Supported employment: review report and Scottish Government response

Part 2: Quality of Provision

Overview

In order to understand the quality of provision of supported employment across Scotland, the research team:

• carried out over 25 semi-structured interviews with Scottish Government representatives, Local Authorities, service providers, amongst others;
• held a focus group with the research steering group focused on three key themes driving quality of supported employment delivery;
• held a focus group meeting with individuals with lived experience, and spoke with individuals with lived experience in deep dive areas;
• undertook four deep dive audits of supported employment service providers, two of which were with Local Authority providers, and two with Fair Start Scotland providers. This involved use of the British Association for Supported Employment (BASE)-endorsed modified version of the Supported Employment Quality Framework (SEQF). This helped us to review the fidelity of supported employment services delivered in Scotland to the SEQF, an internationally agreed model of supported employment; and
• put the findings from the audits into four case studies, noted in Annex B in this report.

Key findings:

1. There are a range of supported employment models being delivered, with some examples of excellent support but variation in outcomes achieved

2. There is limited use of consistent quality standards throughout Scotland, but work is underway to address this

3. There are examples of high-quality employer engagement in Scotland, but opportunities to increase co-production

4. There is positive work underway to develop the workforce

1. There are a range of supported employment models being delivered, with some examples of excellent support but variation in outcomes achieved

Across Scotland, there are a range of supported employment models being delivered. The 5-stage model of supported employment and DFN Project Search were most referenced by responding Local Authority providers (at 65% and 48% respectively). There are also examples of supported businesses employing and supporting people with learning disabilities. The businesses deliver some or all of the 5-stage model.

There was a consensus from interviewees that having a range of needs-lead support is important. We also heard that these models complement each other and are important to build a strong supported employment landscape. For example, Project Search benefits from high-quality local supported employment providers to support interns into the workplace. Supported businesses play a key role in developing the aspirations of employers and showing what is possible.

However, we heard that, regardless of the specific model of supported employment delivered, there needs to be more clarity over quality supported employment standards to ensure clients receive a good service.

Paid Outcomes Achieved

Paid work outcomes are a proxy for the quality of service offered to clients.

Through our survey, we received Local Authority data on outcomes from 16 of the 31 respondents. We asked for "data on the percentage of clients engaged in your programme who go on to secure paid employment with your Local Authority area". The exact wording of the question is noted in Annex A.

There was a significant range in outcomes reported, with one Local Authority reporting that they had supported 10% of clients into work. Another reported helping 83% of clients to secure a paid job. Where data was available, the average outcomes rate amongst Local Authority services was 43%. It is to note that some respondents counted training and learning as a positive outcome, with others only counting paid work outcomes.

Interviewees noted a perception that perceived poor performance amongst Local Authority services may lead to funding cuts. Their keenness not to be disadvantaged in applying for funding was often expressed through a reluctance to disclose any information about their service that might be made public. However, we heard consistently that in the face of poor performance, investment is needed to improve outcomes.

There was limited data available on longer term outcomes, particularly around the percentage of clients who sustain their job for three or six months, suggesting an opportunity to standardise data collection.

Variation in Funding

We received data from 20 Local Authorities on their total annual supported employment funding and the number of people supported each year. The funding per client per annum ranged from <£1,000 to over £7,000.

We were able to source both cost per client data and outcomes data for eight Local Authorities. We plotted the data, and it is presented below:

Despite the small sample size, the plot would seem to suggest a link between more funding per client, and higher job outcomes. We heard that funding security allows services to successfully:

• upskill and retain staff;
• fund in-work support and upskill employers; and
• reduce time and energy spent on funding applications.

Conversations with Fair Start Scotland providers suggested that the current payment by results model acted as a barrier to further investment in supported employment delivery in their locality. This is because the supported employment model requires significant up-front time commitment in vocational profiling with the client and identifying suitable job matches, with no guarantee of a job outcome after this work. This can be challenging when funding is dependent on job outcomes.

16+ Hours of Work

Some providers, particularly those delivering support under Fair Start Scotland, noted that funding was contingent on individuals entering work for over 16 hours. This was reported to be a barrier to working with all clients. Many clients accessing supported employment may want to work on a part time basis initially, with the aim of working towards full time employment in future.

Other individuals may decide that they want to work part time for the foreseeable future. Supported employment is based on the ethos of client preference and therefore this preference should be supported. We therefore heard calls for the 16+ hour of work requirement or link to outcomes funding to be removed.

Delivering Support in Rural Locations

We heard that there are specific challenges to offering quality supported employment in rural areas. There can be additional barriers to employer engagement, exacerbated by the need to overcome stigma in smaller communities where people are well known to each other. We heard from third sector providers that not all Local Authorities are fully bought into the supported employment model. This is particularly the case in instances where there is a continued and established practice of funding day services for clients, rather than employment support.

There were examples of experienced third sector providers having closed in rural locations due to funding insecurity. Other third sector providers expressed concerns that when external funding ends – such as that from the European Social Fund – locally devolved funding may not be used for supported employment or reach third sector providers.

Finally, we heard from some rural Local Authorities that nationally commissioned support, including FSS, has a limited reach in their areas. This is because of the large geographic spread of some regions, and the need for services to be delivered by third sector providers with strong local links. We heard that currently national supply chains are not reaching all of these communities.

Nevertheless, we heard that The Public Social Partnership (PSP) hosted by the Scottish Union of Supported Employment (SUSE) is creating opportunities for collaboration across Scotland, and is giving larger providers the chance to help smaller providers engage with employers.

There are also examples of providers creatively overcoming rural transport challenges. One provider mapped out journey times across a Local Authority area and picked their site based on where was most easily accessible. They also worked with local community transport providers to increase access to the service.

Our report was written amidst the COVID-19 pandemic, and studied provision delivered amidst challenging circumstances posed by the pandemic. With meetings held virtually on forums such as Zoom and Microsoft Teams rather than in person, there appear to have been more opportunities for stakeholders in more rural locations to engage in meetings that may previously have been difficult to attend. However, increased use of remote working relies on clients accessing services to have digital facilities, and digital poverty remains a risk, particularly in more rural locations where access to transport is limited.

2. There is limited use of consistent quality standards throughout Scotland, but work is underway to address this

Quality Standards and Assessment

There is currently limited use of consistent quality standards for supported employment in Scotland. We heard that this makes it challenging for commissioners to understand the quality of supported employment services. Feedback received suggested that performance management tools used by local commissioners are not designed for supported employment. As a result, providers may offer a "supported employment" service with the best of intentions, but the offering may fall short of the expectations initially set out by commissioners, demonstrated by below-target paid work outcomes. Central standards and regular quality assessment may help here.

Positive work is underway to address the shortfall in consistency. Scottish Union of Supported Employment (SUSE) has developed a 6-stage quality assessment model tailored to the Scottish landscape. This includes assessment of the five stages of supported employment as well as leadership and organisational capacity.

Local Authority leads have done some local work to develop standards and quality assurance that they could take forward and would welcome central standards and assessment. This would include common data standards, collection, and benchmarking of performance.

Project Search sites benefit from a standardised quality assurance framework, data collection and communities of practice. This allows the Project Search central delivery team to understand the quality of services offered in individual locations. It also supports sharing of best practice amongst providers and means that performance challenges can be identified and rectified.

Co-production

Importantly, our semi-structured interviews and focus groups highlighted that co‑production is serving to incorporate the voices of those with lived experience into the design of models.

There are some local examples of high-quality and meaningful engagement with people with lived experience. For example, we heard examples of organisations facilitating training to employers lead by people with learning disabilities.

In general, we heard that there was an opportunity to do more on this – there was a request for more examples of people with lived experience on boards of supported employment providers or working within them.

As noted above, providers felt that long-term co-production work is made challenging by fixed term contracts and short funding cycles. Because there is a range of standards in support, we also heard that clients themselves aren't informed about what is on offer. This makes it difficult for clients to hold providers to account so they deliver a high-quality service.

Quality of Delivery: Summary

Our review conducted four deep dive quality assessments of services, following the BASE quality assessment methodology. The sites were selected based on initial data analysis and designed to give a representative sample of commissioning structure, location, and service type.

Site Number / Rationale for Selection

1 Commissioned through Fair Start Scotland (FSS) and delivered by the FSS contract holder that delivers the highest quantity of supported employment through FSS.

2 Commissioned through FSS, subcontracted to a third sector provider, in a region in Scotland with limited Local Authority supported employment provision.

3 Commissioned by a Local Authority and delivered in house by Local Authority in a City Region.

4 Commissioned by a Local Authority and delivered by a local third sector provider.

The deep dive reviews found that there was significant variation in the quality of service delivered across different areas. One Local Authority area had excellent, high-quality provision and high fidelity to the 5-stage model of support, with low caseloads and strong outcomes evidenced. The other Local Authority area offered a pan-disability service with evidence of good practice on some of the 5-stage model, but only very light touch job matching and in-work support. This service also received few referrals for individuals with learning disabilities and autistic people. The Fair Start Scotland services were found not to be delivering the 5-stage supported employment model, had very high caseloads and were not supporting individuals with more moderate or severe disabilities. Reasons for this are given below:

Quality of Delivery: Fair Start Scotland

Our quality reviews of FSS service delivery across Scotland found that services are delivering personalised support to the best of their ability through the contract. When clients enter the service, they are assessed and those identified as having additional barriers to employment are offered supported employment, as required by the Fair Start Scotland contract. However, as noted above, the Fair Start Scotland providers reviewed were not delivering the 5-stage supported employment model.

The main reasons identified for this were:

• Reaching clients furthest from the job market: A majority of referrals to Fair Start Scotland come from Jobcentre Plus, via client self-referral. Those furthest from the job market may not self-refer, and so stand to go without a supported employment service offering. In one service, of the clients receiving supported employment, needs tended to include anxiety, mild depression, and milder forms of learning disability.
• 16+ hours of work: The Fair Start Scotland contract stipulates that clients need to secure 16+ hours of work per week to trigger a success payment. Meeting the target is particularly challenging given the needs and preferences of clients and has been exacerbated by COVID-19's impact upon the labour market.
• The payment-by-results nature of the funding makes it challenging for providers to invest upfront in removing barriers to employment and providing ongoing in work support. This means that while the service may be offered to individuals, the five stages of the model are not consistently delivered.
• High caseloads of 50-60 people on the part of key workers mean it is challenging to offer truly tailored support which ultimately supports clients to find and sustain a job. Supported employment services would generally have caseloads of around 20 to offer truly tailored support. Some services have different staff members delivering different parts of the service.

However, we did find areas of practice where Fair Start Scotland providers were delivering good, individualised support:

• Employer Engagement: One Fair Start Scotland provider views their employer engagement as an opportunity to build diversity and inclusion in the workplace. Employers praised their awareness raising via social media, their staff onboarding processes, and initial worksite reviews to assess suitability for clients.
• Use of Health and Wellbeing Advisors: One Fair Start Scotland provider offers a Health and Wellbeing advisor to every individual identified as having additional barriers to work. They are booked in to see a Health & Wellbeing Adviser within four weeks of starting Fair Start Scotland to establish if more in-depth support is required through the Supported Employment Model (SEM), or through Individual Placement and Support (IPS). Vocational Profiling may also be offered on its own.
• Use of personalized support: Tailored support is offered to each individual client, and in a COVID-conducive manner. Clients praised the online support offering by one FSS provider, with courses available on a range of topics, including to manage anxiety and build confidence. Weekly check ins have been described as a "lifeline" during challenging COVID times.

Quality of Delivery: Local Authority Services

Our quality reviews of service delivery through Local Authorities noted a variation in service design, referral criteria and adherence to the 5-stage model across the two services reviewed. One service sits under the local Health and Social Care Partnership, the other is delivered by a consortium of partners with Council and ESF funding. This variation is not surprising given the locally led commissioning model combined with limited use of standardised quality standards.

The service that was delivering particularly high-quality support to individuals with learning disabilities and autistic people had the following features:

• High-quality delivery of 5-stage model and strong outcomes: The service staff have an average case load of 12 clients. This enables staff to offer tailored, person-centred support which flexes to the needs of service users. Aided by strong networks with employers, colleges and the NHS, around half of all clients engaged secure employment and half of these sustain it for at least six months.
• Partnership building: The team work collaboratively with external parties. Relationships have been developed with wide and varied community organisations, including Prince's Trust, Autism Network Scotland, and Scottish Commission for Learning Disabilities (SCLD).
• Performance amidst COVID-19: Although the number of new engagements dropped slightly due to COVID-19, outcomes targets continued to be achieved. With face-to-face meetings not possible, staff used text messaging, phone calls and virtual meetings to support the health and wellbeing of clients. The service made use of the Connecting Scotland programme, ensuring ICT kit and connectivity was available to vulnerable clients.

The main challenges identified through the review were:

• Securing long-term funding: The service currently relies on a 40% top-up from ESF. This funding brings challenges such as monthly audits, which are onerous for staff. However in its absence, a strategic challenge will be to secure further longer-term funding.
• Managing Case Load Size: The service tries to stick to its small caseload size to provide truly tailored support. This means that they have to find alternative support and services for individuals who are not likely to go on to secure work. They have built relationships with befrienders and mental health services.
• Training and retaining workers: Significant resources are used in training supported employment practitioners. Once trained, retaining expertise can be a challenge in the absence of long-term certainty over funding.

The other Local Authority service, which is a pan-disability service, also demonstrated examples of excellent support:

• The service benefits from a high-quality welfare rights service as evidenced by external reviews, which adds tremendous value and impact for clients using the supported employment service.
• All Partners/Providers evidenced a holistic, client-centred practice with the aim to understand, involve, listen, and provide the best support possible to assist people into paid work. Staff were observed as highly engaged and passionate about their work and delivering the right support for their clients to gain, maintain and sustain paid employment, with low caseloads of around 20 clients to support this.
• Good use of relevant subsidies and Access to Work scheme to provide the employer with funding to offer the in-work support.

The challenges identified through this review were:

• Referrals for people with learning disabilities or autistic people: People with a learning disability or autistic individuals do not routinely stream into this service and the greater proportion of service users appear to be people presenting with mental health conditions.
• Employer engagement could have focused more on building new relationships and carving specific job opportunities. Cross representation of staff reported being more focused on traditional job seeking methods, that lacked some of the depth expected in the 5-stage model.
• Job Matching and Career Progression: Given the presenting service users, job matching, in work support and follow along career progression was understandably lighter touch. There was evidence from interviews that staff had the ability to manage more in-depth delivery of in work support for both the employee and employer.

3. There are examples of high-quality employer engagement in Scotland, but opportunities to increase co-production

We came across many examples of strong relationships between service providers and employers in Scotland. Particularly successful are non-judgemental relationships developed over a period of years through partnership working. However, these do often require investment on the part of service providers up front, in order to upskill employers. Offering longer term funding and employer incentives where appropriate can be particularly challenging given the short-term nature of many service providers' funding streams.

In addition to funding limitations, providers face ongoing challenges to overcome common myths associated with employing people with learning disabilities. It is key to showcase the skills that people with learning disabilities can offer to employers, and this requires an investment on the part of providers and employers, not least in terms of time dedicated. This can be particularly challenging in the instances where providers' key workers have caseloads of 50-60 clients at any one time. The challenge posed by larger caseloads was felt particularly by Fair Start Scotland providers.

We heard that the Public Social Partnership (PSP) hosted by SUSE is developing innovative ways of engaging employers and showcasing what employees with learning disabilities and neurodiversity can offer. For example, the PSP has identified seven employers who will now receive return to work training, to enable them to better support staff with disabilities to stay well in work.

One service had success in raising employer aspirations by gathering local employers to an evening dinner. Everyone involved in delivering the evening, from those on the reception desk to those serving the food had a disability and was in receipt of supported employment. It showed directly to employers the skills these staff bring to an organisation. It led to one on the spot job offer and increased engagement from employers.

Providing On-Going In-Work Support

Raising the aspiration of employers and providing long-term in work support was a key theme emerging from focus group conversations. The length of time for which in-work support is offered can be insufficient, with adjustments made by employers often "one-off". Participants also noted that assistance needs to be provided in such a way that it doesn't undermine the person receiving it and that working alongside other people with disabilities was viewed as positive.

One client had left a job they enjoyed having been treated poorly and not received support. They noted having been mocked by colleagues for their disability.

"I wasn't offered any support and when I asked for it, I was told to 'put up with it'. I loved the job but hated the people, and so I left."

Focus group member

The review saw a number of examples, especially through supported businesses, where individuals had been supported into self-employment. One supported business has supported clients to set up their own companies in catering and hospitality. This support is important in delivering the 5-stage model, as client preferences should be taken into account, including those who want to set up their own business.

4. There is positive work underway to develop the workforce

Efforts to develop staff members within the supported employment space are aided by a range of training opportunities. Positive work is being done by the NIDMAR programme which aims to professionalise the workforce. Some staff are undertaking the Professional Development Award (PDA) in supported employment. Training Systemic Instruction (TSI) also offers a structured approach to teaching vocational and independent living skills, in particular for those with learning disabilities.

NIDMAR

The National Institute of Disability Management and Research (NIDMAR) was founded in 1994. It is committed to reducing the human, social and economic costs of disability. As an education, training and research organisation, NIDMAR's primary focus is the implementation of workplace-based reintegration programmes.

The NIDMAR supported employment case manager training is designed to support the professionalisation of the workforce and equip case managers to have a values-lead approach to supported employment. Participants take an exam which allows them to access a professional qualification, the Certified Disability Management Professional (CDMP) registration. There is also a fast track qualification process for individuals who already hold the PDA in Supported Employment Practice. We heard positive feedback from interviewees about the aim of professionalising the workforce. Survey feedback from participants also show most participants reporting that they will be able to implement module learnings in their working life.

However, undertaking NIDMAR training requires a significant time commitment on the part of students, with a six-hour exam required to secure a "pass". Interviewees from providers and Local Authorities who had attended training or sent team members on the course described NIDMAR training as being interesting, but not necessarily useful in the context of their day-to-day work in the supported employment space, particularly considering the time investment required. Training was viewed as more useful in the context of case management and HR, and is more of an "occupational health qualification" than a supported employment one. We also heard requests to make the qualification more accessible to individuals with learning disabilities. Finally, interviewees noted that the course is more suited to individuals with some experience of delivering return to work services and there is a gap in training for people new to supported employment. We understand that work is underway to develop a NIDMAR apprenticeship programme in response to this.

Professional Development Award (PDA)

The PDA in Supported Employment Practice provides a combination of off-the-job and workplace learning for supported employment practitioners. The award has been designed to be delivered through an inclusive partnership approach; engaging with employers, training providers and approved centres. It provides candidates with the opportunity to develop the knowledge, skills and understanding required to work within a variety of settings, with clients who have additional needs. Candidates also develop the skills required to engage with prospective employers and offer them appropriate support throughout the process.

In interviews with providers, the PDA was consistently highlighted as being the most useful and relevant qualification for supported employment professionals. Interviewees liked the length of the investment in learning required and noted that the content was very tailored towards their day to day work.

We also heard that the content may not have been updated for a few years, so there could be value in refreshing it and ensuring it is up to date for adapted ways of working through COVID, such as more remote working. Interviewees also noted that the training was more suitable for individuals with experience delivering supported employment, and so an entry level course may be useful as an additional course. Finally, interviewees noted that people with learning disabilities deliver supported employment and therefore the qualification should be reviewed to ensure it is accessible for individuals with learning disabilities.

Qualifications and career pathways

The review found variation in the amount and types of training that had been undertaken by different organisations. There was not sufficient data to assess whether services that had undertaken particular qualifications achieved better outcomes. We did hear that because there are not requirements around training for staff, this can result in inconsistent quality of delivery.

Providers also noted that there is a challenge around marketing, recruiting and funding the role, and the work being done by Scottish Government and the NIDMAR programme to professionalise the workforce is therefore welcomed. We heard calls for more clearly defined career pathways with suggested pay grades, along with a shorter introduction training programme for professionals who are new to supported employment.