Disability IS Diversity: Testing a New Approach to Reach ......May 05, 2011 · Included disability...

Disability IS Diversity: Testing a New Approach to Reach Employers

©DBTAC—NE April 27, 2011

DBTAC – Northeast ADA Center1.800.949.4232Hannah Rudstam, Ph.D.

In a nutshell

Why this? Why now?

The promise of knowledge translation (KT) approaches

About our effort• The intervention• The research

Lessons from the field: KT in the world of disability

Your thoughts ©DBTAC—NE April 27, 2011

Why this? Why now?

Let’s start with some uncomfortable truths…


Employment Rate (ER) of Working-Age Population

0102030405060708090

Peak1989/2000

Mar-08 Mar-09

ER Disab.ER No Disab

Source: Bjelland, M., Burkhauser, R., Von Schrader, S., Houtenville, A. (2010). Progress Report on the Economic Well-Being of Working Age People with Disabilities. Rehabilitation Research and Training Center on Employment Policy for Persons with Disabilities, Employment & Disability Institute, Cornell University.

In March, 2009, working age people with disabilities were 22% as likely to be employed as people without disabilities.

Poverty rate (PR) of Working-Age Population

0

5

10

15

20

25

30

Peak low1980/2000

Yr 2007 Yr 2008

PR Disab.PR No Disab.

Source: Bjelland, M., Burkhauser, R., Von Schrader, S., Houtenville, A. (2010). Progress Report on the Economic Well-Being of Working Age People with Disabilities. Rehabilitation Research and Training Center on Employment Policy for Persons with Disabilities, Employment & Disability Institute, Cornell University.

In 2008, working-age people with disabilities were 3.01 times more likely to be living in poverty when compared to people without disabilites.

The story behind these numbers is complex and multi-facetted, but clearly employer unwillingness to hire and retain people with disabilities is a key part of the picture (Kruse & Schur, 2003; Houtenville & Burkhauser, 2004; Hotchkiss, 2004; National Council on Disability, 2007; McMahon, et. al., 2008)

This, despite the fact that employers have a fairly good knowledge of the employment provisions of the ADA (Bruyere, 2000; Hernandez, 2000; Schur, Kruse & Blanck, 2005; Baldwin & Johnson, 2006; Nishii & Bruyere, 2009; Kessler/NOD, 2010)

And…this, despite the fact that there has been a great deal of program effort over the past two decades to reach employers to enhance disability inclusiveness (See, for example, Del Russo, 2009; NCD, 2007)

©DBTAC--NE March 18, 2010

Why this? Why now?

Starting with a thorny question…

Why have so many programs produced so little change?


Switching gears to reach employersA knowing—doing gap

From… •Information dissemination

•Emphasis on legal compliance

•One-time event

•Users’ culture invisible

•Assess using “smile sheets” or knowledge gains

To…•Changing organizational cultures

•An emphasis on making the case

•Sustained effort

•User’s culture front & center

•Assess using ecological approach to program impact


Why this? Why now?

Disseminating information is easy & relatively straightforward;

Changing organizational cultures and practices is difficult and

messy


Switching gears… The promise and appeal of KT

New term, but the problem and the thought history in this area problem is not new…

Many authors, in disability field: (Sudsawad, 2007)

Several definitions: Canadian Institutes for Health Research (CIHR). CIHR defines KT as

…the exchange, synthesis, and ethically-sound application of knowledge—within a complex set of interactions among researchers and users—to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened

health care system (CIHR, 2004).



What about defining KT in the world of disability?

NCDDRs definition: “…the collaborative and systematic review, assessment, identification, aggregation, and practical application of high-quality disability and rehabilitation research by key stakeholders (i.e., consumers, researchers, practitioners, and policymakers) for the purpose of improving the lives of individuals with disabilities" (NCDDR, 2005, as quoted by Sudsawad, 2007).


The thought history of KT: A very brief journey…

1. Diffusion of Innovation theory

2. Action science, theory and research

3. Traditional Evidence Based Practice (EBP)

4. Emerging Evidence-Based Practice Approaches—The European tradition



Points characterizing the KT approach (Sudswad, 2007; Warwick, 2011)

• Not information dissemination

• Encompasses all steps in the stream from knowledge production to knowledge use

• Interactive—engages users in some or all of these steps

• Based on using “best evidence”

• Non-linear

• User- and context-specific

• KT is outcome-/action-based

About our approach:Bridging the knowing—doing gap

Began by looking at obvious but yet invisible features of efforts to reach employers:

• Recognized the existence of different “worlds”

• Recognized the “black box” of on-the-ground cultural context of organizational life


BusinessesLanguage of value propositions

Need to make a profit/meet organizational goals

Discourse of performance

Disability Service Providers

Language of program building

Need to make placements

Discourse of service

People with DisabilitiesLanguage of equal treatment

Need to make a living

Discourse of justice

At the basis of our approach: Recognition of Different worlds: The “receiving cultures” of disability information & messages

Can’t Won’t

Don’t Know

A ecological framework for conceptualizing interventions and program impact…


About the Program: Partnerships

Three stakeholder partners• Businesses/HR professionals• Disability-Related professionals• People with disabilities

Key Partnerships• NJ Society for HR Management• GettingHired, Inc.• NJ Independent Living Centers

Role of partners• Co-designed program• Communications around program• Co-facilitated program• Accreditation (SHRM and CRCC)• Evaluation


About the Program Design

Focus:– Real-life workplace issues

– Minimize legal compliance issues

– Making the business case for disability inclusiveness

– Building partnerships

– Co-creating strategies

– Assessing own barriers

Blended learning:In-person programOnline tutorials

Blended participants:EmployersDisability service providers


The modules – Your partners– The many faces of talent– Disability IS Diversity– The Business Case– Simulations: Hiring &

Accommodation/ Obvious & Non-Obvious Disability

– Co-creating strategies– Thinking through your workplace– Your one strategy– Getting a partner

The details…Five hours

Disability inclusiveness; not legal compliance

High interaction

Intact work teams

Participants:867 over last three yearsMostly employers/businesses

About the In-person Program


The ten learning segments

Based on our prior research

Each segment includes:• Why this? Why now?• Assess your organization• Strategies to consider• Resources

The detailsTwo online learning experiences for

1. Employers/Businesses2. Disability Professionals

Each of the two learning experiences consist of ten learning segments

Each learning experience takes about 2 hours

Accredited

About the Program: Online Learning


About the research: Mixed Methods Pre-post survey

Based on DBTAC—NE Barrier Intervention Model

867 participants in total

479 participated over 16 sessions Dec. 2008 - Dec. 2009

295 (62%) surveys were completed

Of these, 258 (87%) surveys usable for analysis

Follow-up Open-ended Interviews

Open-ended; qualitative interviews

40 interviews

20 additional second-wave interviews

Method: Key action analysis

About the surveyBarrier Intervention Assessment Tool (BIAT)

The details 26 items using Likert-type scales

Four Domains• Knowledge about disability or people with

disabilities (9 items)• Willingness/Beliefs about disability

inclusiveness (Attitudes) (5 items)• Practices—Individual Behavioral

Estimation (6 items)• Practices—Organizational (Behavioral

Intent) (6 items)

Measurement Issues

Excluding the knowledge domain (9 items), a principal component analysis clearly identified 3 factors (Attitudes, Behav Intent & Behav Estimation) from 17 items

Three factors accounted for 99.9% of the total variance

Cronbach’s Alpha internal consistency reliability: r=.94 to r=.95 for three sub-domains

0% 5% 10% 15% 20% 25% 30% 35% 40%

non-profit

state/local gov

other

medical/health

finance/banking/insurance

human svcs

manufacturing

customer serv

info tech

transportation

Retail

35%

21%

16%

7%

5%

4%

4%

3%

2%

1%

1%

Type of Organization

19.8%

80.2%

Job Role

Disability Svc Providers HR/Business

About BIAT Survey Participants

Participant characteristics

0% 5% 10% 15% 20% 25% 30%

0-25

26-100

101-300

301-1000

1001-3000

Over 3000

30%

13%

19%

14%

10%

14%

Size of Business

Findings

Behavior Intention Knowledge Attitude Behavior Estimation

Pre-test 4.6 4.6 5.1 5.4

Post-test 5.5 5.5 5.6 5.7

Difference 0.9 0.9 0.5 0.3

4.6 4.6

5.15.45.5 5.5 5.6 5.7

0.9 0.9

0.50.3

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Comparison of Pre- and Post-tests

Paired t-test Results

Mean Difference

t df p

Behavior Intention 0.93 13.59 257 0.000

Knowledge 0.91 18.58 218 0.000

Attitude 0.48 13.54 228 0.000

Behavior Estimation 0.31 7.24 257 0.000

Between Group Comparisons

4.4 4.5

5.05.3

5.3 5.25.5

5.7

2.0

2.5

3.0

3.5

4.0

4.5

5.0

5.5

6.0


Pre-test Scores and Changes by Job Role

Pre-HR/B Pre_Disab

t=3.5; p=.000t=5.3; p=.000 t=4.8; p=.000t=4.9; p=.000

Between Group Comparisons

5.5 5.5

5.6

5.75.7

5.8

5.85.8

5.2

5.3

5.4

5.5

5.6

5.7

5.8

5.9

6.0


Post Test Scores by Job Role

Post_HR/B Post_Disab

t=2.0; p=.051 t=4.5; p=.000 t=4.8; p=.000 t=2.2; p=.031

About the qualitative follow-up interviews: Key action analysis

The details40 one-hour interviews conducted with

employers/businesses4 - 6 six months post-sessionPurposive/random sampling 15 also received second interview All data is now in…

Key action analysisUnit of analysis is an action, not an

individualAction = Any event, change or

practice as result of interventionFor each action:

• What did they do?• Who was involved?• What happened? • Enabling/inhibiting factors for each

event


©DBTAC--NE May 3, 2010

Interview Findings: Key Actions by Frequency

Included disability inclusiveness message in on-going organizational communications

Examined & changed diversity policy to include disability

Had disability inclusiveness event

Presented case for disability inclusiveness to leadership

Included disability candidate pools in recruitment efforts

Started community of practice or affinity group

Joined disability business group

Undertook accessibility review

Major initiatives

Included disability in supplier diversity

About the follow-up interviews:Factors enabling/inhibiting actions

Enabling factors

Leadership with personal connection Fuel for business case Clear and actionable DI strategiesLeverage emotional engagementNeed to re-invigorate diversity programDSP seeing themselves as a

consultantWillingness to persevere to find right

DSP partnerStrategy choice first; partnership

second

Inhibiting factorsMore to do with organizational culture than

with disability Current climate—Are they in a survival

mode? The emerging “wellness culture”Dispersed organizations—reaching their own

peopleHigh turnover organizationsGoing it alone—only one person in the

organization How well do they reach mid-level managers

And, finally…Lessons from the field…

Eight points:• Interviews included enabling and

inhibiting factors for action

• About what we learned about KT

• How might KT be different in the disability world than in the medical/healthcare world where it was born?



1. Our Lesson…

Partnerships were difficult and frequently

didn’t work

What might this mean for KT?

Stream from knowledge producers to knowledge users in the disability world is more complex and

involves more players than in the

medical/healthcare world

How might KT look different for us?

In the world of disability and employment, KT models/approaches need to be uniquely

created for each knowledge user


2. Our Lesson…Employers were

largely not interested in the majority of

current research on disability

& employment


Less consensus between knowledge

producers and knowledge users

about what constitutes a “desired outcome” than is the case in

medicine/healthcare


In disability & employment world,

knowledge users may have to be more

involved across all phases of a KT effort


3. Our Lesson……And their disinterest largely had little to do with the quality of the evidence or science behind the research

What might this mean for KT?Evidence-based

practice will be less likely to lead to

knowledge translation, given the complexity

and lack of consensus in our stream from

knowledge producer to knowledge user


More involvement in knowledge users in the question posing stage?


4. Our Lesson…Employers: “We don’t

have enough ammunition to make the case to our own

leaders.”


Different players in the stream from

knowledge producers to knowledge users have very differentsets of questions


More research on employers’ questions—their knowledge seeking

priorities (not ours!)


5. Our Lesson…In our study, we

struggled to apply a logic model in terms

of showing employment outcomes


Employment outcomes are less transparent

and on a different time scale than are outcomes in

health/medicine


More attention to how we define and measure an “outcome.” Do we

need to create and validate mediating factors that lead to

outcomes?


6. Our Lesson…On-going

communications were challenged by the fact that different players had different knowledge channels

What might this mean for KT?Multiple paths

will be needed on the journey from

knowledge to action

How might KT look different for us?Far greater need for

thorough consideration of knowledge conduits

used by each stakeholder in the

stream


7. Our Lesson…Disability service

providers did not feel like equal partners.

“The truth is, employers really hold

the power here.”

What might this mean for KT?Greater power

differences between players on the stream

from knowledge production to knowledge

use in the disability arena than in the

medical/healthcare arena

How might KT look different for us?We will need to pay

more attention to whose voice is heard/not heard

during the knowledge production process

—not just the truth, but whose truth?


8. Our Lesson…“Service providers need to speak our

language; they need to live in our world.”


There are more distinct professional

cultures/worlds in the stream from

knowledge producer to knowledge user in our

world than is the case in medicine/healthcare


KT will be more challenging for us (Ferlie, et al 2005); knowledge is

not interpreted in a vacuum and the meaningof the knowledge will be

even more deeply embedded in a distinct user culture than is the

case in medicine/healthcare


What did we learn about how KT models/methods might have to switch gears when applied to the world of disability?

Point…More players with distinct professional cultures in the stream from knowledge producers to knowledge users

Players with differing (and even contradictory) priorities, power, knowledge-user cultures

Research rigor is the key driver for knowledge producers, but is not necessarily the key driver for action for our knowledge users

Unlike medicine, our outcomes are more opaque and may take longer to bring about

KT Implication…Need for distinct KT efforts, run the risk of fragmented KT efforts that loose sight of common outcome

•Question driving the research will be vastly different for different players--More contention over what is “useful” research•Use of mixed methods & action research--a deeper understanding of knowledge-user cultures and sense of “desired “outcomes•Users engaged earlier in the KT process

In medical—key driver of action is rigor of evidence. In disability, key driver more related to knowledge benefit and action-ability within distinct user cultures

Need to create validated “proxies” for outcomes—mediating variables that have been validated to outcomes


KT does hold power and promise!But it won’t be easy…

• More complex• More contentious • More risk of fragmented efforts, loosing site of the

overall goal of enhancing disability inclusiveness• Need to involve more users earlier in the process• Mixed methods and action research• Has to be more than just creating another website

Disability and Business Technical Assistance Center – Northeast ADA

Center

ILR - Employment and Disability InstituteCornell University201L Dolgen HallIthaca, NY 14853

800.949.4232 in NY, NJ, PR, VI

[email protected]

Disability IS Diversity: Testing a New Approach to Reach ......May 05, 2011 · Included disability...

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