Research to Practice Brief
Institute for Community Inclusion
University of Massachusetts Boston 
Issue No. 52, 2012

The 2010–2011 National Survey of Community Rehabilitation Providers Report 1: Overview of Services, Trends and Provider Characteristics
Daria Domin and John Butterworth
Introduction  
This the first in a series of research to practice briefs based on the 2010–2011 National Survey of Community Rehabilitation Providers (CRPs) funded by the Administration on Developmental Disabilities and the National Institute for Disability and Rehabilitation Research. This brief presents findings on people with all disabilities and people with intellectual and developmental disabilities (IDD) who are served in employment and non-work settings by community rehabilitation providers (CRPs). The last national comprehensive survey of CRPs conducted by the Institute for Community Inclusion was in 2002–2003, and also gathered data on provider services for individuals with disabilities (Metzel et al., 2007). This brief will incorporate some of those findings and compare them against the 2010–2011 survey in order to assess the state of integrated employment outcomes of people with disabilities.
Overview of Services
Most CRPs provided both employment and non-work services, although a significant minority provided only work or only non-work services.
Of the 1016 CRPs who responded to the full-length survey questionnaire, 83% described their organization as private non-profit. The remaining CRPs fell into the following categories: for-profit entities (8%), public-state or tribal government (4%), public-local (3%), and other (2%). The average total operations budget reported for employment and day services was $3,839,731 (n=682).
Sixty-nine percent (n=695) of CRPs provided both employment and non-work services. Nineteen percent (n=195) offered employment services only, and 12% (n=117) served only individuals in non-work services. Overall, individual supported employment was the most frequently reported employment service, followed by competitive employment. Facility-based non-work was the most commonly offered non-work service (Fig.1).
Individuals with IDD represented a significant majority of people supported by CRPs. 
In FY 2010–2011, CRPs reported serving a total of 201,672 individuals across employment and day services. Seventy-five percent (n=150,330) of those reported were individuals with IDD. The average number of individuals supported per CRP was 198. 
CRPs were asked to report the number of individuals with any disability and the number of individuals with IDD for nine employment and four non-work settings. The majority of individuals in both disability categories were supported in facility-based and non-work settings—61% of individuals with any disability and 70% of people with IDD. A relatively small percentage of both groups were supported in other services.
The majority of participants in employment services were also individuals with IDD. 
When asked to specify the number served in employment services by disability types, CRPs reported that half of those served in employment services were individuals with IDD (72,833 out of 144,807). Individuals categorized as having a mental illness comprised 19% of those served in employment services. The remaining disability types served by CRPs were physical disability (9%), learning disability (9%), other (6%), substance abuse (3%), blindness or visual impairment (2%), and deafness or hearing impairment (2%). 
Employment Services
Only 28% of individuals with any disability and 19% of individuals with IDD received individual integrated employment supports.
Out of all the respondent organizations, 900 provided employment services to a total of 126,529 individuals with any disability. The overall distribution of services by disability type can be found in Table 1. This section presents findings on employment outcomes for both groups. Thirty-six percent of individuals with any disability were supported in integrated employment settings (group and individual), with the highest number of individuals supported in individual supported employment (14.2%), and followed closely by competitive employment with time-limited supports (13.4%). Overall, only 28% of individuals were supported in individual integrated employment, compared to 24% in the 2002–2003 CRP survey. This shows only a slight increase in the number of individuals with all disabilities supported in this employment category (Metzel et al., 2007).
The percentage served in integrated employment was lower for individuals with IDD compared to individuals with any disability, at 28%. Individual supported employment was also the most common integrated employment service (12.1%), serving almost twice as many individuals as competitive employment, which was the second most common setting (see Table 1). Only 19% of individuals with IDD received individual integrated employment services, not much higher than the 18% found in the 2002–2003 CRP survey (Metzel et al., 2007). 
A quarter of individuals with IDD worked in facility-based employment.
Out of all the work and non-work service settings that CRPs reported offering in FY 2010–2011, facility-based employment was the highest service category for individuals with IDD (25.2%). Ninety percent of those served in sheltered employment were individuals with IDD. In the 2002–2003 survey, CRPs reported serving 36% of people with IDD in sheltered work, demonstrating a significant decrease in seven years (Metzel et al., 2007). Please refer to Table 1 for more information on total served by service category. 
Individual integrated employment services include competitive employment and individual supported employment.
Integrated employment services include competitive employment, individual supported employment, self-employment, enclaves, and mobile crews.
Group supported employment continues to play a smaller but significant role in employment supports. 
While individuals are more likely to be in individual supported or competitive employment services, enclaves and mobile work crews continue to play a significant role in employment supports, particularly for individuals with IDD. Almost 10% of individuals with IDD in this sample participated in group supported employment, or about one third of those in integrated employment. 
A higher percentage of people with IDD were paid in all employment services compared with people with any disability.
The majority of individuals with any disability were paid (76%, n=96,268) in each service setting. Individuals working in mobile crews were the most likely to get paid (96%), while people in competitive employment services were the least likely to receive compensation, although a significant majority did (61%). 
Table 2 displays a breakdown of percentage paid in each employment setting. Eighty-eight percent of individuals with IDD were paid, 11% more than people with any disability. Out of the nine employment settings for which CRPs reported data, individuals with IDD were more likely to get paid in seven of the settings compared to people with any disability, possibly reflecting the long-term engagement with employment supports that many individuals with IDD experience (see Table 2). Because individuals with disabilities other than IDD are more likely to receive time-limited services, they are also more likely to be in a career planning or job development stage of the employment process. Furthermore, a higher percentage of individuals with IDD receiving integrated employment services were paid compared with people with any disabilities (83% and 73%, respectively).
How many people with IDD work for pay in individual integrated jobs?
15% of individuals with IDD were reported to be working for pay in individual integrated employment. This is consistent with the 14.4% reported to work in individual employment by the National Core Indicators project, which collects data at the individual level on individuals supported by state IDD agencies (Human Services Research Institute & Institute for Community Inclusion, 2011).
CRPs were more likely to report that competitive employment services and individual supported employment services increased in the past 3 years than other services.
CRPs were asked to report whether they currently provide or have provided six types of employment services in the past three years. If a respondent answered in the affirmative, they were asked a follow-up question on whether the service increased, decreased, stayed the same, or was discontinued. Individual supported employment was provided by the highest percentage of CRPs (Figure 1). Seventy-one percent of organizations also reported that service provision in this area either increased or stayed the same in the past three years, and only 1% had discontinued the service (Figure 2). 
As compared to other types of employment services, CRPs reported that competitive employment had increased the most in the past three years (47%), while facility-based work decreased more than other services (32%). Less than 1% of respondents reported that they had discontinued facility-based work. The top three employment service settings that CRPs reported as increasing—competitive employment, individual supported employment, and facility-based work—also served the largest number of individuals with any disability (Table 1). 
Medicaid waiver funds were the largest funding source for employment services.
CRPs were asked to report how many people were supported in employment services by various federal, state, and other funding sources. Respondents reported that a quarter (37,513 out of a total of 148,913) of the individuals who received employment services were funded by Medicaid waiver funds. State vocational rehabilitation agencies funded approximately 20% of individuals, while state IDD agencies provided financial support for 16% of those served. The remaining 39% were funded by welfare-to-work (11%), other sources (10%), state mental health agencies (7%), workforce development (3%), and self-pay (>1%). Seven percent were not funded at all. 
Non-Work Services
The number of individuals reported to be receiving non-work services grew compared to the 2002–2003 survey.
Despite the self-reported increase in integrated employment by CRPs in the past three years, a substantial number of people were being served in non-work services by CRPs nationwide. Facility-based non-work was the third most common service for people with any disability (23% served) and the second most common for people with IDD (26%). Community-based non-work served fewer individuals than facility-based non-work for both disability groups.
Compared to the 2002–2003 survey, these data suggest that there has been growth in non-work service participation for individuals with IDD. In 2002–2003, 33% of individuals with IDD were reported to be in non-work services, compared to 43% in the current survey. This change has primarily been offset by a decline in the percentage of individuals with IDD reported to be in facility-based work, dropping from 41% in 2002–2003 to 27.5% in the current survey.
CRPs providing non-work services were asked to report on whether they currently provide or have provided two types non-work services in the past three years. Eighty-five percent (n=423) reported that community-based non-work either increased or stayed the same over the past three years, and only 15% reported that it decreased or was discontinued. CRPs reported almost identical three-year trends for facility-based non-work services: 84% increased or stayed the same, and 16% decreased or discontinued the service.
Data Collection and Methods
This study surveyed 3,551 CRPs nationwide, drawn from a list of 11,712 CRPs compiled from public sources. For states with at least 100 CRPs, organizations for the study were selected using stratified random sampling. All CRPs were included in the sample for states with fewer than 100 organizations on the list. 
A total of 1,309 CRPs completed the survey questionnaire, yielding a 36.9% response rate. Seventy-eight percent of respondent organizations completed the full-length survey (n=1,016), and 22.4% (n=293) completed a condensed version of the survey. Findings for this brief are based on the 1,016 responses to the 2010–2011 National Survey of Community Rehabilitation Providers full-length survey. The data were weighted. 
Conclusion
There has been very little change in reported participation in integrated employment since the 2002–2003 survey for either individuals with any disability or individuals with IDD. However, the data suggest a shift in the balance between facility-based work and non-work services. Participation in non-work services has increased from 33% to 43% for individuals with IDD. Consistent with this trend, there has also been a 5% decrease in the percentage of CRPs offering only work services (from 24% in 2002–2003 to 19% in 2010–2011). At the same time, 5% more CRPs in the most recent survey reported offering only non-work services (from 7% in 2002–2003 to 12% in 2010–2011). 
People with IDD are still the largest customers of CRPs, representing 75% of all those served, a 5% increase since the 2002–2003 survey. Even though CRPs are more likely to report a decrease in facility-based work than other service models, it remains the most common employment outcome for individuals with IDD (25.2%). Future analysis will address geographic differences in trends consistent with other research, suggesting that there are significant state-to-state differences in service participation (NCI, Butterworth et al. (StateDatabook)). 
Although progress has been made in the past several decades in community participation, full participation in the labor force for people with IDD remains an elusive goal for many CRPs. Only 19% of individuals with IDD receive services in individual integrated employment settings, not much higher than the 18% found by the 2002–2003 survey. Furthermore, only 15% of individuals with IDD work for pay in this setting. This is very close to the National Core Indicators project number of 14.4%. 

Figure 1: Percent of CRPs providing services
Employment Services
Individual supported employment was provided by 81.3% (687 out of 845) of CRPs. Competitive employment was provided by 70.5% (586 out of 831) of CRPs. Facility-based work was provided by 67.2% (551 out of 819) of CRPs. Enclaves were provided by 42.8% (340 out of 794) of CRPs. Mobile crews were provided by 41.3% (325 out of 786) of CRPs. Time-limited paid work experience was provided by 24.5% (189 out of 772) of CRPs. Self-employment was provided by 24.5% (189 out of 772) of CRPs. Transitional employment for people with mental illness was provided by 22.6% (174 out of 769) of CPRs. NISH/National Industries for the Blind was provided by 18.8% (142 out of 754) of CRPs.
Non-work Services
Facility-based non-work was provided by 81.4% (591 out of 726) of CRPs. Community-based non-work was provided by 64.9% (463 out of 713) of CPRs. Facility-based non-work for elderly was provided by 32.7% (206 out of 630) of CRPs. Community-based non-work for elderly was provided by 22.6% (144 out of 636) CRPs.

Figure 2: Employment service provision in the past three years
Out of 651 CPRs, 46.6% of CPRs reported that competitive employment increased, 24.5% said it stayed the same, 27.6% said it decreased, and 1.3% discontinued the service.
Out of 703 CPRs, 40.6% of CPRs reported that individual supported employment increased, 29.9% said it stayed the same, 28.5% said it decreased, and 1% discontinued the service.
Out of 588 CPRs, 36.7% of CPRs reported that facility-based work increased, 30.8% said it stayed the same, 31.6% said it decreased, and 0.9% discontinued the service.
Out of 353 CPRs, 35.6% of CPRs reported that enclaves increased, 38.3% said it stayed the same, 24.3% said it decreased, and 1.8% discontinued the service.
Out of 333 CPRs, 32.8% of CPRs reported that mobile crews increased, 45.6% said it stayed the same, 18.6% said it decreased, and 3% discontinued the service.
Out of 203 CPRs, 36.6% of CPRs reported that self-employment services increased, 49.7% said it stayed the same, 11.6% said it decreased, and 2.1% discontinued the service.

Table 1: Total Individuals Currently Served in Work and Non-Work Services
Type of setting	Total reported with any disability	% reported with any disability 	Total reported with IDD	% reported with IDD	
Facility-based work*	41,803	20.73	37,810	25.2	
Facility-based 
non-work*	42,489	21.07	36,259	24.1	
Community-based 
non-work*	25,901	12.84	22,903	15.2	
Individual supported employment (ISE)	28,763	14.26	18,255	12.1	
Competitive employment with time-limited supports	27,087	13.43	9,766	6.5	
Enclaves	10,784	5.35	9,507	6.3	
Mobile crews	5,052	2.51	4,863	3.2	
NISH/National Industries for the Blind*	6,950	3.45	3,433	2.3	
Facility-based non-work for elderly*	3,999	1.98	3,398	2.3	
Community-based non-work for elderly*	2,754	1.37	1,733	1.2	
Transitional employment for people with mental illness	2,925	1.45	1,142	0.8	
Time-limited paid work experience 	2,389	1.18	752	0.5	
Self-employment (entrepreneurism)	775	0.38	510	0.3	
Total Reported**	201,672	100%	150,330	100%	
* 	Denotes facility-based and non-work service settings.
** 	Total reported will include duplication of services in cases where a respondent records an individual in more than one category.

Table 2: Percentage Paid in Employment Settings
Type of setting	% paid with any disability	% paid with 
IDD	
Mobile crews	96.1	94.5	
Enclaves	93.0	90.6	
NISH/National Industries for the Blind	87.6	95.7	
Facility-based work	80.5	91.7	
Time-limited paid work experience 	77.9	89.8	
Transitional employment for people with mental illness	72.0	78.9	
Individual supported employment	71.7	80.1	
Self-employment (entrepreneurism)	70.9	90.2	
Competitive employment with time-limited supports	60.9	77.0	
Average	76.1	87.6	

References
Metzel, D. S., Boeltzig, H., Butterworth, J., & Gilmore, D. S. (2007). Achieving community membership through community rehabilitation provider services: Are we there yet? Intellectual and Developmental Disabilities, 45(3), 149–169.
Bershadsky, J. (2011). Participation in integrated employment national core indicators project, 2009–2010. Boston, MA: Human Services Research Institute & Institute for Community Inclusion, University of Massachusetts Boston. 
Butterworth, J., Hall, A.C., Smith, F.A., Migliore, A., & Winsor, J. (2011). StateData: The National Report on Employment Services and Outcomes. Boston, MA: Institute for Community Inclusion, University of Massachusetts Boston.

Survey Definitions
Employment Settings
Competitive employment with time-limited supports
A person with a disability works in the competitive labor market, and may receive time-limited job-related supports.
Individual supported employment 
A person with a disability works in the competitive labor market, and receives job-related supports on an ongoing basis.
Self-employment (entrepreneurism)
This category includes self-employment, home-based employment, and small businesses. It does not include a business that is owned by an organization or provider and is staffed by employees with disabilities.
Enclaves
Groups of up to eight employees who have disabilities working together at a site where most people do not have disabilities and where they receive ongoing job-related supports.
Mobile crews
Groups of employees with disabilities who typically move to different work sites where most people do not have disabilities.
Facility-based work
This includes sheltered workshops, and businesses owned and operated by an organization, where most people have disabilities.
NISH/National Industries for the Blind (NIB) 
This includes the AbilityOne Program that provides employment opportunities for people who have severe disabilities or who are blind.

Transitional employment 
Time-limited job placement in integrated settings for people with mental illness (e.g., Pathways Model, Fountain House).
Time-limited paid work experience 
This includes internships, apprenticeships, and contextualized learning opportunities in the workforce.

Non-Work Service Settings
Community-based non-work
Programs where people with disabilities spend the majority of their day in the community in places where most people do not have disabilities. The primary focus may include general community activities, volunteer experiences, recreation and leisure, improving psychosocial skills, or engaging in activities of daily living.
Facility-based non-work
Including, but not limited to: psychosocial skills, activities of daily living, recreation, and/or professional therapies (e.g., occupational therapy, physical therapy). Includes day habilitation, medical day care, and day activity programs.
Community-based non-work for elderly people
Programs where people with disabilities, ages 55 and older, spend the majority of their day in the community in places where most people do not have disabilities. The primary focus may include general community activities, volunteer experiences, recreation and leisure, improving psychosocial skills, or activities of daily living.
Facility-based non-work for elderly people
Programs for people with disabilities, ages 55 and older, where most people have disabilities and the site is operated by an organization.

RESEARCH TO PRACTICE
Issue No. 52, 2012
The 2010-2011 National Survey of Community Rehabilitation Providers was developed and implemented with support from the Administration on Developmental Disabilities, U.S. Department of Health and Human Services (#90DN0216) and National Institute on Disability and Rehabilitation Research (NIDRR) and the Rehabilitation Services Administration (RSA), U.S. Department of Education (#H133B070001). The opinions contained in this manuscript are those of the grantee and do not necessarily reflect those of the funders.
The authors acknowledge the work of the survey team including Heike Boeltzig, Kelly Haines, Frank Smith, and Susan Foley. Ben Kramer helped develop the national list of CRPs. Tony Roman from the UMass Boston Center for Survey Research supported sample design and the analysis plan. This survey represents the support and work of a broad array of ICI staff including the graduate assistants, administrative staff, and the Marketing and Communications team. And in particular we thank the pilot sites that tested the survey design and the survey respondents for their willing participation. 
Suggested Citation 
Domin, D., Butterworth, J. (2012). The 2010–2011 National Survey of Community Rehabilitation Providers Report 1: Overview of Services, Trends and Provider Characteristics. Research to Practice Brief, Issue No. 52. Boston, MA: University of Massachusetts Boston, Institute for Community Inclusion.
For more information, contact: 
Daria Domin
Institute for Community Inclusion
University of Massachusetts Boston 
daria.domin@umb.edu
(617) 287.4277 (voice)
(617) 287.4350 (TTY)

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