Natural supports in competitive integrated employment: A scoping review

Abstract

BACKGROUND:

Competitive integrated employment (CIE) improves the quality of life for individuals with intellectual and developmental disabilities (IDD). Individuals with IDD may need additional support in the workplace. Natural supports has been studied as an intervention to provide support and increase vocational and social skills for individuals with IDD in the workplace.

OBJECTIVE:

The purpose of this article is to review the existing literature conducted on implementing natural supports in CIE settings to build vocational or social skills for individuals with IDD.

METHOD:

We followed the PRISMA-ScR process to identify articles across seven databases and coded information related to demographics, methodology, and outcomes.

RESULTS:

Seventeen articles were identified between 1985 –2024 that focused on implementing natural supports in CIE settings for individuals with IDD. Studies addressed vocational and social skills and broader vocational topics such as wages, hours worked, and inclusion in the workplace.

CONCLUSION:

Employees with IDD improved their engagement in vocational tasks, increased their social interactions with coworkers, and improved their quality of life through increased wages, hours worked, and job tenure. Additional research is warranted to provide further evidence on the impact of natural supports in the workplace for employees with and without IDD.

Keywords

Employment review intellectual and developmental disabilities natural supports

1 Introduction

Competitive integrated employment (CIE) is a primary objective for individuals with intellectual and developmental disabilities and their families (IDD; Gilson et al., 2018;Siperstein et al., 2014). Research has shown that CIE has numerous benefits, such as improved economic well-being, quality of life, self-determination, and autonomy, for individuals with IDD (Cimera, 2012;Taylor et al., 2022). National (e.g., Workforce Innovation and Opportunity Act (WIOA), 2014) and state (e.g., Employment First) policies have identified that CIE with minimum wage should be the first employment option of individuals with IDD rather than sheltered workshops or segregated options with subminimum wage (Wehman et al., 2021). Additionally, WIOA has built upon the transition requirements outlined in the Individuals with Disabilities Education Improvement Act (IDEIA, 2004) by instructing Vocational Rehabilitation (VR) agencies to provide individuals with IDD pre-employment transition services (pre-ETS) beginning in high school. Pre-ETS offers education, job training, and skill development in integrated employment settings for youth, including those with IDD, to prepare for post-school employment (NTACT: C, n.d.). Thus, several policies targeting individuals with IDD have been enacted to enhance post-school outcomes for individuals with IDD.

Unfortunately, less than 20% of individuals with IDD are employed in CIE (Hiersteiner et al., 2018) compared to over 65% of individuals without IDD postschool (Bureau of Labor and Statistics, 2018). When individuals with IDD are employed, most work part-time, reducing income and benefits eligibility (Hiersteiner et al., 2018). Moreover, there has been a steady increase in individuals with IDD in sheltered or segregated employment, while those participating in CIE have remained stable (Wehman et al., 2018;Winsor et al., 2019), even when those working in CIE have better wages versus those in sheltered workshops (Cimera, 2012). However, employers with experience hiring and working with individuals with IDD generally have positive perceptions of individuals with IDD in the workforce (Athamanah et al., 2022). In addition, employment practices such as a positive organizational culture and commitment to disability improve workplace inclusiveness (Erickson et al., 2014). Nevertheless, mixed opinions remain about the impact of workplace accommodations and modifications, such as the use of job coaches and coworkers (Athamanah et al., 2022; Erickson et al., 2014). Therefore, identifying interventions that employers approve and can implement efficiently in CIE to build vocational and social skills and maintain employment could increase the employment rate of individuals with IDD.

1.2 Natural supports

One potential intervention that could be utilized in the workplace is “natural supports.” Nisbet and Hagner (1988) initially defined the term as the authentic help that coworkers provided each other in the workplace with or without guidance. They suggested natural supports were a sustainable option for workplace assistance once the employee with disabilities gained the Cartervocational and social skills needed for the job. Butterworth and colleagues (1996) described natural supports as having three components (1) the source of the support (e.g., coworkers), (2) the implementation process of the support, and (3) the relationship of support within the organizational culture. Therefore, a company that embeds these components into their workplace understands the value of natural supports for coworkers with and without disabilities in an authentic work setting.

While Nisbet and Hagner (1988) spotlighted utilizing natural supports in the workplace, there has been limited research on their effectiveness (Test & Wood, 1996;Wehman & Bricout, 1999). Few companies provide coworker or company training to improve their capacity to work with individuals with disabilities (Hagner et al., 1995). In addition, employees with disabilities may not know that natural supports are offered as an accommodation if the company does not provide that information (Wehman & Bricout, 1999). Barriers such as employer unwillingness and lack of qualified coworkers have prevented companies from embedding a natural support framework into employment (West et al., 1997). However, natural supports have been suggested as a sustainable solution to ongoing and consistent training of employees with disabilities due to the long-term cost of job coaches (Nisbet & Hagner, 1988).

Natural supports are generally used when describing adult employees with disabilities and their coworkers. However, this intervention has been used across age groups in PK-12 school settings and is known as peer-mediated intervention (PMI). Research shows that PMI is effective in elementary (e.g., Wu et al., 2020), middle (e.g., Jimenez et al., 2012), and high schools (e.g., Asmus et al., 2016) in improving social interactions and skills in academic and non-academic settings. Thus, implementing a structured natural support program in the workplace could potentially impact the interactions and employment skills of employees with and without disabilities. However, due to the conflicting information on the effectiveness of natural supports, a broad review of the research is warranted to determine whether natural supports are impactful in CIE and can provide adequate support for employees with disabilities.

1.3 Purpose

This scoping review aims to aggregate research conducted on implementing natural supports in CIE settings to build vocational or social skills for individuals with IDD. While the impact of PMI on enhancing academic and social skills in academic and non-academic school settings has been well-researched, considerably less research has addressed the effects of natural supports in CIE settings. Therefore, the following research questions guided the review:

What demographic characteristics, skills, and methodological approaches are presented in the literature?

Were the coworkers without IDD able to effectively implement natural supports for building the social or vocational skills of individuals with IDD in CIE settings?

2 Method

2.1 Search procedures

The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews statement was followed to conduct this scoping review (PRISMA-ScR, Tricco et al., 2018; see Fig. 1). An extensive literature search was conducted in March 2024 using seven educational and social sciences databases: Academic Search Complete, APA PsycArticles, APA PsycINFO, CINHAL, Education Full Text, ERIC, and SCOPUS with the following search terms used: disability (intellectual disabilit*, developmental disabilit*, mental* retard*, autism*, asperger*, multiple disabilit*), intervention (peer mediate*, peer train*, peer tutor*, peer network*, peer support*, natural support*, peer mentor*), and setting (employment*, support* employment*, experience*, internship*, vocational* support*, rehab*, work*, job*, career*, custom* employment*). The terms were combined using the Boolean search operator “and” to include disability, intervention, and settings.

Fig. 1

PRISMA-ScR flow diagram of the included articles

2.2 Inclusion and exclusion criteria

For this review, vocational skills were defined as basic employment skills that could be used in an integrated work setting. For example, vocational skills include money management, time management, organization, and planning. Social skills were defined as social interaction skills typically used in the workplace. Examples of social skills include interpersonal skills, basic communication skills, and problem-solving. To be included in the review, articles required the following criteria: (a) the implementation of natural supports in an integrated employment setting between individuals with and without IDD; (b) be a research study (e.g., quantitative, qualitative, mixed methods); (c) include individuals with IDD in the participant pool; (d) addressed building vocational or social skills; and (e) published in English. Also, there were no date restrictions on included articles because we wanted to explore all published material. Exclusion criteria excluded studies (a) that did not assess natural supports, (b) did not include individuals with IDD, (c) were not a data-based and published research article, (d) were not in English, and (e) were conducted in a segregated setting (e.g., sheltered workshop).

2.3 Study selection

The search was not limited by publication date and yielded 1,271 articles. First, a graduate student (4^th author) was trained to screen titles and abstracts to identify potential articles following inclusion criteria. Next, a reliability check to decrease researcher bias was conducted across 21.5% (n = 273) of the possible articles by the first author and averaged 85.8% reliability. Discrepancies were resolved through discussion between the first and fourth authors. Sixty-nine articles were subsequently identified, and full-text copies were retrieved. Then, three authors (LA, EF, EB) conducted a more in-depth screening and a reliability check to confirm the study methods, study context, and study participants of the 69 articles. Twenty articles were checked for reliability (29%) and averaged 91.9% reliability. Again, any discrepancies were resolved through discussion. Following this second screening, 11 articles were identified to be included in this review. Finally, a reference list review and forward search were conducted on each article resulting in an additional six articles for a total of 17 papers included in this review.

2.4 Data extraction

A codebook was created to collect specific data from each article. These data included (a) participant demographics (e.g., the number of participants, ethnicity, gender, age); (b) disability type (e.g., autism, intellectual disability, severe, other); (c) country where the study was conducted; (d) employment setting (e.g., restaurant, grocery store, hotel); (e) research methodology (e.g., quantitative, qualitative, mixed methods); (f) quantitative methods (e.g., group, descriptive-quantitative, single-case research design, other); (g) qualitative methods (e.g., phenomenological, case study, other); (h) data collection methods (e.g., formal and informal rating scales, direct observation, survey, interviews, focus groups); (i) data analysis (e.g., statistical analysis, visual analysis, thematic or content analysis, grounded theory, other); and (j) outcomes (e.g., social, vocational, other).

Several inputting methods were used to extract data into an Excel spreadsheet. For example, the total number of employees with disabilities was entered into the column “Number of employees with disabilities,” as well as “Employees with Disabilities” ethnicity and gender columns. If the study did not report the ethnicity or gender of the employees, a “1” was entered into the “Not Clearly Specified” column. For binomial categories such as data collection methods or methodology, a “1” or a “0” was entered into the column. For example, if the study utilized a single-case research design, a “1” was entered into the “Single-case research design” column, and a “0” was entered into the other quantitative research designs. Reliability was conducted on 30% (n = 5) of the data extracted from the included articles and averaged 91% reliability. Again, discrepancies were resolved through discussion.

3 Results

A total of 17 articles were identified between 1985 –2024 that focused on implementing natural supports in CIE settings for individuals with IDD. Twelve of the 17 articles were written in or before 2000 and published in ten different journals. The 17 articles were divided into two groups –direct evaluation of an implemented intervention of natural supports in CIE (n = 11, Group 1) and self-reported use of natural supports in CIE (n = 6, Group 2). Self-reported use of natural supports was defined as the study participants reported they implemented natural supports in a CIE setting. Studies in Group 2 focused on the outcomes (e.g., cost efficiency, job retention, wages, integration) of implementing natural supports in CIE versus the intervention itself. In Group 2, four articles (Mank et al., 1997a, 1997b, 1999, 2000) were included, but demographics were coded from one study as the same sample was used across all four articles. Results are aligned with the research questions proposed in this review.

3.1 Research question 1: Demographic information, skills, and methodological components

In Group 1 (n = 11, see Table 1), the studies included 56 employees with IDD, 58 without disabilities, and 12 other participants (e.g., job coaches, comparison groups). Of the studies that reported gender information, 22 employees with IDD were male, 14 were female, and two studies did not report gender or the gender distribution among participants was unclear. Only two studies reported the gender of employees without disabilities (Lee et al., 1997;Storey & Garff, 1997). When reported, age was similar for coworkers (18–54 years) and individuals with disabilities (17–51 years). Eight studies included individuals with intellectual disabilities, one study with autism spectrum disorders, and two studies with severe disabilities. Nine studies were conducted in the United States, one study in Australia, and one study in the United Kingdom. Finally, studies were conducted in various employment settings, such as restaurants, hotels, grocery stores, retail, retirement homes, and country clubs.

Table 1
Participant demographics

Code Frequency Code Frequency

Group 1 (n = 11) Group 2 (n = 3)^∧

Number of employees Number of employees

With IDD 56 With IDD 568

Without IDD 58 Without IDD 385

Others 12 Others 0

Ethnicity of employees^* Ethnicity of employees^*

With IDD 2 With IDD 1

Without IDD 0 Without IDD 0

Not clearly specified 9 (w IDD) 11 (w/o IDD) Not clearly specified 1 (w IDD) 1 (w/o IDD)

Gender of employees^* Gender of employees^*

With IDD 9 (22 males, 14 females) With IDD 1

Without IDD 2 (1 male, 1 female) Without IDD 0

Not clearly specified 2 (w IDD) 9 (w/o IDD) Not clearly specified 1 (w IDD) 1 (w/o IDD)

Age of employees^* Age of employees^*

With IDD 17–51 years old With IDD 18–69 years old

Without IDD 18–54 years old Without IDD 0

Not clearly specified 8 (w/o IDD) Not clearly specified 1 (w/o IDD)

Disability^* Disability^*

Autism 1 Autism 0

Intellectual disability 8 Intellectual disability 3

Severe disability 2 Severe disability 0

Settings^, + Settings^

Retirement home 1 Multiple settings 3

Restaurant 5

Hotel 3

Grocery store 2

Construction 1

Medical 1

Childcare 1

Cleaning 1

University cafeteria 1

Retail 1

Country club 1

Code	Frequency	Code	Frequency
Group 1 (n = 11)	Group 2 (n = 3)^∧
Number of employees		Number of employees
With IDD	56	With IDD	568
Without IDD	58	Without IDD	385
Others	12	Others	0
Ethnicity of employees^*		Ethnicity of employees^*
With IDD	2	With IDD	1
Without IDD	0	Without IDD	0
Not clearly specified	9 (w IDD) 11 (w/o IDD)	Not clearly specified	1 (w IDD) 1 (w/o IDD)
Gender of employees^*		Gender of employees^*
With IDD	9 (22 males, 14 females)	With IDD	1
Without IDD	2 (1 male, 1 female)	Without IDD	0
Not clearly specified	2 (w IDD) 9 (w/o IDD)	Not clearly specified	1 (w IDD) 1 (w/o IDD)
Age of employees^*		Age of employees^*
With IDD	17–51 years old	With IDD	18–69 years old
Without IDD	18–54 years old	Without IDD	0
Not clearly specified	8 (w/o IDD)	Not clearly specified	1 (w/o IDD)
Disability^*		Disability^*
Autism	1	Autism	0
Intellectual disability	8	Intellectual disability	3
Severe disability	2	Severe disability	0
Settings^*, +		Settings^*
Retirement home	1	Multiple settings	3
Restaurant	5
Hotel	3
Grocery store	2
Construction	1
Medical	1
Childcare	1
Cleaning	1
University cafeteria	1
Retail	1
Country club	1

Note.^* = the number of studies that reported information. ⁺ = multiple sites, the number could equal more than 17. ^∧= In Group 2, four articles (Mank et al., 1997a, 1997b, 1999, 2000) were included, but demographics were coded from one study as the same sample was used across all four articles.

In Group 2 (n = 6), the studies included 568 individuals with IDD and 385 without disabilities (i.e., vocational rehabilitation agencies). Two articles did not report or were unclear about participant ethnicity or gender (Cimera, 2001; West et al., 1997), and one did not report participant age (West et al., 1997). All six studies focused on individuals with intellectual disabilities and assessed either state or national data about employees with disabilities in CIE.

Included studies addressed social outcomes, vocational skills outcomes, and more broad vocational issues (e.g., wages, inclusion, hours worked). For example, studies addressing social outcomes focused on interactions between coworkers with and without IDD or generalizing social interaction training. Furthermore, studies addressing vocational skills focused on coworkers without IDD training those with IDD on work tasks or coworkers with IDD completing work tasks. Studies assessing broad vocational issues included studying wages, inclusion into the workplace, or hours worked per week. All, but one study utilized a quantitative research design to assess the impact of natural supports. Kaehne & Beyer (2013) conducted a mixed-methods study using descriptive-quantitative and case-study designs. There were two group studies (e.g., group comparison), six single-case design studies (e.g., multiple-baseline, alternating treatments design, intervention design, etc.), eight descriptive-quantitative designs, and one intervention study that did not report their design (Curl et al., 1992). In addition, the majority of studies (n = 9) collected data through direct observation to monitor whether the intervention was impacting specific social or vocational skills. However, only one study collected data by directly interviewing the participants (Kaehne & Beyer, 2013). Finally, conducting statistical analyses of the data was the most used data analysis method in the studies (n = 11), and one study did not report any clear data analysis (Chadsey et al., 1997).

3.2 Research question 2: Implementing natural supports

In Group 1, nine studies deemed natural supports effective in building vocational skills, social interactions between employees with and without disabilities, and obtaining and maintaining CIE (see Table 2). Additionally, the studies reported increased wages, hours worked per week, and job tenure for employees with disabilities. However, two studies (Chadsey et al., 1997; Kaehne & Beyer, 2013) found mixed results when implementing natural supports. Chadsey and colleagues (1997) implemented two interventions to assess social interactions between employees with and without disabilities. The first intervention modified the workplace environment to be more socially inclusive, and the second intervention trained coworkers on interaction strategies. While neither of these interventions demonstrated improved social interactions among the employees, Chadsey and colleagues (1997) observed that the presence of job coaches decreased socialization among employees with and without disabilities. Kaehne and Beyer (2013) assessed the impact of a peer support model that could be used to deliver supported employment in CIE. This article reported the results of a smaller sub-study within a more extensive program evaluation and reported that employees with and without disabilities socially interacted at work but did not continue these interactions outside the workplace.

Table 2
Study information for included articles in this review

Authors, year Research method Disability Data collection measures Data analysis Outcomes Deemed effective¹

Group 1 (n = 11)

Breen (1985) Single-case design Autism Direct observation Visual analysis Social •Yes – participants generalized their learned social behaviors across people.

Chadsey (1997) Single-case design Severe disability² Direct observation Visual analysis Social •Mixed – did not see improvement in social behaviors of individuals with severe disabilities, but did observe that job coaches hindered socialization between employees with and without severe disabilities.

Curl (1992) Intervention research but method not clear Intellectual disability Direct observation, self-report No analysis was reported Vocational •Yes – taught employees without disabilities to train and assess new workers with disabilities (e.g., increase work skills, retainment).

Farris (2001) Group comparison Intellectual disability Formal rating scales³, Informal rating scales⁴ Statistical analysis Vocational •Yes – coworkers could be used to help coworkers with ID obtain jobs and support in CIE; hours, wages, & job tenure were the same between the coworker model and job coach model; increased social involvement between coworkers with and without disabilities.

Hood (1996) Single-case design Intellectual disability Direct observation Visual analysis Vocational •Yes – individuals with ID were supported by a coworker without disabilities to maintain employment.

Kaehne & Beyer (2013) Mixed method (DQ⁵, case study) Intellectual disability Informal survey, interviews Statistical analysis, thematic analysis Both •Mixed – increased social interaction at work but not outside of work.

Lee (1997) Group comparison Severe disability Formal rating scales, direct observation Statistical analysis Social •Yes – employees with severe disabilities trained by coworker had more social interactions than those trained by a job coach.

Likins (1989) Single-case design Intellectual disability Direct observation Visual analysis Vocational •Yes – employees with ID improved accuracy of vocational tasks and quality checks when taught by coworker without disabilities.

Mautz (2001) Single-case design Intellectual disability Direct observation Visual analysis Social •Yes – increased social interaction between coworkers with and without ID; needed communication devices, job coach facilitation training, and eliciting coworker support for social integration to be impactful.

Storey & Garff (1997) Single-case desgin Intellectual disability Direct observation Statistical analysis Social •Yes – effective social skill instruction by coworker without disabilities and increase in integration in CIE.

Wiener (2003) DQ Intellectual disability Direct observation Statistical analysis Vocational •Yes – when compared to job coach supported employees with ID, natural supported employees with ID experienced superior worker benefits in job tenure, gross wages, and hours worked per week.

Group 2 (n = 6)

Cimera (2001) DQ Intellectual disability Survey Statistical analysis Other⁶ •Mixed – no significant relationships between coworker involvement &cost efficiency of supported employment programs, but coworker involvement increased length of time employees with ID held their job.

Mank et al. (1997a) DQ Intellectual disability Survey Statistical analysis Other •Yes – the more typical the employment setting, the more likely employees with ID received better wages and social interaction outcomes.

Mank et al. (1997b) DQ Intellectual disability Survey Statistical analysis Other •Yes – when coworkers were provided with training on disability and awareness, the more likely employees with ID had greater monthly wages and more typical social interactions.

Mank et al. (1999) DQ Intellectual disability Survey Statistical analysis Other •Yes – involving coworkers without disabilities in supporting coworkers with ID was related to valued outcomes, higher wages, and meaningful interactions with coworkers without disabilities.

Mank et al. (2001) DQ Intellectual disability Survey Statistical analysis Other •Yes – outcomes could be increased even with a high level of direct support (e.g., job coaches) if there is coworker training and involvement in the work setting.

West (1997) DQ Intellectual disability Survey Statistical analysis Other •Yes – majority of respondents deemed natural support strategies were highly effective and used most often in the job training &monitoring phases of supported employment.

Authors, year	Research method	Disability	Data collection measures	Data analysis	Outcomes	Deemed effective¹
Group 1 (n = 11)
Breen (1985)	Single-case design	Autism	Direct observation	Visual analysis	Social	•Yes – participants generalized their learned social behaviors across people.
Chadsey (1997)	Single-case design	Severe disability²	Direct observation	Visual analysis	Social	•Mixed – did not see improvement in social behaviors of individuals with severe disabilities, but did observe that job coaches hindered socialization between employees with and without severe disabilities.
Curl (1992)	Intervention research but method not clear	Intellectual disability	Direct observation, self-report	No analysis was reported	Vocational	•Yes – taught employees without disabilities to train and assess new workers with disabilities (e.g., increase work skills, retainment).
Farris (2001)	Group comparison	Intellectual disability	Formal rating scales³, Informal rating scales⁴	Statistical analysis	Vocational	•Yes – coworkers could be used to help coworkers with ID obtain jobs and support in CIE; hours, wages, & job tenure were the same between the coworker model and job coach model; increased social involvement between coworkers with and without disabilities.
Hood (1996)	Single-case design	Intellectual disability	Direct observation	Visual analysis	Vocational	•Yes – individuals with ID were supported by a coworker without disabilities to maintain employment.
Kaehne & Beyer (2013)	Mixed method (DQ⁵, case study)	Intellectual disability	Informal survey, interviews	Statistical analysis, thematic analysis	Both	•Mixed – increased social interaction at work but not outside of work.
Lee (1997)	Group comparison	Severe disability	Formal rating scales, direct observation	Statistical analysis	Social	•Yes – employees with severe disabilities trained by coworker had more social interactions than those trained by a job coach.
Likins (1989)	Single-case design	Intellectual disability	Direct observation	Visual analysis	Vocational	•Yes – employees with ID improved accuracy of vocational tasks and quality checks when taught by coworker without disabilities.
Mautz (2001)	Single-case design	Intellectual disability	Direct observation	Visual analysis	Social	•Yes – increased social interaction between coworkers with and without ID; needed communication devices, job coach facilitation training, and eliciting coworker support for social integration to be impactful.
Storey & Garff (1997)	Single-case desgin	Intellectual disability	Direct observation	Statistical analysis	Social	•Yes – effective social skill instruction by coworker without disabilities and increase in integration in CIE.
Wiener (2003)	DQ	Intellectual disability	Direct observation	Statistical analysis	Vocational	•Yes – when compared to job coach supported employees with ID, natural supported employees with ID experienced superior worker benefits in job tenure, gross wages, and hours worked per week.
Group 2 (n = 6)
Cimera (2001)	DQ	Intellectual disability	Survey	Statistical analysis	Other⁶	•Mixed – no significant relationships between coworker involvement &cost efficiency of supported employment programs, but coworker involvement increased length of time employees with ID held their job.
Mank et al. (1997a)	DQ	Intellectual disability	Survey	Statistical analysis	Other	•Yes – the more typical the employment setting, the more likely employees with ID received better wages and social interaction outcomes.
Mank et al. (1997b)	DQ	Intellectual disability	Survey	Statistical analysis	Other	•Yes – when coworkers were provided with training on disability and awareness, the more likely employees with ID had greater monthly wages and more typical social interactions.
Mank et al. (1999)	DQ	Intellectual disability	Survey	Statistical analysis	Other	•Yes – involving coworkers without disabilities in supporting coworkers with ID was related to valued outcomes, higher wages, and meaningful interactions with coworkers without disabilities.
Mank et al. (2001)	DQ	Intellectual disability	Survey	Statistical analysis	Other	•Yes – outcomes could be increased even with a high level of direct support (e.g., job coaches) if there is coworker training and involvement in the work setting.
West (1997)	DQ	Intellectual disability	Survey	Statistical analysis	Other	•Yes – majority of respondents deemed natural support strategies were highly effective and used most often in the job training &monitoring phases of supported employment.

Note.¹ = Deemed effective by authors; ² = Severe disability was used to describe participants with disabilities; ³ = Formal rating scales include scales & surveys that have been deemed reliable and valid; ⁴ = Informal rating scales include scales & surveys created by the authors for the purpose of the study; ⁵ = DQ –Descriptive-Quantitative; ⁶ = Other included social and vocational outcomes as well as other variables (e.g., wages, hours, cost efficiency).

In Group 2, five studies deemed natural supports effective for increasing wages, meaningful social interactions between employees with and without disabilities, and job training and monitoring phases of supported employment. However, one study (Cimera, 2001) demonstrated mixed results for natural supports in the workplace. Cimera (2001) found that natural supports did not significantly improve relationships between coworkers with and without disabilities or the cost efficiency of supported employment programs. However, he identified that natural supports did increase the length of time the supported employees maintained the job.

4 Discussion

This scoping review examined the literature on natural supports for individuals with IDD and the impact on vocational or social skills in CIE. While there are a limited number of studies, the outcomes are positive. For example, findings from the included studies showed that employees with IDD improved their engagement in vocational tasks or increased their social interactions with coworkers. Further, natural supports improved the quality of life for employees with IDD through increased wages, hours worked, and job tenure. Thus, natural supports may effectively improve vocational or social skills for employees with IDD within CIE settings.

Over 82% of articles implementing natural supports in inclusive employment settings in the community were deemed effective. The employees with IDD successfully learned, implemented, and maintained vocational and social skills across various employment sites (e.g., hotels, department stores, restaurants, etc.) from their coworkers. These results could be essential when determining how much job coaching support an employee may need. Using job coaches for employees with IDD is valued by employers (Athamanah et al., 2022), and supported employment is a cost-effective intervention (Mavranezouli et al., 2014). Training coworkers to support employees with IDD may provide companies with a sustainable, cost-effective option for hiring those with disabilities. This could decrease the negative stigma around the cost of employing individuals with disabilities and promote a positive organizational culture for all employees.

While Chadsey and colleagues (1997) did not see improvements in employees with disabilities’ social skills, they did observe that the presence of job coaches hindered social interactions between employees with and without disabilities. Concern with job coaches impeding socialization is similar to paraprofessionals impacting the socialization between students with and without disabilities in the classroom (Giangreco, 2021;Giangreco et al., 2004). Thus, an employed individual (e.g., job coach, paraprofessional, teacher assistant, etc.) impacts socialization between individuals with and without IDD, regardless of age or setting. Again, utilizing natural supports to assist in the workplace may be an opportunity to encourage acceptance and understanding among employees to build an inclusive employment setting.

In addition, the literature revealed that natural supports improved both vocational tasks (e.g., making salads, laundry, etc.) and social interaction skills (e.g., conversations with coworkers) of their coworkers with IDD. These results are important because they demonstrate that coworkers without disabilities can effectively implement natural support strategies to address the vocational or social needs of those with IDD. While more recent studies need to be conducted, job coaches and employers can feel confident that using natural supports in the workplace will improve the skills of employees with IDD. Further, the last time a study about natural supports in the workplace for employees with IDD was published was in 2013. Employment has changed in those ten years (e.g., jobs requiring higher-level social or analytical skills, increased preparation including needing a degree or vocational training, decreased manufacturing employment, etc.; Pew Research Center, 2016), including changes due to the COVID-19 pandemic. Future research on implementing natural support is critical due to the ever-changing employment landscape.

Finally, this review shows that CIE can successfully implement natural supports. This substantiates that natural supports (i.e., PMI) should not be restricted to classroom settings. A wealth of research demonstrates the benefits of peer-mediated interventions across ages and settings for students with and without disabilities (e.g., Carter et al., 2017;Travers & Carter, 2022). However, minimal research assesses natural supports in high school work-based learning experiences (WBLE; Athamanah & Cushing, 2019; 2022). Therefore, strengthening educators capacity to implement natural supports in WBLEs could provide students with and without disabilities the experience of working together in an integrated employment setting.

4.1 Limitations

There were several limitations identified in this review. First, participant demographics were rarely reported. Without this information, it may be difficult to generalize these results to different CIE settings. Future research should include detailed participant demographics to evaluate specific factors (e.g., age, gender, education) and the effect these factors may have on outcomes for employees with IDD. Second, only one study utilized a qualitative methodology to explore the impact of natural supports on the participants. Kaehne and Beyer (2013) applied a mixed method methodology by including a case study and conducting interviews with the participants in their paper. Future research needs to focus on applying qualitative methods and methodologies to present a holistic picture of how natural supports in the workplace impact the employees with and without disabilities, the employers, and the organizational culture. Third, study quality was not conducted because most articles (n = 16) were published before 2005. Finally, only published articles and articles written in English were included in the review. It is possible that we missed studies in gray literature (e.g., dissertations, books) or articles published in other languages. These could include studies with additional participant demographics or different methodologies.

4.2 Implications and recommendations

This scoping review highlights the need for more research that evaluates the effectiveness of natural supports on vocational and social skills for individuals with IDD in CIE settings. Thus, several recommendations for future research and practice regarding natural supports in employment settings exist. First, several studies identified mixed results on the impact of natural supports and the employee’s vocational and social skills. Furthermore, the last published study addressing natural supports in CIE was in 2013. Thus, additional quantitative and qualitative studies need to be conducted to provide solid evidence of how and why natural supports are effective in CIE and evaluate natural supports in current employment settings.

Next, research on how natural supports influence the employment outcomes for coworkers without disabilities is also necessary. Peer-mediated interventions have demonstrated positive outcomes for participants without disabilities across the age span and setting (e.g., Athamanah & Cushing, 2022; Athamanah et al., 2020; Carter et al., 2017; Schaefer et al., 2016). Therefore, future research on natural supports should include the effects on coworkers without disabilities, their perceptions about working with employees with IDD, and how to possibly improve the implementation of natural supports using qualitative methods to understand their experiences as natural support coworkers.

Finally, if individuals with IDD are to secure and maintain post-school employment alongside coworkers without disabilities, then practicing vocational and social skills in segregated settings is not consistent with generalizing skills into different settings. Therefore, transition and vocational education programs should include vocational opportunities for individuals with and without IDD to build skills together while accessing authentic work settings in the community. This opportunity to work collaboratively in an inclusive environment, with teacher support and guidance, may improve all participants’ vocational and social skills. It may also offer individuals with IDD opportunities to practice and generalize the learned skills in different work and work-based learning settings with coworkers, preparing them for post-school employment.

5 Conclusion

This scoping review identified the current body of knowledge focused on natural support interventions in CIE for individuals with IDD addressing vocational and social skills. Employers, employees, and vocational rehabilitation counselors may need effective interventions that can be easily supported and implemented in CIE to build the vocational and social skills of individuals with IDD. Natural supports are successful for individuals with IDD to learn and practice vocational and social skills in CIE settings (e.g., Curl et al., 1992; Hood et al., 1996; Lee et al., 1997). Therefore, future studies should examine the effects of natural supports in CIE addressing vocational and social skills for individuals with and coworkers without IDD. Furthermore, school personnel (e.g., special educators, counselors, transition specialists) may begin to apply natural supports in work-based learning settings to prepare individuals with IDD for successful post-school employment outcomes. Providing individuals with IDD opportunities to engage in authentic work experiences with more natural supports could enhance their quality of life and promote a successful transition to adulthood.

Footnotes

Acknowledgments

The authors have no acknowledgments.

Conflict of interest

The authors declare they have no conflict of interest.

Ethics statement

Not applicable.

Funding

The authors report no funding.

Informed consent

Not applicable.

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