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Cost Efficiency and Funding

  • Cimera, R. E. (2006). The future of supported employment: Don’t panic! Journal of Vocational Rehabilitation, 24(3), 129–136. Reproduced with Permission.
    Author explores the validity of other literature’s proposed ways to improve supported employment by analyzing the state of supported employment from both the perspective of cost efficiency to provide services and the need to better research how employers benefit from hiring people participating in supported employment programs.
  • Cimera, R. E. (2007a). The cost of supported employment and sheltered workshops in Wisconsin (FY 2002-FY 2005). Journal of Vocational Rehabilitation, 26, 153–159. Reproduced with Permission.
    Researcher analyzed three fiscal years of Wisconsin’s VR services and determined that although initial costs are greater than non-supported employment options, the cost of continued services drops after four years of operation. Provides information on how to access cost efficiency of successful closures. Explores possible explanations for increasing expenses. Breaks down cost of supported employment by nature and severity of disability.
  • Cimera, R. E. (2007b). The cumulative cost-effectiveness of supported and sheltered employees with mental retardation. Research & Practice for Persons with Severe Disabilities, 32(4), 247–252. Reproduced with Permission.
    Examines and compares cumulative costs of the full "employment cycle" (referral, assessment, placement, follow-along, graduation/job-termination) of 56 supported employees and 171 people participating in a sheltered workshop. Both groups of employees were diagnosed with intellectual disorders and deemed “most significantly disabled.” Determined that not only was supported employment 64.5% more cost effective than sheltered workshops, sheltered workers receive services for a longer duration than supported employees. Discusses the possible reasons supported employment is more cost-effective than sheltered workshops. Discusses how to keep cost-effective analysis in context with findings.
  • Cimera, R. E. (2007c). Utilizing natural supports to lower the cost of supported employment. Research and Practice for Persons with Severe Disabilities, 32(3), 184–189. Reproduced with Permission.
    Study to determine whether using natural supports can decrease overall cost of providing supported employment in Wisconsin based on three cost analyses: looking at data collected before and after the Natural Supports Initiative (NSI) was passed, comparing per capita costs of supported employment from NSI agencies to costs generated by every other agency in Wisconsin and determining whether NSI agencies incurred greater costs than non NSI agencies. NSI agencies were more cost efficient than non-NSI agencies. Proposes reasons as to why NSI agencies were more cost efficient.
  • Cimera, R. E. (2008a). The costs of providing supported employment services to individuals with psychiatric disabilities. Psychiatric Rehabilitation Journal, 32(2), 110–116.

    http://dx.doi.org/10.2975/32.2.2008.110.116. Copyright © 2008 American Psychological Association. Reproduced with permission
    Objective: The purpose of this study was to determine whether supported employees with psychiatric disorders cost Vocational Rehabilitation more to serve than supported employees with other conditions (e.g., mental retardation). Method: A structured cost-accounting methodology was used to compare the adjusted costs(in FY 2005 dollars) of services received by all supported employees funded by Vocational Rehabilitation in Wisconsin from FY 2002 to FY 2005. Results: Supported employees with psychotic and non-psychotic disorders were among the least costly populations to serve via supported employment. They averaged annual per capita expenditures of $3,846 and $2,579, respectively. Supported employees, as a whole, generated average annual per capita expenditures of $4,683. Conclusions: Based upon data presented here and by other researchers, it would appear that individuals with psychiatric disorders are cheaper to serve than populations more traditionally referred to supported employment (e.g., individuals with mental retardation). If this conclusion is disseminated to referring agencies, perhaps individuals with psychiatric disorders will be referred to supported employment in greater numbers.

  • Cimera, R. E. (2008b). The cost-trends of supported employment versus sheltered employment. Journal of Vocational Rehabilitation, 28(1), 15–20. Reproduced with Permission.
    Explores cumulative cost trends of a "full employment cycle" for clients in sheltered workshops compared to supported employment agencies for people with intellectual disorders. For every one sheltered employee, three supported employees could have been funded. Researcher concludes that over time, supported employment is a better investment for tax payers because supported employment costs gradually decline over the course of the employment cycle while sheltered workshop employees have a slight increase in cost over time—two intertwining reasons for the increase could be because a sheltered worker has a longer "employment cycle" and the person has the same amount of supervision at the beginning of the employment cycle as they do at the end.

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  • Cimera, R. E. (2009b). Supported employment's cost efficiency to taxpayers: 2002 to 2007. Research & Practice for Persons with Severe Disabilities, 34(2), 13–20. Reproduced with Permission.
    Studied gross monthly benefits vs gross monthly costs to calculate cost efficiency of VR clients from 2002-2007. Also compared nine categories of disabilities to determine which type of disability was most cost-efficient to tax payers. Researcher concluded supported employment is cost effective to tax payers, regardless of the disability. Secondary conditions did not significantly increase cost. Both clients with and without secondary conditions achieved similar outcomes.
  • Cimera, R. E. (2010a). Can community-based high school transition programs improve the cost-efficiency of supported employment?. Career Development for Exceptional Individuals, 33(1), 4–12. Reproduced with Permission.
    Researchers compared the data of 254 transition age youth living with a variety of disabilities to see which employment model (no transition services, school-based transition services, community-based transition services offered at school and students not interested in services) was most cost effective for taxpayers. Researchers matched individuals based on primary disability, presence of secondary disability, length of employment, and cost of supported employment services received. Cost of vocational services forgone, taxes paid, changes in governmental subsidies and tax credits. 85% of students who received community-based services through their school were more cost effective than their peers who did not receive transitional services. 88.2% of students who received community-based services during high school were more cost-efficient than their school-based transitional services. The cause for greater cost-efficiency is because students who participated in the community-based services stayed at their job double the length of time (averaged) than their peers receiving school-based transitional services. However, because participants made so little money, only 6 of the participants actually made enough money to pay taxes, rendering every employment model not cost-effective for taxpayers. This study did not explore the non-monetary benefits (improved quality of life, happiness, independence, etc). Supported employment programs need to explore ways to become more cost-effective.
  • Cimera, R. E. (2010b). National cost efficiency of supported employees with intellectual disabilities: 2002 to 2007. American Journal on Intellectual and Developmental Disabilities, 115(1), 19–29.
    Defines cost efficiency (monetary benefits vs monetary costs) and explains different ways to measure cost efficiency. Explores weaknesses in cost-efficiency analysis (age of literature, economic variables, funding sources, localized data, variations in economic achievement outcomes and small sample sizes). Looks at how to best determine if supported employment is cost-efficient from a taxpayer’s perspective. Explores whether secondary conditions impact cost-efficiency of supported employment model, discusses changes in cost efficiency and delineates which states, territories are most cost efficient. Explores possible reasons behind effectiveness.
  • Cimera, R. E. (2012). The economics of supported employment: What new data tell us. Journal of Vocational Rehabilitation, 37(2), 109–117. Reproduced with Permission.
    Comparative literature review juxtaposing pre-2000 research on supported employment with research conducted post 2000. Continuous analysis is required because economic data is highly fluid over time. Concluded that regardless of the type of disability, people who participate in supported employment programs have better outcomes than those who participate in sheltered workshops. Working in the community makes greater economic sense. Sheltered workshops are not as cost effective as supported employment. During an "employment cycle," returns a net benefit to tax payers. Rise in cost-efficiency over sheltered workshops is likely due to increased wages. Relative value of what sheltered workshop employees earned decreased by 40.6%. Acknowledged that even with the increased wages, supported employees do not have income sufficient to mitigate poverty which makes supported employment fall short of expectations. Supported employment costs are contingent upon location and vary dramatically. Supported employment costs fluctuate monthly - especially during the first several months of a newly enrolled participant. Researchers must base cost-efficiency analysis on entire "employment cycle" (enrollment, pre-employment support, postemployment support, disenrollment) to obtain accurate cost efficiency data. When other researcher do not take the entire employment cycle into account, it can skew cost-efficiency data. Individuals served in a community-based model are more cost effective longitudinally than segregated workers. Explores ways to reduce costs of supported employment including using transition programs, proving training for natural supports and involving coworkers in the training of supported employees. Because cost-effective programs are more likely receive long-term funding, it is vital to learn strategies to drive down costs.

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  • Cimera, R. E. (2014b). Reducing the cost of providing supported employment services: A preliminary study. Journal of Rehabilitation, 80(3), 4–10.
    Wisconsin's supported employment "follow along" services analyzed for cost efficiency, comparing "follow along" supported employment services for 19 individuals provided by "individual-provided" (non-Job coaches/natural supports) and 19 individuals receiving supported employment services from agency trained job coaches. Both groups were matched based on six variables. Proposes arguments for and against individual-provided follow-along services. In addition to exploring how to reduce the cost of supported employment, author explores service quality provided by cheaper service options. Findings reveal that people who received individual-provided supported employment services were nearly twice as likely to keep community-based jobs. Individual service providers were more effective a providing follow along services. Hypothesized that success rates also increased because individual-provided supported employment services are more effective because the person is vested in the person receiving services, knows their interests better and has a better understanding of the person's capacity and how to better relate and motivate them. Concludes that agency provided supported employment services are more likely to allow the individual to simply return to a sheltered workshop when things become challenging.
  • Rusch, F. R., & Braddock, D. (2004). Adult day programs versus supported employment (1988–2002): Spending and service practices of mental retardation and developmental disabilities state agencies. Research and Practice for Persons with Severe Disabilities, 29(4), 237–242. Reproduced with Permission.
    Researchers found that sheltered workshops received four times the financial resources of supported employment. The number of supported employment programs more than doubled during 1988-2002, but most of the growth slowed after the initial four years. 25-30% of people living with severe disabilities participate in supported employment. Amount spent on supported employment is less than a fourth of what is spent on adult day programs and sheltered workshops, even though the number of people participating in sheltered workshops and supported employment is near equal. In 2002, funding for segregated adult day programs is four times that of supported employment. Researchers provide recommendations to better prepare students with disabilities for transition to employment and encourages high schools to take the lead in implementing them.

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