The cost-effectiveness of supported employment for people with severe intellectual disabilities and high support needs: a pilot study

The costs and outcomes of supporting seven people with severe intellectual disabilities and high support needs in part-time employment were compared w ith those of a Special Needs Unit (SNU) of a day centre, both within-subjec t and against an equal-sized comparison group. The income of those employed was described. Direct observation of the employment activities and represe ntative SNU activities were undertaken to assess participant engagement in activity and receipt of assistance, social contact in general and social co ntact from people other than paid staff. Costs of providing service support were calculated taking account of staff:service user ratios, staff identit ies and wage rates and service-administrative and management overheads. Emp loyment was associated with greater receipt of assistance, higher task-rela ted engagement in activity and more social contact from people other than p aid staff. SNU activities were associated with greater receipt of social co ntact. Supporting people in employment was more expensive than in the SNU. Cost-effectiveness ratios of producing assistance and engagement in activit ies were equivalent across the comparative contexts. The SNU was more cost- effective in producing social involvement; employment in producing social c ontact from people other than paid staff.