest predictor of a CIE outcome. Participants who received SE were more likely to achieve CIE than participants who did not receive SE (OR = 5.58, 95% CI [5.27, 5.90]). Finally, the addition of adjunctive SVRA services accounted for an additional 12% variance in CIE outcome.

This study evaluated how much SE predicted CIE outcomes beyond the variance already explained by demographic covariates of youth and young adults with IDD. SE explained an additional 9.3% variance in CIE outcome after controlling for the effect of demographic covariates. Specifically, youth and young adults with IDD who received SE are 5.82 times more likely to achieve CIE than those who did not, even after controlling for the effect of demographic variables. For the final model, SE was still a stronger predictor than other adjunctive SVRA services, indicating that SE significantly helped youth and young adults with IDD achieve CIE. Adjunctive SVRA services explained an additional 12% variance in CIE outcome after controlling for the effect of demographic covariates and SE. Job search assistance, job placement assistance, and workplace support significantly predicted CIE for youth and young adults with IDD. Especially, workplace support was the strongest predictor of CIE among significant adjunctive SVRA services. Youth and young adults with IDD who received workplace support are 4.77 times more likely to achieve CIE than those who did not receive workplace support after controlling for the effect of demographic variables and other SVRA services. In addition, participants who received job placement assistance are 2.7 times, and participants who received job search assistance are 1.55 times more likely to achieve CIE than those who did not receive those services. Workplace support, as defined in RSA-911 data, refers to a short-term assistance service given to individuals who have secured employment. Its purpose is to stabilize their job placement and improve their ability to retain the position. Consequently, there's an overlap between workplace support and SE. Despite accounting for the impact of SE, workplace support remained a significant predictor. This outcome highlights the crucial nature of offering support to acclimate individuals to their new work environment at the initial stages of employment. Notably, even when considering these adjunctive services, SE retained its position as the most powerful predictor for CIE among youths and young adults with IDD. This underscores the necessity for a comprehensive strategy that begins from the job search phase and extends to providing workplace support – a central component of SE. This holistic approach emerges as crucial for enabling individuals with IDD to successfully attain CIE.

It is important to mention that although SE significantly predicted CIE for youth and young adults with IDD, the percentage of participants who used the services was only 13.7% in this study. Similarly, job search assistance, job placement assistance, and workplace support were also less utilized, 16.7%, 19.4%, and 11.6%, respectively. These findings indicated that youth and young adults with IDD may not have enough access to those effective services. It is critical for SVRAs to consider an effective service delivery mechanism for youth and young adults with IDD and engage them to receive the SVRA services that are needed to achieve their employment goals.

In the present study, all demographic covariates significantly predicted CIE outcome in the final model even after controlling other demographic variables, SE, and adjunctive SVRA services variables. Among the demographic variables, education attainment predicted the CIE outcome significantly. Those with IDD with higher education were more likely to achieve CIE than youth and young adults with IDD without a high school diploma. For example, young adults with IDD who completed 4-year college or higher are 6.98 times more likely to achieve CIE than youth and young adults with IDD without a high school diploma. This indicates that it is important to provide youth and young adults with IDD with access to higher education, at least a high school diploma or equivalent diploma. SVRAs provide services for post-secondary education or training, such as four-year college or university, graduate college or university, and vocational training. These services enable youth and young adults with IDD to meet the demands of a working environment by gaining more professional skills and knowledge and having practical experience regarding the tools and environments in which they will work.

Participants with low income were less likely to achieve CIE compared to participants who were not low income. Youth and young adults with IDD and low income may be recipients of benefits from one or more disability supports (e.g., social security disability programs and public health care programs). Those individuals and their families may be highly concerned about the potential disruption or reduction of public benefits and eligibility resulting from increased employment activity and earnings. Work incentive benefits counseling helps beneficiaries of social security disability programs understand how earning money may affect public benefits, allowing for informed choices about employment options. However, only 5.5% of participants in this study received work incentive benefits counseling. Iwanaga et al. [23] showed that benefits planning increased employment opportunities and outcomes for individuals with ID. Therefore, it is critical to make sure youth and young adults with IDD with low income have access to these services and provide information to assuage economic concerns related to the effect of income on financial benefits. Other limitations that individuals may encounter from low-income communities may include lack of community resources such as transportation, limited job opportunities, and other supports leading to poor CIE outcomes. Vocational rehabilitation professionals need to evaluate the barriers that individuals from low-income areas face that are preventing CIE outcomes.

White youth and young adults with IDD were more likely to achieve CIE than other race/ethnic groups. Specifically, Black participants were 0.25 less likely, and Hispanic participants were 0.27 less likely to achieve CIE. Also, female participants were less likely to achieve CIE than male participants. SVRA counselors and community rehabilitation providers may need additional training in cultural responsivity to meet the employment support needs of those consumers to ensure they achieve CIE.

Implications

The implications of these findings are important to researchers, policy makers, and service providers alike. First, research has defined SE as a four-phase service for individuals with IDD but has not developed fidelity components of that service by which to measure its adherence to the evidence-based model. This is a critical need in the field. Consumers might have more confidence in SE if they were able to know more about the exact components that comprise successful implementation for individuals with IDD. To improve access to evidence-based SE, researchers should develop a fidelity scale that includes core practices that have been found efficacious for job seekers with IDD. For example, job seekers with IDD using SE often have limited work histories and less understanding of their work preferences so more time is needed to gather information that will inform the job development phases. Further, people with IDD tend to require a higher intensity of on-the-job instruction and workplace modification [11, 25]. These should be essential elements in a fidelity scale. Future research should establish fidelity markers of SE for job seekers with IDD.

Public policy and regulations regarding the delivery of SE has been vague about what constitutes quality SE services for individuals with IDD. The lack of a minimum standard of SE service delivery may have resulted in highly variable quality. This, in turn, may have depressed the number of individuals with IDD seeking services. Policy makers could strengthen SE regulations by providing specific guidance regarding the essential elements of SE in the regulations themselves. The Rehabilitation Services Administration has not, to date, evaluated the quality of SE services except through the closure process. While this process promises incentives to community rehabilitation agencies for successful closures, this system might inadvertently disincentivize the provision of services to those with the most significant disabilities, specifically those with IDD [26]. Policy makers could build more incentives in the system by rewarding quality service delivering in addition to outcomes only.

Finally, community rehabilitation programs and state vocational rehabilitation agencies could increase the quality of SE services by addressing the employment support profession. Employment specialists supporting individuals with IDD require intensive training across distinct skill sets. Specifically, they need intensive training in person-centered assessment practices, the use of scored task analyses to teach multistep work and social skills, structured repeated trials to teach discrete tasks, behavioral rehearsal, visual and self-directed prompting procedures, and the installment of self-management procedures to address behaviorally challenging situations [25]. In addition, employment specialists often assist people with IDD in navigating the natural changes that occur in business to maintain employment over time [27]. These skills are unique to meeting the needs of individuals with IDD. Such skill sets are learned through a combination of didactic learning, and on-the-job training. To date, such training has been suggested, but not uniformly mandated [15].

Limitations

There are several limitations that should be considered when interpreting the present findings. First, this study used the RSA-911 database, secondary data with an ex-post-facto design; therefore, we cannot make cause-and-effect inferences regarding the relationships between the predictors and the outcome variable. First, SE and the adjunctive SVRA services were dichotomously coded, received vs. not received. Therefore, the quality, fidelity, intensity, or duration of SE and the adjunctive VR services were not considered. This is a critical consideration because Wehman et al. [28] asserted that measuring the quality and intensity of interventions provided throughout the SE process is imperative. Thus, additional research is needed to develop the fidelity of SE implementation, especially for people with IDD, and to investigate the quality of SE services being provided by SVRAs.

Third, the coding of the CIE at case closure variable is solely defined as whether the individual is employed 90 days from initial employment. The RSA-911 database does not provide longer-term tracking to monitor job retention. Future research should extend the frame of observation beyond the conventional 90 days case closure criterion to examine the long-term effects of SE services for young people with IDD, and clinical assessment instruments must be developed and validated specifically for transition-age youth and young adults with IDD with competitive integrated employment outcomes.

CIE plays a pivotal role in enhancing the overall well-being—psychological, physical, and social—of individuals with disabilities, particularly among youth and young adults with IDD. This study's findings highlight the efficacy of SE in facilitating the attainment of CIE for youth and young adults with IDD, especially when complemented by SVRA services. These insights also shed light on the crucial elements that can elevate the quality of SE services. As a result, the knowledge gleaned from this study has the potential to inform the development of fidelity components within the realm of SE.

Compliance with Ethical Standards

Funding: This article was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (Grant #90RTEM0003).

Conflict of Interest: The authors declare that they have no conflict of interest.

Data availability statement

This study used the U.S. Department of Education, Rehabilitation Services Administration Case Service Report (RSA-911) dataset.

Rehabilitation Services Administration (2022). Case service report (RSA-911). U.S. Department of Education, Office of Special Education and Rehabilitative Services, Rehabilitation Services Administration. https://rsa.ed.gov/performance/rsa-911-policy-directive

Informed Consent: Informed consent was obtained from all individual participants (state vocational rehabilitation consumers) through state vocational rehabilitation counselors through their service provision.

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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No competing interests reported.

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Supported Employment, Demographic Covariates, and Adjunctive Vocational Rehabilitation Services as Predictors of Competitive Integrated Employment for Young Adults with Intellectual and Developmental Disabilities: A Hierarchical Logistic Regression Analysis

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