Research in Developmental Disabilities 53-54 (2016) 358–366

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Research in Developmental Disabilities

Do inclusive work environments matter? Effects of

community-integrated employment on quality of life for
individuals with intellectual disabilities
Rachel N. Blick, Katherine S. Litz, Monica G. Thornhill, Anthony J. Goreczny *
Chatham University, Woodland Road, Pittsburgh, PA 15232, United States

A R T I C L E I N F O A B S T R A C T

Article history: More individuals with an intellectual disability now possess prerequisite skills and
Received 21 May 2015 supports necessary for successful work force integration than did previous generations.
Received in revised form 15 January 2016 The current study compared quality of life of community-integrated workers with those
Accepted 25 February 2016 participating in sheltered vocational workshops and adult day care programs. We
Available online 12 March 2016 considered numerous indices of quality of life, including inclusion and community
participation; satisfaction within professional services, home life, and day activities;
Keywords: dignity, rights, and respect received from others; fear; choice and control; and family
Community-integrated employment
satisfaction. Our data revealed several important differences in quality of life across
Sheltered workshops
daytime activities; participants involved in community-integrated employment tended to
Adult day programs
Quality of life
be younger, indicated a greater sense of community integration, and reported more
Community inclusion financial autonomy than did those who participated in adult day care programs and
Intellectual disability sheltered workshops. However, individuals reported no differences in overall satisfaction
across daytime activities. We discuss generational differences across employment status
as well as possible explanations to account for high levels of satisfaction across daytime
activities.
ß 2016 Elsevier Ltd. All rights reserved.

[16_TD$IF]Although individuals with an intellectual disability (ID) historically did not enter the employment arena, work-for-pay
opportunities gradually developed in midst of the 20th century. The introduction of sheltered workshops provided the first
vocational opportunity for individuals with ID. Sheltered workshops, a daytime activity for individuals with ID in which
attendants perform routine tasks such as assembling, manufacturing, and gardening, allow individuals with ID an
opportunity to learn various skills and gain experiences that are beneficial prior to working in the community (Cimera,
Wehman, West, & Burgess, 2012; Flores, Jenaro, Begoña Orgaz, & Victoria Martı́n, 2011).
Before establishment of these sheltered workshops, adults with ID had minimal opportunities to engage in structured
activities outside of their place of residence; therefore, sheltered workshops became commonplace during the 1950s and
1960s as a form of respite for families who cared for their relatives with ID (Dague, 2012). Sheltered workshops continue to
be a preferred method of respite for many families today due to their ability to provide consistent hours and long-term
stability (Dague, 2012; Migliore, Grossi, Mank, & Rogan, 2008; Siperstein, Parker, Drascher, 2013).

* Corresponding author. Tel.: +1 4123651886.

E-mail address: Goreczny@chatham.edu (A.J. Goreczny).

http://dx.doi.org/10.1016/j.ridd.2016.02.015
0891-4222/ß 2016 Elsevier Ltd. All rights reserved.
 R.N. Blick et al. / Research in Developmental Disabilities 53-54 (2016) 358–366 359

Arrival of community-integrated employment in the 1980s provided new opportunities for persons with ID once
considered ‘too disabled’ to contribute to the labor market (Dague, 2012). Community-integrated employers compensate
their employees with ID at or above minimum wage and provide work opportunities within a body of co-workers who
mostly consist of persons without a disability (Migliore, Mank, Grossi, & Rogan, 2007). Community-integrated employees
with ID work in a breadth of industries, including customer service, hospitality, clerical, janitorial service, and manufacturing
(McGlinchey, McCallion, Burke, Carroll, & McCarron, 2013; Siperstein et al., 2013).
Unfortunately, employees with ID often do not receive the same employment benefits, amount of assigned work hours,
and career advancement opportunities as those without ID. For example, Lindstrom, Hirano, McCarthy, and Alverson (2014)
reported that employees with ID rarely receive raises unless they coincide with increases in state minimum wage.
Furthermore, one recent study revealed that only 26% of workers with ID maintained full-time employment and only 35%
received employer-sponsored benefits (Siperstein et al., 2013). One possible reason for workplace inequality is that
employees with ID often lack opportunities for career advancement, in part due to their status as part-time, low skill
employees in the service industry (Lindstrom et al., 2014). Lindstrom et al. (2014) also [40_TD$IF]posited that acquisition of additional
hours or increased pay may subsequently jeopardize their ability to maintain government-supported benefits and supports,
thus deterring highly qualified candidates from seeking career-advancement opportunities. However, employees with ID
reported receiving gifts and other types of accolades from management and customers to recognize their kindness,
commitment, and hard work (Donelly et al., 2010; Timmons, Hall, Bose, Wolfe, & Winsor, 2011).
Although persons with ID receive limited tangible incentives for their participation in the competitive workforce,
community-integrated employment yields numerous opportunities for intrinsic rewards. One valuable benefit of
community-integrated work is development of social capital, which is typically difficult for individuals with ID to attain (Hall
& Kramer, 2009; Condeluci, Ledbetter, Ortman, Fromknecht, & DeFries, 2008). For instance, workers with ID frequently
interact and build rapport with their co-workers and customers without ID. Through building these relationships, workers
reported instances of being included in community activities outside of work, such as attending church functions (Donelly
et al., 2010). These affirmations have immense impact on recipients; employees with ID participating in these activities
indicated feeling a sense of belongingness (Donelly et al., 2010). Inclusive experiences such as these would be less likely to
occur if these individuals instead participated in sheltered workshops.
Adult day care programs are another type of daytime activity available to individuals with ID and are the only programs
available in some regions (Makharadze, Kitiashvili, & Bricout, 2010). Crites and Howard (2011) described adult day care
programs as establishments that provide care and educational activities, such as trivia, crafts, and music, to teach and
enhance participation, physical education, communication, memory, and overall daily living skills of individuals with ID.
Furthermore, adult day care programs provide opportunities for community integration with various outings and field trips
(Makharadze et al., 2010).
Research has indicated that attending adult day care is advantageous over spending time at home or in an institution. For
instance, Makharadze et al. (2010) found that individuals who attended an adult day care program demonstrated more
advanced language skills and reported having more friends than did those who did not participate in adult day care
programs. Moreover, Campbell (2012) observed that individuals involved in adult day care programs valued its proxy as a
socialization center and appreciated the sense of safety adult day care programs provided.
Overall, most individuals with ID and their families favor community-integrated employment over alternative daytime
activities (Dague, 2012; Donelly et al., 2010; Timmons et al., 2011). In a study conducted by Migliore [2_TD$IF]et [41_TD$IF]al. (2007), 74% of
individuals and 67% of families preferred employment outside of workshops. Unlike sheltered workshops, family members
asserted that community-integrated employment provides opportunities for skill development and community
involvement in an inclusive setting (Dague, 2012; Donelly et al., 2010; Timmons et al., 2011).
Studies have attempted to determine which type of setting yields the highest quality of life for individuals with ID but have
provided inconsistent evidence. According to Kober and Eggleton (2005), community-integrated employment correlated with a
greater sense of social belonging and empowerment than did sheltered workshops. Furthermore, community-integrated
employees reported a greater objective quality of life – specifically in the domains of health, productivity, and emotional well-
being – than did those involved in less-inclusive activities (Beyer, Brown, Akandi, & Rapley, 2010). However, in an alternative
study, community-integrated employment did not exclusively associate with superior quality of life (Verdugo, Jordan de Urries,
Jenaro, Caballo, & Crespo, 2006). These mixed results are possibly due to the heterogeneity of constructs used to quantify quality
of life. In addition, to our knowledge, studies have yet to compare quality of life across community-integrated employment,
sheltered workshops, and adult day care programs using a large sample. One advantage of evaluating all three types of settings
in one study is to permit an examination of impact of paid employment, such as community-integrated employment, on quality
of life. Therefore, the purpose of the current study was to explore quality of life among individuals with ID across the following
daily activities: adult day care programs, sheltered workshops, and community-integrated employment.

[42_TD$IF]1. Methods

[43_TD$IF]1.1. Participants

The present investigation included 477 individuals with ID residing in Southwestern Pennsylvania who participated in
Pennsylvania’s Independent Monitoring for Quality (IM4Q) Program. Since its inception in 1999, IM4Q has been an ongoing
360 R.N. Blick et al. / Research in Developmental Disabilities 53-54 (2016) 358–366

program that evaluates quality of life of individuals with ID who participate or intend to participate in services funded by
Pennsylvania’s Office of Developmental Programs (ODP). ODP uses participants’ responses to revise and improve policy and
quality of services provided by Pennsylvania’s intellectual disability system. The original sample consisted of 795
individuals; however, the current study utilized data from 477 of these participants. Reported ages of participants ranged
from 18 to 90 years, with an average age of 48.9 years (SD = 14.57).

[4_TD$IF]1.2. Instrument

The principal data source for the IM4Q program is the Essential Data Elements (EDE), an 85-item comprehensive,
structured interview developed by the IM4Q program that evaluates the following domains of quality of life: Inclusion/
Community Participation; Satisfaction; Dignity, Rights, and Respect; Fear; Choice and Control; and Family Satisfaction. The
first 35 questions of the EDE, completed exclusively by the participating individual with ID, pertain to their satisfaction with
paraprofessional staff, residential programs, and daytime activity programs (e.g., sheltered workshops, community-
integrated employment, or adult day care programs). If participants are unable to communicate with IM4Q staff,
interviewers omit this first section of the EDE from the interview. A person other than the participant may answer the latter
50 questions related to other measures of quality of life, including frequency of community outings, choice and control over
housing situations, and access to technology, amongst other domains (see Table 1 for a full analysis on who completed each
section). This instrument measures data at nominal, ordinal, interval, and ratio levels. Previous research revealed high inter-
rater reliability for previous versions of this instrument, with item inter-rater reliabilities ranging from 82 to 99% (Goreczny,
Miller, Dunmire, & Tolge, 2005). The monitor agreement score was higher than 94% for 61% of questions and higher [45_TD$IF]than 89%
for 96% of questions, with overall monitor agreement score higher than 84% for all but one question, which had an inter-rater
reliability of 82% (for additional information about the scale, please see Goreczny et al., 2005).

[46_TD$IF]1.3. Procedure

The Pennsylvania Office of Developmental Programs (ODP) generated a random sample of participants who utilize their
sponsored services throughout Pennsylvania. ODP then forwarded the sample to our local program. Once received, we
collaborated with county staff and supports coordinators to collect information necessary (e.g., contact person, telephone
number, and address) to contact individuals and schedule interviews. A research staff member called the contact person to
arrange an interview at the participant’s site of their choosing (e.g., home, day program, work setting). Individuals with ID
and other persons familiar with the individual, such as a family member, legal guardian, or paraprofessional staff,
participated in the interview. In an effort to maintain reliable data, two interviewers conducted the structured interview and
resolved any inter-rater disagreements following data collection. One interviewer read all questions, and both interviewers
recorded their impressions independently. At the end of the interview, the two interviewers reviewed each question and
resolved any differences by discussing what led each interviewer to their answer. They recorded one answer for each
question.

[47_TD$IF]2. Results

[48_TD$IF]2.1. Demographics

We collapsed the data and assigned participants into one of three groups (adult day care programs, sheltered workshops,
or the community-integrated employment group) depending on their response to the question regarding what they do most
weekdays. It is important to note that only participants themselves could answer this question by self-report; thus, we
excluded from the current study those individuals who could not communicate or required assistance, such as a proxy, when
answering questions. Furthermore, we eliminated those individuals who reported attending school most weekdays (through
high school, n = 23, 2.8%; college or trade school, n = 2, [49_TD$IF]0.3%) or had retired (n = 11, 1.4%). Among our entire sample, 82.7% of
participants completed the first two sections of the EDE independently through self-report; the remaining 17.2% of our
sample was unable to complete these sections by self-report due to unwillingness to participate or some other reason, such
as lack of understanding questions. Table 1 presents data of who completed each section of the instrument.

Table 1
Analysis of who completed each section of the Essential Data Elements.

Section of Essential Completed by

Data Elements
Participant (%) Staff Family/friend/guardian/ Participant and staff Participant and family/friend/
advocate guardian/advocate

Sections I and II 82.7 N/A N/A N/A N/A

Section III 56.8 18.9% 1.3% 19.6% 3.4%
Section IV 51.1 19.6% 1.7% 23.4% 4.2%
 R.N. Blick et al. / Research in Developmental Disabilities 53-54 (2016) 358–366 361

A slight majority of our sample reported participating in adult day care programs (n = 243, 50.9%), followed by sheltered
workshops (n = 176, 36.9%), and then community-integrated employment (n = 58, 12.2%). Of the 58 persons who reported
working in their communities for pay, only 11 (21.2%) indicated that they worked full-time. We calculated mean age across
daytime activity status: adult day care program (M = 50.68, SD = 15.05); sheltered workshop (M = 49.41, SD = 16.64); and
community-integrated employment (M = 42.04, SD = 11.45). As demonstrated through univariate analysis of variance, we
discovered a significant difference between ages of participants based on employment status: Tukey post hoc analysis
revealed that individuals who reported participating in community-integrated employment [50_TD$IF]were younger than those[17_TD$IF]
involved in sheltered workshops and adult day care programs.

[51_TD$IF]2.2. Quality of life subscales

Six sub-scales related to quality of life for individuals with ID were available for univariate analysis of variance analyses
(as displayed in Table 2) because they are continuous variables, and we used Tukey post hoc analyses to determine locus of
differences when we found a significant ANOVA result. One of the six subscales, community activity scale, demonstrated a
significant difference at the p < 0.05 level across daytime activity status (p = 0.008). Individuals who maintained community-
integrated employment reported going out into the community more frequently (M = 48.43, SD = 10.63) than did those
participants in adult day care programs (M = 43.30, SD = 14.63) and sheltered workshops (M = 44.01, SD = 12.60). ANOVA did
not reveal significant differences for the other quality of life subscales: dignity, rights, and respect; fear; choice and control;
family satisfaction; and participant satisfaction. See Table 2 for full analyses.

[52_TD$IF]2.3. Satisfaction with daytime activity

We used chi-square analyses to evaluate questions related to satisfaction with daytime activity because these questions
were at the nominal or ordinal level. As demonstrated by representative frequency distributions displayed in Table 3, chi-
square [53_TD$IF]analyses revealed no significant between-group differences in any variables related to satisfaction with current
daytime activities. For example, nearly all participants (approximately 95%) across employment statuses and settings
reported liking their daytime activity, and few (14.0%[54_TD$IF] of community-integrated workers, 21.4% of sheltered workshop
workers, and 16.7% of adult day care attendees) expressed interest in changing their activity. Moreover, a majority of
individuals reported never feeling afraid or scared at their place of daytime activity (90.6%[5_TD$IF] of community-integrated
workers, 88.6% of sheltered[56_TD$IF] workshop workers, and 92.4% of adult day care attendees). Per the chi-square [53_TD$IF]analyses,
employment status and setting had no significant effect on overall life happiness.

[57_TD$IF]2.4. Choice and control

We used chi-square analyses to evaluate questions related to choice and control because these questions were at the
nominal or ordinal level. As indicated by representative frequency distributions recorded in Table 4, chi-square analyses
revealed a significant interaction at the p < 0.05 level between type of daytime activity and variables related to choice and
control. Individuals performing paid work in their communities reported having a key or another way to enter their homes
on their own more often than did those who do not maintain community-integrated employment (p = 0.001). Chi-square
analysis also demonstrated that community-integrated workers were more likely to report creating their own daily
schedules, whereas their counterparts participating in other activities tended to report that other people (i.e., staff or family
member) decided their daily schedules (p = 0.005).
Daytime activity status also affected financial autonomy. According to the frequency distributions (Table 4), individuals
who work in the community were more likely to report having a bank account that they can access on their own (p = 0.019)

Table 2
Univariate analysis of variance results comparing quality of life subscales across daytime activities.

Variable Community- Sheltered Adult day care

integrated employment program
employment

Mean Standard Mean Standard Mean Standard F p Partial Eta

deviation deviation deviation squared

Age 42.04a 11.45 49.41b 14.53 50.68b 15.05 7.79 0.000** 0.036
Dignity, rights, & respect scale 75.58 8.90 75.36 10.13 74.28 8.67 0.76 0.466 0.004
Afraid scale 93.45 14.80 89.54 17.59 90.40 16.91 1.10 0.333 0.006
Choice & control scale 60.92 17.38 55.79 17.96 55.50 20.97 1.89 0.152 0.008
Frequent community activity scale 48.43a 10.63 44.01b 12.60 43.30b 14.63 4.91 0.008** 0.021
Family satisfaction scale 93.02 11.63 89.11 13.22 90.71 13.08 0.437 0.648 0.010
Participant satisfaction scale 88.64 15.31 85.71 18.24 88.09 18.24 1.03 0.358 0.005

Tukey’s post hoc analysis: results with the same letter superscript are not significantly different from one another.
** p < 0.01.
362 R.N. Blick et al. / Research in Developmental Disabilities 53-54 (2016) 358–366

Table 3
Chi-square analysis results comparing levels of satisfaction across various daytime activities.

Type of daytime activity

Variable Community-integrated Sheltered Adult day care x2[1_TD$IF] p Cramer’s V

employment workshop

Do you like what you do during Yes n = 56 n = 160 n = 197 2.327 0.676 0.052
the day? 96.6% 95.2% 95.2%
In-between n=2 n=3 n=4
3.4% 1.8% 1.9%
No n=0 n=5 n=6
0.0% 3.0% 2.9%

Would you rather do something Yes-I would n=8 n = 34 n = 31 3.025 0.554 0.061
else during the day? 14.0% 21.4% 16.7%
In-between n=0 n=2 n=3
0.0% 1.3% 1.6%
No-I like what n = 49 n = 123 n = 152
I do now 86.0% 77.4.% 81.7%

Are you ever afraid or scared at Always n=1 n=4 n=2 1.620 0.805 0.047
your place of daytime activity? 1.9% 2.7% 1.2%
Sometimes n=4 n = 13 n = 11
7.5% 8.7% 6.5%
Never n = 48 n = 132 n = 157
90.6% 88.6% 92.4%

Overall, are you happy or sad Happy n = 40 n = 109 n = 142 6.030 0.197 0.089
with your life? 72.7% 73.6% 80.2%
In-between n = 12 n = 27 n = 19
21.8% 18.2% 10.7%
Sad n=3 n = 12 n = 16
5.5% 8.1% 9.0%

and having greater choice in budgeting their money (p = 0.019)[58_TD$IF] compared to those who attend sheltered workshops or adult
day care programs. However, daytime activity status had no bearing on overall financial status; between 90 and 94% of all
participants across daytime activities reported having enough money each week to live comfortably. Despite the variance in
financial autonomy, we found no significant differences in choice of daytime activity. Approximately half of the participants
across groups reported choosing their current daytime activity.

[59_TD$IF]2.5. Community inclusion

We used chi-square analyses to evaluate questions related to community inclusion because these questions were at the
nominal or ordinal level. Chi-square [53_TD$IF]analyses revealed several significant relationships at the p < 0.05 level between
frequency of community outings and daytime activity (see Table 5). For instance, community-integrated workers reported
going out to eat (p = 0.021), going to the bank (p = 0.042), and running errands (p = 0.050) on a more frequent basis than [60_TD$IF]did
those who participated in sheltered workshops or adult day care programs. However, individuals who attended adult day
care programs indicated that they go out into their communities for fun significantly more often than did those who
participated in sheltered workshops or community-integrated employment (p = 0.005).

[61_TD$IF]3. Discussion

Results of the present study revealed several significant differences in quality of life between individuals with ID
employed in community settings and those who attend adult day care programs or sheltered workshops. For instance,
individuals working in community-based settings generally reported increased choice and control over their daily activities
as well as increased opportunities for community inclusion. This is a valuable finding; it suggests that community-based
integration correlates with a sense of normalcy consistent with lives of co-workers who do not have an intellectual disability.
A possible explanation, though merely speculation, for why community-integrated workers demonstrate high levels of
choice and control in their lives is a possible bidirectional influence of employment on self-determination: (a) Those who
exert autonomy in their everyday lives may be more likely to pursue and obtain community-integrated employment than
those who exercise less choice and control in their lives, and/or (b) Maintaining community-integrated employment
cultivates feelings of self-determination. These ideas mirror thoughts of Kober and Eggleton (2005), who speculated that
individuals who feel empowered may ‘‘self-select’’ community-integrated employment over alternative activities. However,
more research is necessary to accept this hypothesis.
 R.N. Blick et al. / Research in Developmental Disabilities 53-54 (2016) 358–366 363

Table 4
Chi-square analysis results assessing choice and control across various daytime activities.

Type of daytime activity

Variable Community- Sheltered Adult day x2 p Cramer’s V

integrated workshop care
employment

Do you have a key or another Yes n = 37 n = 65 n = 68 24.981 0.000** 0.231

way to enter your home 63.8% 37.1% 28.7%
without the assistance of No n = 21 n = 110 n = 169
others? 36.2% 62.9% 71.3%

Did you choose what you Person Made n = 28 n = 87 n = 100 7.473 0.113 0.092
do during the day? Choice 50.9% 55.4% 43.5%
Person Had Some n = 19 n = 38 n = 74
Input 34.5% 24.2% 32.2%
Someone Else n=8 n = 32 n = 56
Chose 14.5% 20.4% 24.3%

Who decides your daily Person Decides n = 50 n = 111 n = 176 15.023 0.005** 0.127
schedule? 86.2% 64.5% 73.6%
Person Has Help n=7 n = 46 n = 38
Deciding 12.1% 26.7% 15.9%
Someone Else n=1 n = 15 n = 25
Decides 1.7% 8.7% 10.5%

Do you have enough money Yes, I Have Enough n = 53 n = 160 n = 219 0.674 0.714 0.038
to do many of the things Money and Can Get 91.4% 94.1% 92.4%
you want to do each week? What I Want When
I Want
No, I Do Not Have n=5 n = 10 n = 18
Enough Money and 8.6% 5.9% 7.6%
Cannot Get It

Do you choose what you Yes, I Choose Alone n = 58 n = 145 n = 199 11.829 0.019 0.113
spend with your spending 100.0% 85.3% 83.3%
money? Yes, I Choose With n=0 n = 22 n = 32
Help 0.0% 12.9% 13.4%
No, Someone Else n=0 n=3 n=8
Chooses 0.0% 1.8% 3.3%

Do you have a bank account Yes n = 40 n = 84 n = 110 7.952 0.019*[19_TD$IF]2 0.134

that you can get access 70.2% 50.9% 49.8%
independently? No n = 17 n = 81 n = 111
29.8% 49.1% 50.2%

* [3_TD$IF]p < 0.05.

** p < 0.01.

An alternative speculation for increased choice among those who participate in community-integrated employment may
possibly be a byproduct of their lifestyle as working individuals. For example, family members or residential staff who work
with persons with ID may promote autonomy (e.g., distributing house keys) to accommodate their changing needs.
Longitudinal investigations assessing variations in self-determination throughout young adult employees’ careers can
provide additional details on the relationship between self-determination and choice of activities; future research needs to
explore this.
Findings from the current study [62_TD$IF]suggest that participants involved in community-integrated employment engaged in
community activities (e.g., dine at restaurants and run errands) more frequently than did those participants in sheltered
workshops and adult day care programs. Community-integrated workers may participate in these activities more often than
do those individuals who attend sheltered workshops or adult day care programs because experiences in the community
may be an accustomed part of their everyday lives. For instance, community-integrated workers may eat at community-
based restaurants during their lunch breaks. Individuals involved in sheltered workshops and adult day care programs may
not have this opportunity.
However, individuals involved in adult day care programs reported going into the community for fun more often than did
community-integrated workers. One could speculate that individuals participating in the inclusive workforce have less time
to enjoy entertaining events than do adult day care program attendees, although data in the current study indicate that 78.8%
of community-integrated employees work part-time. This evidence contradicts our assumption that adult day care program
attendees have more free time available to participate in fun activities outside of the home. Perhaps instead, differing
perceptions of fun activities among study participants affected the finding. It is possible that ‘fun’ outings are more
prominent in the minds of adult day care program attendees than they are among community-integrated workers because
364 R.N. Blick et al. / Research in Developmental Disabilities 53-54 (2016) 358–366

Table 5
Chi-square analysis results comparing frequency of community outings across daytime activity.

Type of daytime activity

Variable Community-integrated Sheltered Adult day x2 p Cramer’s V

employment workshop care

How often do you go out to eat? >2/Week n=7 n=8 n = 12 23.833 0.021* 0.161
12.3% 4.8% 5.1%
2/Week n = 12 n = 12 n = 20
21.1% 7.3% 8.4%
1/Week n = 18 n = 59 n = 72
31.6% 35.8% 30.4%
2-3/Month n = 11 n = 54 n = 75
19.3% 32.7% 31.6%
1/Month n=7 n = 25 n = 36
12.3% 15.2% 15.2%
<1/Month n=0 n=1 n=8
0.0% 0.6% 3.4%
Never n=2 n=6 n = 14
3.5% 3.6% 5.9%

How often do you go to a shopping >2/Week n=2 n=9 n = 16 18.143 0.111 0.140
center, mall, or other place to shop? 3.4% 5.4% 6.8%
2/Week n=5 n = 11 n = 17
8.6% 6.6% 7.2%
1/Week n = 29 n = 46 n = 61
50.0% 27.5% 25.8%
2-3/Month n=9 n = 47 n = 62
15.5% 28.1% 26.3%
1/Month n=9 n = 31 n = 48
15.5% 18.6% 20.3%
<1/Month n=4 n = 13 n = 16
6.9% 7.2% 6.8%
Never n=0 n = 10 n = 16
0.0% 6.0% 6.8%

How often do you go to a bank or ATM? >2/Week n=1 n=1 n=1 21.627 0.042* 0.158
1.7% 0.7% 0.5%
2/Week n=2 n=6 n=3
3.4% 3.9% 1.4%
1/Week n = 13 n = 20 n = 32
22.4% 13.1% 14.5%
2-3/Month n = 16 n = 36 n = 45
27.6% 23.5% 20.4%
1/Month n=9 n = 18 n = 25
15.5% 11.8% 11.8%
<1/Month n=4 n=1 n=7
6.9% 0.07% 3.2%
Never n = 13 n = 71 n = 108
22.4% 46.4% 48.9%

How often do you go on errands or >2/Week n=8 n=7 N = 19 21.059 0.050* 0.155
attend appointments? 14.0% 4.4% 8.4%
2/Week n=0 n=5 n = 15
0.0% 3.2% 6.6%
1/Week n=4 n = 24 n = 40
7.0% 16.2% 17.7%
2-3/Month n = 18 n = 62 n = 73
31.6% 39.2% 32.3%
1/Month n = 20 n = 50 n = 55
35.1% 31.6% 24.3%
<1/Month n=6 n=8 n = 19
10.5% 5.1% 8.4%
Never n=1 n=2 n=5
1.8% 1.8% 2.2%

How often do you go into the community >Month n = 35 n = 111 n = 188 15.031 0.005** 0.127
for fun? 61.4% 65.3% 77.7%
<Month n = 15 n = 36 n = 43
26.3% 21.2% 17.8%
Never n=7 n = 23 n = 11
12.3% 13.5% 4.5%

* p < 0.05.
** p < 0.01.
 R.N. Blick et al. / Research in Developmental Disabilities 53-54 (2016) 358–366 365

such events are an apparent deviation from their routine, whereas someone who regularly integrates into the community for
work may not perceive the occasion as significant.
Severity of intellectual impairment may also affect how an individual experiences fun; Johnson, Douglas, Bigby, and
Iacono (2012) revealed that individuals with severe ID experience merriment while engaging in simplistic rhythmic play and
involved in brief and undemanding social interactions. It is important to note, however, these researchers only explored
individual experiences of fun among participants with severe ID. Level of ID could be a factor that influences the way
individuals experience fun; further investigation on this topic may clarify the variance of data. Future research also needs to
look into the role of severity of ID in quality of life overall and as it relates specifically to differential impact of the various
daytime activities. The current study did not examine how level of ID influences quality of life because these data were not
available. In addition, we did not collect data regarding participant demographics, such as gender, race/ethnicity, and
socioeconomic status. Thus, we recommend future researchers also explore how these factors influence overall quality of life
among individuals with ID and utilize multiple regression analyses to determine the relative influence of these factors, as
well as work setting, on quality of life.
Despite significant differences in community inclusion and choice and control, community-integrated workers did not
report greater satisfaction in day activity than their cohort participating in other activities. In fact, nearly all participants
(over 95%) across groups reported satisfaction with their current daily activity. In addition, few participants across groups
expressed interest in changing their current daytime activity. Lack of experience with and awareness of alternative, available
activities might be one reason for these [63_TD$IF]results or participants may simply desire to stay with what they know instead of
venturing into activities unknown or unfamiliar to them. Future research is necessary to explore these and other possible
explanations. Employment status also appears to have only a minimal effect on overall life happiness for individuals with ID:
Rate of happiness varied by approximately 8% in our sample—too thin of a margin to deem significant. Because all
participants were living within a specific geographic region (i.e., the Commonwealth of Pennsylvania) and a limited amount
of participants were working in community-integrated employment (12.2%)[18_TD$IF], future research using a geographically diverse
sample and a large sample of employed individuals is necessary to replicate these findings.
Individuals involved in sheltered workshops and adult day care programs may have reported high levels of satisfaction
and little interest in changing their situation due to comfort, companionship, and a sense of competency they associate with
their daytime activity. Recent research provides evidence consistent with this hypothesis. Timmons [2_TD$IF]et [41_TD$IF]al. ([64_TD$IF]2011) suggested
that individuals feel anxious at the prospect of working in the community, which may explain why individuals did not want
to leave their current program. This apprehension may stem from previous adverse experiences interacting with persons in
the community or from a fear of failure due to a perceived lack of skills or competency (Timmons et al., 2011). Moreover,
individuals with ID who thrive in sheltered workshops occasionally feel inclined to stay in that restrictive environment so
they can maintain their status as a competent worker and role model for their lower functioning peers (Timmons et al.,
2011). This ‘‘big fish/small pond’’ mentality may limit growth of individuals who could potentially expand their skills in the
community.
A minority of individuals with an intellectual disability reported contributing to the competitive workforce, indicating a
diminutive world of work for individuals within this population. Approximately 12.2% of our sample reported working in the
community for pay, which is consistent with the growing body of literature that has measured employment rates for
individuals with ID (Flores et al., 2011; Joshi, Bouck, & Maeda, 2012; McGlinchey et al., 2013; Siperstein et al., 2013). Those
few who do work in the community tend to be young in age: Research indicates that younger adults tend to over-represent
the competitive labor force within the ID population. Flores et al. (2011) reported that competitively employed workers are
younger than those who participate in sheltered workshops and adult day care programs. Our data replicate this finding:
Participants in the present investigation tended, on average, to be eight years younger than persons who attend adult day
care programs. The World Health Organization (2000) reported that nations do not provide supports necessary for aging
adults with ID to reach their potential, which creates a significant barrier to achieving inclusion in everyday life.
Supplemental investigation is necessary to unravel effects of age and attitudes towards community-integrated employment
for persons with ID. Indeed, future research needs to evaluate quality of life overall for older versus younger individuals with
ID.
As reflected in other bodies of work, merely comparing employment status may not produce representative results. To
illustrate daily experiences of persons with ID at work, researchers instructed workers with ID to photograph specific aspects
of their jobs that they liked or disliked using the photovoice method (Akkerman, Janssen, Kef, & Meininger, 2014). Photovoice
is a qualitative research method in which participants document images that represent their lived experiences (Wang &
Burris, 1994). Through this process, researchers identified several key factors related to job satisfaction and [65_TD$IF]well-being.
Common themes that impacted work satisfaction included nature of the work, working conditions, job demands, social
relations at work, perceived support, perceived autonomy, opportunities for using competencies, opportunities for growth
and development, and meaningfulness, themes that resonate as important for both individuals with and without ID
(Akkerman et al., 2014). These results reveal the complexity of researching effects of employment on quality of life.
Nevertheless, it is encouraging to discover that differences in community inclusion and choice and control appeared in
the current study despite the sample comprising mostly of part-time employees (78.8% of those employed in community
settings). These data suggest that part-time community-integrated work is sufficient for individuals with ID to experience an
increase in outings outside of the home and to exercise control in their daily lives. Due to a lack of full-time opportunities
available in the community, it is promising to find evidence that supports the idea that persons with ID do not need a
366 R.N. Blick et al. / Research in Developmental Disabilities 53-54 (2016) 358–366

full-time workload to reap benefits of community-integrated employment. Practitioners can use these results to help
improve quality of life among their clients with ID. Nonetheless, future work needs to investigate other advantages that full-
time work may bestow upon individuals with ID and compare differences overall between individuals with ID employed in
full-time jobs versus those employed in part-time positions.

Acknowledgement

The authors would like to acknowledge and thank Craig Casillo and Julie E. Williams for their valuable contributions
reviewing previous drafts of this manuscript. The authors also acknowledge funding from the Department of Human Services
from Allegheny, Greene, and Washington Counties (Pennsylvania) without which we would not have been able to complete
this work.

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