Journal of Vocational Rehabilitation xx (20xx) x–xx 1

DOI:10.3233/JVR-201075
IOS Press

1 Review Article

2 Workplace supports for employees with

intellectual disability: A systematic review

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3

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4 of the intervention literature
Sarah R. Carlsona,∗ , Mary E. Morningstarb and Vidya Munandara

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a The University of Kansas, Lawrence, KS, USA
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b Portland State University, Portland, OR, USA

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Revised/Accepted July 2019

8 Abstract.
BACKGROUND: Competitive integrated employment often remains out of reach for people with intellectual disability.
9
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10 Consistently poor outcomes have resulted in research and policies promoting employment through the provision of workplace
11 supports. Researchers have established a substantial body of intervention research addressing pre-employment supports.
12 However, minimal intervention research exists addressing the provision of supports subsequent to job placement.
13 OBJECTIVE: The objective of this study was to systematically examine the body of intervention research associated with
14 workplace supports used to address career maintenance and career advancement for employees with intellectual disability.
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15 METHODS: A systematic literature review was conducted, examining intervention research published between 1984 and
16 2018. Fourteen studies met inclusion criteria. These studies included 85 employees with intellectual disability and 57 support
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17 providers (e.g., employment specialists, job coaches, co-workers).

18 RESULTS: Results revealed evidence of interventions addressing career maintenance through the provision of training to
19 both support providers and employees with intellectual disability. Training addressed workplace performance and social
20 integration. No interventions were identified promoting career advancement.
21 CONCLUSION: This paper offers an overview of the current intervention research base addressing workplace supports for
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22 employees with intellectual disability and makes recommendations for research, policy, and practice.

23 Keywords: Literature review, intellectual disability, employment, workplace supports

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24 1. Introduction competitive integrated employment secures eco- 31

nomic well-being, thereby increasing the likelihood 32

25 Meaningful employment is a defining goal of of self-sufficiency and the potential for upward 33
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26 adulthood. Having a disability does not lessen the mobility (Blackorby & Wagner, 1996). The bene- 34

27 desire to achieve this goal (Migliore et al., 2007). fits of work are not just monetary, as employment 35

28 Work allows employees with disabilities oppor- expands personal and professional networks, builds 36

29 tunities to learn new skills and sharpen existing social connections, and expands community par- 37

30 ones (Wehman, 2011). The pay associated with ticipation (Brown et al., 2006). Most importantly, 38

∗ Address
consistent and valued work has a substantial influence 39
for correspondence: Sarah R. Carlson, Department of
Special Education, University of Kansas, Rm. 521 JR Pearson Hall,
on feelings of self-worth and emotional well-being 40

1122W. Campus Road, Lawrence, KS 66045, USA. Tel.: +1 785 (Kober & Eggleton, 2005; Schur, 2002). It is clear 41

864 0545; E-mail: sarah.carlson@ku.edu. that disability should not deter a person from entering 42

1052-2263/20/$35.00 © 2020 – IOS Press and the authors. All rights reserved
 2 S.R. Carlson et al. / Workplace supports

43 the workforce, finding meaningful work, and experi- legislation has focused specifically on competitive 95

44 encing career advancements. integrated employment. In 2014, Congress passed the 96

45 The number of people with disabilities who are Workforce Innovation and Opportunity Act (WIOA), 97

46 employed remains discouragingly low; and is even funding state and local workforce initiatives that pro- 98

47 more dismal for people with intellectual disability, vide job training and related services to people facing 99

48 such as those with significant limitations in intel- employment barriers, including people with disabil- 100

49 lectual functioning and adaptive behavior (Erickson ities (P.L. 113–128). Numerous legislative efforts 101

50 et al., 2012; Schalock et al., 2010). In 2000, the have also been made at the state-level. For example, 102

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51 National Organization on Disability conducted a Employment First, a policy and advocacy position 103

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52 survey on a national cross-section of 1,000 adults established in 2012, encourages the full inclusion 104

53 with and without disabilities. Results indicated that of people with significant disabilities in integrated 105

54 only 8% of adults with intellectual disability were employment (Cannella-Malone & Schaefer, 2015). 106

55 employed in the year 2000 compared to 81% of These policies and initiatives support opportunities 107

56 those without disabilities. More recent data con- for people with disabilities to have meaningful com- 108

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57 firm outcomes remain essentially unchanged (Hall munity employment (Nord et al., 2013). 109

58 et al., 2011). Research has demonstrated that over- Another critical tactic for improving the employ- 110

59 whelmingly, people with intellectual disability and ment outcomes of people with intellectual disability 111

60 their families prefer competitive (i.e., full-time or is the use of employment support interventions. One 112

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61 part-time employment where an employee receives early intervention, supported employment, was pro- 113

62 commensurate wages), integrated (i.e., at a location moted in the Developmental Disability Act of 1984 114

63 where people without disabilities make up the major- (P.L. 98–527) and the Rehabilitation Act of 1986 115

64 ity of employees) employment (Migliore et al., 2007). (P.L. 99–506). This intervention acknowledged the 116

65 When people with intellectual disability are necessity of ongoing supports to people with disabil- 117
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66 employed, they are often involved in precarious work, ities to obtain and maintain employment. Supported 118

67 such that their jobs offer minimal benefits, few hours, employment is defined as competitive employment 119

68 and low wages (Benach et al., 2014; Steinmetz, (i.e., full or part-time) for which wages paid are 120

69 2006). Employees with intellectual disability are commensurate with coworkers’ earnings occurring 121

70 twice as likely to experience job loss, partly because in integrated settings where supported employees are 122

their jobs have lower status and less stability (Kaye, working and interacting with co-workers without dis-
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71 123

72 2009; Yelin & Trupin, 2003). Low-quality jobs have abilities (Sima et al., 2015). This intervention calls for 124
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73 resulted in far greater periods of unemployment than professionals to provide individualized and intensive 125

74 counterparts without disability, causing employees assistance to employees with disabilities through (a) 126

75 with intellectual disability to experience difficulties job development and placement, (b) job-site train- 127

76 related to sustaining employment after initial place- ing and advocacy, (c) on-going assessment, and (d) 128

77 ment (Rumrill & Roessler, 1999). Employees with follow-along employment services (Wehman, 2012). 129
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78 intellectual disability are also less likely than coun- A more recent intervention is customized employ- 130

79 terparts without disabilities to progress or advance ment. Customized employment is a flexible process 131

80 through promotion or job expansions (Steinmetz, designed to personalize the employment relationship 132

81 2006). These limited employment circumstances are between a job candidate and an employer in a way that 133
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82 highly consequential for employees with intellectual meets the needs of both (Parent, 2004). It is based 134

83 disability, leading to substantially lower job security on an individualized match between the strengths, 135

84 and higher rates of poverty (Schur et al., 2009), as conditions, and interests of a job candidate and the 136

85 well as social isolation and issues with psychological identified business needs of an employer. 137
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86 and physical health (Brand, 2015). In addition to providing specialized supports 138

87 Poor employment outcomes have prompted to employees with intellectual disability, employ- 139

88 national and state-level efforts promoting meaning- ment support interventions also identify and utilize 140

89 ful employment for people with intellectual disability. supports available within the employee’s work envi- 141

90 National legislation, such as the Developmental Dis- ronment. These supports, known as natural supports, 142

91 abilities Bill of Rights Act of 1984 (P.L. 98–527) and include assistance, relationships, and interactions that 143

92 the Americans with Disabilities Act of 1990 (P.L. enable a person to secure, maintain, and advance 144

93 101–336), has promoted employment access and in ways that correspond to the typical work rou- 145

94 engagement for people with disabilities. More recent tines and social actions of other employees (Rogan 146
 S.R. Carlson et al. / Workplace supports 3

147 et al., 1993). Natural supports, which are both typi- 2. With whom and by whom have these supports 198

148 cally available and perceived as normative within the been provided? 199

149 employee’s work environment, are provided by work- 3. What is the methodological quality of the inter- 200

150 place resources (Butterworth et al., 1997). Although vention research identified? 201

151 conceptualized differently throughout the literature,

152 definitions of natural supports consistently empha-
153 size typical settings, conditions, and features of
154 employment as well as reliance on co-workers and

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155 other company personnel in designing and providing 2. Method 202

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156 supports to employees with disabilities.
157 Although employment support interventions, such We applied a structured approach to identify 203

158 as supported and customized employment and the intervention research addressing the provision of 204

159 use of natural supports, have been established for employment supports by both support providers (e.g., 205

160 over three decades, little research has been con- job coaches/employment specialists) and natural sup- 206

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161 ducted examining how to effectively provide supports ports (e.g., co-workers/managers) to employees with 207

162 to employees with intellectual disability. The inter- intellectual disability after initial job placement. In 208

163 vention research that does exist focuses primarily the following section, we describe the methods used 209

164 on strategies to support attainment of employment. to systematically examine the literature base, includ- 210

ing inclusion criteria, literature search procedures,

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165 However, the process of sustaining and advancing 211

166 after a job is secured includes added complexities and coding methods. 212

167 that have not been sufficiently examined. Consid-

168 ering that work is dynamic, changes in the work 2.1. Inclusion criteria 213

169 environment may necessitate changes to the types

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170 and frequency of supports provided to employees We selected studies based on six criteria. 214

171 with intellectual disability (Bellamy et al., 1988). First, we included publications from peer-reviewed 215

172 Workplace supports may be needed to ensure that journals describing empirical, intervention-based 216

173 an employee’s needs are met, thereby guaranteeing investigations using group (i.e., experimental or 217

174 sustained employment with opportunities for career quasi-experimental) or single-case designs. We 218

advancement (Berg et al., 1997). excluded case reports, observational studies, qual-
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175 219

176 The issue of supporting employees with intellec- itative studies, or other non-intervention studies. 220
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177 tual disability to maintain and advance in careers is Second, we only included studies in which par- 221

178 not new, however it appears to remain unanswered. ticipants with a diagnosis of intellectual disability 222

179 Therefore, a systematic review of the literature is were included. We chose to limit the search, thereby 223

180 warranted. The purpose of this review is to iden- excluding publications targeting employees with 224

181 tify intervention research related to the provision of emotional, behavioral, learning, or physical disabili- 225
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182 workplace supports after an initial job placement is ties, unless the publication also included participants 226

183 secured for an employee with intellectual disability. with intellectual disability. Third, we only included 227

184 We sought not to document the magnitude of inter- studies in which employees were in high school 228

185 vention effects or to compare the efficacy of different through adulthood. Fourth, we only included stud- 229
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186 intervention approaches; but rather, to delineate the ies occurring in integrated employment settings. We 230

187 extent to which specific intervention strategies have excluded any study conducted in a sheltered work- 231

188 been evaluated thus far and to characterize the over- shop or segregated or simulated work setting. Fifth, 232

189 all quality of the studies comprising the literature. we only included studies examining outcomes related 233
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190 In doing so, we aimed to provide the field with to career maintenance or advancement. We excluded 234

191 information about the range of potential interven- studies focused on career development or job attain- 235

192 tion strategies and to identify key gaps in the current ment. Finally, we only included studies published 236

193 knowledge base. To accomplish this, we sought to in English, peer-referenced print or online journals 237

194 answer the following research questions: between January 1984 and June 2018. We selected 238

1984 as the start date because it marked the passing 239

195 1. What types of supports are used to promote of the Developmental Disability Act (P.L. 98-527), 240

196 career maintenance and advancement among which authorized the original provision of supported 241

197 employees with intellectual disability? employment. 242

 4 S.R. Carlson et al. / Workplace supports

243 2.2. Literature search procedures they utilized qualitative research methodologies. Ten 294

additional articles were excluded because of issues 295

244 We employed a systematic approach to iden- with research design. More specifically, these articles 296

245 tify studies meeting the inclusion criteria. First, we (a) were practitioner papers, (b) were demonstration 297

246 performed electronic searches using the following projects, or (c) used surveys or questionnaires. Four- 298

247 databases: ERIC, EbscoHost, and PsycInfo. We uti- teen articles were removed for other reasons, such as 299

248 lized various combinations of keywords describing not including people with intellectual disability, not 300

249 the population (i.e., intellectual disabilit*), domain addressing career maintenance and advancement, or 301

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250 (i.e., employment), and type of support (i.e., for- not focusing on workplace supports. This left a total 302

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251 mal support, informal support, natural support, job of eight articles. 303

252 coach, employment agency, and family support). Finally, an ancestral search of the eight identified 304

253 Operational definitions of keywords are available articles was conducted to identify additional articles 305

254 from the lead author upon request. This initial search meeting inclusion criteria not identified by either of 306

255 produced 487 articles. We reviewed titles to deter- the prior search methods. This led to the identification 307

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256 mine if the abstract should be read and evaluated for of five additional articles. One article provided results 308

257 possible inclusion. Of the 487 articles, we excluded for two separate studies. Thus, fourteen empirical 309

258 431 because the study title: (a) related to other adult studies published in thirteen peer-reviewed articles 310

259 domains (i.e., independent living), (b) described sup- were included in the final review. Figure 1 provides 311

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260 ports provided to family members of people with a flowchart of the search process. 312

261 intellectual disability (i.e., mothers), and (c) uti-

262 lized non-intervention research methodologies (i.e., 2.3. Coding procedures 313

263 surveys and questionnaires). This resulted in 56 arti-

264 cles identified for subsequent abstract review. We We coded each article twice. First, we coded 314
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265 reviewed the abstracts of each article to determine each study according to a number of key elements 315

266 if the full article should be read and evaluated for (e.g., demographics, research design, and interven- 316

267 inclusion. Of the 56 articles, we excluded 32 based tion characteristics). Key elements were coded using 317

268 on abstracts, primarily because abstracts described a researcher-developed coding sheet. When informa- 318

269 the use of non-intervention research methodologies; tion was not available in an article, it was coded as 319

leaving the remaining 24 articles for a full article not reported (NR).
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270 320

271 review. The articles included in this review involved mul- 321
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272 Additionally, we performed a hand search of the tiple groups of participants, including supported 322

273 Journal of Vocational Rehabilitation. This journal, employees, job coaches, employment specialists, 323

274 which frequently publishes articles relevant to this co-workers, and workplace managers. As a result, 324

275 review, was not available in the institution’s online demographic information was coded for each par- 325

276 library databases. Thus, a hand search was necessary. ticipant group. For supported employees (i.e., 326
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277 We reviewed issues published between the years of employees with intellectual disability), demographic 327

278 1991, the journal’s first year of publication, through information included age, gender, disability, and 328

279 2018. We reviewed the index of each issue to identify race. Information regarding the supported employ- 329

280 articles focusing on people with intellectual disabil- ees’ jobs were coded for location, job duties, 330
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281 ity, workplace supports, and career maintenance or work hours, and job tenure. For support providers 331

282 advancement. We then reviewed the title, abstract, (i.e., job coaches/employment specialists and co- 332

283 method, and results sections of articles identified workers/managers), the demographic information 333

284 as potentially eligible to determine if the study met included age, gender, race, job tenure, and educa- 334
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285 inclusion criteria. This resulted in the identification tional level. 335

286 of 43 additional articles. Next, we coded the research design based on 336

287 Among the 67 articles selected from the elec- whether the study was quantitative or mixed method. 337

288 tronic search (n = 24) and hand search (n = 43), 14 For quantitative studies, research method, research 338

289 were removed as duplicates, with the 53 remain- questions, independent and dependent variables, 339

290 ing articles read in their entirety. After downloading duration of the intervention, assessment measures, 340

291 and reading each article, 45 were removed. Twelve analysis procedures, treatment reliability, inter- 341

292 studies were excluded because they utilized a cor- observer agreement, maintenance, and social validity 342

293 relational design, while nine were removed because codes were collected if present. For mixed-methods 343
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Fig. 1. Summary of the literature search procedures.
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344 studies, we coded both quantitative elements as group design and single-case design studies (Cook et 366

345 described above as well as qualitative elements al., 2014). Standards for group design studies include 367

346 according to method, research questions, duration, 24 quality indicators, while standards for single-case 368

347 location, and results. design studies include 22 quality indicators. The 369

348 Finally, we coded intervention characteristics. standards for both single-case and group design stud- 370
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349 Training was an essential element of each study’s ies address eight areas of research: (a) context and 371

350 intervention. As a result, we coded training inter- setting, (b) participants, (c) intervention agents, (d) 372

351 vention’s according to content, methods, materials, description of practice, (e) implementation fidelity, 373

352 recipient, trainer, location, and length. We also coded (f) internal validity, (g) outcome measures/dependent 374
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353 for intervention results, noting the location and length variables, and (h) data analysis. If the study addressed 375

354 of data collection. a specific quality indicator, it received a score of “1.” 376

355 To answer the research question associated with If it did not address a quality indicator, it received 377

356 methodological quality, we coded each study uti- a score of “0.” If the quality indicator did not apply 378
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357 lizing single-case or group design according to the to a particular study, it was marked as not applica- 379

358 Council for Exceptional Children’s Evidence-Based ble (NA). Each study’s score on individual quality 380

359 Practice Standards, a set of standards for identify- indicators was totaled, divided by the total number of 381

360 ing evidence-based practices in special education. quality indicators, and multiplied by 100%. 382

361 CEC’s Evidence-Based Practice Standards, which

362 were systematically vetted by expert special educa- 2.4. Interrater reliability 383

363 tion researchers through a Delphi study, provide an

364 integrated set of standards for classifying the evi- Interrater reliability was established across all 384

365 dence base of practices based on findings from both studies. The first and third authors compared each 385
 6 S.R. Carlson et al. / Workplace supports

386 study item-by-item. Agreements and disagreements group-design (n = 2), and mixed-methods (n = 1) to 430

387 were recorded and used to calculate interrater relia- provide workplace performance and social integra- 431

388 bility (i.e., number of exact agreements, divided by tion supports. Support provider training covered a 432

389 agreements plus disagreements). For key elements, wide variety of topics and content, including work- 433

390 the mean interrater reliability was 91.8% (range: place supports (n = 9), social integration strategies 434

391 89.5% to 94.7%). For quality indicators, the mean (n = 3), disability history and awareness (n = 2), con- 435

392 interrater reliability was 93.3% (range: 81.8% to textual changes (n = 2), workplace culture (n = 1), and 436

393 100.0%). Consensus was met on disagreements. employment consulting (n = 1). Studies focused on 437

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workplace performance addressed prompting strate- 438

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gies, evaluation methods, and systematic instruc- 439

394 3. Results tional strategies (i.e., cueing, corrective feedback, 440

reinforcement, fading, task analysis). For studies 441

395 A total of 14 studies were included in this sys- addressing social integration, training included con- 442

396 tematic review. Studies were published across nine tent related to natural support strategies (e.g., asking 443

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397 journals between 1984 and 2016. The majority of questions, understanding workplace norms). Job 444

398 studies (n = 8, 57.1%) were published before 2000, coaches/employment specialists were the only group 445

399 with four studies (28.6%) published between 1984 to receive training on employment consulting prac- 446

400 and 1989 and four studies (28.6%) published between tices, while co-workers/managers were the only 447

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401 1990 and 1999. Three studies (21.4%) were pub- group to receive training on topics of disability aware- 448

402 lished between 2000 and 2005, and three more were ness and disability history. 449

403 published between 2010 and 2016. Overwhelmingly, the collected data was positive, 450

demonstrating that the training interventions resulted 451

404 3.1. What types of supports are used to promote in anticipated changes. Of the articles describing 452
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405 career maintenance and advancement? positive outcomes, they were described with vary- 453

ing levels of detail. Several of the studies described 454

406 Two types of supports emerged: (a) supports positive outcomes through statistical significance. 455

407 for workplace performance and (b) supports for In the following studies, all of the outcome mea- 456

408 social integration. All 14 studies addressed career sures were statistically significant: Hagner, Dague, 457

& Philips (2014) and Farris & Stancliffe (2001). For

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409 maintenance. None of the studies incorporated an 458

410 intervention to promote career advancement. Among studies not using statistical significance, positive out- 459
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411 the 14 studies, seven focused on improving workplace comes were demonstrated through single-case design 460

412 performance, six aimed to enhance social integration, graphs. The following single-case studies demon- 461

413 and one intervened on both workplace performance strated significant findings as reported by the authors: 462

414 and social integration. Most of the studies inter- Brock, Page, & Seaman (2016); Gilson & Carter 463

415 vened by providing training (n = 11, 78.6%). Training (2016); Hood, Test, Spooner, & Steele (1996); and 464
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416 was provided to job coaches/employment special- Storey & Garff (1997). The remaining five stud- 465

417 ists (n = 4, 28.6%), co-workers/managers (n = 1, ies demonstrated mixed results, meaning significant 466

418 7.1%), supported employees (n = 2, 14.3%), sup- results were demonstrated on certain measures while 467

419 ported employees and co-workers/managers (n = 3, non-significant results were obtained on others. 468
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420 21.4%), and job coaches/employment specialists Seven studies assessed the impact of training 469

421 and co-workers/managers (n = 1, 7.1%). Two studies supported employees using single-case design. Train- 470

422 (14.3%) intervened through contextual interventions, ing provided to supported employees addressed 471

423 or changes to the work environment. One study uti- both social integration (n = 3) and workplace perfor- 472
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424 lized both training and contextual interventions (e.g., mance (n = 4). Studies focused on social integration 473

425 Hood et al., 1996). See Table 1 for a summary of the addressed the topics of question-asking, social behav- 474

426 interventions’ key elements. iors, and social integration. Studies addressing work- 475

place performance address the topics of accuracy, 476

speed, quality control, and supervisor satisfaction. 477

427 3.2. Training Three of the studies demonstrated positive results, 478

meaning that the training interventions resulted 479

428 Eleven studies assessed the impact of training in anticipated changes. Significant outcomes were 480

429 support providers using single-case design (n = 8), demonstrated through single-case design graphs. 481
 S.R. Carlson et al. / Workplace supports 7

Table 1
Summary of Interventions’ Key Elements
Purpose Type of Recipient Inter- Inter- Location Skills Address by
of Inter- of Inter- vention vention of Inter- Intervention
Support vention vention Design Features vention
Study
Workplace Performance

Social Integration

Training

Contextual Intervention

Supported Employees

Employment Specialists

Co-Workers/Managers

Single-Case

Group
Mixed-Methods
Maintenance

Social Validity

Worksite

Online

Other

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Brock et al. X X X X X task analysis,
(2016) simultaneous
prompting,

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least-to-most
prompting
Chadsey X X X X X social interactions,
et al. (1997) employment
integration, co-worker
involvement

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Chadsey- X X X X X frequency of
Rusch et al. questions, topics
(1984) initiated, topics
continued,
conversational ability
Farris & X X X X X X co-worker
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Stancliffe involvement
(2001)
Gilson & X X X X X X X X social interaction, task
Carter engagement,
(2016) proximity of job
coach
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Hagner et al. X X X X X workplace culture,

(2014) level of job coach
support, job
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satisfaction, level of
teamwork
Hood et al. X X X X X X X accuracy of task
(1996) completion,
supervisor satisfaction
Lee et al. X X X X X X types of social
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(1997) interactions, number

of social interactions
Likins et al. X X X X X X X accuracy, time
(1) (1989)
Likins et al. X X X X X X X accuracy, time, quality
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(2) (1989) control checking

McHugh X X X X X vocational integration,
et al. (2002) social validation
Park & X X X X X X social behavior of
Gaylord-Ross supported employees,
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(1989) social validation

Parsons et al. X X X X X X X job coach support,
(2001) performance of
supported employee
Storey & X X X X X X X vocational integration,
Garff (1997) social validation
 8 S.R. Carlson et al. / Workplace supports

482 The following single-case studies demonstrated Table 2

483 significant findings as reported by the authors: Hood, Demographics of Supported Employees (N = 85)
484 Test, Spooner, & Steele (1996); Parsons, Reid, Green, n (%)
485 & Browning (2001); and Storey & Garff (1997). The Gender
486 remaining four studies demonstrated mixed results, Female 45 (52.9%)
Male 40 (47.1%)
487 meaning significant results were demonstrated on Race/ethnicity
488 certain measures while non-significant results were African American 1 (1.2%)
489 obtained on others. White 2 (2.4%)

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Not specified 82 (96.5%)

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Disability
490 3.3. Contextual interventions Intellectual Disability 85 (100%)
Reported severity
491 To provide workplace performance and social Mild 8 (9.4%)
Moderate 1 (1.2%)
492 integration supports, some studies in this review inter- Severe 38 (44.7%)
493 vened through the use of contextual interventions Other descriptors (e.g., “moderate to severe) 38 (44.7%)

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494 (i.e., interventions altering the work environment Job type
495 to enhance supported employees’ performance). Food service 55 (64.7%)
Housekeeping/janitorial 11 (12.9%)
496 Two contextual interventions changed environmen- Office setting 5 (5.9%)
497 tal aspects of the worksite. For example, Hood, Test, Cashiers 4 (4.7%)

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498 Spooner, and Steele (1996) implemented the use of Animals 2 (2.4%)
499 visual supports detailing necessary environmental Grocery stores 2 (2.4%)
Customer service 2 (2.4%)
500 arrangements (e.g., specific tables, positions of work- Education 1 (1.2%)
501 ers relative to equipment). Contextual interventions Retail 1 (1.2%)
502 were also used to increase social integration using Healthcare 1 (1.2%)
Dock assistant 1 (1.2%)
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503 an ecological model. Chadsey, Linneman, Rusch,
Job status
504 and Cimera (1997) interviewed co-workers to gather Part-time 54 (63.5%)
505 information about the culture of the work setting Full-time 2 (2.4%)
506 (e.g., social customs, gathering places, celebrations, Not specified 29(34.1%)
507 and work space). They then used this information to
rate the supported employee’s level of social inte-
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508

509 gration. After identifying discrepancies, the authors Table 3

Demographics of Support Providers (N = 57)
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510 suggested possible contextual changes, such as hav-

511 ing the supported employee take breaks at the same n (%)
512 time as another co-worker, or changing the supported Type of supports
Job coach/employment specialists 24 (42.1%)
513 employee’s route from their workstation to the break Co-workers 18 (31.6%)
514 room to interact with co-workers along the way. Managers 10 (17.5%)
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Other employees 5 (8.8%)

Gender
515 3.4. To whom and by whom are supports
Female 24 (42.1%)
516 provided? Male 6 (10.5%)
Not Specified 27 (47.4%)
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517 Across the 14 studies, 85 supported employees Race/ethnicity

African American 1 (1.8%)
518 with intellectual disability were provided supports European American 5 (8.8%)
519 by 57 support providers, including job coaches/ Not specified 51 (89.5%)
520 employment specialists and co-workers/managers. In Education
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521 the following sections, we describe the characteris- High school diploma 3 (5.3%)
GED 1 (1.8%)
522 tics of these two groups of participants. Summaries Associate’s degree 2 (3.5%)
523 of these descriptions can be found in Tables 2 and 3. Bachelor’s degree 7 (12.3%)
Master’s degree 2 (3.5%)
524 3.5. To whom are supports provided Not specified 42 (73.7%)
Work experience
Experience 30 (52.6%)
525 People with severe intellectual disability were No experience 6 (10.5%)
526 most frequently represented (n = 38, 44.7%) across all Not specified 21 (36.8%)
527 studies. A few participants were identified with mild
 S.R. Carlson et al. / Workplace supports 9

528 (n = 8, 9.4%) and moderate (n = 1, 1.2%) intellectual quality indicators were addressed by 100% of studies. 576

529 disability. Authors used ranges, such as moderate Studies consistently did not address: (2.1) partici- 577

530 to severe, to describe 38 supported employees. No pant description, (3.1) intervention agent description, 578

531 persons were labeled with profound intellectual dis- (7.6) evidence of validity, and (8.3) appropriate effect 579

532 ability. Supported employees ranged in age from 16 size. See Table 4 for a detailed summary of described 580

533 to 73 years old and were evenly distributed between quality indicators. 581

534 males (n = 40, 47.1%) and females (n = 45, 52.9%). We also coded studies for treatment reliabil- 582

535 Only one study reported race, and among the three ity, inter-observer agreement, maintenance data, and 583

f
536 subjects, two were white, and one was African Amer- social validity. Nine studies reported on treatment 584

roo
537 ican. reliability, while ten studies reported inter-observer 585

agreements. Less than 30% of studies (n = 4) col- 586

538 3.6. By whom are supports provided lected maintenance data. Less than half of studies 587

(n = 6) collected social validity data. 588

539 Supports were provided by 57 support providers

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540 across the 14 studies, including job coaches/
541 employment specialists (n = 24, 42.1%), co-workers 4. Discussion 589

542 (n = 18, 31.6%), managers (n = 10, 17.5%), and other

543 employees (n = 5, 8.8%). Only one study targeting six The purpose of this systematic literature review 590

tho
544 job coaches reported race: five were white and one was to better understand career maintenance and 591

545 was African American. Level of education was only advancement for employees with intellectual dis- 592

546 described for 15 job coaches/employment specialists, ability. To accomplish this, we characterized the 593

547 many of whom held a bachelor’s degree (46.7%). intervention literature base describing the provision 594

548 Most job coaches/employment specialists (93.7%) of workplace supports after initial job placement. 595
Au
549 were experienced, with job tenure ranging from 16 Findings from this review highlight several consider- 596

550 months to 30 years. ations, complexities, and challenges associated with 597

the provision of such supports. Four critical issues 598

551 3.7. What is the methodological quality of the emerged from the results. These issues, described 599

552 intervention literature? below, relate to the focus of the literature, descrip- 600

tions of supported employees, descriptions of support

d

601

553 The majority of studies (n = 11, 78.6%) assessed providers, and the methodological quality of the lit- 602
cte

554 the impact of interventions, directed at both sup- erature base. 603

555 ported employees and support providers, through the

556 use of single-case design, with ten of the eleven 4.1. Limitations 604

557 studies utilizing multiple baseline or multiple-probe

558 designs. Three studies (21.4%), conducted with both Prior to discussing the results of this systematic 605
rre

559 supported employees and support providers, uti- literature review, it is important to explain search 606

560 lized a combination of descriptive statistics, repeated and analysis decisions and how they may have lim- 607

561 measures ANOVA, and non-parametric analyses ited the conclusions drawn. First, we only included 608

562 (i.e., Mann-Whitney U-Tests). One study aimed at intervention-based research found in educational and 609
co

563 job coaches/employment specialists implemented a psychological databases. It is possible that including 610

564 mixed-methods approach, utilizing a combination of correlational literature could have revealed additional 611

565 content-analysis and regression. research useful in answering our review’s research 612

566 When coding single-case and group design stud- questions. Second, our review focused on character- 613
Un

567 ies according to CEC’s Evidence-Based Practice izing the current intervention literature base. It did 614

568 Standards, we assessed the percentage of quality not consider the magnitude of intervention effects 615

569 indicators described in each study. The average per- or the efficacy of different intervention approaches. 616

570 centage of quality indicators described in each study Although outside of the scope of the current review, 617

571 was 84.9%, with percentages ranging from 66.7% these are important topics that should be addressed 618

572 to 100%. Only two studies addressed every quality by future research. 619

573 indicator. We also assessed the percentage of studies Several elements of the studies included within this 620

574 addressing each of the quality indicators, with per- review also influenced its results and conclusions. 621

575 centages ranging from 0% to 100%. Seventeen of the The majority of included studies utilized single-case 622
10
Quality Indicator
1.1 Context and setting
2.1 Participant description
2.2 Participant disability
or risk status
3.1 Intervention agent
description
3.2 Training of
Intervention agents
4.1 Description of
intervention materials
4.2 Description of
intervention materials
5.1 Implementation
fidelity
5.2 Treatment
dosage/exposure
5.3 Comprehensive
assessment of fidelity
6.1 Systematic
manipulation of
independent variable
6.2 Baseline description
6.3 Limited access to
treatment in baseline
6.4 Description of
assignment to groups
6.5 Three demonstrations
of experimental effect
6.6 Sufficient baseline
length and pattern
6.7 Control for common
threats to internal
validity
6.8 Overall attrition
6.9 Differential attrition
7.1 Socially important
outcome variable
7.2 Dependent variable
definition and
measurement
7.3 Findings fully reported
7.4 Timing/frequency of
outcome measures
7.5 Interobserver
agreement
7.6 Evidence of validity
8.1 Appropriate data
analysis techniques
8.2 Single-subject graph
8.3 Appropriate effect size
% of QIs identified
Chadsey et al. (1997)
Brock et al.(2016)
1 1
1 0
NA 0 0
1 0
1 1
1 1
1 1
1 1
1 0
1 0
1 1
1 1
1 1
NA NA
1 1
1 1
1 1
NA NA
NA NA
1 1
1 1
1 1
Un
1 1
1 1
NA NA
NA NA
1 1
NA NA
100 77.3
S.R. Carlson et al. / Workplace supports
Table 4
Summary of Quality Indicators Described
Park & Gaylord-Ross (1989)
Chadsey-Rusch et al. (1984)
% of Studies addressing QI
Farris & Stancliffe (2001)
Gilson & Carter (2016)
Likins et al. (1) (1989)
Likins et al. (2) (1989)
Storey & Garff (1997)
McHugh et al. (2002)
Parsons et al. (2001)
Hagner et al. (2014)
Hood et al. (1996)
Lee et al. (1997)
f
roo
1 1 1 1 1 1 1 1 1 1 1 1 100
0 0 1 0 0 0 0 0 0 0 0 0 7.1
0 1 0 1 0 1 1 1 1 1 0 53.8
0 0 1 0 1 0 0 0 1 0 0 0 28.6
rP
1 1 1 1 1 1 1 1 1 1 1 1 100
1 1 1 1 1 1 1 1 1 1 1 1 100
tho
1 1 1 1 1 0 1 1 0 1 1 1 85.7
1 0 1 0 1 1 1 1 0 1 1 1 78.6
1 0 1 0 1 1 1 1 0 1 1 1 71.4
1 0 1 0 0
Au 1 1 1 0 1 1 1 64.3
1 1 1 1 1 1 1 1 0 1 1 1 92.9
1 1 1 1 1 1 1 1 1 1 1 1 100
1 1 1 1 1 1 1 1 1 1 1 1 100
d
NA 1 NA 1 NA 1 NA NA NA NA NA NA 100
cte
1 NA 1 NA 1 NA 1 1 1 1 1 1 100
1 NA 1 NA 1 NA 1 1 1 1 1 1 100
1 NA 1 NA 1 NA 1 1 1 1 1 1 100
rre
NA 1 NA 1 NA 1 NA NA NA NA NA NA 100%
NA 1 NA 1 NA 1 NA NA NA NA NA NA 100
1 1 1 1 1 1 1 1 1 1 1 1 100
co
1 1 1 1 1 1 1 1 1 1 1 1 100
1 1 1 1 1 1 1 1 1 1 1 1 100
1 1 1 1 1 1 1 1 1 1 1 1 100
1 1 1 1 1 1 1 1 0 1 1 1 92.9
NA 0 NA 0 NA 0 NA NA NA NA NA NA 0
NA 1 NA 1 NA 1 NA NA NA NA NA NA 100
1 NA 1 NA 1 NA 1 1 1 1 1 1 100
NA 0 NA 0 NA 0 NA NA NA NA NA NA 0
86.4 66.7 100 66.7 91.0 81.8 91.0 91.0 68.2 91.0 91.0 86.4
 S.R. Carlson et al. / Workplace supports 11

623 research designs carried out with as few as one (Test et al., 2004). Furthermore, Test and colleagues 673

624 or two participants. The external validity of these found that available training programs are often 674

625 studies may be limited, as intervention effects are not driven by compliance regulations, prescribed top- 675

626 sufficiently replicated across multiple participants, ics, or annual reviews of specific information, not by 676

627 settings, or skills. Also, including studies from a the demands of the worksite or the needs of support 677

628 nearly three-decade time span opened this review providers. 678

629 to inconsistencies in understandings of intellectual Developing comprehensive, cohesive, and cost 679

630 disability and research design standards. efficient training systems are needed, given the 680

f
importance of training as well as the difficulties 681

roo
631 4.2. Workplace supports are limited in finding, providing, and financing training for 682

employment providers. The results of this systematic 683

632 The results of this systematic literature review review demonstrate that training support providers, 684

633 found that all studies focused only on career main- whether job coaches or co-workers, leads to enhanced 685

634 tenance, as evidenced by interventions’ focus on employment outcomes. This information can be used 686

rP
635 workplace performance and social integration sup- by employment agencies and policymakers when 687

636 ports. The studies confirmed the importance of advocating for policy changes to ensure a high quality 688

637 accessing workplace performance supports for suc- provision of training. 689

638 cessful employment outcomes among employees Our findings also have implications for practi- 690

tho
639 with intellectual disability as established from prior tioners, including support providers and supported 691

640 research (Brady & Rosenberg, 2002; Cannella- employment programs. Research has indicated that 692

641 Malone & Schaefer, 2015; Rogan et al., 2000). A the quality of workplace supports is dependent upon 693

642 person’s ability to perform the essential work tasks of the skill level of the support provider (Grossi et 694

643 a job influences the likelihood that they access com- al., 1991). The results of this systematic literature 695
Au
644 petitive integrated employment (Heller et al., 2005). review demonstrate that the provision of training does 696

645 Results also confirmed previous literature espousing enhance the skills of support providers. As adult agen- 697

646 the importance of social integration as a critical ele- cies continue to develop programs for employees 698

647 ment of integrated employment (Brickey et al., 1985; with intellectual disability, it is imperative they prior- 699

648 Butterworth & Strauch, 1994; Chadsey, 2007). It has itize training among support providers, including job 700

been consistently demonstrated that employees with coaches, employment specialists, co-workers, and
d

649 701

650 disabilities who are socially included at work are managers. They should focus specifically on how they 702
cte

651 more likely to maintain their employment (Agran administer trainings and ensure the content of training 703

652 et al., 2016). Unfortunately, this systematic review extends beyond learning a job and increasing social 704

653 did not identify a single study connected to career inclusion to training promoting career advancement. 705

654 advancement. The degree to which workplace perfor-

655 mance and social integration improve the likelihood 4.3. Limited understanding of those receiving 706
rre

656 of career advancement remains unanswered. and providing supports 707

657 What this systematic literature review did reveal

658 was the critical role of training to the provision The studies included in this literature review did 708

659 of workplace supports. Training was an essential not sufficiently describe supported employees in 709
co

660 element in all of the intervention studies, most regards to their racial/ethnic backgrounds. Of the 710

661 often targeted at support providers (i.e., job coaches, fourteen studies, only one reported the race of three 711

662 employment specialists, co-workers, managers). This participants. A lack of information about race poten- 712

663 finding does not come as a surprise, as past research tially masks larger issues reported previously, such 713
Un

664 revealed that quality employment supports are depen- as underutilized employment services among people 714

665 dent upon the education and training of providers with disabilities who are culturally and linguistically 715

666 (Butterworth et al., 2012; Novak et al., 2014). Ongo- diverse. This is particularly evident among formal 716

667 ing training has been identified as essential for programs providing employment supports, such as 717

668 providing quality supports to employees with intel- Vocational Rehabilitation (Middleton et al., 1996; 718

669 lectual disability (United States Department of Health National Council on Disability, 1999). When people 719

670 and Human Services, 2017). It is known that sup- with disabilities who are culturally and linguisti- 720

671 ported employment programs report difficulties in cally diverse do access employment services, they are 721

672 finding appropriate training for support providers more likely to experience disparities in the services 722
 12 S.R. Carlson et al. / Workplace supports

723 received and outcomes achieved (Taylor-Ritzler et al., 84.9%, with percentages ranging from 66.7% to 773

724 2010). Researchers have identified several potential 100%. Results also identified the percentage of 774

725 disparities, including cultural groups’ lack of trust studies addressing each of the quality indicators, 775

726 in governmental institutions and racial mismatches ranging from 0% to 100%. Seventeen of the qual- 776

727 between service providers and supported employees ity indicators were addressed by 100% of studies. 777

728 (Taylor-Ritzler et al., 2010). The lack of robust demo- Of concern was the finding that only 7% of the 778

729 graphic data found among the studies in this literature studies adequately described study participants and 779

730 review may mask this potential issue. In the future, only 28.6% adequately described intervention agents. 780

f
731 defining and describing participants is clearly needed. Another concern relates to the fidelity of implemen- 781

roo
732 The second research question also focused on tation. Authors inconsistently reported information 782

733 the staff providing employment support. Literature regarding the fidelity of intervention implementa- 783

734 review results were able to ascertain the level of tion, hampering the strength of results. Less than 784

735 education of formal support providers (i.e., job 65% of studies reported treatment fidelity. Simi- 785

736 coaches/employment specialists), but not those of the larly, generalization and maintenance results were 786

rP
737 informal supports (i.e., co-workers/managers). Most not found, with less than 30% of studies exam- 787

738 job coaches held a bachelor’s degree, with some hold- ining maintenance of learned skills. When study’s 788

739 ing even higher degrees. For example, Gilson and considered maintenance data, it was most often col- 789

740 Carter (2016) included three job coaches in their lected immediately following stabilization of data. 790

tho
741 study, all of whom had a bachelor’s degree or master’s Only two studies collected generalization or main- 791

742 degree in special education. Formal support providers tenance data after sufficient passing of time, in both 792

743 also had a significant amount of related work experi- instances six months later. Considering the long-term 793

744 ence. Almost all (94%) job coaches and employment effects of training interventions toward demonstrat- 794

745 specialists had prior experience, ranging in length ing that supported employees can obtain new skills 795
Au
746 from 16 months to 30 years. The fact that employment and maintain the skills already acquired, generaliza- 796

747 providers were well-educated and experienced may tion and maintenance data are a possible marker of 797

748 have influenced their proficiency in facilitating sup- career advancement. It was impossible to understand 798

749 ports, independent of the training they received. More whether initial workplace performance interventions 799

750 effective staff, such as those with higher levels of edu- were sufficiently robust in supporting potential career 800

cation and greater amounts of training, translate into advancement.

d

751 801

752 better outcomes for people with disabilities, a factor Given the range of years of the published stud- 802
cte

753 that may have influenced results and impacted gen- ies, it is not surprising that early research did not 803

754 eralizability (Wehman & Targett, 2002; Butterworth adhere to CEC’s Evidence-Based Practice Standards, 804

755 et al., 2012). which were published more recently. Future research 805

756 Unlike the job coaches and employments special- should adhere to the field’s research standards, 806

757 ists included in these studies, the national picture describing participants and procedures to ensure gen- 807
rre

758 illustrating the quality of job coaches and employ- eralizability, maintenance, and replication. Studies 808

759 ment specialists is not as robust, with most working targeting employment maintenance and advancement 809

760 with little to no formal training (Grossi et al., 2001; are only truly effective if participants, both sup- 810

761 Hagner et al., 2002: Novak et al., 2014). Researchers ported employees and support providers, maintain 811
co

762 should make efforts to conduct research with all sup- acquired skills over time and generalize them to new 812

763 port providers, even those without relevant training environments. Finally, researchers should also more 813

764 or experience, solidifying our understanding of the frequently assess social validity, given the impor- 814

765 types of training required for successful provision of tance of understanding which supports are effective 815
Un

766 employment supports. by acknowledging the perspectives of those who use 816

them (Wood & Steele, 1992). 817

767 4.4. Methodological quality of research methods

4.5. Conclusion 818

768 Several concerns emerged regarding the method-

769 ological quality of the studies included in this The results of this review revealed interven- 819

770 review. Using CEC’s Evidence-Based Practice Stan- tions used to successfully train support providers 820

771 dards, it was revealed that the average percentage and supported employees to learn initial workplace 821

772 of quality indicators identified by each study was performance skills, as well as increase social inte- 822
 S.R. Carlson et al. / Workplace supports 13

823 gration within competitive integrated employment. Brickey, M. P., Campbell, K. M., & Browning, L. J. (1985). A 874

824 However, the degree to which these interventions five-year follow-up of sheltered workshop employees placed 875

in competitive jobs. Mental Retardation, 20, 67-83. 876

825 support employees with intellectual disability in
*Brock, M. E., Cannella-Malone, H. I., Schaefer, J. M., Justin- 877
826 maintaining or advancing within their career remains Page, E., Andzik, N. R., & Seaman, R. L. (2016). Efficacy of 878
827 unknown. Scant research is available regarding the training job coaches to implement evidence-based instructional 879

828 quality of workplace supports provided to employees strategies. Journal of Vocational Rehabilitation, 45, 351-364. 880

829 with intellectual disability, despite enhanced poli- https://doi.org/10.3233/JVR-160835. 881

Brown, L., Shiraga, B., & Kessler, K. (2006). The quest for 882
830 cies and increased initiatives promoting improved

f
ordinary lives: The integrated post-school vocational func- 883
831 employment outcomes for this group. Given the con- tioning of 50 workers with significant disabilities. Research

roo
884
832 sequences of unsuccessful employment, it is our hope and Practice for Persons with Severe Disabilities, 31, 93-121. 885

833 that the results of this literature review will be used https://doi.org/10.1177/154079690603100202. 886

834 to promote positive action on behalf of people with Butterworth, J., Migliore, A., Nord, D., & Gelb, A. (2012). Improv- 887

ing the employment outcomes of job seekers with intellectual 888

835 intellectual disability in the workplace and facilitate
and developmental disabilities: A training and mentoring inter- 889
836 advancements in research, policy, and practice. vention for employment consultants. Journal of Rehabilitation,

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78(2), 20-29. 891
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and outcomes. Institute for Community Inclusion. 894

Butterworth, J., & Strauch, J. D. (1994). The relationship between 895

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838 The author(s) declare no potential conflicts of inter- social competence and success in the competitive work place 896
839 est with respect to the research, authorship, and/or for persons with mental retardation. Education and Training in 897

840 publication of this article. Mental Retardation and Developmental Disabilities, 29, 118- 898

133. 899

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