Customised Employment and Practice Fidelity.

One of the significant issues confronting the use of evidence-based practice is fidelity to the model and evidence. For some time, Customised Employment, like many practices in community health, has seen significant numbers of people adopt the name but not the authentic practice. This has only increased since the Disability Royal Commission and NDIS review mentioned it. We saw this with person-centred practice, PBS, and a range of practices that, in reality, require significant education and guidance to be delivered properly. The lack of fidelity to these practices not only undermines their effectiveness but also raises concerns about the quality of service provided. You can’t stop this from happening, especially in a space that has few protected titles, but we can certainly work towards addressing this issue.

?Of course, we can put some safeguards in place and hope that, in time, the community will wake up to opportunists. One of the earliest safeguards is the Discovery Fidelity Scale developed by Griffin Hammis Associates and Utah State University. Developed in response to known practice issues such as shortcutting and to ensure that Discovery is properly funded, it works well in the US employment space. Recognising the different funding models, we have been actively working with our technical partners at Griffin Hammis to adapt it to Australia, aligning it with our policy and funding settings. This ongoing work, which received ethics approval from the University of Melbourne, is a collaborative effort that will ensure the integrity of Discovery and Customised Employment practice in Australia. Currently in write up, we hope for the research to see the light of day later this year.

?Will that be enough to ensure that individuals and families get what they are paying for? Probably not, because we know that without proper training, ongoing mentoring, and technical support, it won’t be embedded inside an organisation. In the USA, they have gone some way towards introducing national practice standards to support this. We’ve been doing the same thing here in Australia and will take this a step forward with the CE Community of Practice members later this year.

?At our CE Virtual Conference in June, we were delighted to hear that a Random Control Trial has been successful in shifting CE to a genuine evidence-based practice. We, with our research partners, will look to replicate this in Australia to extend the evidence base further.

?While our US colleagues have been developing fidelity scales, we’ve been taking a different but complementary approach by focusing on developing tools to measure the quality of employment. Quality in Disability Employment or any employment program is an often-talked-about but nefarious element. It's worth recognising that in compliance-based systems, quality is a measure of system effectiveness, not individual outcomes.

?Our approach complements Customised Employment and Discovery in that it focuses on the job's impact. The DFS focuses on practice fidelity, while the Personalised Inclusive Employment Outcome Measure (PIEOM) focuses on the job's impact, which, by default, becomes a measure of the job's quality. We’re about to start small-scale validity testing before moving to ethics-approved large-scale testing and validation later this year. At this point, we can also see its use in measuring progress towards employment for NDIS clients, which is a helpful element when having planning discussions with the NDIA.

?It's not a quick journey; we’ve been researching and training provider staff and community members on Discovery and Customised Employment for well over a decade and delivering practice for the past five years. We know the challenges, but we also know the barriers that some representative bodies put in place to advance practice (odd for sure, self-interest definitely). That’s why we work in the community with providers, community groups, families, and individuals. That’s why we partner with organisations and individuals open to advancing disability employment locally and globally.

?A word of warning about CE: It’s not a quick process. It’s about developing a real understanding of the person you support. This is occasionally missed or not heard in discussions with families, and it can create issues if it isn’t reinforced. We'll all make this mistake from time to time, so it’s essential to manage family expectations and hold on to the integrity of the process.

?This is another reason why comprehensive training, ongoing mentoring, and technical support are essential to maintaining the integrity of our work. It’s worth remembering that Basic Discovery training is recognised as 40 hours of theory, practice, and mentoring and that the complete Customised Employment program is 120 hours, and with good reason. Despite what looks like a deceptively simple process, it's both complex and nuanced.

?Discovery and Customised Employment are not flavours of the month to be imitated for a while before you move on to the next flavour.

?You can read about the outcome measure at this link: https://tinyurl.com/4jbfpvxs

?You can access comprehensive Customised Employment, Discovery and Disability Employment training via this link: https://college.cderp.com.au

?For a 2024 update on the state of evidence and practice: https://tinyurl.com/4m3vca8r