Bass, M. Drewett, R. with a chapter by Corden, A.,

1997,

Reviewed by Patricia Thornton,
Social Policy Research Unit,
University of York

Methodology

This longitudinal, mainly qualitative study, was funded by the Joseph Rowntree Foundation. It tracks 22 people with learning difficulties who entered work through Liverpool supported employment agencies between January 1993 and October 1994. It was possible to carry out semi-structured interviews with 13 people before they started supported work (most in day services), with 12 of those two months after work started, and with eight of the 12 after six months in supported work. Engagement and interactions were measured through observations with 11 people at the same points in time. Carers (number not given) were interviewed about participants' support needs at the same intervals. Twenty employers took part in semi-structured interviews after three months' employment and an unspecified number of supported employees' immediate supervisors were interviewed about their work performance. A detailed analysis was carried out of the financial implications of moving into supported employment with reference to a sub-group of ten recruited to the study between April 1994 and March 1995.

The study began at a time when about 1600 people with learning difficulties were supported by 79 supported employment agencies nationwide. Liverpool was chosen as the site of the research because Merseyside had an unusually high concentration of supported employment agencies at that time and a much higher proportion of supported employees in Liverpool had severe disabilities. In December 1992 seven agencies in Liverpool supported 49 people with learning disabilities in employment and by April 1995 nine agencies supported 121 people. Six agencies were involved in supporting the 22 study participants; three voluntary sector, two local authority social services departments and one NHS Trust.

The only criterion for selection of participants with learning difficulties was that they had not previously had a supported employment job. The supported employment agencies put the research team in contact with people willing to participate; refusals are not reported. Sixteen men and six women were selected, aged between 18 and 55 (no age breakdown is given). Ten had no previous experience of employment or work placements. Eleven lived with family, three independently and eight in group homes.

To identify level of disability, participants' ability to function in day-to-day life was measured using the validated Adaptive Behaviour Scale. The Scale was completed by interview with the person who knew the person best, either a family member living with the person or a key worker for people in supported living situations. Observations of engagement and interactions in day services prior to taking up supported work and in work were carried out by researchers using hand-held computers. Three 30-minute observations were made of each participant in both settings. Engagement, non-engagement, interaction with others and type of interaction were keyed in. The data were downloaded for statistical analysis. Semi-structured interviews were tape-recorded and transcribed for thematic analysis. Quotations in the report were presented as far as possible in proportion to the size of the opinion groups they represented. Case studies of four supported employees are used to illustrate experiences.

Critical Appraisal

The methodological details given above are dispersed throughout the 73-page report, with no full methodological summary to aid the reader. Some relevant data are missing, notably the number of interviews obtained with carers and with employees' immediate supervisors.

The proportion of participants interviewed at baseline is low and no explanation is given. Presumably communication problems prevented the inclusion of some study participants, but this is not stated and it appears that no attempt was made to elicit views from people who did not communicate by speech. It seems that the 11 people observed are additional to those interviewed but this is not clearly stated.

Tests of inter-rater reliability in observation measurement are not referred to.

The report quantifies analytical results, which is inappropriate for a qualitative study. There is an inappropriate tendency in the report to present differences in perceived outcomes as if they were hard facts and to generalise from them.

Key Findings

Supported employment was highly valued by its users, providing improved reported and objectively measured social engagement. It provided substantially greater opportunities for people to mix with non-disabled people than traditional Adult Training Centres. Social relationships did not usually extend outside working hours, however. People with higher support needs spent much less measured time in interactions with non-disabled people than did those with lower support needs. Supported employment was found to provide engaging and rewarding activities for people of all levels of ability, with most supported employees saying they found their work activities stimulating and enjoyable. This contrasts with their day services where people said they had much less to do and were often bored and where higher levels of disengagement were measured.

People with high support needs received higher levels of support staff attention in supported employment services than in traditional day services, while the opposite was found in day services. People with mild disabilities tended to receive less staff support after two months in employment than in traditional day services yet were usually better off in terms of engagement, reported satisfaction and wages. The conclusion is drawn that supported employment is more efficient in its use of staff time than day services and that supported employment provides better value for money.

Supported employment was generally well regarded by employers, and most who used a supported employment agency said they would do so again. However, supported employment agencies were criticised for not providing sufficient clear information and for poor communication. A minority were unhappy with the support job trainers provided to employees; job training was poor or support was felt to create dependency.

Few users felt involved in choosing their job, with none offered a range of jobs to choose from. Although none complained of a lack of choice, the authors comment that it is worrying that services were not providing their users with a sense of self-determination and control.

While many of those interviewed said they entered supported employment to earn a proper wage, eight people earned nothing and only one unpaid job developed into a paid position over the six months. The study did not uncover why people were working for no wage. Although most people with high support needs were found unpaid jobs the study found that such people could succeed in the more highly paid jobs. The majority (16) were in part-time work of less than eight hours a week, topping up benefits with wages where they were paid, and only three (all with lower support needs) worked over 30 hours. The financial analysis demonstrates the disincentives in the benefit system to earning beyond the earnings disregard and the benefit traps facing those living in supported accommodation. It also shows how some people were financially no better off in work, or even worse off because of work-related expenses.

Social Work Practice Implications

This study reports on the early days of supported employment and findings may not be typical of current practice. Nevertheless, many messages for social work practitioners remain valid. In particular, the option of supported employment should be raised when discussing day services with clients of all ability levels, and practitioners should familiarise themselves with supported employment agencies' services. The Welfare to Work Joint Investment Plans for Disabled People will be useful sources of information. Practitioners should ensure that clients are offered jobs of good quality, have a choice of jobs, can move or return to day services if unhappy with their job, can earn a real wage and are not out of pocket. For those wanting to work more than 16 hours a week Tax Credits now may boost their wage, and clients and their carers need help to take them up.