Customized employment discovery fidelity: Developing consensus among experts

BACKGROUND: Despite promising economic and job growth over the last decade, achieving quality employment outcomes for people with significant disabilities remains a challenge in the United States. Recent legislation responded to this challenge by, among other things, expanding the definition of supported employment to include customized employment. Customized employment uses an individualized process to first examine a person’s skills, interests, and support needs and then to create integrated employment by matching these with business needs. As states integrate customized employment into their service delivery systems, they will need guidelines about what is and what is not considered best practice. Because discovery is the foundation of the customized employment process, measures to determine adherence to critical elements of the discovery process must be developed. OBJECTIVE: The purpose of this study was to generate consensus about what experts believe are acceptable and unacceptable tenets of customized employment discovery systems and services. METHODS: A 3-step, modified online Delphi method was used to obtain consensus from a panel of experts in customized employment discovery. The Delphi panel rated items on a discovery systems and discovery services fidelity scale over three iterations. RESULTS: A total of 60 discovery systems and services tenets were reviewed by the panel. Of the 20 systems discovery tenets, 14 of the acceptable and three of the unacceptable systems tenets met criteria for consensus. Of the 40 discovery services tenets, 20 of the acceptable and 10 of the unacceptable services tenets met criteria for consensus. CONCLUSIONS: While there appears to be subtle differences in what experts believe are acceptable and unacceptable tenets of discovery, a significant majority of the acceptable and not acceptable discovery systems and services tenets achieved consensus after three iterative rounds. As more is learned about the critical components of the discovery process, a fidelity scale can ensure consistent implementation of discovery.