[Excerpt] Between 1988 and 1996, the number of individuals supported by state mental retardation/developmental disabilities (MR/DD) agencies who participated in some type of community employment increased by 200%. Despite this increase, many agree that outcomes in community employment are in great need of improvement and vary widely among states. The purpose of this report is to highlight the successful practices of states that have been identified as  high-performers  in integrated employment for people served by state MR/DD agencies

Institute for Community Inclusion

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INSTITUTE FOR
COMMUNITY 
INCLUSION
I February 2003Volume 9, Number 1PracticeResearchto
High-Performing States in Integrated Employment 
by Allison Cohen, John Butterworth, Dana Gilmore, & Deborah Metzel
Institute for Community Inclusion 
University of Massachusetts Boston
www.communityinclusion.org
Introduction
Between 1988 and 1996, the number of individuals 
supported by state mental retardation/developmental 
disabilities (MR/DD) agencies who participated in some 
type of community employment increased by 200% 
(Butterworth, Gilmore, Kiernan, Schalock, 1999). Despite 
this increase, many agree that outcomes in community 
employment are in great need of improvement and vary 
widely among states. The purpose of this report is to 
highlight the successful practices of states that have been 
identified as "high-performers" in integrated employment 
for people served by state MR/DD agencies.   
What does it mean to be "high-performing?"  
We defined "high-performing" as: a high rate of 
individuals with MR/DD in integrated employment; 
a high percentage of individuals with MR/DD in 
integrated employment; and/or growth 
in integrated employment over time. 
Rate refers to the number of people 
in integrated employment per state 
population. Percentage of people in 
integrated employment is based on 
the total number enrolled in day and 
employment services throughout the 
state. We also considered residential 
outcomes as an additional indicator 
of overall commitment to community 
inclusion (Prouty & Lakin, 2000). 
Using the above criteria and data from 
ICI's national data collection for day 
and employment services for people 
with developmental disabilities, ICI staff 
selected 13 states and interviewed key 
informants to explore the organizational 
variables that have resulted in successful 
integrated employment outcomes (see 
table at right). Respondents included 
state vocational rehabilitation (VR) 
and MR/DD administrators, non-
profit service providers, and disability 
advocates.   
Findings
The following brief summarizes the data collected 
from participating states. Although common themes 
emerged, the states also had unique differences. While we 
acknowledge that all states encounter a number of barriers 
to supporting people in the community (including limited 
funding and resistance from traditional VR providers and/
or families and individuals, to name a few) this publication 
specifically highlights "what's working" among states. 
These seven themes are: 
1. Clearly defined goals and data collection
2. Strong agency leadership
3. Interagency collaboration
4. Ongoing training and outreach
5. Communication through relationships
6. Local control
7. Flexibility and respect for innovation
Criteria used to determine high-performance in integrated employment (IE)
State
IE rate 
FY90*
IE rate 
FY99*
% change in 
IE rate 
FY90-99 
% in IE
FY90
% in IE
FY99
% change 
in IE
FY90-99 
% in 
1-6 pers. 
residence 
FY99**
CO 54 66 13 44 42 -5 86
CT 74 100 35 39 59 51 77
DE 17 56 227 17 35 106 66
FL 15 23 36 21 30 43 58
MI 10 90 817 7 38 443 97
MN 47 117 150 33 52 58 81
NH 67 75 12 55 50 -9 96
OH 17 59 252 9 23 156 50
OK 10 39 271 12 37 208 51
SD 42 167 299 9 61 578 59
UT 24 39 66 30 40 33 66
VT 40 97 144 29 35 21 100
WA 41 70 71 48 58 21 77
Natl. avg 25 47 133 21 30 43 62
*Integrated employment rate – integrated employment cases per 100,000 state population
**Data from Prouty & Lakin, 2000
2 • Institute for Community Inclusion • Research to Practice, Vol. 9, No. 1 High-Performing States in Integrated Employment • 3
1. Clearly defined goals and data collection
Clearly defined goals and data collection mechanisms 
that track these goals are key in overcoming systemic 
barriers to integrated employment. Like many 
other states, the challenges Delaware has faced 
are philosophical ones. Resistance to change from 
community rehabilitation providers operating 
facility-based services, in addition to lack of financial 
incentives, have impeded the state's MR/DD agency 
from realizing greater success. To address these 
challenges, the state created a comprehensive strategic 
plan and measurable goals for supported employment 
outcomes. Florida also has measurable goals and has 
implemented statewide performance indicators, with 
the goal of 30 percent of adults receiving services 
participating in integrated employment. South Dakota 
has an informal goal of increasing employment by 20 
percent and has been closely measuring employment 
service outcomes for over ten years.  
Changes in administration can make it difficult to 
sustain integrated employment efforts on a statewide 
basis. In order for the effort to be maintained more 
seamlessly, Washington has relied on comprehensive 
data collection and effective use of this data. This 
has been critical in planning for future employment 
needs of individuals with disabilities.  
2. Strong agency leadership 
Strong agency leadership can do much to further 
integrated employment in states. In Michigan, 
participants identified many forward-thinking leaders 
at the state and local levels in the mental health and 
rehabilitation systems and at the Developmental 
Disabilities Council. In the late 1980s, the directors of 
these three groups were instrumental in establishing 
a state commitment to integrated employment 
and were also able to direct financial resources 
for this purpose. The current state directors are 
continuing this commitment. Although the Michigan 
Department of Community Health has required 
its 49 community mental health service programs 
for persons with mental illness or developmental 
disabilities to report outcome data, administrators 
chose not to establish formal goals or targets. Instead, 
outcomes are reported and published for local 
communities. "Widespread dissemination of the 
outcome reports has kept the state moving in the 
intended direction."  
In Delaware as well, strong and dedicated leadership 
from the VR agency has been very important. 
The leadership has been on several levels, through 
facilitating and funding training, fostering involvement 
in the use of PASS plans and IRWE to offset additional 
costs for people with disabilities who want to work, and 
through service delivery.  
3. Interagency collaboration 
Interagency collaboration was identified as key to the 
expansion of integrated employment. For over ten 
years in Ohio, formalized collaborative efforts between 
the state's VR and MR/DD agencies were identified 
as instrumental in making integrated employment 
successful. These agencies have worked hard to better 
streamline their funding mechanisms. Operating in 
four counties, Project MORE was a collaboration 
among the Ohio Rehabilitation Services Commission 
(Ohio's VR agency, which also was the project lead) 
and the Departments of Mental Health, Education, and 
MR/DD. Through local demonstration activities, the 
project sought to create a structure with consumers, 
families, service providers, and employers as equal 
partners in the effort to increase employment for 
individuals with disabilities.      
In addition, Ohio's MR/DD and VR agencies developed 
a joint vision statement in 2002 that stated that it 
was the mutual goal of both agencies to provide 
services to persons with disabilities geared toward 
wrapping services around a paycheck rather than a 
benefits check. Both agencies held a series of regional 
meetings to communicate this joint vision statement 
to staff and to reiterate the commitment of both 
agencies. These agencies, in conjunction with the Ohio 
Association of Adult Service Directors, are developing 
regional Technical Assistance Teams to enhance local 
collaborative efforts to improve outcomes for persons 
with MR/DD. 
In Florida, the Departments of Education, Vocational 
Rehabilitation, and Developmental Disabilities have 
cooperative agreements, participate in Agency Partners 
Meetings, and keep the exchange of information 
constant around employment issues. Coordination also 
exists on the local service delivery level.  
Early interagency coalitions in Connecticut established 
long-lasting relationships that are still fostered today.  
It is clear that these early partnerships continue to be 
nurtured and valued for their capacity to create better 
employment outcomes for individuals with disabilities. 
2 • Institute for Community Inclusion • Research to Practice, Vol. 9, No. 1 High-Performing States in Integrated Employment • 3
4. Ongoing training and outreach  
Many state stakeholders highlighted the importance 
of training and outreach to promote integrated 
employment. In Colorado, respondents felt that 
this message was communicated aggressively. "We 
presume that people with disabilities can work." 
A "tremendous amount" of training, conferences, 
and other educational events is provided related to 
integrated employment, both for programs already 
supporting people in the community and for those 
that are facility-based. Florida officials have worked 
hard to develop a high quality model for a training 
curriculum for employment specialists, but have had 
difficulty broadly administering training because of 
limited funding.  
At the onset of its supported employment initiative in 
the 1980s, Connecticut had a strong and highly visible 
investment in training at multiple levels including 
managers, line supervisors, and front-line staff.  Many 
of the state's MR/DD staff who led early supported 
employment initiatives continue to provide leadership 
in this area, and the MR/DD agency continues to 
support the state's annual supported employment 
conference. This is a collaborative venture developed 
by state agencies, the state University Center for 
Excellence in Developmental Disabilities Education, 
Research, and Service (UCEDD), and provider groups.  
5. Communication through relationships
Relationships that foster communication among 
staff can often result in better service delivery 
outcomes. Much of Vermont's success in integrated 
employment was attributed to its small size (a 
factor also cited in New Hampshire and Delaware). 
Fewer bureaucratic layers enable people to work 
closely with each other and align the priorities of 
their agencies. Local relationships were cited as the 
key to successful practices. Despite turnover in the 
coordinators for integrated employment, this group 
in Vermont has been close-knit. Originating from the 
grassroots level and promoted by state VR and DD 
leaders, dissemination of the value base for integrated 
employment was targeted to programs that were 
receptive to change and likely to create a structure that 
would make integrated employment possible. 
Respondents from Michigan also reported that 
open dialogue and debate are mechanisms that have 
helped overcome barriers to integrated employment. 
Communication at multiple levels helps to sustain the 
momentum for an ongoing commitment to integrated 
employment for people served by their MR/DD agency. 
6. Local control
Although a state-level commitment to integrated 
employment is critical, practical implementation 
of employment supports happens at the local level. 
In Washington, success in supported employment 
"didn't happen by a stroke of luck, it took 25 years." 
The bifurcated system in this state allows one level of 
government to concentrate on supported employment. 
Counties are in control of planning and coordination 
and have a great deal of autonomy in funding 
decisions. The emphasis on local economic factors has 
come down from the state administration. Informants 
believe that this local control makes all the difference. 
Respondents noted that it has been difficult to sustain 
integrated employment efforts on a statewide basis. 
When changes in state administration have altered the 
focus on integrated employment, local leaders worked 
to continue the momentum.    
7. Flexibility and respect for innovation
A high level of trust and respect between the state and 
its providers can encourage creative problem-solving 
and innovative employment supports. Perhaps the 
most important factor in New Hampshire is the state 
administration's respect for and support of new ideas 
among its service-providing agencies. The overall 
culture of the state seems to allow for values-based 
supports and flexible services. For instance, the state 
MR/DD agency has contracted with a small, innovative 
provider for use as a consultant to help other agencies 
think more creatively about community employment 
supports and the transition from facility-based 
services.  
Providers themselves have also noted the state's 
flexibility and have cited it as a boon for the expansion 
of integrated employment. For instance, when a 
woman who was receiving services from the MR/DD 
agency and working at home expressed an interest 
in office space but lacked the financial means, the 
provider asked the state if they could temporarily 
set her up in their agency offices. Although not an 
ideal location and against regulations that were 
meant to promote greater community inclusion, the 
state trusted that the provider was working with the 
woman to eventually establish a more integrated work 
environment. It is clear from this example that the state 
was allowing the agency to consider the individual first 
and the policy second.  
Institute for Community Inclusion
UMass Boston
100 Morrissey Boulevard
Boston, Massachusetts 02125
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PAID
BOSTON, MA
PERMIT NO. 52094
www.communityinclusion.org
For more information, contact:
Allison Cohen
Institute for Community Inclusion
UMass Boston
100 Morrissey Boulevard
Boston, Massachusetts 02125
617.287.4361 (v); 617.287.4350 (TTY)
allison.cohen@umb.edu
This publication will be made available 
in alternate formats upon request.
The authors would like to thank Sheila Fesko from 
the Institute for Community Inclusion, as well as the 
research participants for their efforts in this project.
This brief is available online at
www.communityinclusion.org
Conclusion
These interviews with key informants yielded much rich 
information about state and local integrated employment, 
and several themes emerged across states. Clear leadership, 
organizational variables that promote integrated employment, 
communication among stakeholder agencies, and respect for 
innovation are some of the most important ideas that were 
brought to light through the research. The enclosed checklist 
is offered as a planning tool for states to identify effective 
mechanisms for promoting employment in their state and to 
help them create a sustainable plan to increase their capacity 
to expand opportunities for integrated employment for 
individuals served by their MR/DD agencies.  
Sources Cited
Butterworth, J., Gilmore, D., Kiernan, W. E., & Schalock, R. (1999). 
State trends in employment services for people with developmental 
disabilities: Multiyear comparisons based on state MR/DD agency 
and vocational rehabilitation (RSA) data. Boston: Children's 
Hospital, Institute for Community Inclusion.
Prouty, R., & Lakin, K. C. (2000). Residential services for persons 
with developmental disabilities: Status and trends through 1999. 
Minneapolis, MN: University of Minnesota, Research and 
Training Center on Community Living.
This document was supported in part by cooperative agreement 
# 90DN0126 from the Administration on Developmental Disabilities, 
Administration for Children and Families, U.S. Department of 
Health and Human Services. Grantees undertaking projects under 
government sponsorship are encouraged to express freely their findings 
and conclusions. Points of view or opinions do not necessarily represent 
official Administration on Developmental Disabilities policy.
Strategies for 
success
Current examples in my state
Ways my state could expand 
opportunities 
Clearly defined goals and 
data collection
Strong agency leadership
Interagency 
collaboration
Ongoing training and 
outreach
Communication through 
relationships
Local control
Flexibility and respect for 
innovation
Strategic Planning Tool for States
Institute for Community Inclusion • Research to Practice, Vol. 9, No. 1


High-Performing States in Integrated Employment

[Excerpt] Between 1988 and 1996, the number of individuals supported by state mental retardation/developmental disabilities (MR/DD) agencies who participated in some type of community employment increased by 200%. Despite this increase, many agree that outcomes in community employment are in great need of improvement and vary widely among states. The purpose of this report is to highlight the successful practices of states that have been identified as "high-performers" in integrated employment for people served by state MR/DD agencies.high_performing_states.pdf: 155 downloads, before Oct. 1, 2020

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