Scoping Review of Cost Analyses of Employment Services for Individuals with Intellectual and Developmental Disabilities

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This summary is for general information and reference purposes. The original article is owned and copyright protected by the IOS Press.

A quick look:

When we evaluate the outcomes for individuals with intellectual and developmental disabilities (IDD) in achieving competitive integrated employment, it is important to consider the cost-benefit of those services. Cost-benefit is an analysis of how much is costs to achieve a certain beneficial outcome. For CIE, we can calculate this in terms of how much it costs and benefits the individual worker or we can think about it in terms of those overall return on investment from the perspective of a tax payer. The purpose of this scoping review was to analyze and synthesize the research on these cost-benefit analyses and what they tell us about different types of vocational services provided to individuals with IDD. This review looked at not only research articles, but also “grey literature” or reports, policy documents, and other ways that these cost-benefit analyses might have been published that might not have been published in a research journal. The review resulted in a total of 26 studies in addition to those other reports and documents. The main findings of the review were that services that were integrated in community businesses had the most benefit for how much they cost (from both the worker and the tax payer perspective) and lower benefits for sheltered workshops and services that segregated individuals with IDD.

Key Findings:

  • Several "integrated" vocational models were highly cost-beneficial across several studies like supported employment and customized employment.
  • Sheltered workshops provided little or no cost-benefit, and much less than integrated models from the perspective of both workers and tax payers.
  • "Pre-training" does not work—Providing training in segregated settings for individuals before they started working in the community actually reduced effectiveness of services
  • Supported employment costs went down over time but stayed the same for sheltered workshops
  • Individuals that had previously had a job through supported employment services needed less costly services to achieve the same outcome as those who had not worked before

Putting It into Practice:       
To create more positive employment opportunities for youth with IDD:

  • Individuals with IDD should be encouraged to engage in integrated and individualized vocational services in real work settings for real pay.
  • Practitioners should rely on individual models of employment rather than group models.
  • Providing long-term supports to individuals with IDD is very important to ensuring job stability, opportunities for retraining, and helping employees to grow in their roles.
  • Training is important for staff working to support individuals with IDD in supported employment and other integrated models, especially for those that may be used to providing other types of services previously.

More about this Article
Recent U.S. policy and action has emphasized the importance of CIE as the goal of employment services for people with disabilities, and in many cases has encouraged states to move away from sheltered workshop models. This review gives more evidence to support that stance, and should provide encouragement to individuals and their families to demand integrated, individualized employment services like supported employment and customized employment. For service providers, this review gives another clear indication that the future is real work for real pay through integrated employment services.


Article Citation: Taylor, J., Avellone, L., Cimera, R., Brooke, V., Lambert, A., & Iwanaga, K. (2021). Scoping Review of Cost Analyses of Employment Services for Individuals with Intellectual and Developmental Disabilities. Journal of Vocational Rehabilitation.


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Virginia Commonwealth University, Rehabilitation Research and Training Center (VCU-RRTC) is an equal opportunity/affirmative action institution providing access to education and employment without regard to age, race, color, national origin, gender, religion, sexual orientation, veteran’s status, political affiliation, or disability.  The VCU-RRTC is funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant #90RTEM0003).  NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). If special accommodations are needed, please contact Vicki Brooke at (804) 828-1851 VOICE or (804) 828-2494 TTY.