CONTINUOUS QUALITY IMPROVEMENT IN SUPPORTED EMPLOYMENT

by Christy Lynch, Chief Executive Officer, KARE

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In recent years KARE has invested in person-centred planning and supported employment. Supported employment enables individuals with disabilities to choose the job they want in a regular company and have on-the-job training and ongoing support.

Individual support allows the person to do real work for real pay. It has the potential to offer something to all of the 200 adults who avail of our services.

Mary, who is 24 years of age and has a moderate learning disability, has been in supported employment for the past four years. Mary is paid by her employer, really enjoys her job, has made lots of friends in the company and is very well supported by her colleagues and the job coach who visits intermittently. Over the years her self-confidence has increased, her financial situation has improved, and she is now talking about how her career needs to develop and the goals she would like to achieve in the next few years. Mary is one of over 100 people in our service now working in the open labour market.

In thinking about the quality of the supports we offer Mary, we asked ourselves:

  • Has Mary really chosen this job?
  • Is she as fully included in her workplace as she might be?
  • What do her family think?
  • What do her employers and co-workers think of her performance at work?

We decided that we needed a quality evaluation to review the programme. Many of the quality evaluations that were available were not geared to supported employment, which is a relatively new and innovative approach.

At that time we were involved in a European-funded project with a number of supported employment services. All were struggling with the issue of quality. We approached five ‘experts’ in the area of supported employment to develop a quality measure for supported employment. The result was an instrument called Continuous Quality Improvement in Supported Employment (CQI), and KARE was one of two agencies in Ireland which piloted the instrument. CQI acknowledges that quality requires ongoing continuous improvement to which everybody must be fully committed.

Using this CQI system, the quality evaluation took approximately one week. Two of the CQI developers acted as facilitators rather than decision-makers, as CQI assumes that the people who are actually involved with the system are best placed to measure its effectiveness. The facilitators assist staff in looking objectively at the programme and the areas where the quality might be improved. To do this the facilitators were provided with key information in advance, i.e. the numbers of people at work, the types of job they were working at, levels of pay etc. They spent the first couple of days with three individuals who were availing of the supported employment programme–meeting with their families, talking to the individuals, visiting them at work etc.

Prior to the facilitators’ arrival we held focus group meetings with parents, with employers, with co-workers, with staff and with clients. All of these focus groups had independent facilitators and the outcomes fed in to the CQI process. The rest of the evaluation involved stakeholders–board members, management, clinicians, clients, frontline staff and parents–working in small groups and taking a detailed look at six key areas of the supported employment process:

  • Job development
  • Career development
  • Training and support
  • Inclusion of supported employees
  • Organisational environment
  • Quality of life

These groups identified the areas in which we were doing well and also the gaps in service or the areas that needed improvement. By the end of the process we had agreed an action plan and identified the specific areas of the service where we needed to improve the quality. As this action plan was developed by all of the key stakeholders there was strong ownership within the agency. At the same time it had been facilitated by two independent people who ensured a level of objectivity and asked the difficult questions which at times needed to be asked.

Since the evaluation we have set up several small working groups who are tackling particular areas:

  • focusing on careers rather than initial jobs by changing the way we did our vocational profiling;
  • offering employers opportunities to become more actively involved;
  • looking at quality-of-life issues outside the workplace as many of the young adults wanted to change other aspects of their lives outside of their 9-to-5 jobs.

This approach involves all of the key people and the plan is developed and owned by the agency–and so is more likely to be followed through. There is always the danger that people may feel that they have been over-criticised or not recognised for their good work. Our experience of CQI has been quite the opposite. Staff and families were energised by the experience and committed themselves to working even harder to improve the quality of the lives of the people we work with.

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