Research & Practice for Persons with Severe Disabilities. Vol. 29. No. 4. 237-242

copyright 20(M byTASH

Adult Day Programs Versus SupportedEmployment (1988-2002): Spending andService Practices of Mental Retardation

and Developmental DisabilitiesState Agencies

Frank R. RuschThe Pennsylvania State University

David BraddockThe University of Colorado

While supported employment has made significantgains since its format introduction in 19H4 (P.L. 9H-527),.segregated services contintie to outpace the growth ofsupported employment. We discuss these and other im-portant trends in this article, and conclude with recom-tnendations that include (I) ensuring that all youngadults leave high .school competitively used or admittedto postsecondary education by age IS and (2) that highschools coordinate post-placement follow-tip for 3 vearsfollowing emptoymctu or enrollment in postsecondaryeducation. These recotnmendations are made becattsealihmgh ctirrent research suggests practices exist lo em-ploy persons with severe disabilities outside shelteredworkshops and adult day care centers, these programscontintie to grow at an alarming rule. In fact, the growthof supported employment has all but stalled since 2000.Diverting people and resources al the juncture betweenhigh school preparation and assuming adult roles suchas employment appears to be a more realistic plan topromote integrated services over the foreseeable ftiture.

As early as 1978, investigators began to evaluate theemployabiiity of persons with severe disabilities outsidesheltered workshops (Rusch. Connis. & Sowers, 1978;Sowers, Rusch. Connis, & Cummings. 1980). primarilyfocusing upon competitive employment with Ihc provi-sion of long-term support after placement, often by atrained "job coach" (Rusch & Mithaug, 1980). Prior to1980, the primary employment option for persons with

The authors thank Rahul Ganguly for his assistance in thepreparation of figures contained in this article.

Address all correspondence and requests for reprints toProf. Frank R. Rusch, The Pennsylvania Stale University. De-partment of Educational and School Psychology and SpecialEducation. 228 CEDAR Building, University Park, PA 16802-3109.

disabilities was the sheltered workshop, or remaining athome under the supervision of family. Today, however.there is little doubt that supported employment is aviable option for persons with severe disabilities, theirfamilies, and advocates.

In 1995. two articles were published that suggestedthat supported employment "had lost much of it mo-mentum" (Wehman & Krege!, 1995. p. 286) and that "adual system of integrated versus segregated services"(McGaughey. Kiernan, McNally. Gilmore. & Keith,1995, p. 270) defined the future employment of personswith disabilities in the United States. As pointed out byWehman and Kregel (1995). supported employmentstate systems change grants were awarded to all 50states through Title !II, Part C of the RehabilitationAct Amendments of 1986, which resulted in model sup-ported employment programs being established in vir-tually every state. McGaughey et al. (1995) reportedthat the number of local community rehabilitationagencies providing supported employment-related ser-vices grew from just over 300 in 1986 to approximately5,(K)0 in 1993. Clearly, new opportunities were estab-lished for supported employment as a result of thisgrowth. However, as McCaughey et al. (1995) pointedout. expanded opportunities for segregated employ-ment were also established.

ln this article, we focus upon the spending and ser-vice practices of mental retardation and developmentaldisabilities state agencies (MR/DD) rather than thosevocational rehabilitation agencies reported on hyWehman and Kregel (1995) in their article. "At thecrossroads: Supported employment a decade later."published in Journal ofthe Association for Persons withSevere Handicaps and more recently in Kiernan et al.'s(1997) AAMR-sponsored monograph, "Integrated em-ployment: Current status and future directions." We

237

238 Ruseh und Braddock

focus upon MR/DD agencies because we believe thatthe persons who are served by these agencies mostlikely represent persons with severe disabilities. Conse-quently, although our data may underrepresent the to-tal number of supported employees receiving services,our results may be more representative of trends inalternative service provision for persons with severedisabilities in the United States. We attempt, however.to make comparisons between the data we collectedand those collected and reported by Wehman and Kre-gel (1995) and Kiernan et al. (1997). In addition, weexpand upon results recently reported by Braddock,Rizzolo. and Hemp (2004). which focused upon thegrowing role of Medicaid in employment expansion.

The results reported in this article are important be-cause they provide readers with an important snapshotof how effective local service providers have been inproviding past, current, and possibly future generationsof adolescents and young adults with severe disabilitiesintegrated versus segregated employment. As discussedin this article, segregated employment receives lourtimes the financial resources that integrated employ-ment services do today, and the trend is toward furthergrowth in segregated adult services. Against this reality,this article makes two bold recommendations for prac-tice that we believe are necessary to ensure that futuregenerations of young people with severe disabilitiesfind their roles in society apart from sheltered, segre-gated services,

MethodOur study used data collected by Rizzolo. Hemp.

Braddock. and Pomeranz-Essley (2004). Readers are

referred to data collection, reliability, and analytic pro-cedures described in detail by Rizzolo et al. (2004).Briefly, data collection instruments were mailed to thedirectors of the 50 MR/DD state agencies and theagency in the District of Columbia. Several hundredfollow-up contacts were made across nil MR/DD de-partments to ensure the reliability and validity of dataacquired from published and unpublished state budgetand program documents. For the purposes of this in-vestigation, two broad categories of state spending andservices were studied: funds supporting (1) persons insegregated facilities (e.g.. adult day care, work activi-ties, and sheltered workshops) and (2) persons in sup-ported employment.

ResultsFigure 1 shows the percentage of all persons with

severe disabilities who were participants in states' MR/DD supported employment programs as a share of totalday/work program participants. The percentage of sup-ported employment participants more than doubledfrom 198S to 2002. from 9% to 24%. However, uponfurther inspection it is evident that the growth of sup-ported employment slowed considerably over the past10 years (19% to 24%) versus the first 5 years (9% to19%). Furthermore, growth in the number of supportedemployment participants dropped to 3% annually be-tween 2000 and 2002, compared with 15% per yearduring 1988 to 20(K). The initial growth in supportedemployment services was no doubt a result of statesimplementing model supported employment programsfollowing the 19K4 Developmental Disabilities Actamendments. Nevertheless. 76% of all day program

S9 90 91 92 93 94 95 9S 97 9S 99 0 20C1 2002

Fiscal Years

Figure 1. Percentage of adutls participating in supporled cmpkn'mcnl. l'-)HS-2()()2. (Adapted frotn Braddock et al.. 2004)

Spending nn Adult Duy Programs Vs. Supported Employment. 1988-2002 239

participants received services in adult day care, adultwork activities, and extended sheltered employmeniprograms. These estimates are similar to thost; reportedby McCiaughey et al. (\995), indicating that 70% of allpartieipants in their study were In segregated programs.

Figure 2 displays the total number of individuals whoparticipated across all day and work programs, andthen specific data regarding day programs, shelteredworkshops, and supported/competitive employment.We display these data across four approximately equaltime periods (i.e.. 1988. 1993. 1998. and 2002). Thesedata are worthy of close examination. Note that abouthalf of all participants (N = 239,(XH)) were involved inday programs in 2002, with an additional 126.0(K) par-ticipating in sheltered workshop employment. Alsonote the steady increase in the number of day programparticipants aeross each of the four time periods, froma low of 106,000 in 1988 to 239,000 in 2(H)2. Interest-ingly, there was a slight drop in the number of shelteredworkshop employees between 1998 and 2002 (131.000to 126.000). The larger increase in day program partici-pants can be explained by noting that two optionalMedieaid programs. Clinic and Rehabilitative Services,underwrite adult day programs. In 2002. federal Med-ieaid funding for adult day eare programs totaled $488million (Fig. 3).

Supported employment has continued to grow overthe 15-year period under examination here. In 1988there were 23,000 supported employees; in 2002 statesreported that 118.000 individuals with severe disabili-ties participated in supported employment. These num-bers differ from those reported hy McGaughey et al.(1995) and Wehman and Kregel (1995), Again, the pri-mary reast)n for this discrepancy relates to our foeusupon MR/DD state systems only versus these systemsand the slale voeational rehabilitation systems. Mc-

Gaughey et al.'s (1995) and Wehman and Kregel's(1995) estimates ranged from 100.000 to 300,0(K) indi-viduals participating in supported employment. Al-though the total number of participants seems to differ,the pereentages of adults with severe disabilities whoparticipate seem to agree to a much greater extent, withapproximately 25% to 30% participating in supportedemployment.

Figure 3 also suggests another interesting trend. Theamount of federal money spent in support of day pro-grams dropped, from a high of $517 million in 1998 to$488 million in 2002. At the same time, the amount ofmoney that states spend on supported employment hasgrown appreciably since the Balanced Budget Actamendments of 1997 removed the requirement thathome and community-based serviees waiver (HCBS)spending he limited to individuals who were previouslyinstitutionalized. This numher grew from virtually zerospending in 1988 to $108 million in 2002. However, re-gardless of this inereasing trend, the amount spent forsupported employment in 2004 ($108 million) was lessthan one fourth that spent on adult day programs spon-soring segregated day care, work activities, and employ-ment. This trend is also noteworthy as we recognizethat the United States enjoyed the largest economicgrowth of any period in history beginning in 1992 andending in about 2(X)2.

Supported employment receives less than 20% of thetotal day program funding, which is not surprising whenconsidering long-standing legacies of local support bypoliticians, community leaders, and parents for segre-gated employment patterns that predate supported em-ployment by several decades. It can be assumed thatthese patterns of support are not easy to change, evenif providers wanted to follow the recommendationsmade by Wehman and Kregel (1995). which included

Thousands olDa y/Wo rk P a rti c i pa nts

1993 1998

Fiscal Year

HDay Programs QShettered Workshp BSuKi/Comp Emp

Figure 2. Total number of adults participiiting in adult day programs, sheltered workshops, and supported/competitive employmentacross four time periods (1988. 1993. 1998, and 2(X)2). (Adapted from Braddock ct al.. 2(H)4)

240 Rusch und Bniddock

I SfHndIng In Ullhon

|BDay Programs • Supporled EmpJ

Figure 3. Federal support for segregated versus supported employment lYom 1988 to 2O()2. (Adapted from Braddock et al.. 2004)

converting day programs to integrated employment andpromoting meatiingful outcomes.

DiscussionOur findings suggest some positive and also some

sobering news in terms of employment for persons withsevere disabilities in the United Stales. For the firsttime in history, the number of adults who are partici-pating in supported employment and sheltered work-shops is about equal (118.U00 vs. 126,000, respectively).Also, we have seen a drop in federal support of adultday programs (from $517 million to $488 million). Onthe negative side, our research found 365,000 personswith severe disabilities participating in adult day careand extended sheltered workshop programs in 2002.compared with 118.()()() who are In supported or com-petitive employment positions. Furthermore, the num-ber of individuals who participate in adult day pro-grams appears to have increased at about the same rateas those who participated in supported employment(see Fig. 2). Both programs enrolled approximately100.000 participants between 1988 and 2002 (l33.0rK) inadult care programs vs. 95,000 in supported/competitiveemployment). Day programs and sheltered workshopsgrew from 236,000 participants in 1988 to 365.000 par-ticipants in 2002—a growth of about 129.000 new par-ticipants. Competitive and supported employment pro-grams grew from 23,000 participants in 1988 to 118,(K)0participants in 2002—a growth of 95,0(X} new partici-pants. Finally, funding for segregated adult day pro-grams is over four times that for supported employmentin 2002 ($488 million vs. $108 million).

These data suggest that supported employment is aviable program and is recognized as a fundable optionbetween both state MR/DD and vocational rehabilita-tion programs. However, although a viable program,supported employment has not enjoyed the same finan-cial support as alternative, segregated adult day pro-grams over the past 15 years. In part, segregated op-tions have been the expected outcomes for persons withsevere disabilities sinee funding for sheltered work-

shops were introduced in the 1954 Vocational Rehabili-tation Aet Amendments (P.L. 83-565). Sheltered work-shops, and the research and training-related programsthat support them, have had an almot̂ t 25-year headstart over those addressing supported employment.

It is safe to say that a dual system of service deliveryfor sheltered and integrated employment exists in theUnited States, and that, despite the growth of sup-ported employment, we have underestimated the sizeand strength of sheltered workshops, adult work activi-ties centers, and adult day care programs (ef. Me-Gaughey et al., 1995). In 1997, Kiernan et al. estimatedthat there were 5,861 adult service providers, with 4,988providers offering supported employment serviees.They suggested that the typical earnings of shelteredworkshop employees are about $400 per month. Thismeager monthly allocation represents less than onethird of the total earned by adult service providers fromall sources. For example, in 2002 Missouri shelteredworkshop revenue exceeded $100 milhin, with grosssales accounting for $71,434,677 and state and countyaid accounting for $29,532,140: miscellaneous sourcesof income accounted for $6,668,415 (Young. 2{K)3). Theapproximately 7,000 adults with severe disabilities whoworked in Missouri's community rehabilitation provid-ers" sheltered workshops made approximately $31 mil-lion in 2002, suggesting that their monthly earningswere equivalent to those estimated by Kiernan et al.(1997).

Unless we consider promoting new challenges thatcompete with funding for integrated employment, seg-regated employment will continue to thrive. Clearly,segregated employment is alive and well today, but so isthe potential to promote segregated employment. Sec-ondary special edueation, in particular, has experienceda renaissanee in praetices since the passage of the 1983Individuals with Disabilities Edueation Aet (P.L. 98-199), which introduced "transition servi:es'" (Rusch &Phelps, 1987), and the subsequent reauthorization ofIDEA (P.L. 101-476) in 1990, which included a precisedefinition of transition serviees. The 1990 definition

spending on Adult Day Prujirams Vs. Supported tnipluyniL'nt. IVS8-2IKJ2 241

named the types of outcomes that our schools should beattempting to achieve, including posisccondary educa-tion, vocational training, integrated employment (in-cluding supported employment), continuing and adulteducation, adult services, and independent living orcommunily participation (IDEA. P.L. 101-476. 34 CFR.Section 31100.18).

Unlortunately, even with legislation (ocused uponschool practice and outcomes, there have not been anysignificant gains in the employment rates of youngadults with severe disabilities since the early 19S0s. Onthe one hand, our schools have never been as preparedas they are today to change the employment patterns ofpersons with severe disabilities. On the other hand, wecontinue to miss the mark in our quest to meet theexpectations of the vast majority of young adults whowant to work, and their families and friends who do notsee segregated employment as the preferred employ-ment option. In the concluding section of this article wemake two recommendations that we believe are criticalto our stemming the growth of segregated employmentversus promoting the growth of integrated employ-ment.

Recommendations for Preparation and Employmentof Youths With Severe Disabilities

With our rising awareness of the rights of personswith severe disabilities, our better understanding andinterest in their desires and goals, and our 25-year his-tory of defining best practices to achieve these rights,desires, and goals, we make the following recommen-dations, directed toward our public schools' role in thepreparation and employment of youths with severe dis-abilities.

Basic to these recommendations is the contentionthat schools must partner with federal, state, and localservices to ensure that students find gainful employ-ment and become contributing members of society,which has been a primary goal of our public educationsystem since its formal creation over 100 years ago. Theprimary role of schools should be the coordination ofthe following two recommendations, not assuming themajority of costs and responsibilities.

Recommendation 1Our first recommendation is that all students must

leave high school competitively employed or admittedto a university, college, trade school, or certificationprogram in their 18th year, and that high schools as-sume the leadership role in this effort.

No student should leave high school with an uncer-tain future. Employment and postsecondary educationmust become a reality lor all students with severe dis-abilities. We recommend that high sehools assume theleadership role in guaranteeing that all youths are eom-petitively employed or enrolled in postsecondary edu-eation on or before their lKth year. It is important that

we recognize that the dual system of adult service pro-vision in the United States is complicated and resistantto change and represents over 50 years of tradition. Atbest, we can expect only continued ineremental ehangeif we are to follow reeommendations that point to com-munity rehabilitation providers taking the lead in con-verting their resources to support services that chal-lenge their very existence.

We propose that all students with a disability musthave an Individualized Program of Employment (IPE)or an Individualized Program of Postsecondary Educa-tion (IPFE) completed in their 18th year. A nationwideWeb-based system that promotes the coordination ofintegrated employment at the local level must be estab-lished. Virtually every community in America has ac-cess to vocational rehabilitation, and all students withdisabilities are eligible for Social Security benefits. It istime to move forward with efforts that coordinate theseprograms and the myriad adolescent- and adult-reiatedsocial services that exist to support housing, incomesupport, and workforce investmenls. High schools can-not be expected to provide the entire financial supportneeded to meet this first recommendation; partnershipswith the Social Security Administration, state voca-tional rehabilitation, and state MR/DD programs mustbe made.

Virtually every high school in America providescounseling to students without disabilities who are en-rolling in universities and colleges after graduation.These students have access to a well-defined system ofqualifying for entrance and receiving gift aid such asgrants and scholarships and/or self-help aid such asFederal Work-Study, campus jobs, and loans. Studentscan apply lor federal financial aid by completing theFree Application for Federal Student Aid (FAFSA).This system can and should also benefit students withsevere disabilities wishing to enroll in postsecondaryeducation.

Recommendation 2All students must have aecess to long-term follow-up

services to ensure their successful transition to inte-grated employment and/or postsecondary education.

All youth with severe disabilities must have access tocoordinated, long-term, follow-up support services thatfocus upon (1) placing students in jobs that providebetter wages. (2) developing workplace supports, (3)retraining in the event of losing one's job. and (4) work-ing with the complex network of adult services agenciesto provide coordinated housing, income, and medicalsupports. Such coordination must continue for at least 3years after a student leaves high school.

Since the passage of legislation that has targetedtransition from school to work, we have not affected thenumbers of youth with disabilities who are competi-tively employed, with or without support. Proportion-ately, our track record today is worse than it was 20

242 Rusch and Braddock

years ago. This record is in stark contrast to our poten-tial: we have never been better prepared to offer triedand tested "best practices" that eould ehange these out-comes (Rusch & Chadsey-Rusch, ]99H: Rusch, inpreparation). We must focus upon these outcomes now.High sehools must assume the leadership role in ensur-ing that current and future generations of students withsevere disabilities are diverted away from segregatedservices and included in the mainstream of society.

Further, universities, colleges, trade schools, and cer-tification programs must be expected to place their stu-dents in competitive employment after they have com-pleted their postseeondary education. A nationwide ef-fort involving high sehools, postsecondary educationinstitutions, and all social services agencies must coor-dinate the employment of students with severe disabili-ties after they complete postsecondary instruction.

ConclusionsMuch progress has been made over the past 25 years

in terms of identifying best practices that promote theintegrated employment of persons with severe disabili-ties. However, our research suggests that persons withsevere disabilities are just as likely to wind up in seg-regated work as they are integrated work, despite over-whelming evidence that persons with severe disabilitiescan meet their lifelong goals of being competitively em-ployed and earning wages that they ean rely upon tomeet their personal needs and desires. There is alsooverwhelming research thai points to savings to societythat are three- to tour-fold in support of integrated em-ployment, not segregated employment (Rusch, Conley,& McCaughrin, 1993).

Schools and all professionals, parents, and consumersmust work toward building new bridges between thehigh sehool programs that are preparing our youth andthe myriad adult services agencies that are designed toprovide income support, training, housing and more(e.g., social security programs, state voeational rehabili-tation programs, state MR/DD program). In the next 25years we should see new and impressive trends in ourefforts to provide a certain and desired future tor allpersons with severe disabilities, including the eonver-sion of scarce resources toward the support of theseservices versus adult day programs that promote thesegregation and marginatization of an entire population(Deviieger, Rusch, & PI'eiffer, 2003), programs thatclearly are alive and well today. We must focus ourresources upon integrated employment for all studentsin their 18th year, including providing additional op-portunities for an education, and we must recognize theneed to coordinate services to support these youngadults as they beeome valued members of our society.

ReccivLjd: Ft-bruary 2. 2004Final Acceptance: December J7, 2(X)4Editor in Charge: Martin Agran

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