Social Care Research 86 - May 1996
Supported employment for people with learning difficulties

Supported employment is a service for people with learning difficulties, which enables them to find and hold down real jobs by providing the support and training they need at work. A two-year study of six supported employment agencies operating in Liverpool has found that:

• People with learning difficulties were more satisfied with supported employment services than with traditional day services. Most highly valued was the real increase in purposeful activity.
• Employers who had used supported employment agencies were impressed by the training provided to the employee and by their work performance. Most employers said that they would use the agency again.
• Supported employment agencies had found paid jobs for most people, but most of the jobs were part time, and some people were unpaid.
• People with severe and multiple difficulties were found work, but the quality of their jobs, in terms of wages and interaction with other people, was lower than for more able people.
• After two months the amount of direct staff time required to support a group of employees in jobs was the same as it had been to support them in day services.
• Social security provision and arrangements for paying for accommodation could be powerful influences in planning suitable jobs in terms of hours worked and wage levels.
• Smooth transitions to wages raised living standards for some people and enabled greater power and consumer choice. For others, however, the move to work resulted in financial stress, with delays in getting both wages and in-work benefit support.

Introduction

Supported employment is a service which aims to help people with severe learning difficulties to work in real paid jobs in ordinary work places. Research was carried out into six supported employment agencies operating in the Liverpool area. The supported employment services were provided by an NHS Trust, by local authority Social Service Departments, and by the voluntary sector. Funding was from NHS and local authority sources.

The employees

Twenty-two people with learning difficulties who were using supported employment services took part in the research, 16 men and six women. Most lived at home with their families, but some lived in group homes, and a small minority lived independently with support.

Four people had worked before, eight had taken part in some form of work experience, and ten had no previous experience of work.

They varied greatly in the severity of their difficulties. Some people had mild learning difficulties and few support needs. They required support in budgeting and reading. Others had severe learning difficulties that limited or prevented speech. They needed help to prepare food, to maintain their living environment, and to carry out self-care tasks. Some people had physical and sensory disabilities in addition to learning difficulties. They needed help to eat and drink, to move around, and to hold objects.

The jobs

Most of the employees were working part time, a large number for less than eight hours per week. Only people with mild learning difficulties were in full-time work.

Most people were being paid for their work, but eight (out of 21) were earning nothing. Only one unpaid position developed into a paid job over the course of the study.

People with severe difficulties were more likely to be in unpaid work, although the agencies secured paid jobs for a small number of people with severe learning difficulties.

People in full-time work were earning more per hour than those in part-time work, although full-time rates of pay were low compared to the Merseyside average for all full-time employees.

Most of the employees (14/22) remained in their first job for the full six months they were in the study. A small number of people were sacked or made redundant by their first employer (4/22). The same number resigned from their first job. Some people who were sacked or who resigned were found a second job during the course of the study.

Financial implications of starting work

Information about people's financial circumstances was available for ten supported employees.

Prior to the move to work all ten depended on income support and most received disability living allowance. Those living in group homes or supported lodgings faced constraints on the amount of work and level of wages for which it was sensible to aim. Their arrangements for paying for their accommodation depended on continued entitlement to high levels of income support. In this situation only part-time or unpaid work was sensible.

Six months after starting work two of the ten employees felt better off financially. For the person in full-time work, wages now made up a substantial part of his weekly income, and he paid national insurance contributions and income tax, and a greater contribution to the costs of his care. A third person had initially felt better off in full-time work than when claiming income support, but had left this job because he was not enjoying it.

Three of the ten employees were financially worse off in work. A person who had taken unpaid work had to spend money on extra clothes for an office job. Two others should have been better off, but the transition did not go smoothly. There were delays in establishing payment of wages and in getting the in-work benefits to which they were entitled, leading to financial stress and the loss of interest in work.

Four of the ten had not experienced much financial impact, but their circumstances had not been followed for quite as long.

Advice and support about making use of new spending power were important. Carers and families also sometimes needed advice here if the employee's spending patterns changed in ways that were unexpected, or challenged previous expectations or assumptions.

Overall the ten moves to supported employment did lead to some reduction in public expenditure on social security, and some increase in income tax payments and national insurance contributions from employers and employees. Savings to the public purse, however, also included money lost by employees who did not take up entitlements to in-work benefits.

Activity and occupation

Before starting supported work most people using traditional adult training centres were bored and dissatisfied with the activities provided for them:

"It's just that we don't do much on it at the moment and that's why I'm doing nothing at the moment...well it does get boring you know."

People using community-based day services and taking part in a range of activities such as shopping, going to college, and using the library were more satisfied with their activities than adult training centre users.

When people began supported employment most became much more satisfied with the activities they took part in. Employees felt their work was interesting and provided an appropriate level of challenge. One person said,

"I like work...doing the job properly like that. I think it's just right for me."

Observations of people moving from traditional day services to supported employment confirmed that they were significantly more engaged (occupied in purposeful activities) when in employment. In day services people were engaged for 25 minutes in every hour, whilst in supported employment they were engaged for 45 minutes every hour. People with the most severe difficulties were just as fully occupied in supported employment as were people with mild difficulties

A small minority found their work too hard. One person described his work as,

"Hard...very physical...boring...it wears me down."

Relationships in day services and at work

Most users of adult training centres interviewed before they began supported employment were unhappy with the behaviour of other centre users. People reported that they had suffered verbal and physical aggression from other users, and reported a generally high level of tension.

"Some of them don't get on. They get on each others' nerves. They say the same sentences, the same sounds, they can't get on and it makes some people very unsettled."

Despite these concerns most people interviewed also reported having friends at the centres.

The chance to meet new people and make new friendships, especially with people who were not disabled, was a major reason for people entering supported employment. Most people who could be interviewed felt that they had made friends since starting work. Many people mentioned specific friends by name, and spoke in positive terms about these new people in their lives. The supported employees mostly felt that their colleagues treated them with warmth and respect, and without discrimination. Many people felt that their work places were supportive, and that help was available from colleagues should it be needed:

"I had to ask Johnny. Johnny comes to the rescue then....he watches out for me."

Whilst supported employees were involved in more interactions with people who were not disabled than they had been in day services, observations of interactions at work revealed that people with severe difficulties spent less than five minutes in each hour in interactions with colleagues. This was a significantly smaller amount of time than for people with mild difficulties.

Relationships with colleagues outside work

Relationships with colleagues had not extended beyond the workplace. One supported employee reported very unhappy experiences with colleagues. He felt shunned and rejected, saying that people treated him differently and ignored him.

Supported employees' views of their job trainer

Supported employees were mostly positive about their working relationship with their job trainer. Most often expressed was the feeling that the job trainer had been an effective teacher of work tasks:

"I've been taught very well."

Most employees felt that they had needed the support and training provided by their job trainer in order to succeed in their new job:

"I've got my doubts if l could do it on my own."

However, not everybody felt that a job trainer had been necessary for them, and some felt that their job trainer could have withdrawn their support earlier than they did. Several supported employees mentioned the help available to them from colleagues and supervisors and explained how this reduced their need for a job trainer:

"One of the lads said, 'How long is your trainer here for?' I know he was there to help me out, but that's what the lads are there for."

Provision of staff time in day services and in supported employment

Supported employment services are better than traditional day services at focusing staff support on those who need support. In day services people with mild difficulties received significantly more staff attention than did people with severe difficulties. Two months after people entered supported employment, however, this situation had been reversed: people with severe difficulties received more attention.

Supported employment is no more costly in terms of direct staffing requirements than are traditional day services. After two months of employment, the total amount of direct staff support provided to the group of supported employees as a whole was the same as had been provided to them in their day services.

Employers' views

Employers were, overall, very satisfied with the services provided by the supported employment agencies and the work performed by their supported employees. Sixteen of the 18 employers questioned said that they would use the same agency again. The quality of training and support provided to the employees by the agencies was the major source of satisfaction:

"I think the support was excellent. The job trainer was fabulous."

Employers were less impressed with the quality of communication between supported employment agencies and themselves.

Supported employment: quality and growth

This research suggests that supported employment is a service that enables people with learning difficulties to find and keep real jobs and enjoy them. It provides better outcomes than more traditional forms of service for a similar investment of staff support. It is an option that should be made available to a greater number of people with learning difficulties.

Whilst supported employment has demonstrated the capacity to obtain real jobs for people with severe difficulties, they tend to work fewer hours, to be unpaid and to be less well integrated. The greatest area of concern is financial: some people are doing productive work, yet are financially worse off for going to work. Supported employment agencies, purchasers, care managers, and users should be aware of the high standards that supported employment is capable of delivering, and not accept second-best.

About the study

The research was carried out over a two-year period by Malcolm Bass and Robert Drewett from Durham University, with the assistance of Jan Lackey and Rebecca Velangi from North Mersey Community NHS Trust. Anne Corden from the University of York analysed the financial data. Information was obtained by interview, direct observation, and psychometric testing.

Further information

For further information on the research, and details of the full report, contact Malcolm Bass, Hart Lodge, Jones Road, Hartlepool TS24 9BD (telephone: 01429 868837)