A VOCATIONAL COMMUNITY REHABILITATION PROGRAM CASE STUDY: IDENTIFICATION OF EFFECTIVE ORGANIZATIONAL AND SERVICE DELIVERY PRACTICES FOR WORKERS WITH DISABILITIES By Rosanne Renauer A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of Rehabilitation Counselor Education —Doctor of Philosophy 2021 ABSTRACT A VOCATIONAL COMMUNITY REHABILITATION PROGRAM CASE STUDY: IDENTIFICATION OF EFFECTIVE ORGANIZATIONAL AND SERVICE DELIVERY PRACTICES FOR WORKERS WITH DISABILITIES By Rosanne Renauer Community Rehabilitation Organizations (CRO)s are non-profit entities that were originally legally established to support the mission of the federal vocational rehabilitation system and continue to do so today. While sometimes negatively characterized as sheltered workshops, many have evolved into independent entities that develop and provide a myriad of essential services to persons with disabilities, often in continued partnership with vocational rehabilitation (VR). VR has been charged with improving performance through transforming systems and the transformation must extend to its partners and service providers. This study concentrates on CROs and identifies factors that promote and support best practices within those entities leading to employment of persons with disabilities. A case study of a high performing CRO was conducted to identify and investigate the elements that promote and support best practices leading to employment of persons with disabilities. The current study (a) attempts to bridge gaps in current literature on best, promising and emerging organizational and service delivery practices within CROs, (b) investigates organizational and service delivery CRO practices that can improve and lead to enhanced and competitive, integrated employment outcomes for workers with disabilities and (c) explores the role of leadership, innovation and the components of organizational well-being within CROs. Based on numerous interviews with staff at three levels of the organization, the findings demonstrate patterns of specific organizational practices, mission driven culture, holistic wellbeing practices, intentional leadership and structural elements that encourage and support the development of innovative, effective service delivery practices. Effective service delivery practices concentrate on practices that drive upward mobility for workers with disabilities and a mission driven culture of continuous improvement. Keywords: vocational community rehabilitation organization, vocational rehabilitation, workplace culture, evidence based vocational rehabilitation practices, leadership, innovation, wellbeing, disability, organizational structure Copyright by ROSANNE RENAUER 2021 This dissertation is lovingly dedicated to the memory of Doris Ann Decker Renauer, my mother, to whom I attribute my optimism, resilience, tenacity and work ethic. v ACKNOWLEDGEMENTS I have music strains going through my head…. I’ve always been able to identify my emotional mood by the music floating around in my brain. Whether it’s the uplifting classical notes of Mozart or my hometown Detroit’s ’s classic Motown dance tunes, it’s been a great bellwether for me. During this last year of the pandemic, Fleetwood Mac’s refrain of ‘ another lonely day’ from You Can Go Your Own Way was way too popular in my head. For a while. it was Elton’s John’s Goodbye Yellow Brick Road, ‘ I should have stayed on the farm …’. Lately it’s been Sheryl Crow’s All I Wanna Do and now seemingly out of nowhere, Cat Stevens’ tunes keep intruding and entertaining me especially Wide World, one of my favorite tunes and places! It’s hard to believe that I started this journey in 2016; well, a lot earlier depending upon when you want to define start. It has been an exhilarating, humbling unforeseeably amazing, challenging, wonderful and uniquely life changing experience. I have so much admiration and gratitude to the many people who supported me along the way and without whom, I would not be at this culmination point. First and foremost, I want to thank Dr. Michael Leahy, my academic advisor, mentor and Committee Chair. I am simply delighted to have had the immense benefit of working with one of the true legends in the rehabilitation field. Your guidance, support and friendship have been so valuable and helpful throughout this time. See you in Ireland! I am truly thankful for the support of each of the MSU faculty and my Committee members who have freely shared their expertise, teaching, valuable time and guidance: Dr. Michael Moore, Dr. Amelia Gotwals, Dr. Gloria Lee and Dr. Connie Sung. You have strengthened the quality of this study and broadened my perspectives on education and rehabilitation. I have enjoyed getting to know each of you vi better. A special note of thanks and recognition to Dr. Andrew Nay, my teaching coordinator advisor, who was always generous, supportive, student centered, technologically savvy and just overall great. I appreciate the teaching advisory support afforded by Dr. John Kosciulek during our mutual time at MSU and his ongoing willingness to engage in thoughtful discourse. I also want to acknowledge and thank Dr. Stephanie Baier and Dr. Su Pi other faculty who were instrumental in my academic development. A shout out to the good people of D2L, always so positive, helpful and so important! To my excellent MSU colleagues, my cohort, my friends, who have been such a significant part of this experience. You have changed my perspectives in positive meaningful ways. You have offered technology advice and other useful suggestions freely. I cherish the camaraderie, the laughter and the memories. Best always to each of you and may you always find joy in your chosen work, Alicia Strain, Heekyung Lee, Sara Grivetti, Jorem Awadu, Kristin Houck, Brenna Breshears, Allison Levine, Adriza Caesar, Amy Heathfield. See you at the golf outing!? I offer special thanks to Dr. Bob McConnell, Dr. Carol Berquist, Dr. Lynn Boza for your generosity, encouragement, support and long term friendships. To the People of Peckham. You are the best! Mitch, Greta, Jo, Justin, Sara, Caleb, Ann, Matt, the list goes on! Thank you for your never wavering commitment to the people and to vocational rehabilitation! Another shout out to Leslie, my wonderful weekly masseuse who kept me physically healthy (and mentally sane). Everything is better with massage! Thank you. My friends Amy, Karen and siblings Jeannie, Kevin, Sandy, Jerry and especially Terry and Caryn have been wonderful throughout and I want to thank them and recognize their steady vii support. I’m so glad my 91 year old dad, Stanley J. Renauer is now finally able to congratulate me as he has envisioned doing for the last five years. The strong support, humor and love of my daughter, Chelsea Rose Roberts, has meant so much to me always and especially during this journey. You are my heart and I love you! I have music strains going through my head…… Katrina and the Waves, I’m Walking on Sunshine…. viii TABLE OF CONTENTS LIST OF TABLES ................................................................................................................... xii LIST OF FIGURES ................................................................................................................ xiii KEY TO ABBREVIATIONS ................................................................................................. xiv CHAPTER ONE ........................................................................................................................ 1 INTRODUCTION ..................................................................................................................... 1 Statement and Significance of the Problem .......................................................................... 2 Purpose of the Study .............................................................................................................. 7 Research questions ................................................................................................................. 8 Description of the Study ........................................................................................................ 8 Theoretical Framework ......................................................................................................... 9 Summary .............................................................................................................................. 10 Definition of Terms .............................................................................................................. 11 CHAPTER TWO ..................................................................................................................... 16 LITERATURE REVIEW ....................................................................................................... 16 Vocational Rehabilitation .................................................................................................... 16 Legislation and History.................................................................................................... 16 AbilityOne ........................................................................................................................ 19 Social Enterprise .................................................................................................................. 20 Community Rehabilitation Organizations ......................................................................... 21 Workforce Innovation and Opportunities Act (WIOA) .................................................... 23 Competitive Integrated Employment ................................................................................. 24 Evidence Based Practices in CRO and VR Service Delivery ............................................. 27 Positive Psychology, Well Being and Rehabilitation .......................................................... 31 Structure .............................................................................................................................. 36 Organizational Performance ............................................................................................... 37 Transformational Leadership ............................................................................................. 43 Organizational Culture........................................................................................................ 45 Culture and Climate ............................................................................................................ 48 Summary .............................................................................................................................. 50 CHAPTER THREE ................................................................................................................. 53 METHODOLOGY .................................................................................................................. 53 Trustworthiness ................................................................................................................... 53 Design ................................................................................................................................... 55 Unit of Analysis and Sample ............................................................................................... 58 Case Selection ....................................................................................................................... 59 Procedures ............................................................................................................................ 62 Subjects/Participants ....................................................................................................... 63 Participant Demographics ............................................................................................... 64 ix Instrumentation ............................................................................................................... 66 Data Analysis ....................................................................................................................... 67 CHAPTER FOUR ................................................................................................................... 79 RESULTS ................................................................................................................................. 79 Revisiting the Data ............................................................................................................... 80 Revisiting the Analysis Process ........................................................................................... 80 Responses to the Research Questions ................................................................................. 81 Findings ................................................................................................................................ 82 Description of the Organization ...................................................................................... 82 Interdependent Major Themes ........................................................................................... 85 The Mission ...................................................................................................................... 88 A Healthy Workplace and Employee Well Being ........................................................... 89 Leadership Characteristics .............................................................................................. 92 The People ........................................................................................................................ 94 Innovation ........................................................................................................................ 95 Emerging and Promising Practices Overview .................................................................... 96 Organizational Practices ..................................................................................................... 97 1.0 Incentivizing Behavior: Mission Engagement Experience (MEE) .......................... 98 2.0 An Innovation Tool: Mini Grants ............................................................................ 99 3.0 Health and Wellness: A Flexible Workplace .......................................................... 101 4.0 Leadership: The Business Planning Process ........................................................... 103 5.0 The Right Stuff: Investing in Talent ....................................................................... 105 Talent Acquisition. ..................................................................................................... 105 Talent Development and Training ............................................................................ 105 Talent Retention. ........................................................................................................ 106 Alignment with the Mission ....................................................................................... 107 Staff Recognition ........................................................................................................ 107 6. 0 Organizational Structure: The Mission Initiatives Team .................................... 108 Advocacy. ................................................................................................................... 110 Structure and Communication: Differing perspectives. .......................................... 110 Service Delivery Practices ................................................................................................. 112 1.1 Personnel: Vocational Services Specialists (VSS) ................................................... 113 2.1 Targeted Training, Stackable Credentials and Upward Mobility ......................... 114 3.1 iStrive ........................................................................................................................ 116 4.1 AVAIL ...................................................................................................................... 118 5.1 Health and Wellness: Investing in Team Members ................................................ 119 Summary of Organizational and Service Delivery Practices ........................................... 120 CHAPTER FIVE ................................................................................................................... 121 DISCUSSION......................................................................................................................... 121 Addressing the Research Questions .................................................................................. 122 Summary of Major Study Findings .................................................................................. 124 Leadership and Leadership Transition ............................................................................ 125 Culture ............................................................................................................................... 129 A Healthy Workplace: Holistic Health and Well Being ................................................... 130 x Innovation .......................................................................................................................... 132 Positionality ........................................................................................................................ 134 Limitations ......................................................................................................................... 135 Implications ........................................................................................................................ 137 Fiscal Stability ................................................................................................................ 137 Evidence Based Practices in Community Rehabilitation Organizations .................... 140 The Future ...................................................................................................................... 142 Directions for Future Research ......................................................................................... 143 Concluding Remarks ......................................................................................................... 145 APPENDICES ....................................................................................................................... 147 APPENDIX A ................................................................................................................... 148 APPENDIX B ................................................................................................................... 151 APPENDIX C ................................................................................................................... 154 APPENDIX D ................................................................................................................... 156 REFERENCES ...................................................................................................................... 158 xi LIST OF TABLES Table 1: Evidence based Levels…………………………………………….………………..….30 Table 2: Research Design Activities…………………………………………………….…........58 Table 3: Document Review Chart………………………………………………………….........63 Table 4: Individual Descriptors of Participants using Dedoose……………………………........64 Table 5: Summary of Participant Demographics……………………………………….….........65 Table 6: Example of Codebook Excerpt…………………………………………………...........72 Table 7: Progression from Practices and Codes to Categories and Major Themes.…………….86 Table 8: Major Themes: Description and Primary Code Contributor…………………………..87 Table 9: Organizational Practices, Description and Code Contributors..………………………97 Table 10: Service Delivery Practices, Description and Code Contributors………….………..112 xii LIST OF FIGURES Figure 1: Eight Dimensions of Wellness…..………………………………………………........ 35 Figure 2: Coding Flowchart……………………………………………………………………...71 Figure 3: Excerpt from Dedoose Code Book……………………………………………….........76 Figure 4: Example of Coding Matrix Chart generated by Dedoose Software…………………...76 Figure 5: Peckham Community Partnership Foundation Financial Status 2018-2019………….84 Figure 6: Peckham Revenues and Impact 2018-2019…………………………………………....85 Figure 7: The Cyclical Nature of Successful Innovation……………………………………….137 xiii KEY TO ABBREVIATIONS ADA CIE Americans with Disabilities Act Competitive Integrated Employment CRO Community Rehabilitation Organizations DOJ DOL DOE EBP EF Department of Justice, US Department of Labor, US Department of Education, US Evidence Based Practices Employment First EFSLMP Employment First State Leadership Mentoring Project GAO IDD IPS General Accounting Office, US Intellectually Developmentally Disabilities Individual Placement Services JWOD Javits Wagner O’Day Act MI Motivational Interviewing MQR Modified Quality Research NIRN National Implementation Research Network NISH National Industries for the Severely Handicapped ODEP Office of Disability Employment Policy SE SSI SWB VR WA Supported Employment Social Security Insurance Subjective Well Being Vocational Rehabilitation Working Alliance WIOA Workforce Innovation and Opportunities xiv CHAPTER ONE INTRODUCTION Work is a central activity in our lives. Work is fundamental to the physical and psychological well-being of people with and without disabilities (Chan, Leahy& Saunders, 2005). Prior to capitalism most societies had no generic concept of work. People were engaged in a wide variety of activities, but it did not occur to anyone to refer to all these activities collectively as ‘work’. Some people raised animals or tended crops, others made barrels or ships or silver dishes. They were referred to as shepherds or farmers, coopers or shipwrights or silversmiths rather than as workers. So, the concept ‘work’ in capitalism denotes not merely the labor process but the assignment of more and more human activities to production and thus to the organization of society through work (Cleaver, 2002). Work denotes one’s standing in society, offers individual and group identity and supports a standard of living based on wages. Work is a fundamental need of individuals and is certainly a need of individuals with disabilities. In 2018, according to the Centers for Disease Control, one in 4 or 25% of U.S. adults - 61 million Americans - had a disability that impacted major life activities. The Annual Disability Statistics Compendium, shows that 37 percent of U.S. citizens with disabilities ages 18-64 living in the community in 2018 had a job, compared to 77.2 percent for people without disabilities. Using 2011 as a point of comparison, we see these figures virtually unchanged, with the employment rate of working-age people with disabilities in the United States at 33.4% compared with 75.6% for people with no disability. This continuing 40-42.2 percentage point gap contributes to people with disabilities having significantly lower household incomes and being far more likely to live in poverty (Erickson, Lee, & von Schrader, 2012). The gap between employment rates of those with disabilities compared to those without has not changed 1 substantially over the past decade. Various measures have been tried worldwide in order to increase access of people with disabilities to the labor market, including laws and regulations, vocational rehabilitation (VR) and attitudinal change, among other interventions (World Health Organization, 2011). This gap has remained constant for many years suggesting that new mechanisms must be identified to increase and improve the employment status of persons with disabilities. Significant changes have occurred at the Federal level that promote inclusion and integration of people with disabilities into society. These include the Supreme Court Olmstead decision, the Workforce Innovation and Opportunity Act (WIOA), the Home and Community Based Services (HCBS) Settings Final Rule, and several key Department of Justice (DOJ) cases that further interpret the Americans with Disabilities Act (ADA). These changes largely reflect law, policy and regulation. The alignment of these game changers creates unprecedented opportunities for employment for people with disabilities (Moore & Friedman, 2017). Statement and Significance of the Problem Despite national and state policies promoting competitive integrated employment, a large percentage of adults with significant disabilities remain in facility based sheltered workshops or non-work programs – also often segregated – even though a majority of individuals would either like employment outside sheltered workshops or to be able to at least consider it an option (Butterworth, et al., 2013). Recognizing the importance of work, VR professionals have consistently advocated for it as a fundamental human right of people with disabilities (Marrone, Golowka, 2000). Job placement of people with disabilities at the highest level possible has been central to the mission of many vocational rehabilitation programs (Rubin & Roessler, 2001). Persons with disabilities 2 often require supports and services to obtain employment. These supports are typically offered through community rehabilitation programs and organizations (CROs) and VR. A "community rehabilitation program" is a program that provides directly or facilitates the provision of vocational rehabilitation services to individuals with disabilities to enable the individual to maximize opportunities for employment, including career advancement. (Federal Register). A community rehabilitation organization (CRO) is a nonprofit charitable organization or institution incorporated in Michigan that is operated for the purpose of carrying out a recognized program of employment and training services for people with disabilities (Michigan.gov). As entities originally established by law to support the mission of the federal vocational rehabilitation system, CROs remain key service provider partners to VR in most states (RSA-911). The performance of VR agencies in assisting consumers to achieve employment outcomes depends on the availability of an appropriate network of service providers, given that much of the mission of the agency involves: working with consumers to identify services that will support achievement of the vocational goal; arranging with available providers to deliver those services either through comparable benefits or through purchase and supporting consumers as they proceed through services to an employment outcome. The availability of rehabilitation-related, employment and educational and other services and service providers can improve or constrain a local VR office’s ability to help consumers move into employment outcomes that meet their goals and preferences (DOE, 2005). The state vocational rehabilitation system remains dependent upon the purchase of services from community rehabilitation programs to provide quality services that address the needs of participants in the program. Rehabilitation facilities (CROs) provide comprehensive vocational rehabilitation services, including vocational evaluation and assessment, counseling and guidance, retraining support, job analysis, job 3 development, competitive job placement services, and accommodation assistance through fee for service or contract (Michigan.gov). Services purchased by VR from CROs on behalf of VR eligible individuals with disabilities include assessment services such as community-based evaluation, vocational and other training services, such as workplace readiness training, work- based learning, job search and job placement, job retention, job follow-up, and job follow-along services (RSA-911). Community vocational rehabilitation organizations are expected to be high performing, to demonstrate accountability and achieve results that support public funding and private contributions. Much in the same manner required by the GAO of the federal VR system, CROs need to implement changes necessary to become high performing and engage in best practices leading to better results for persons with disabilities. Organizational barriers including poor leadership, cultures resistant to change, insufficient support from colleagues, and bureaucratic constraints thwart efforts to implement and maintain innovation. Today, thousands of Community Rehabilitation Programs (CRPs) face demands for fundamental change as they are being tasked to address community employment as the first option for individuals with significant disabilities who require their services and supports. The Employment First movement has had a groundswell of support through progressive grassroots state initiatives, the Office of Disability Employment Policy (ODEP) at the U.S. Department of Labor, the Administration on Community Living (ACL), various Department of Education (DOE) projects and the national Workforce system through Workforce Innovation and Opportunity Act (WIOA). According to Griffiths, (2017) this is not a minor change in strategic direction. CROs must comply, adapt, perform, or slowly fade into irrelevance. Many CROs can be characterized as the laboratories where promising workplace policies and practices have been and will be developed, 4 demonstrated and implemented to enhance employment outcomes. CROs can and should be part of any cohesive strategy designed to achieve better results for persons with disabilities. CROs need to transform, that is, recognize, initiate and implement changes necessary to become high performing and engage in best practices leading to better results for persons with disabilities. CRO mission statements vary but can be interpreted as supporting increased independence and self-sufficiency of individuals with disabilities and other underrepresented populations who present substantial challenges and barriers to reaching an employment goal. CROs then must be invested in creating, developing and maintaining a workplace that promotes the achievement of the mission. This can be a daunting task and result in poor outcomes even with the best of intentions as human service occupations are noted for high burn out rates (Thomas, Kohli, & Choi, 2014). Given the number of potential and real barriers to high performance within CROs and the urgent need for innovation and transformation of systems, (GAO report, 2005) it is critical to identify, use and share best practices developed by CROs that change the employment gap and result in desirable outcomes for employment and independence of persons with disabilities. Culture is considered to be one of the most significant factors in bringing about organizational change and modernizing public administration and service delivery (Jung, 2009). While organizational culture has been popularized since Peters and Waterman’s best-selling book In Search of Excellence in 1984, the concept of well-being has become trendy recently and is being discussed as a cultural factor that applies to individuals and to organizations. At a December 2019, Lansing, MI meeting of a newly convened Culture Collective chapter, creating a culture of well-being was identified as popular at other chapters including San Francisco. Organizational practices that promote a culture of well-being have been shown to be 5 instrumental in creating a workplace that engages in effective service delivery, customer satisfaction and development of innovative workplace practices (Cartwright & Cooper, 2009). A culture of well-being creates a workplace environment that positions people to do their best work. It can be identified as performance enhancing, often achieving exceptional outcomes and engaged in the functions of the organization that support the mission. Organizations that provide a clear mission and vision, offer meaningful work, and actively seek ways to help people integrate their personal and professional lives will reap the benefits of retaining energized employees who are equipped to bring their best selves to work each day (Van DeVoorde, Paauwe & Van Veldhoven, 2012). CROs must create workplace environments that position people to do their best work if we are to “move the needle’ of societal employment change for persons with disabilities. Is it a surprise that oftentimes PWDs do not want to leave a supportive environment to engage in competitive, integrated work in the community? A paradigm shift is needed to establish the CRO as the 21st century workplace model that can be used to inform the competitive, integrated larger private for-profit workplace. CROs are exquisitely positioned to demonstrate the role of workplace well-being and show private employers how to develop into desirable workplaces that support a culture of wellbeing and create good jobs, hire workers with disabilities and offer viable choices for all workers. While the contributions of culture and well-being within high performing organizations has been studied within corporate America, this subject requires additional scrutiny within the government and nonprofit arena and more specifically within community-based rehabilitation organizations. Leahy et al. (2009) suggested that the emphasis of VR in the future will be on the meaning of research findings to practitioners and consumers in improving services, 6 interventions, and employment outcomes for persons with disabilities, and translating and disseminating evidence-based practices (EBP) that come from research efforts to the level of the organization that will affect and inform practice and policy. A high performing CRO, independent of bureaucratic entrenchment and the government restrictions that limit innovation, may be better positioned to not only adopt but create, develop and implement innovative, cutting edge options for persons with disabilities. As a nimble, agile, better resourced, committed organization unrestrained by more traditional decision-making hierarchical structures, a successful CRO is poised to offer business a sustainable model for increasing the employment of persons with disabilities. As the emphasis shifts to translating research findings to practitioners to improve services and outcomes, all organizations will need to engage in practices that support retention of skilled staff, financial stability, enhanced employment outcomes and community engagement in order to remain viable. High performing CROs with a culture of well- being and evidence based organizational and structural practices may be optimally positioned to meet the expectations and challenges of the 21st century. Purpose of the Study The primary objective of this qualitative study is to investigate and identify the organizational elements that advance emerging and promising organizational and programmatic practices within vocational community rehabilitation organizations. The secondary objective of this study is to identify innovative emerging and promising vocational rehabilitation service delivery practices within vocational community rehabilitation program organizations (CRO)s that optimize employment outcomes of people with disabilities. The further intent is to investigate the concept of well-being and 7 its relationship to evidence based emerging and promising vocational rehabilitation practices, policies and procedures. Research questions It is hypothesized that successful -defined as high performing or performance enhancing -vocational community rehabilitation organizations will exhibit a culture and climate of well-being that can be effectively explained and contributes to optimized outcomes for persons with disabilities. These same organizations engage in effective evidence-based practices, policies and procedures that optimize outcomes for persons with disabilities. The primary research questions are: 1. What are the best models of effective practice, policy and procedures within a successful community rehabilitation organization that assist individuals with disabilities achieve employment outcomes? 2. Do the models of effective practice, policy and procedures result in the creation of an environment that promotes innovation and high performance? Description of the Study A community rehabilitation organization identified as high performing will be selected and invited to participate in the study. A sample of employees from the organization representing three levels (executive, middle management and direct service) of the organization will be recorded in individual hour long semi structured interviews with the researcher. The transcripts of an anticipated 32-36 hours of data will be the foundation of a qualitative analysis using thematic analysis and a modified quality research (MQR) coding process. In preparation for this research, a small initial study was 8 conducted with a CRO in southeast Michigan. The methodology used was comparable to the current study, however, changes to the interview protocol resulted in a more streamlined questionnaire for the current study. Current interview questions address the interviewee’s position, experience, beliefs and understanding of the mission and perception of practices contributing to accomplishment of the mission. Observation and review of relevant documents such as annual reports are expected to contribute to the validity of the findings. Theoretical Framework This qualitative study employs thematic analysis within the confines of case study methodology. A progressive approach will be used to identify emerging considerations as the study continues and semi structured interviews identify additional discussion items. The role of conceptual and theoretical frameworks is to make the research findings meaningful and generalizable. Linking together findings into a coherent structure can make them more accessible and more useful to others. Concepts from theories are often used as a framework rather than the full theories (Polit & Tatano, 2004). Concepts from transformational leadership theory introduced by Burns in 1978 will be used as an expanded study framework. While contemporary leadership theory focuses on individual leader’s traits, behaviors and situational contexts, transformational leadership theory provides context for the enhanced practice of participatory management that empowers others, facilitates redefinition of mission and vision, evokes commitment, and instills enthusiasm (Frank, 2002). Transformational leaders are agents of change within organizations and society. Transformational leadership is an influential relationship among those leaders and their followers, where both raise one another to 9 higher levels of morality and motivation (Burns, 1978). Transformational leadership can move organizations to deeper levels of communication that deal with meaning, value, myth, belief, symbol, and ritual. When leaders facilitate this kind of process, they reframe the culture of organizations (Bolman & Deal, 1995). These organizations then become more than systems designed to achieve particular objectives. They develop into vibrant communities where the people who comprise them are bound up with their mutual well- being and effect real change (McCoy, 1985). Summary Identifying workplace characteristics, policies and best practices that have the greatest impact on attitudes, recruitment, hiring, retention, advancement and full inclusion of people with disabilities is imperative. Community Rehabilitation Organizations (CRO) s are entities that were originally legally established to support the mission of the federal vocational rehabilitation system and continue to do so. Many have evolved into independent entities that develop and provide a myriad of services to persons with disabilities. The best and most successful performance enhancing organizations can be expected to demonstrate practices which can be replicated by other organizations that are striving to succeed in providing services that support individuals with disabilities. Describing features of organizational practice and culture in language that can be easily understood and implemented toward positive outcomes is important to effect change. Given the number of potential and real barriers to high performance within CROs and the urgent need for innovation and transformation of systems, it is critical to identify, use and share best practices demonstrated by high performing CROs that result in desirable outcomes for employment and independence of persons with disabilities. 10 Definition of Terms Ability One Program means ‘the program authorized by the JWOD Act to increase employment and training opportunities for persons who are blind or have other severe disabilities through Government purchasing of commodities and services from nonprofit agencies employing these persons.” (According to 41 CFR 51-1.3 Title 41: Public Contracts and Property Management Subtitle B; Other Provisions Relating to Public Contracts Chapter 51; Committee for Purchase from People Who Are Blind or Severely Disabled Part 51-1;) CARF is an independent, nonprofit accrediting body whose mission is to promote the quality, value and optimal outcomes of services through a consultative accreditation process that centers on enhancing the lives of the persons served. Founded in 1966 as the Commission on Accreditation or Rehabilitation Facilities, and now known as CARF International, the accrediting body establishes consumer-focused standards to help organizations measure and improve the quality of their programs and services (CARF International). Case Study is a form of qualitative scientific inquiry examining a system that is defined, or bounded, by an array of data and illustrates specified phenomena as they occur in a natural context or setting through a process of empirical investigation within a specified timeframe (Stake, 1995; Yin, 2009). The case study research designs most frequently used are exploratory, explanatory, and descriptive. Exploratory designs define research questions and determine feasibility of research procedures, often as a prelude to additional research efforts. Explanatory designs seek to establish cause-and-effect relationships, and descriptive approaches attempt to present a complete depiction of a phenomenon within its context (Hancock & Algozzine, 2006). 11 Community Rehabilitation Programs / Organizations CRO means a program that provides directly or facilitates the provision of vocational rehabilitation services to individuals with disabilities, and that provides the following services, singly or in combination for an individual with a disability to enable the individual to maximize opportunities for employment, including career advancement (A) medical, psychiatric, psychological, social, and vocational services that are provided under one management (B) testing, fitting, or training in the use of prosthetic and orthotic devices (C) recreational therapy (D) physical and occupational therapy (E) speech, language, and hearing therapy (F) psychiatric, psychological, and social services, including positive behavior management (G) assessment for determining eligibility and vocational rehabilitation needs (H) rehabilitation technology (I) job development, placement, and retention services (J) evaluation or control of specific disabilities (K) orientation and mobility services for individuals who are blind (L) extended employment (M) psychosocial rehabilitation services (N) supported employment services and extended services (O) services to family members when necessary to the vocational rehabilitation of the individual (P) personal assistance services or 12 (Q) services similar to the services described in one of subparagraphs (A) through (P) (According to 29 USCS § 705(5) [Title 29. Labor; Chapter 16. Vocational Rehabilitation and Other Rehabilitation Services; General Provisions]. Competitive integrated employment means “work that is performed on a full-time or part-time basis (including self-employment) and for which an individual is compensated at a rate that-(A) Is not less than the higher of the rate specified in section 6(a)(1) of the Fair Labor Standards Act of 1938 (29 U.S.C. 206(a)(1)) or the rate required under the applicable State or local minimum wage law for the place of employment; (B) Is not less than the customary rate paid by the employer for the same or similar work performed by other employees who are not individuals with disabilities and who are similarly situated in similar occupations by the same employer and who have similar training, experience, and skills; …and is at a location—(A) Typically found in the community; and (B) Where the employee with a disability interacts for the purpose of performing the duties of the position with other employees within the particular work unit and the entire work site, and, as appropriate to the work performed, other persons (e.g., customers and vendors), who are not individuals with disabilities (not including supervisory personnel or individuals who are providing services to such employee) to the same extent that employees who are not individuals with disabilities and who are in comparable positions interact with these persons; and Presents, as appropriate, opportunities for advancement that are similar to those for other employees who are not individuals with disabilities and who have similar positions.” [34 CFR §361.5(c) (9)] 13 Evidence-based practices for rehabilitation counseling is a decision-making process beginning with formulating appropriate questions, determining best practice based on the most current resources available, and critically appraising the evidence for validity and applicability to the situation at hand (Chan, 2010). Organizational climate is the recurring patterns of behavior, attitudes and feelings that characterize life in the organization (Schein, 2011). Organizational culture is the shared beliefs and assumptions about the organization’s expectations and values. These "unwritten rules" and perceived expectations drive our behavior in organizations (Schein, 2011). Organizational Development (OD) is an ongoing, systematic process of implementing effective system-wide change. OD is frequently defined as a planned effort that takes place organization- wide, is managed from the top, and is intended to increase the organization effectiveness and health through planned interventions in the organization’s processes based on scientific knowledge. (Beckhard, 1969). Organizational Leadership is the multidisciplinary study of leadership drawing upon theories and applications from related fields of psychology, education, management and medicine. (Anderson, 2013). Leadership scholarship focuses on both the organization and individual; for purposes of this study the organizational context will be emphasized. 14 Rehabilitation is defined as “a holistic and integrated program of medical, physical, psychosocial and vocational interventions that empower a person with a disability to achieve a personally fulfilling socially meaningful and functionally effective interaction with the world. (Banja, 1990, p. 615). Rehabilitation Counseling is defined “as a profession that assists persons with disabilities in adapting to the environment, assists environments in accommodating the needs of the individual and works toward full participation of persons with disabilities in all aspects of society, especially work” (Szymanski, 1985, p.3). 15 CHAPTER TWO LITERATURE REVIEW The purpose of this study is to investigate the CRO organizational elements that advance emerging and promising organizational and programmatic practices within vocational community rehabilitation organizations. Therefore, the literature review addresses the following areas: vocational rehabilitation, community rehabilitation organizations, evidence-based practices in CRO and VR service delivery, relevant legislation, transformational leadership and as it applies to organizations: well-being, climate and culture, performance and theory. Vocational Rehabilitation Legislation and History Beginning in 1920 with the enactment of the Civilian Vocational Rehabilitation Act known as the Smith Fess Act, persons with physical disabilities, age 16 and older were provided guidance, education, prosthetics and other restoration, training toward employment and job placement. The Social Security Act of 1935 created a permanent VR program and notably created a foundation for the 1936 Randolph Shepherd Act that allowed people who were blind to operate vending stands on federal property. That was followed by the Wagner O’Day Act of 1938 that established the nonprofit national Industries for the Blind and mandated government purchases of their products. The VR Act Amendments of 1954 during the “golden period” of rehabilitation provided SSI for individuals who were blind, poor, aged or disabled, expanded funding through a new favorable matching funds ratio, created graduate rehabilitation programs and supported facility development. This legislation (P.L. 565) also provided for the improvement of existing facilities 16 and/or workshops providing services to the disabled. In 1965, new amendments to the VR Act (P.L. 333) improved financing, encouraged states to serve the severely disabled, included extended evaluation, and provided for the construction of rehabilitation facilities and workshops. The VR Amendments Act of 1965 further expanded funding and addressed the construction of new rehabilitation centers (Peterson & Aguilar, 2004). In the context of the US civil rights movement in the 50s and 60s, there emerged a parallel movement in the broader disability community for self-determination and equal treatment under the law. Consisting of disability advocacy organizations, rehabilitation professionals, policy makers and academics, this community recognized principles which came to be known as independent living or rehabilitation philosophy. The principles include self- determination, societal contribution, holistic approach to rehabilitation, focus on residual assets and capabilities, the intrinsic value of each human being, environmental restructuring to fit people, dignity of risk, transdisciplinary team functioning, normalization, reality factors, criterion of ultimate functioning, and coping and adaptation ( Maki, Riggar, 2003). These tenets were the basis for legislation such as the Rehabilitation Act of 1973 known as the “billion-dollar program” that espoused greater consumer involvement as well as subsequent legislation such as the 1992 Amendments to the Rehabilitation Act which furthered client centered and consumer driven planning. For the first time, the 1992 legislation (Title 3.2) replaced the construction authority with increased personnel training in existing facilities to include career advancement, technical expertise and in-service training. Subsequently, the Workforce Investment Act of 1998 integrated the Rehabilitation Act but the state federal system maintained its autonomy from the one stop system. (Peterson, Aguilar, 2004)). The Workforce Innovation and Opportunity Act of 2014 (WIOA) further integrated the nation’s workforce 17 system and through Subtitle B: Vocational Rehabilitation Services - (Sec. 411) required that gainful employment of persons with disabilities in integrated settings shall be competitive integrated employment. The first major reform of the nation’s workforce system in 15 years, it was enacted to address certain problems facing the U.S. workforce, including significant projected shortages in the necessary numbers of workers with postsecondary education and lack of workforce participation by individuals with disabilities. Existing facilities/CROs continued to expand services to individuals of working age with disability barriers and to newer populations such as ex-offenders and others with barriers to employment. Today, the United States Vocational Rehabilitation System (VR) is administered by the US Department of Education. The goal of VR is to increase independence in adults with disabilities and to maximize employment outcomes. In order to be determined eligible to receive VR services, an individual must have a physical or mental impairment that creates a barrier to employment, need VR services to prepare for, secure, retain, or regain employment, and be able to benefit from VR services. Examples of potential VR services are assessment, job placement assistance, assistive technology, and on-the-job training. Services are routinely purchased from community rehabilitation organizations on behalf of an eligible individual who has an active individualized written rehabilitation plan. VR services have been found to be a stronger predictor of work success than either medical or psychological factors and are associated with improved competitive employment rates (Dutta, et al, 2008). Provision of VR services represents perhaps the most important factor for achieving employment success. The Americans with Disabilities Act (ADA) of 1990 was essentially a civil rights act and mandated accessibility and the use of reasonable accommodations for otherwise qualified individuals (McMahon, 2016). In conjunction with the prevailing rehabilitation philosophy, this 18 supported an even stronger emphasis on competitive integrated employment. At the same time, the AbilityOne program, originally entitled the Javits Wagner O’Day program, was still in place and growing. AbilityOne The AbilityOne Program is among the nation’s largest sources of employment for people who are blind or have significant disabilities. Through a network of more than 600 nonprofit agencies, the program provides the Federal Government with products and services at fair market prices. The procurement of these products and services results in employment of more than 100,000 individuals according to SourceAmerica, previously known as National Industries for the Severely Handicapped (NISH) and the primary nonprofit coordinating association for AbilityOne. Current product lines include aircraft and vehicular equipment and supplies, clothing, textiles and individual equipment, food processing, packaging and distribution, hardware and equipment food processing, packaging and distribution, hardware and equipment, office products. pens, binder, clips, paper products, environmentally friendly and recycled products, e.g., biodegradable disposable cutlery, military specific products such as chemical protective over garments and cold weather infantry kits and medical supplies such as catheters and surgical masks. Services include custodial, administrative services, contact centers, document management services, fleet management food service, full facility management, grounds maintenance, healthcare environmental/ hospital services, laundry services, secure mail/digital document services and supply chain management (AbilityOne website). Understanding the legislative history informing and influencing development of the state- federal VR program and its relationship to citizens with disabilities and to the broader 19 community helps provide a context for the importance of the current need for improved outcomes for people with disabilities. Social Enterprise Social enterprises are businesses that exist for a social purpose and operate in commercial markets to financially support their activities (Ebrahim, et al. 2014). Social enterprises participate in the market economy but pursue social returns as their primary goal (Austin et al., 2006). Social enterprises not only face the challenges of for-profit enterprises such as finances, customers, suppliers, and entry barriers, but also the challenges associated with achieving their social mission (Austin et al. 2006). A supported social enterprise can be more specifically defined as an organization engaged in market-oriented activities, but also relying on government programs, foundations, and social procurement arrangements, and that is most often supported by an affiliated nonprofit organization that started the enterprise and continues in a parenting role. Because they provide employment and job training for people who often face significant and complex challenges to finding and maintaining employment, and the target group requires extraordinary supports, the operating cost of such an enterprise cannot be recovered through sales revenue alone. Substantial amounts of monetary and in-kind support of various sorts (e.g., government programs, foundation funding and volunteer labor), acquired through the parent nonprofit organization or independently, are needed for organizations to remain viable (Chan, Ryan & Quarter, 2017). In a recent study of four social enterprises, findings determined that while all four social enterprises acknowledged dual social and financial accountability, financial performance was consistently prioritized. Specifically, a pragmatic approach emerged with financial performance considered essential to address long-term social objectives. ( Bradford, Luke &Furneaux,2020). The four social enterprises identified accountability for social 20 performance in terms of progress towards mission and meeting targets; they were conscious of the importance of accountability for financial performance; however, this was shared internally or to specific publics. Findings from this study revealed a planned emphasis rather than tension, potentially attributable to a rational approach, and the integrated nature of the organizations. Communicating accountability for both social and financial performance is important for social enterprises, improving performance (Nicholls (2009) and reinforcing legitimacy (Connolly and Kelly 2011). Community Rehabilitation Organizations These nonprofit entities operate as a direct service provider to persons with disabilities and often as an employer if community employment is not feasible. Sometimes negatively characterized as sheltered workshops, many have evolved into independent entities that independently develop and provide a myriad of services to persons with disabilities. Similar to VR, often the mission of these organizations is to increase the independence and self-sufficiency of individuals with disabilities who present substantial challenges and barriers to reaching an employment goal. Wallin (1967) outlined the objectives of workshops to include the development of vocational competence; training for competitive employment; providing academic remediation; treating personality maladjustments; and providing appropriate job placement and follow-up. Beginning in the early 1970s, reviews documented ineffective or inefficient practices in workshops now known as CROs and called for changes (Rosen,1993). These practices included: the limited effectiveness of workshops in achieving rehabilitation or employment outcomes; exclusive or primary use for severely or chronically disabled populations; and the potential for exploitation of workers with disabilities (Conte,1982). Criticism continued into the 80’s and 21 beyond identifying a lack of placement in meaningful or competitive employment (Rusch, Chadsey-Rusch & Lagomorcino, 1987; Bellamy, Rhodes, Bourbeau & Mank, 1986), the low client wage structure of workshops and federal disincentives to earning higher wages by reduction of federal benefits especially health care insurance available through Medicaid (Schuster, 1990). With the decline of mass production industries and blue-collar jobs nationally, Shuster suggested that increasingly workshops will be unable to provide necessary work (1990). This proved true although CROs developed contract work with the Javits Wagner O’Day Act. Fully thirty-three years ago, CROs were enmeshed in an attempt to move workers with disabilities from the sheltered floor of the CRO into competitive supported employment. Somewhat (eerily) similar to this current study, the literature review search led to an article investigating the change process of three CROs using a qualitative case study analysis to understand change from an organizational systemic perspective. (Hagner, 1989). According to Hagner, fundamental change had taken place in each organization toward what we now call community-based services. In each instance, one or two people were leaders in the initialization and formalization of the change and also occupied formal leadership positions. Notably, economics was a stimulus for change in two of the three organizations and "closing the workshop" was a process unique to each agency. Each agency continued to utilize its original facility and the agencies' changes to supported work did not involve a complete break from past patterns of services. Most often "closing the workshop" actually meant adding new programs which were perceived as less segregated by staff. Specific, purposeful tactics employed by change agents included staff incentives and training, resolution of individual concerns, job restructuring, information management, staff turnover, physical relocation, and support system development. Hagner concludes that organizational change is an extraordinarily complicated, 22 difficult, long-term, and unpredictable process that has for too long been neglected or treated simplistically and is not well understood even by those who have experienced it (1989). Sheltered workshops can be altered to become more normalizing than the typical workshop of the 60s and 70s, yet still provide the structure and support required by the individual with disability (Rosen,1993). Today in the United States between 20% and 25% of the country’s persons with IDD are working competitively; more importantly in some states such as Vermont, Connecticut, Michigan, Oregon, Nebraska, Idaho, and Nevada, this percentage is much higher, rising above the 50% level of employment (Winsor et al., 2017). This is important because it demonstrates vocational capacity and suggests that perhaps in other states there are exogenous policies and practices (e.g., insufficient Medicaid Waiver support) that are interfering with higher quality outcomes. It is now established that many people with IDD can work who never were thought able to before; this is a positive breakthrough that has emerged over the past three decades. Recent policy developments through the reauthorization of WIOA, as well as efforts by the U.S. Department of Justice (DOJ) to enforce ADA regulations around segregated settings, offer fresh hope of improving these rates through earlier intervention and interagency collaboration (Winsor, et al, 2017). Workforce Innovation and Opportunities Act (WIOA) In 2014 Congress passed the Workforce Innovation and Opportunities Act (WIOA) establishing competitive integrated employment for people with disabilities as a national priority. The explicit goal of the law is to increase competitive integrated employment and the law defines employment for people with disabilities as Competitive Integrated Employment (CIE). It redefined competitive employment as fully integrated. The law requires that people with disabilities be paid the same wages and have the same benefits as people without disabilities, and 23 to interact with coworkers and get the same opportunities for career advancement as coworkers without disabilities. It substantially restricts the use of subminimum wages, especially for youth. WIOA requires state agencies such as Vocational Rehabilitation, Medicaid, Departments of Education, and State Developmental Disability Authorities to work together, prioritize CIE and address disincentives to employment for people with significant disabilities. States have already made positive changes consistent with WIOA. Vermont has eliminated the use of sheltered workshops (Stockton, 2014) and Massachusetts has stopped funding sheltered workshops as of August 2016 (NASDDDS, 2016). New Hampshire was the first state to ban subminimum wage employment in 2015, Senate Bill 47 (Carlson, 2015). The Maryland General Assembly followed this example on May 19, 2016 with the Ken Capone – Equal Employment Act (2016), eliminating the use of subminimum wage (Grunberger, 2016). Competitive Integrated Employment Office of Disability Employment Policy (ODEP) defines competitive integrated employment (CIE) as work paid directly by employers at the greater of minimum or prevailing wages with commensurate benefits, occurring in a typical work setting where the employee with a disability interacts or has the opportunity to interact continuously with co-workers without disabilities, has an opportunity for advancement and job mobility, and is preferably engaged full- time (ODEP website). Across the nation there are thousands of employers that hire people with disabilities. Any employer that hires a person with a disability may apply for a 14(c) certificate to pay subminimum wage. However, according to the GAO, Special Minimum Wage Program report, GAO-01-886, 95% of all workers with disabilities being paid less than minimum wage under the 14(c) programs were employed by sheltered workshops, not typical employers. The sheltered 24 workshop model was originally designed to provide general training and experience for people to help them move to competitive jobs. The model has not worked for people with disabilities. The same GAO report estimates that less than 5% of the workers left to take a job in the community. People with significant disabilities are successfully employed in much the same way as people without disabilities. The person’s skills, abilities and interests are identified and matched to available jobs. Training, if needed, is tailored to the job. Most people in sheltered workshops or pre-vocational services stay in those programs and do not move on to CIE (GAO). For example, according to a recent DOJ Findings Letter, nearly half (46.2%) of the people in sheltered workshops in Rhode Island had been there for a decade or longer and over a third (34.2%) were there for 15 or more years. Similarly, the DOJ found that the average stay in sheltered workshops in Oregon was more than a decade (11.72 years) while some people reported staying for 30 years or more. The study concluded that in order to effectively eliminate the sub-minimum wage, there had to be simultaneous efforts to build capacity in sheltered work programs while ensuring that all employees receive high-quality services to secure competitive, integrated employment opportunities. The same study found that of the over 5,000 employers who hold subminimum wage employer certificates, less than 1% of these employers are private businesses (Butterworth et. al, 2007). Policy in support of CIE is beginning to change at least in part due to the convening of the Advisory Committee on Increasing Competitive Integrated Employment for Individuals with Disabilities (the Committee) mandated by section 609 of the Rehabilitation Act of 1973, as amended by section 461 of the Workforce Innovation and Opportunity Act. The Secretary of Labor established the Committee on September 15, 2014 to study and prepare findings, conclusions and recommendations for Congress and the Secretary of Labor on (1) ways to 25 increase employment opportunities for individuals with IDD or other individuals with significant disabilities in CIE; (2) the use of the certificate program carried out under section 14(c) of the Fair Labor Standards Act of 1938 (29 U.S.C. 214(c)); and (3) ways to improve oversight of the use of such certificates. (Federal Register, 2016). Recommendations from the Final Report of the Committee (2017) and a 2016 TASH presentation reflected a need for the following: enhancing competencies of employment specialists, evidence-based research, research on CIE for those with the most significant disabilities, school-community relationships, the provision of transition and employment knowledge to family members, seamless transition to paid employment prior to graduation, inclusive social skills instruction and staff training at all levels (Mank, 2016, Wehman, 2018). The United States Department of Labor (DOL), ODEP has prioritized investment in state systems change efforts that result in increased competitive integrated employment opportunities for individuals with significant disabilities. This priority reflects growing support for a national movement called Employment First (EF) and a framework for systems change that is centered on the premise that all citizens, including individuals with significant disabilities, are capable of full participation in competitive integrated employment and community life. The Employment First State Leadership Mentoring Project (EFSLMP) assists states in identifying and addressing changes in state policies, funding models, and practices to increase access to and outcomes associated with CIE. The Project conducted qualitative assessments of state policies, funding priorities, and practices to determine if they align with systems change principles and capacity-building efforts as defined by ODEP (2014). Seven of nine states achieved pending or full systems change during the program year through their involvement in EFSLMP. Evidence included: MOUs, organization of conferences, training events, completion 26 of HCBS waivers and modifications, completion of Unified State Plans that changed policy and practices and increased the capacity of state systems for competitive integrated employment opportunities for individuals with disabilities (Klayman, 2017). The state federal VR program, community rehabilitation programs and citizens with disabilities have made substantial progress toward inclusion in the larger society and promoting competitive integrated employment, however an understanding of the history suggests the need for improved practices that are evidence based in reaching this goal. Evidence Based Practices in CRO and VR Service Delivery Persons with disabilities often require supports and services to obtain employment. Vocational rehabilitation services are associated with employment outcomes; provision of services is a predictor of successful client outcomes (Frain, Ferrin, Rosenthal & Wampold, 2006, Mackay, et al, 2018, Tucker & Abrams, 1989). These services are typically offered through CROs and VR. The EBP construct is increasingly shaping vocational rehabilitation research and practice. The Rehabilitation Services Administration (RSA) of the United States Department of Education is beginning to emphasize vocational rehabilitation services that integrate the best research evidence with clinical expertise and client perspectives (Dutta, et al, 2008). National Implementation Research Network (NIRN) defines evidence-based practices (EBP) as skills, techniques, and strategies that are used effectively by a practitioner (NIRN, 2009). Implementation is defined as a specified set of activities designed to put into practice an activity or program of known dimensions. According to these definitions, implementation processes are systematic, purposeful, and are described in sufficient detail such that independent observers can detect the presence and strength of the specific “set of activities” related to 27 implementation (NIRN, 2009). EBP and interventions are necessary for quality and timely provision of services to people with disabilities whether provided by VR or CROs. More specifically, the provision of evidence-based VR services and interventions are needed to improve successful employment outcomes for persons with disabilities. The use of EBP in VR represents a wide array of services and interventions based on various levels of “evidence” and applications within the state-federal VR program. Current EBP initiatives described in the rehabilitation literature cover a variety of topics ranging from EBP decision models, knowledge translation, pedagogy, ethics, rehabilitation counselor knowledge, application of EBP and adaptation of emerging best practices (Leahy, et al., 2014). Recently, a literature review concluded that EBPs, while practiced in specific areas of rehabilitation counseling and VR service delivery, are still not a common practice at the system or practitioner level. The review also concluded that EBPs are inconsistent in application and scope and lack a formal methodological approach on how to design, implement, and analyze results. (Fleming, Del Valle, Kim & Leahy, 2013). Graham et al. noted the consistently high unemployment rate for individuals with disabilities and stressed the importance of EBP in VR service delivery as a bridge for unemployed individuals with disabilities to gain employment (2013). Graham also recognized that EBP is valued differently by the state federal VR program, community rehabilitation organizations and other practice settings. While each practice setting strives to achieve competitive employment outcomes for their clients, program effectiveness and outcomes are measured differently. As applied to rehabilitation counselors, evidence-based practice holds counselors accountable and provides an indication of cost-effective services in an increasingly expensive service system. Accountability is required because systems are shifting to payer- driven systems (Chan, Leahy, Saunders, Tarvydas, & Ferrin, 2003). 28 More recently, a comprehensive, qualitative case study of four state VR agencies identified promising and EBPs used to improve management and clinical rehabilitation counseling practices. In the study, EBPs were defined as interventions supported by randomized controlled trials (the two highest levels of evidence in the evidence hierarchy), while promising practices were defined as any intervention, program/service, strategy, or policy that has strong quantitative and qualitative data showing positive outcomes, but does not yet have enough research or replication to support generalizable positive outcomes for consideration as an evidence-based practice (Anderson, et al, 2014). Using Delphi procedures, VR experts were queried regarding the applicability of promising or evidence-based VR practices for improving psychosocial and employment outcomes of people with disabilities receiving services from state VR agencies. Of the 13 promising/evidence-based VR practices ranked as having a high level of relevance, only 3 were rated as having a high level of evidence: working alliance (WA), Individual Placement & Support (IPS), a model of Supported Employment (SE) and Motivational Interviewing (MI), a goal directed counseling technique, which attempts to help a client overcome ambivalence to change. The remainder of the top tier VR services (e.g., secondary transition services, demand-side employment strategies, benefits counseling, customized employment, person centered planning and soft skills training) were ranked high in relevance to VR, but not as high in terms of levels of evidence. Some of these employment services can be viewed as promising practices, while others can be considered emerging practices. Emerging practices are practices that have anecdotal evidence and are consistent with professional wisdom but are not necessarily based on research or theory and have not been studied through the collection of original data. Because many of the practices are emerging practices, they were also ranked relatively low in terms of levels of evidence (Anderson, et al, 29 2014). The table below clarifies the evidence levels associated with the distinctions above regarding EBP, promising and emerging practices (Leahy, et.al., 2018). Table 1: Evidence Based Levels Evidence Based Levels Level of Evidence Evidence Strong evidence from at least one systematic review of multiple well-designed randomized controlled trials. Strong evidence from at least one properly designed randomized controlled trials of appropriate size. Evidence from well-designed trials without randomization, single group pre-post, cohort, time series, or matched case-controlled studies. Evidence from well-designed non-experimental studies from more than one center or research group. Opinions of respected authorities, based on clinical evidence, descriptive studies, or reports of expert committees. 1 2 3 4 5 There are evidence-based practices already in use in community rehabilitation programs. One of these is supported employment for individuals or as it is now known, Individual Placement and Support (IPS), a model with clear principles and procedures that when adhered to with fidelity, result in significantly improved employment outcomes compared with traditional stepwise VR methods (Becker et al., 1999; Bond, 1998; Bond, McHugo, Becker, Rapp, & Whitley, 2008). The purpose of supported employment is to support individuals with the most significant disabilities in achieving competitive employment outcomes in integrated work 30 settings (Wehman, Chan, et al., 2014). It is worth highlighting supported employment as an evidence-based practice as it was a dramatic shift from providing vocational services in day programs and workshops to assuring support at a community integrated job site. (Wehman, et al, 2018). Another evidence-based practice is consumer empowerment and self-efficacy or self- concept as factors influencing employment outcomes. Consumer self-concept has been demonstrated to be an effective predictor of employment outcomes within the state VR program (Saunders, Leahy, & Frank, 2000). Positive relationships also exist among empowerment, self- concept, self-esteem, consumer involvement, service satisfaction, employment outcomes, community integration, and quality of life (Ferris, 1999; Kosciulek, 2005; Kosciulek, 1999; Saunders et al., 2000). By establishing a better foundational understanding of the concepts of emerging, promising, evidence-based, and best practice, leaders can choose to move toward developing or adopting organizational best practice frameworks through which both practitioners and managers can then identify and apply specified evidence-based practices (Driever, 2002). While evidence- based practices are known to improve and achieve successful outcomes for individuals with disabilities, in order to be routinely successful, these practices must be established, developed, implemented and integrated within the framework that comprises the culture of vocational community rehabilitation programs. Positive Psychology, Well Being and Rehabilitation Positive psychology is an umbrella term for the study of positive emotions, positive character traits, and positive institutions (Seligman, 2000). At an individual level, positive 31 psychology is concerned with studying and developing happiness, well-being, and character strengths to promote optimal functioning. Notwithstanding the lack of empirical investigation, many of the tenants of positive psychology are already implicitly integrated into vocational rehabilitation approaches and programs. Through the process of vocational assessment, job training, and job placement, vocational counselors promote well-being through engagement with work. There are numerous potential benefits associated with incorporating positive psychology measures and interventions into existing VR practices (Mills, Kreutzer, 2015). Robert Quinn, co-founder of the Center for Positive Organizations at the University of Michigan’s Ross School of Business emphasizes a systemic approach that reshapes the entire culture of an organization so that people flourish in their work and exceed expectations. At the simplest level, in a positive organization, people are flourishing as they work and exceeding expectations. Positive cultures emerge from positive practices. The continuous introduction of new, positive, practices is what generates a more positive organization (Quinn, 2015). Well-being is an abstract construct, as it is typically portrayed through the measurement of many different variables (e.g., life satisfaction, happiness, positive affect) Diener, 2003, Lucas et al., 1996). The definition of well-being is usually assumed and is lacking in clarity with similar terms used interchangeably. Well-being has been measured in research using various scales, which may not capture the complexity of the concept (Stanley & Cheek, 2003). Well- being is often investigated as an outcome or dependent variable, but occasionally it is studied as an antecedent or predictor variable. Increasingly, it is also considered as a moderating influence. These diverse applications underscore the broad utility of well-being constructs in contemporary scientific research (Ryff, 2014). The Government Office for Science Foresight Report on Mental 32 Capital and Wellbeing suggests that wellbeing is a dynamic state that is enhanced when people can fulfil their personal and social goals and achieve a sense of purpose in society (Dew, 2008). Well-being can be defined in terms of an individual's physical, mental, social, and environmental status with each aspect interacting with the other and each having differing levels of importance and impact according to each individual. Sixsmith, et al describes the components relevant to the concept of well-being: • • • • • • • • • • • Individual characteristics of people: functional ability and physical and mental health. Physical environmental factors including facilities, amenities, and housing standards. Social factors such as family and social networks. Living environment including household status, household conditions, and neighborhood. Socioeconomic factors including income, standard of living, and ethnicity. Personal autonomy factors such as ability to make choices and control. Subjective satisfaction on the person's evaluation of their quality of life. Psychological health such as psychological well-being, morale, and happiness. Activities such as hobbies, leisure, and social participation. Life changes such as traumatic or disruptive events or lack of change. Care including expectations, amount, and kind of support. A change in the different aspects of well-being of an individual may be reflected in an alteration of behavior or the performance of a task or activity (Sixsmith, et al, 2007). 33 When people are engaged in “meaningful work,” it tends be a major source of positive affect, satisfaction, self-identity, psychological well-being, and esteem (cf. Arnold, Turner, Barling, Kelloway, & McKee, 2007; Martela, 2010). A study by Campbell et al. found that even when income differences were controlled, unemployed people were the unhappiest. This suggests that unemployment has a devastating impact on subjective well-being (SWB) for many persons that goes beyond the obvious financial difficulties involved. Rather than being static, wellbeing emerges from how people interact with the world around them at different points in their lives. It is not necessarily the same as being happy, since anxiety, depression and anger are sometimes to be expected in life. According to Diener (2009), subjective well-being has three hallmarks. First, it is subjective: it resides within the experience of the individual. Second, subjective well-being includes positive measures. It is not just the absence of negative factors, as is true of most measures of mental health. Third, the subjective well-being measures typically include a global assessment of all aspects of a person’s life. Although affect or satisfaction within a certain domain may be assessed, the emphasis is usually placed on an integrated judgment of the person’s life. There is evidence that employee well-being affects organizational level measures of performance (Wood, Van Veldhoven, Croon, & De Menezes, 2012a). More simplistically and functionally, organizational well-being can be described as wellness of the body, mind, and spirit or an integration of the cultural, social, and the physical environment. There does not appear to be a strong distinction between well-being and wellness: both employ holistic frameworks that call for integration of various aspects of the body mind and spirit and can be conceptually applied to individuals and potentially to organizations. Swarbrick presents a wellness model and describes it as a conscious, deliberate process that requires a 34 person to become aware of and make choices for a more satisfying lifestyle (Johnson, 1986; Swarbrick, 1997). Wellness is the process of creating and adapting patterns of behavior that lead to improved health in the wellness dimensions and heightened life satisfaction (Johnson, 1986). Wellness and well-being is holistic and multi-dimensional, and includes physical, emotional, intellectual, social, environmental, and spiritual dimensions. Figure 1: Eight Dimensions of Wellness The Eight Dimensions of Wellness model has been enthusiastically adopted by the Substance Abuse & Mental Health Administration in the service of a potential recovery model that contrasts starkly with the standard medical model (SAMSA, 2016). This wellness approach, identifies goals, preferences, interests, and strengths of the individual. Wellness centers on health, whereas the medical model focuses on illness or disease management. The wellness approach offers a holistic framework in which to view the person as a whole being (physical, 35 spiritual, emotional, environment, social, occupational-leisure, intellectual, and environmental dimensions). This holistic model has potential application to a holistic understanding of organizational health, wellness and rehabilitation. In healthy organizations, culture, climate, and practices create an environment conducive to employee health and safety as well as organizational effectiveness (Lowe, 2010). Positive organizational health psychology calls for an organizational approach centered on enhancing and promoting resources and talents (Di Fabio, 2017). Positive organizational health calls for early interventions aimed at increasing well-being of workers at different levels (individual, group, organization, and inter-organization) to promote healthy organizations. Recently, the concept of health-promoting leadership (Jiménez et al., 2016) was developed as a leadership style for creating conditions that enhance employee health in a healthy work environment. New awareness is needed of the value of developing early interventions and new approaches from a primary preventive perspective toward fostering healthy work environments. Enhancing the resources, strengths, and talents of workers and groups is the best way to achieve well-being and healthy workplaces. By focusing on positive work experiences in today’s changeable and competitive marketplace, the worker, team, and organization is strengthened. Organizational practices aimed at achieving positive work experiences and positive psychological narratives at work are a key part of promoting healthy organizations (Di Fabio, 2017). Structure Organizational structure contributes to the amount and type of interaction among and between staff within an organization. An organizational structure is the method that an 36 organization employs to delineate lines of communication, policies, authority and responsibilities. It determines the extent and nature of how leadership is disseminated throughout the organization as well as the method by which information flows. Organizations commonly adopt either a flat or hierarchical structure. (Harris, 2002). An article by Meehan (2019) identifies the advantages of a flat organizational structure as follows: elevates the employees' level of responsibility in the organization; removes excess layers of management and improves the coordination and speed of communication between employees; Fewer levels of management encourage an easier decision-making process among employees. A review of the literature by Lam, (2004) supports a finding of non-hierarchical structure contributing to a more open, innovative environment. Organizational Performance Securing and maintaining employment are perhaps the most important and tangible outcomes of successful vocational rehabilitation programs. They also serve as a means of examining the effectiveness of these programs (Johnston & Granger, 1994; Thomas & Menz, 1997). Employment outcomes have often been used as a benchmark of program success for community-based rehabilitation programs (CRPs). However, a 2001 study could not find any research that confirmed that a consensus exists of what constitutes an employment outcome. Because a standard employment outcome reporting mechanism is not presently used for persons exiting CRPs, comparisons of programs, program models, or treatment effects cannot be reliably and validly accomplished. The study also revealed that the top concerns among the groups studied were not wage and benefits expectations as may have been expected. The top concerns were quality of employment, quality of services, and opportunity for informed choice (Thomas, Menz, Rosenthal, 2001). According to Johansen and Le Roux, a standard for nonprofit 37 organizational effectiveness is extremely challenging because effectiveness is multidimensional and difficult to define (2012). A 253-page report entitled: Effective VR Service Delivery Practices describes a 4-state sample focused on the state -federal VR program identifying effective practices that lead to successful employment outcomes for persons with disabilities( Leahy, et al, 2014). The study identified 4 high performing states: Texas, Utah, Mississippi and Maryland and interviewed staff involved with the agency’s innovations and best practices across three organizational levels within each state agency: senior managers, mid-level managers and selected counselors. Multiple domains appeared at each organizational level and among the common agency domains were Culture and a second domain: Leadership. The following will attempt to (greatly) synthesize and illustrate the nature of the culture domain and leadership domain in the report. Staff in the Texas Department of Rehabilitation Services (TDRS) agency believed the culture shift was due to the current Assistant Commissioner who has been place since March of 2008 and who provided hands on leadership for the program. Since 2008, the agency transformed into a “flattened” horizontal organizational structure with open communication at all levels of organization. Leadership encouraged risk taking which improved the morale of agency staff who are no longer anxious about taking risks with developing innovative practices in fear of retribution if the practice fails. The staff is motivated to undertake risks to develop and implement innovative practices in an effort to enhance service delivery to both customers and employers. Culture is considered an environment where all staff are “very encouraged to be creative, be visionary to deliver VR message, goals and mission.” (p.60). This culture shift to a horizontal organizational structure that emphasizes open communication, less reliance on bureaucratic procedures and promoting flexibility in service delivery has led to shorter response 38 time to service delivery and less customer complaints. The elements of culture as characterized might be identified as leadership, comfort with risk taking, open communication, mission focused and autonomy. Mission focused is an important element defined for purposes of this discussion as meeting the needs of clients through service delivery that results in employment and customer satisfaction. In many instances, the type of leadership required to change culture is transformational because culture change needs enormous energy and commitment to achieve outcomes. Bass (1999) stated that "for an organizational culture to become more transformational, top management must articulate the changes that are required.... The behaviors of top-level leaders become symbols of the organization's new culture" (p. 16). This is a strategy adopted by the Utah State Office of Rehabilitation (USOR): A transformational agenda, described as the development and promotion of an agency culture that would allow best practices to be adopted and innovation to occur. There was general support for a “culture shift” that seems to center around the effort to increase professionalism of agency staff. Professionalization has been supported by external factors (i.e., licensure of rehabilitation counselors in Utah, certification of job coaches) and internal processes developed by the agency (i.e., streamline provision of VR benefits, giving counselors/specialists greater ownership of services and supporting independent decision-making (p.82). Key to the transformational leadership process engaged in by Utah is counselor autonomy and decision making. While the term “Transformational Agenda” may not have been intended to reflect the literature associated with this term, the process and subsequent actions of this reform of existing practices appear to be consistent with published accounts on transformational leadership in that, “Transformational leaders help team members view their work from more elevated perspectives 39 and develop innovative ways to deal with work-related problems” (Corrigan, Lickey, Campion, & Rashid, 2000, p. 56 as cited in RRTC-EBP-VR). The unique aspect of USOR’s transformational agenda is the drive to develop the transformation leadership capacity at all levels of the agency rather than simply those currently in leadership positions. USOR managers saw culture change as extremely important to achieving the current and future success of the agency. By focusing on team efforts and a shared vision, they viewed all staff as engaged in promoting a higher level of professionalism, and a return to the values that brought many to consider careers in rehabilitation counseling. Transformational leadership can impact staff to exceed existing performance expectations. Culture is inextricably linked to transformational leadership in this setting. The elements of culture as characterized include autonomy, leadership, communication, teamwork, mission focused and non- hierarchical or individual leadership/autonomy at all levels. Despite operating within a predominately rural state with 21.6% of the state’s population living below the federal poverty level (the national average is 14.3%) and one of the highest unemployment rates in the country at 9.1%, the Mississippi Department of Rehabilitation Services (MDRS) consistently excels in achieving employment outcomes, achieving a 73.69 % closure rate compared with the national average of 52.9% (RSA). The report continues with recognition of the agency’s consistent strong leadership for fifteen years and the encouragement of innovative practices in VR service design and delivery to enhance employment outcomes for customers. The agency is very flexible and staff appreciate administrators’ openness to new ideas, “they encourage us to think outside the box” also noting “if you don’t like change, this is not the agency for you.” Counselors stated that they are encouraged to continuously think about how to enhance services to “improve employment outcomes to our clients.” There is a stated 40 openness to risk taking whether or not they are successful. Effective staff relations and teamwork is fostered through frequent training and professional development opportunities, and common goals or desired outcomes (specifically, employment outcomes) are communicated across the organization. Regular meetings keep teams connected and mini conferences are important in cultivating regional and statewide connections. Off-site team building events are encouraged and provide staff with an opportunity to reduce stress and celebrate success together through awards, recognition, socialization, and other motivational strategies. The metaphor of “family” was used to describe the closeness and camaraderie experienced by MDRS staff members. In Mississippi, elements of culture that are strong include collegiality, teamwork, leadership, autonomy, communication and mission focused. Author’s anecdotal note: At a National Rehabilitation Conference hosted by the Mississippi Rehabilitation Association and attended by a large number of their agency staff, there did seem to be an exceptionally friendly, supportive demeanor and “culture of caring” in evidence. In the Maryland Division of Rehabilitative Services (MDORS) agency, the culture can be described as focused on creating value for the individual through the development and implementation of innovative services that meet the customers’ vocational rehabilitation need. Here, culture revolves around stressing organizational values and a commitment to continuous improvement. Culture included a spirit of collaboration both within the agency and outside the agency when working with partners. Collaboration means being solution focused and, “looking for better ways to get the job done” (p. 153). As was demonstrated in Utah, management fosters an agency culture of valuing the mission, valuing the individual and collaboration. The environment encourages creativity and promotes the development of innovative VR service delivery practices throughout the agency. MDORS offers leadership training at different levels to 41 include new staff, emerging, experienced staff and executive staff. There is support for being creative and engaging in innovative efforts to improve services to consumers. DORS places heavy emphasis on collaboration with a consumer centered approach to providing services. Critical thinking is also an important value in developing appropriate and effective services. The elements of culture that are most strongly identified here are: leadership, risk-taking, continuous improvement, collaboration and professionalism. According to Sherman et al. (2014), there is mounting pressure for the state-federal VR program to demonstrate accountability for employment outcomes. Current challenges are 1) budget deficits, 2) changes in implementation of services due to legislative mandate, 3) shifts among common measures of performance and 4) the need to provide objective evidence to justify rehabilitation services (Chan, Rosenthal, & Pruett, 2008). These challenges require leadership within the VR Program to harness a cohesive strategy and focus on performance improvement (Sherman, et al, 2014). The state-federal vocational rehabilitation (VR) program needs to implement the changes necessary to become high performing, achieve better results and demonstrate relevance in today’s workplace and economy. These changes include strong leadership that practices a transformational agenda providing a vision and innovation. It includes the development of a culture that supports continuous improvement and support for risk taking in pursuit of improved employment outcomes for people with disabilities. CROs are currently key partners in providing services to persons with disabilities in collaboration with the state -federal VR program and are subject to accountability as well. Leadership within CROs must embrace the need to achieve high performance through the implementation of cohesive strategies that apply evidence-based practices within the organizational culture and within the operational environment to include service provision. 42 Transformational Leadership A substantial body of research has accumulated on transformational–transactional leadership theory over the past twenty years. Transformational leaders offer a purpose that transcends short-term goals and focuses on higher order intrinsic needs. Transactional leaders, in contrast, focus on the proper exchange of resources. A 2004 study by Judge and Piccollo tested the validity of the two types of leadership and conducted a thorough and comprehensive meta- analysis of transformational or charismatic and transactional leadership. Overall results revealed that transformational leadership has relatively high levels of validity ( .44) and transformational leadership and charisma display similar overall validities. A major dimension of transactional leadership is contingent reward, the degree to which the leader sets up constructive transactions or exchanges with followers. The leader clarifies expectations and establishes the rewards for meeting these expectations. Transformational leadership and contingent reward also displayed similar validities. Transformational and transactional leadership are so highly related that it makes it difficult to separate their unique effects. Yukl and Van Fleet (1992) noted “Bass views transformational and transactional leadership as distinct but not mutually exclusive processes” (p. 176). Transformational leadership has been widely researched and associated with followers' performance, attitudes, health and well-being ( Lowe et al., 1996, Skakon et al., 2010). Empirical evidence has suggested that transformational leadership is linked to outcomes that most organizations, individuals, and leaders presumably would value. Followers of transformational leaders should be more satisfied with their leaders (Bass, 1999) and, by extension, their jobs as a whole. Judge and Piccolo found strong correlations between transformational leadership and follower satisfaction with leader, follower job satisfaction and follower motivation. 43 There are 4 components to transformational leadership, sometimes referred to as the 4 I's: • Idealized Influence (II) – the leader serves as an ideal role model for followers; the leader "walks the talk," and is admired for this. A transformational leader embodies the qualities that he/she wants in his/her team. In this case, the followers see the leader as a model to emulate. For the followers, it is easy to believe and trust in a transformational leader. • Inspirational Motivation (IM) – Transformational leaders have the ability to inspire and motivate followers through having a vision and presenting that vision. Combined, these first two I's are what constitute the transformational leader's charisma. A transformational leader manages to inspire the followers easily with clarity. The transformational leader convinces the followers with simple and easy-to-understand words as well as with their own image. • Individualized Consideration (IC) – Transformational leaders demonstrate genuine concern for the needs and feelings of followers and help them self-actualize. This personal attention to each follower assists in developing trust among the organization's members and their authority figure(s). Teams are able to rely on and work together so decisions can be made more quickly, the transformational leader increases their buy-in. • Intellectual Stimulation (IS) – the leader challenges followers to be innovative and creative, they encourage their followers to challenge the status quo. A common misunderstanding is that transformational leaders are "soft," but the truth is that they constantly challenge followers to higher levels of performance (Bass, 1985). An important part of transformational leadership is to present followers with a vision and help them see the ‘bigger picture’ (Nielsen, Randall, et al., 2008). Studies have found that transformational leadership may be related to followers' actual experience of meaningful work, both cross-sectionally (Arnold et al., 2007, Nielsen, Yarker, et al., 2008) and over time (Nielsen, 44 Randall, et al., 2008). Further, Sparks and Schenk (2001) found that transformational leaders inspire a ‘higher purpose’ in followers' work. By helping employees to find the meaning and significance of their work, making them feel supported by the organization and strengthening their sense of worth and competence, transformational leaders boost job engagement, a key aspect of the human dimension of organizational sustainability (Vila-Vázquez ,2018). Support for innovation is defined as “practical support of attempts to introduce new and improved ways of doing things in the work environment” (West, 1990, p. 315) and thus refers to cooperation among team members and their mutual assistance in the development and application of novel ideas. By providing intellectual stimulation, transformational leaders may also encourage followers to think “outside the box” (Jung, Chow, & Wu, 2003) and to adopt an explorative thinking style. They point out different and unusual perspectives to look at old problems and to stimulate followers to critically appraise existing assumptions and working methods (Bass, 1985), which in turn should enhance team innovation. In summary, leaders play an important role in the creation, development and maintenance of an organization’s culture. In highly innovative organizational cultures, one is more likely to see transformational leaders with clearly articulated vision, alignment of staff around the vision, and empowerment of staff to take responsibility for moving the organization toward the vision. (Anderson, 2013) Organizational Culture A review of relevant literature suggests that organizational culture is an area ripe for exploration even though it is 37 years since Peters and Waterman’s best-selling book In Search of Excellence (1984) made the argument that company success could be attributed to an 45 organizational culture that was decisive, customer oriented, empowering, and people oriented. “Without exception, the dominance and coherence of culture proved to be an essential quality of the excellent companies” (p. 75). Organizational culture is considered to be one of the most significant factors in bringing about organizational change and modernizing public administration and service delivery (Jung, 2009). Kotter (2008) reported that firms with performance enhancing cultures grew their net income 75% between 1977 and 1988, as compared to a meager 1% for firms without performance enhancing cultures over the same period of time. The Cornell EP-RRTC team conducted an in-depth literature review on employer practices that affect employment outcomes for people with disabilities and found that more than half of the 243 articles included a focus on organizational culture, climate, and attitudes (55%), workplace accommodation (63%), and/ or recruitment and hiring (53%) (Bruyere, 2014). In their article entitled “A Strong Market Culture Drives Organizational Performance and Success”, Gallagher and Brown (2007) stated that a company’s culture influences everything a company does. It is the core of what the company is really like, how it operates, what it focuses on, and how it treats customers, employees, and shareholders. Although there is as yet no single, widely agreed upon conception or definition of culture, there is some consensus that organizational culture is holistic, historically determined and socially constructed and it involves beliefs and behavior, exists at a variety of levels, and manifests itself in a wide range of features of organizational life. Gallagher and Brown (2007) stated that between 1990 and 2007, more than 60 research studies covering 7,619 companies and small business units in 26 countries have found that market culture and business performance are strongly related. This positive correlation is 46 identified by more than 35 performance measures, including return on investment, revenue growth, customer retention, market share, new product sales, and employee performance. It is widely accepted that organizational culture has an influence on an organization’s performance. McLean identifies several characteristics of organizational culture and dimensions of organizational climate, as they relate to supports or impediments to creativity and innovation that appear consistently in the literature. On the supports side, these include organizational encouragement, supervisory encouragement, work group encouragement, freedom/autonomy, and resources. On the impediments side, control is the dimension that has been identified as decreasing organizational creativity and innovation (2018). Kanter also addressed supports to innovation within organizations (1988). On the supports side, innovation is most likely to occur in organizations that (a) have integrative structures, (b) emphasize diversity, (c) have multiple structural linkages inside and outside the organization, (d) have intersecting territories, (e) have collective pride and faith in people’s talents and (f) emphasize collaboration and teamwork (p. 383). Another contribution to culture is organizational structure. Organizations in stable, unchanging environments tend to develop structures that are mechanistic and formal. Those that must deal with more uncertain, innovative environments develop more organic, adaptive structures” (Dessler, 1986, p. 94). A horizontal or flat structure is one in which there is a more diffuse chain of command and a network of communication among all stakeholders. Communication is the key to a lateral or horizontal structure and there are frequent formal and informal meetings among members. (Marlowe & O’Connor,1997). “Effective communication in change-infused cultures requires horizontal communication across departments and inter- organizational boundaries at the peer level” (Marlow & O'Connor, 1997, p. 68). 47 Culture and Climate Climate and culture are similar terms often used interchangeably. There is value in understanding how both climate and culture influence work. The distinction can be visualized through the analogy of a river. Everything you see on the surface – the flow of the water, the shape of the riverbed is climate. Climate itself is a manifestation of the underlying, ever- changing, yet powerful current of culture (Ward, 2015). Edgar Schein said “90% of our behavior in organizations is driven by cultural rules.” He writes in The Handbook of Organizational Culture and Climate: “A climate can be locally created by what leaders do, what circumstances apply, and what environments afford. A culture can evolve only out of mutual experience and shared learning” (2011). According to Schein, the biggest danger in trying to understand culture is to oversimplify it in our minds. It is tempting, and at some level valid, to say that culture is just “the way we do things around here,” “the rites and rituals of our company,” “the company climate,” “the reward system,” “our basic values,” and so on. These are all manifestations of the culture, but none is the culture at the level where culture matters. A better way to think about culture is to realize that it exists at several “levels,” and that we must understand and manage the deeper levels (1997). Organizational culture tends to be unique to a particular organization, composed of an objective and subjective dimension, and concerned with tradition and the nature of shared beliefs and expectations about organizational life. It is a powerful determinant of individual and group behavior. Organizational culture affects practically all aspects of organizational life from the way in which people interact with each other, perform their work and dress, to the types of decisions made, its organizational policies and procedures, and its strategy considerations (Buono & Nichols, 1985, p. 482). 48 Glisson describes organizational culture as best represented by the behavioral norms and expectations that characterize a work environment. These norms and expectations direct the way employees in a particular work environment approach their work, specify priorities, and shape the way work is done. Proficient organizational cultures, for example, expect service providers to be up to date on state-of-the-art practices and to place positive client outcomes as a top priority (2015). ‘Climate for excellence’ consists of shared group norms about “excellence of quality of task performance” (West, 1990, p. 313) and may be evidenced by each team member’s commitment to high quality standards, critical appraisals, monitoring, and clear performance criteria within the team. For purposes of this study, organizational culture is the shared beliefs and assumptions about the organization’s expectations and values. These “unwritten rules” and perceived expectations drive our behavior in organizations. Organizational climate is the recurring patterns of behavior, attitudes and feelings that characterize life in the organization. Sherman, et al, (2014), introduces several common domains that influence the culture of vocational rehabilitation organizations: leadership, support for innovative and promising practices, partnerships, staff training and development, working alliance and client-centered services. In addition, individual unique domains include return on investment, service integration and business model, increasing visibility and communication /constituent relations, rehabilitation counselor and unit autonomy specifying flexibility and resources. There are aspects of culture that affect the workplace outcomes. Inclusive workplaces are those places where not only employees with disabilities benefit from attention for specific support but all others involved in the same workplace as well (Irvine, 2006). Management style, flexibility, sense of belonging, 49 supervision and teambuilding in different workplaces were mentioned as relevant factors that support an inclusive workplace (Ellenkamp, 2016). Summary The scientific study of rehabilitation is concerned with determining those variables that account for differences in recovery or adaptation and how the interactions among these variables affect process and outcomes. These variables may apply to all participants in the rehabilitation process: the individual with the disability, the caregiver or family and the rehabilitation practitioner and service provider. The role of the rehabilitation practitioner, whether located at VR, a CRO or elsewhere is to determine and apply this knowledge in practical rehabilitation settings to maximize the independence and quality of life of the individual with the injury or illness. (Siegert, 2005). This is a long-standing need but what has changed is the urgency with which this knowledge must be obtained and applied if rehabilitation organizations and their constituencies are to thrive in the 21st century. This chapter (a) provided a history of the legislative development of rehabilitation counseling and the concurrent growth of community rehabilitation organizations; (b) reviewed the concept of evidence based practice and its relationship to vocational rehabilitation along with current and evolving efforts at application (c) described organizational culture and the influences contributing to an effective, capacity building and high performing organization (d) considered the impact of transformational leadership and (e) discussed the role of well-being and positivity in creating and sustaining environments that result in desirable outcomes. The current study seeks to (a) bridge gaps in current literature on best, promising and emerging organizational and service delivery practices within CROs, (b) investigate innovation 50 leading to organizational and service delivery CRO practices that improve and lead to enhanced and competitive, integrated employment outcomes for workers with disabilities and (c) explore the concept of organizational well-being within CROs. From the beginning, CROs developed as necessary service providers to the state federal VR system and now similarly, to the state federal VR program, CROs must engage in major change. If they are to remain viable within the context of the 21st century and its ever-expanding implications for normalizing disability in the workplace, they must meet this challenge. This study is significant because it documents the foundation and the potential future for CROs that continue to serve an underrepresented population with continuing barriers to employment. CROs must identify and use all the tools available to meet the challenge of the ever-growing demand for competitive integrated employment for workers with disabilities. Only then will they have the potential to become national examples for bridging the gaps within the larger employment community. Based on the literature, these tools include culture and leadership, the specifically replicable elements of culture and leadership that will address sustainable, positive change. The influence of organizational culture and leadership on achievement and its relationship to the attainment of preferred vocational outcomes for persons with disabilities is a critically significant topic of study within rehabilitation. There is still much to be learned about the role of culture, innovation, the impact of leadership and the relationship to organizational well-being in providing services that are exceptional. Given the existing literature, an acknowledgement and exploration of the role of culture and the impact of leadership is foundational to creating and maintaining high performance and identification of emerging, promising and best practices. CROs must be engaged in offering vocational rehabilitation service delivery practices that can ultimately move 51 a facility from a dated “sheltered workshop image” to a vibrant role model of inclusion and progress in the larger community. Productivity and innovation improve when leaders emphasize culture and values in an organization and clearly articulate the change that is required (Bass & Avolio, 1993; Niehoff, Enz, & Grover, 1990). A high performing CRO independent of bureaucratic entrenchment and government restrictions that limit innovation, may be better positioned to not only adopt but create, develop and implement the innovative, cutting edge options for persons with disabilities. There seems to be a good fit between an exploration of organizational culture and what its relationship to high performing VR agencies is or should be. While research has investigated best, promising and emerging practices within the state federal VR system, this is needed at the CRO level as well. Understanding the role that organizational development, well-being and culture performs in considering readiness, capability, and commitment to change within these programs is critical for success. While the contributions of culture within high performing organizations have been studied within corporate America, this subject has not been researched in the nonprofit arena and not within community rehabilitation programs. Within community-based rehabilitation organizations charged with paradigm shifting change, an emphasis on evidence-based practices, policies and procedures will support a sustained effort to meet the vocational needs of persons with disabilities. CROs are continuing to provide services to persons with disabilities in collaboration with the state -federal VR program and continue to be accountable to their constituency as well as to the purchasers of services. By providing evidence based, promising and emerging service delivery practices that meet the needs of individuals with disabilities, CROs can and will survive and thrive. 52 CHAPTER THREE METHODOLOGY This chapter begins by discussing the value of qualitative research and describing the concept of trustworthiness and its application to the validity of the research. It reminds the reader of the research questions first identified in Chapter one followed by a rigorous description of the procedures used in the study design. This includes the unit of study and case selection criteria, the data gathering methods and instrumentation, an in-depth discussion of data analysis procedures, application of the theoretical framework and concluding remarks. Qualitative research remains relevant in rehabilitation research today as it is a means of (a) studying behavior within the context of a particular rehabilitation organization or setting, (b) understanding the subjective meanings and perspectives in the rehabilitation process, (c) looking at new trends and previously unexplored areas of rehabilitation service delivery, and (d) examining complex interactive social processes (Hagner and Helm,1994, p. 293). Qualitative research in rehabilitation provides a unique lens that reflects the perspectives and experiences of the human beings that deliver and receive services through which rehabilitation, life experiences, and social policies can be viewed. It is a way to address complex, dynamic phenomena that are not easily quantified. Szymanski identified qualitative research as a valuable contributor to rehabilitation research in her editorial on research design (1993). Trustworthiness The individual researcher is required to assure rigor and trustworthiness. The criteria of credibility, transferability, dependability, and confirmability are used to evaluate trustworthiness and address challenges to methodological rigor in qualitative research (Hoyt & Bhati, 2007). Qualitative researchers can demonstrate how data analysis has been conducted through 53 recording, systematizing, and disclosing the methods of analysis with enough detail to enable the reader to determine whether the process is credible. Credibility or internal validity is established through extended participation by the researcher, prolonged engagement and investment of adequate time with the organization. Triangulation of sources obtained by interviewing people at different levels of the organization and using diverse data sources such as observation, the annual report, independent assessment documents and other written materials contributes to credibility. Transferability, also conceptualized as external validity, or generalizability, requires ‘thick description’ as essential to transfer the original findings to another context (Guba & Lincoln, 1989, p.316). Dependability, also conceptualized by Guba & Lincoln (1989) as a replacement for reliability is achieved through the techniques of establishing credibility, in this study, the investment of adequate time and use of triangulation. Confirmability or objectivity uses the tools of credibility to establish trustworthiness (Morse, 2015). In addition, trustworthiness is described as the one thing that differentiates qualitative research from anecdotes or mere journalism (Williams & Morrow, 2009). Achieving trustworthiness requires ascertaining the integrity of the data, considering subjectivity and reflexivity and clearly communicating findings and applicability to research and practice. Integrity of the data requires the transparent description of procedures to allow replication of same. It also presents information about the quality and quantity of the data, rich data based on diverse perspectives of participants in the sample and saturation based on reaching a point where no new information is obtained. Interview protocols, recruitment strategies, the interview and transcription process, and other details of importance add to trustworthiness (Williams & Hill, 2012). 54 Research is inherently subjective, so a balance of subjectivity and reflexivity is necessary. One's scientific worldview, research questions, and analytic design is influenced by one’s biases, so it is important to intentionally proceed, to recognize and explore these biases through reflexivity and awareness of the self (Williams & Morrow, 2009). The third requirement for trustworthiness is clearly communicating the findings and the application of findings. Moreover, the findings should be supported by participant quotes. Qualitative research views the study location and context as contributing to the meaning made by study participants. Interpretation of the findings is key to application of the findings. According to Williams and Morrow (2009), the application should improve the outcome for individuals or groups, reveal limitations in current approaches, suggest new alternatives to consider, encourage further dialogue on the topic, suggest a new course of action based on the data in terms of practice or research or contribute to social justice and social change. Providing study participants with an opportunity to review and comment on the results is also a recommended strategy for enhancing trustworthiness (Hill et al., 1997). The primary research questions are: 1. What are the best models of effective practice, policy and procedures within a successful community rehabilitation organization that assist individuals with disabilities achieve employment outcomes? 2. Do the models of effective practice, policy and procedures result in the creation of an environment that promotes innovation and high performance? Design Of primary importance is using the method which most appropriately fits the research question. (Creswell, 2007; Hoyt & Bhati, 2007). The case study approach provides a 55 comprehensive and sophisticated research strategy that Yin refers to as an "explanatory case study" (1994). “Case studies are the preferred strategy when ‘how’ or ‘why’ questions are being posed, when the investigator has little control over events, and when the focus is on a contemporary phenomenon within some real-life context” (Yin, 2003, p. 1). In this study, the question, “How does the organization achieve the results it achieves” must be answered through a rich narrative that requires a case study. The current case study is consistent with the National Institute on Disability and Rehabilitation Research (NIDRR) stages-of-research framework, the objective being to inform new lines of research related to practices, programs, or policies that help support decisions or priorities (NIDRR, 2013). At the same time, it is consistent with the concept of the instrumental case study as it intends to gain insights into the phenomenon of high performance with a CRO (Stake, 2001) . An embedded case study is a single case study design in which subunits within the larger case are targeted as part of the study (Yin, 2003; Merriam, 1998). An example of an embedded single case study is a rehabilitation facility or CRO being studied as the large unit or single case and analysis occurring in the form of an evaluation of the programs, services, or human resources within the facility. The analysis from these levels would then be brought back to the facility level for analysis. The interaction between the whole unit (facility) and the embedded components (specific programs, services, and human resources) is a critical piece of the equation. A case study then is an empirical inquiry that investigates a contemporary phenomenon in depth and within its real-life context especially when the boundaries between the context and the phenomena are not evident. (Yin and Davis, 2007). The embedded case study approach (used here) is one that involves more than one unit of analysis allowing for a more detailed level of inquiry. The embedded case study design is 56 an empirical form of inquiry appropriate for descriptive, explanatory and exploratory studies, where the goal is to describe the features, context, and process of a phenomenon, specifically key components of human and environmental systems (Scholz, 2011, p. 25). With embedded case studies, global statements and conclusions are derived by an intuitively qualitative process based on both experiential understanding and a synthesis process supported by the methods. This study uses an embedded case study methodology based on traditional case study conventions. Single case studies often disclose new phenomena that have remained unrecognized before, and only when the phenomena have been uncovered can they become targets of confirmatory studies. Thus, single case studies contribute to the richness of research (Bao, Poppel & Zaytseva, 2017). Extensive resources and time are often needed to conduct the research but is justified given the expected outcome. The primary data gathering method of this research is individual and group interviews conducted via Zoom. The case study design integrated document review and brief interviews with relevant stakeholders in the organization. The case study data consists of transcripts of interviews with staff, board members, community members and includes artifacts of the organization such as the annual report, CARF status, program brochures and related marketing materials such as videos and the annually published calendar showcasing team member artistry. Document analysis is a form of qualitative research in which documents are interpreted by the researcher to give voice and meaning around a topic (Bowen, 2009). It utilizes content analysis as a means of identifying meaningful and relevant information and provides supplementary research data as a complement to other data collection (Bowen, 2009). The case study design intended to integrate other data, specifically observation within the primary workplace, however, due to COVID restrictions, onsite observation was not possible as a data gathering activity. 57 Table 2: Research Design Activities RESEARCH ACTIVITIES Document Review Interviews Observation (did not occur due to COVID restrictions) SAMPLE METHOD DATA COLLECTION Relevant documents: CARF Report, Annual report, Program Brochures Staff of the CRO at three levels: executive, mid and direct service Physical environment and location Document Review Document Checklist Semi structured, in person/virtual, audio taped Interview Protocol Direct field observation Notes DATA ANALYSIS TECHNIQUE Inductive content analysis Inductive qualitative analysis Inductive qualitative analysis Unit of Analysis and Sample A case is defined as a phenomenon occurring in a bounded, or specified, context and is, in effect, the unit of analysis (Stake, 1995). The unit of analysis is the community rehabilitation organization. The sample consists of the identified staff employed by the selected organization who will be interviewed. The sample was deliberately configured to include representatives of each level of the organization: executive level, mid-level program managers and direct service staff. Document review and interviews with associated Board members and community partners were used to validate the findings and to capture different dimensions of the same phenomenon through triangulation of data. Triangulating multiple sources of data is useful because it allows a comprehensive investigation of the phenomena being studied. (Creswell & Piano Clark, 2007). 58 Rigorous embedded case study designs triangulate data using different methodologies depending upon the source and "window" on the phenomenon (Scholz & Tietje, 2002; Yin, 1994). Case Selection A community rehabilitation organization (CRO) is a nonprofit charitable organization or institution incorporated in Michigan that is operated for the purpose of carrying out a recognized program of employment and training services for people with disabilities (Michigan.gov). The term “nonprofit” is at best nebulous and possibly misleading in that it implies organizations that provide a public service and have a mission that does not include making money. For the purposes of this study, we will use five defining characteristics of nonprofit organizations as described by Wolf (1999): (1) They must have a public service mission (2) They must be organized as a not-for-profit or charitable corporation (3) Their governance structures must preclude self-interest and private financial gain (4) They must be exempt from paying federal tax (5) They must possess the special legal status that stipulates gifts made to them are tax deductible, (p. 21). Wolf further describes the advantages of being a nonprofit organization (NPO) as “private sector organizations with a public purpose” and are thus afforded great flexibility in their operations (Wolf, 1999, p. 40). There is no central directory of community rehabilitation organizations although the State of Michigan, Workers’ Compensation Agency maintains an updated registry as of 1/02/2020 of approved vocational rehabilitation facilities. These 115 facilities may be used to serve injured workers. This listing also specifies whether a facility has CARF accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF) in one or more areas under the Employment and Community Services unit, such as Community Employment/Job Development and Comprehensive Vocational Evaluation Services (LARA website). In contrast, the 59 membership of Incompass, the states’ membership based CRO professional association in Michigan, is currently at 53 in number (Incompass website, 2020). A DOL federal website, identifying organizations holding a certificate allowing payment of subminimum wages lists 25 facilities in Michigan although in 2014, MI Protection and Advocacy (MPAS), claimed the existence of over 70 non-profit CROs operating sheltered workshops located in 39 Michigan counties. For practicality, the conducted case study is located in Michigan and is identified as CARF accredited on the Workers’ Compensation approved directory and also as a member of Incompass. The organization, Peckham, was selected for study on the basis of its exemplary performance and achievement. This CRO has been consistently viewed as high performing or performance enhancing by the larger community, service purchasers and peer organizations. It meets standards identified here: positive community reputation, internal growth over time, accreditation from the associated accrediting body i.e., CARF, Commission on Accreditation of Rehabilitation Facilities, staff who are in evidence at professional associations and workshops, attainment of workplace awards, customer satisfaction metrics, verifiable community impact and successful service delivery to persons with disabilities. One notable factor contributing to successful outcomes for persons with disabilities is attainment by the CRO of federal contract work awarded under the Ability One or The Javits– Wagner–O' Day Act 41 U.S.C. §46 et seq. This is a law passed in 1971 requiring that all federal agencies purchase specified supplies and services from nonprofit organizations employing a stipulated percentage of persons with disabilities. Sales and services to the federal government under this program are currently valued at more than $3.6 billion (abilityone website). The significance of this selection factor is the rigorous application process engaged in over a period 60 of years by the CRO required to demonstrate capacity to successfully meet the demands of the contract. The CRO attaining a substantial contract is necessarily large enough in the number of workers to handle the contract and has been in existence long enough to be stable. Once awarded to the CRO, contracts typically provide competitive and above average wages to workers, require high quality control and if performed successfully, provide a long-term level of employment and revenue stability to workers and to the organization. The organization selected for this study has substantial contracts attesting to ability and performance. In addition, the current CEO of Incompass, the associated professional organization that represents these entities was contacted and asked to endorse the selection of the organization and confirm membership. The CEO is familiar with the operations of the organization and can be relied upon to confirm the accuracy of several organizational factors contributing to the selection such as size, positive reputation and member of the professional association. This contributory selection factor also submits that a high performing organization values professional membership and will be an active member of a major professional association. The organization itself provided documentation of the attainment of the highest level of Commission on the Accreditation of Rehabilitation Facilities (CARF) status. The managers of the local vocational rehabilitation offices, typically large purchasers of service, were queried to determine overall customer satisfaction with purchased services. Peckham, the organization selected for the case study has a positive reputation in the community, has been lauded by its purchasers of service and other CROs, is responsive and is high performing having placed 785 persons into employment outside of Peckham in 2019. Client Satisfaction Surveys rate the organization 4.45 on a 1 to 5 scale ( Peckham Annual Report 2018-2019). It has been accredited at the highest standard by CARF and has maintained accreditation over many years. The site was selected then, 61 based on the following factors: awarding and maintenance of federal contract work, reputation in the community, CARF status, professional visibility at conferences, the annual report addressing financial stability, size based on the number of employees and locations, years in existence or longevity, and the satisfactory purchase of services by VR and other vendors. Additional description of these factors is found in Chapter Four as complementary to the findings and provides a more in-depth narrative of the organization to accompany subsequent remarks on potential for generalizability of the findings. Procedures The CEO of the organization was contacted by email and invited to participate in the study given the organization’s interest and ability to participate, provide requested documentation, make staff available for interviews and engage in the research process. Initially the Study Description Document ( Appendix A) was shared and subsequently, the Study Description, Minimal Risk Consent Document (Appendix B) and Interview Protocol Questions (Appendix C) were shared. The CEO agreed to the study after consultation with the management team and identified a liaison to coordinate with the researcher. Data Collection Data collection consisted of document collection and engaging in recorded and transcribed interviews with staff of the organization. Key documents requested included the agency Annual Report, an organizational chart, a statement of any awards or honors received within the most recent five years, and the CARF survey findings. These documents were used to validate the selection of the organization as meeting performance standards and as an adjunct to the collected interview data. Descriptive literature as available identifying specific programs or practices was requested following the interviews. 62 Table 3: Document Review Chart Document Title CARF Survey Description Audience Major content addressed Accreditation review and report of findings The organization and interested others Basis for accreditation Identification of specific programs and services Strengths and weaknesses Exemplary recognition for Veteran services, wellness, innovation, art therapy, peer self- advocacy, receptivity of personnel Financial Statement Communication and Message Impact of Business Activities Foundation Activities Recognition and Strengths Awards for Companies That Care, Great Place to Work, Veteran Services, Wellness Funded by Foundation Contributing Artists Community Integration Beauty and Creativity Annual Report Awards Calendar Statement of preceding year company activities addressing financial performance List of Awards received over the past 5 years An annual calendar with client created artwork The organization, funders and other stakeholders Researcher, community and organization Funders, interested others, community A document review was conducted of each identified document listed in the table however documents were not subjected to thematic analysis given the nature and organizational use of the documents. Document content contributed to contextualizing the rich narratives of the case study, provided a higher level of description and supported validation of results. Subjects/Participants Individuals representing three levels of the organization were identified and interviewed using semi structured interviews. The design deliberately included a representative sampling 63 roughly equal in numbers at each level. This included upper management or C staff, mid-level management or supervisors and counselor or case managers called vocational services specialists. All members of the executive team were interviewed for a total of 9 persons at the executive level including two retirees, 12 persons designated middle managers or supervisors and 10 persons considered Vocational Services Specialists (VSS) or otherwise interacting directly with team members. Participant Demographics Table 4: Individual Descriptors of Participants using Dedoose Descriptors of participants are position level, length of employment in years, education level, disclosed disability, ethnicity, gender and age. Position titles and specific disability were identified but not published to maintain anonymity of participants. 64 Table 5: Summary of Participant Demographics Participants Position Level Length of Employment in Years For all Participants Education Level Disclosed Disability Ethnicity Gender Age Totals by Category 1 Executive 9 2 Mid Manager 12 3 Direct Service 10 1 High School 1 2 Some College /Voc Training 7 3 BA or BS Degree 7 4 Master’s Degree 15 5 PhD, EdD 1 Caucasian 19 African American 7 Hispanic 1 Asian 2 Mixed Race 2 Male 13 Female 18 Total Average/Mean Range 31 12 Average Years of Employment 10.745 1 – 40 Years Average Age of Participant 41.9 25 – 68 Years of age Demographic data was collected on 31 participants. Of the 31, 9 participants were identified as executive level, 12 as mid manager and 10 as direct service staff. The average years employed of all participants was 10.745 with a range from 1 year to 38 years. The average age of all participants was 41.9 years of age with the range being between 25 and 68 years of age. The gender breakdown was 13 males, 18 females. The ethnic identification showed 19 participants identified as Caucasian, 7 participants identified as African American, 1 participant identified as 65 Hispanic, 2 participants identified as Asian and 2 identified as Mixed. The number of participants who disclosed a disability was 12. The specific disabilities were: Visual Impairment, Diabetes, Learning Disability, Attention Deficit Hyperactivity Disorder(ADHD), Hearing Loss, and Post-traumatic Stress Disorder (PTSD), Anxiety, Mobility and Spinal Cord Injury. Instrumentation Prior to scheduling of interviews through the designated liaison, each participant was emailed the Minimal Risk Consent Document(Appendix A) and Interview Protocol Questions (Appendix B). A signed copy of each participant’s Consent Form was returned to the researcher and is in a secure file. At the beginning of each Zoom recorded interview, the researcher advised participants that involvement was voluntary. Participants were assured of anonymity in the compilation of the narrative report. Some participants indicated their willingness to participate and acknowledged personal enthusiasm for the task. Many had reviewed the interview protocol questions in advance and had available notes or written answers to interview questions. In several instances at disclosure of disability, the researcher inquired as to whether accommodations were required and was advised they were not. After responding to any questions or ascertaining that there were no questions, the researcher began by asking specific demographic information. Data was gathered using in-depth semi structured questions (Appendix B) with each participant. In preparation for this research, a small initial study was conducted with a CRO in southeast Michigan. The methodology used was comparable to the current study, however, changes to the interview protocol resulted in a more streamlined questionnaire for the current study. A study conducted by Leahy, et al on effective VR service delivery practices offered additional guidance beyond consideration of the specific research questions and theoretical framework in the construction of the interview questions (2014). The 66 use of the Interview Protocol Questions afforded the collection of consistent data across participants and was designed to elicit information from participants about practices and services they believed to be successful, innovative and contributing to positive employment outcomes for workers with disabilities. Expansion of interview questions was based on progressive findings and further exploration of responses from participants occurred. Individual interviews were conducted for approximately an hour with 31 participants, a representative sample of the total staffing number. Interviews were recorded on Zoom and transcribed using secure data transcription services. This researcher found the participants to be forthcoming, candid and thoughtful. The CEO provided a capable liaison to coordinate the scheduling of the interviews, collection of documents and miscellaneous requests. Overall, the data collection experience was quite satisfactory and indeed exceeded expectations. Data Analysis The general analytic strategy is a combination of approaches: thematic analysis, a modified consensual qualitative research analysis and the use of a theoretical framework to consider potential themes and to structure the analysis. The primary analytic technique is thematic analysis. Thematic analysis (TA) has a less coherent developmental history and appeared as a ‘‘method’’ in the 1970s but was often variably and inconsistently used (Braun, Clarke, 2014). Good specification and guidelines were identified by Boyatzis (1998) in a key text focused around ‘‘coding and theme development’’ that moved away from the embrace of grounded theory. Thematic analysis as a widely used approach really ‘‘took off’’ within the social and health sciences following the publication of a paper “Using thematic analysis in psychology in 2006” (Braun & Clarke, 2014, 2006). The ‘‘in psychology’’ part of the title has 67 been widely disregarded, and the paper is used extensively across a multitude of disciplines (Braun, Clarke, 2014). The current analysis is similar to consensual qualitative research (CQR) in the following ways. CQR involves three central steps. Domains (i.e., topics used to group or cluster data) are identified and used to segment interview data. Core ideas or summaries of the data that capture the essence are subsequently abstracted from the interview data within domains. Finally, cross- analysis is used to construct common themes across participant groups and develop categories that describe the common themes reflected in the core ideas within domains across cases. What differs here is the use of a primary researcher versus several to identify the domains, synthesize the core ideas and engage in cross analysis. Transformational leadership theory forms the nexus of the theoretical framework used to strengthen, expand and validate the identified domains or themes. Transformational leadership is grounded in the four dimensions: Idealized Influence or role modelling, Inspirational Motivation or clear vision, together creating leader charisma, Individualized Consideration or genuine concern for followers and Intellectual Stimulation or valuing innovation. In highly innovative organizational cultures, one is more likely to see transformational leaders with clearly articulated vision, alignment of staff around the vision, and empowerment of staff to take responsibility for moving the organization toward the vision (Anderson, 2013). Thematic analysis (TA) is a method for identifying, analyzing, and interpreting patterns of meaning (‘themes’) within qualitative data. TA can be applied across a range of theoretical frameworks and research paradigms. Thematic analysis involves searching across a data set, whatever that data set is, in this case, a number of interviews, to find repeated patterns of meaning. Part of the flexibility of thematic analysis is that it allows researcher judgment to 68 determine themes in a number of ways; it is important that researchers are consistent in how this is done within any particular analysis (Braun & Clarke, 2006). In this study, codes are created inductively based on the interview questions as well as deductively based on the interpretation of the interview data. The researcher has the responsibility and becomes the instrument for analysis, making judgments about coding, theming, decontextualizing and recontextualizing the data (Starks & Trinidad, 2007). Braun and Clarke describe the phases of the Thematic Analysis Process : 1. Familiarizing yourself with your data: Transcribing data (if necessary), reading and re-reading the data, noting down initial ideas. 2. Generating initial codes: Coding interesting features of the data in a systematic fashion across the entire data set, collating data relevant to each code. 3. Searching for themes: Classifying codes into potential themes, gathering all data relevant to each potential theme. 4. Reviewing themes: Checking if the themes work in relation to the coded extracts (Level 1) and the entire data set (Level 2). 5. Defining and naming themes: Ongoing analysis to refine the specifics of each theme, and the overall story the analysis tells, generating clear definitions and names for each theme. 6. Producing the report: The final opportunity for analysis. Selection of vivid, compelling examples, final analysis of selected extracts, relating the analysis to the research question and literature, producing a scholarly report of the analysis (2006). The first step of the data analysis strategy was to organize and prepare the data to include the transcription of interviews, collection of notes and identification of associated materials such as the CARF report, the annual report and any other facility created videos, brochures or 69 documents obtained in the course of the study. The second step involved a general immersion into the data through rereading transcripts, considering the tone, the depth and credibility of the information and recording general thoughts. The transcripts played an important role in generating concepts and theories—identifying main “stories” in the data (Deterding &Waters, 2018). The next step was the coding process. The unit of analysis used for coding is defined as the entirety of the research interview or the full transcription of each interview. This was chosen to provide the researcher with contextual entities by which reasonable and valid meanings can be obtained and analyzed across all cases. Following guidelines espoused by Cote,1993, the interview transcripts were partitioned into chunks of information called “meaning units”. This is a segment of text… comprehensible by itself and containing one idea or piece of information (Tesch,1990). This step was accomplished using Dedoose software that imported transcriptions of each interview and allowed the researcher to highlight passages line by line that were then coded for meaning. According to Deterding & Waters, flexible coding can help move the field of qualitative data analysis into the twenty-first century (2018). Researchers using the flexible coding process aim to construct an account of the data that meets the threshold of theoretical validity (Maxwell 1992). A theoretically valid explanation is an “abstract account that proposes to explain what has been observed,” where concepts and their relationships have a strong basis in the data (Evans, Huising, Silbey 2016). Using the steps described by Tesch (1990) and incorporating the recommendations of Detering & Waters (2018) for flexible coding, a list of codes were compiled. Initial codes were identified using concepts within the interview questions and constructs within the theoretical framework. New codes were added based on a review of each 70 transcript deconstructing the meaning of the interview and the researcher’s interpretation of the meaning if it did not apply to an already identified topic. The overlap of these codes contributed to intrinsic validity. Figure 2: Coding Flowchart 71 The Coding Flowchart demonstrates the progression from inputs into coding to eventual interpretation of the data using thematic analysis. The coding is initially informed by provisional codes, the interview questions, the theoretical framework and by the new meanings in the interview transcripts that are not otherwise identified. The codes are revised, amended and subcodes are created. Subsequently, the codes are categorized into larger groups of meaning and patterns of response that inform the themes. The themes, considered findings, are interpreted in response to the research questions. Concurrently, codes were operationalized in a code book and assigned meaning. The codebook is a record of a series of codes. By assigning codes operationalized in the codebook to the unit of analysis or interview transcript, the coding process proceeds as a critical link between data collection and interpretation of meaning (Weston, et al, 2001). This process was enhanced through the use of Dedoose software which offered efficiency and storage in creating definitions, adding or deleting codes and connecting transcript passages to codes and quotes. A manual excerpt of the Codebook is provided here. Table 6: Example of Codebook Excerpt Code Balancing internal organizational demands Description the act of maintaining equilibrium between employee human demands and needs and systemic demands and needs Example They just did the flu shot and they brought I believe CVS to our building. So they made it convenient for everyone to get that. And it was at no cost to us, so that was pretty awesome. I'm not sure what to call it, but in February they did where there were stations that you got your blood pressure checked and I think glucose or body mass. 72 Table 6 (cont’d) Example of Codebook Excerpt Autonomy Alignment with the values Individual well being the ability to act in a self- directed way including decision making using values and independence; feeling comfortable with the ability to act without fear of negative consequences a property in organizations that have a critical mass of people with a common language of values and clarity about how their personal values, personal vision/mission and goals align with the desired values, mission/vision and goals of the organization a complex combination of a person's physical, mental, emotional and social health factors linked to happiness and life satisfaction and how one feels about themselves and their life Sharing knowledge, I feel that nothing is a secret. I had an old CEO tells me, ‘D, ask me a question, it doesn't matter.’ I said, okay, what color is the table. He says, ‘I don't know, but my brother knows.’ I said ‘okay’. In saying that, letting people share knowledge, my manager doesn't have to be here. He could be anywhere. If the knowledge is shared, when the question arises, if the knowledge is shared, then we have the answers. And we are able to provide answers from shared knowledge. I think I found the values online and then actually came here and they were open to meeting with me, to giving me a tour of the facilities to talking with me, which I was incredibly impressed with, that they were just willing to do that for pretty much a nobody. And then went from there as, "Yep, this is the place where I think I belong." And then started working towards making myself what I thought would be the best version of myself to work here. They just did the flu shot and they brought I believe CVS to our building. So they made it convenient for everyone to get that. And it was at no cost to us, so that was pretty awesome. I'm not sure what to call it, but in February they did where there were stations that you got your blood pressure checked and I think glucose or body mass. And each one of them was worth certain points and then you can apply those points to dollars and use it to pay for your benefits. 73 Table 6 (cont’d) Example of Codebook Excerpt Organizational well being the organization's ability to promote and maintain the physical, psychological and social wellbeing of workers at all levels and for every job... Fun culture an organizational culture, in which happiness plays a central part represented by visible stories, celebrations, norms and values and shared beliefs 74 every decision that I have been able to witness here, or every discussion about changes and or longer-term goals or even shorter term projects, has had the mission right at the center. And you have a CEO that is always, always caring about team members, those clients we serve. And I've seen the same kind of care be extended to the staff and other employees that service those clients. And it's just engrained, it's in the air here. I don't know a better way to say it. It's woven throughout the policies. with the response to COVID, we had to set up screening. So Peckham employees volunteered to conduct that, do the temperature checks and ask the questions to get people in. And one of the Peckham employees here at the greenhouse decided to make that really fun. And she did a lip sync. It wasn't even a lip sync video, she actually sang. She dressed up as an Elvis impersonator and made up this song about participating in screening. Another day the screeners all put on costumes just to say happy Friday. You show up and it's a banana that's taking your temperature or a monkey that's asking you the questions. So I certainly think having fun and finding ways to enjoy work and make work a fun place is definitely part of the culture around here. Also, a huge culture shift from where I came from, which was about as stiff and buttoned up as you can get. The codebook identifies the code, provides a definition or descriptor of the code and a quote or material that represents the code. Following the coding assignment that involved defining and assigning a code or codes to passages of each transcribed interview, transcripts were shared with an outside PhD level educator for verification of the data codes through intercoder agreement. The intercoder agreement function makes it possible to compare two people coding the same document independently of each other with the goal of achieving as high a level of agreement as possible between independent coders to reach a practical level of coding quality. The codes were subsequently reviewed again to condense and clarify the meanings. A second and third level coding review based on additional review of the transcript excerpts was conducted. This resulted in more specific coding groups, sub groupings and the identification of initial categories or themes. Themes serve as a starting point in categorizing or clustering copious amounts of information and may include context and specific strategies or interventions (Hill et al., 1997, Fereday & Muir-Cochrane, 2006). Categorizing specific codes into general theme areas was based on the number of similar meaning statements, responses to the interview questions and perceived alignment to the codes. This process was a combination of inductive and deductive researcher interpretation and the use of analysis software. The data analysis resulting in themes informing the results was conducted through a combination of researcher directed decisions about codes, assigning meaning, developing themes and interpretation. This process was enhanced and supported with the use of Dedoose software. The software offers visually descriptive data and supports comprehensiveness and reliability of the findings if used correctly. 75 Figure 3: Excerpt from Dedoose Code Book Figure 4: Example of Coding Matrix Chart generated by Dedoose Software 76 The qualitative data analysis tool, Dedoose, was used to further facilitate the data interpretation through cross- analysis. Cross-analysis within the software relies on a matrix process that uses descriptors to cross check coded responses. This analysis was conducted at the position level descriptor to yield themes and categories identified by the three organizational levels of staff interviewed. This allows for another level of categorization and conceptualization to address cross themes and support validity of findings. (Dedoose, version 8.3.45-2,2020, Hill et al., 1997). The strategies used in this study to establish validity are triangulation of the different data sources, the use of a detailed descriptive narrative combined with Dedoose data collection and the positionality of the researcher that includes the substantial amount of time spent in the field. Explanation building is narrative and offers explanatory propositions. It is expected to reduce threats through a consideration of alternative plausible explanations. According to Maxwell (1992), reliability refers to a particular type of threat to validity. If there are differing accounts of the phenomena, data or events, then the differences must be resolved. The inclusion of three levels of staff in the study was warranted to address the potential for differing accounts. As needed, any differing accounts were resolved through analysis; additional participant interviews were not required. The IRB agreed to the study given the assurance that no interviewees would be compromised or harmed as a result of participation in the study. Conventional confidentiality practices were followed to assure interviewees of anonymity. Given the high profile of the organization, it is possible that participants may be recognized even with pseudonyms or initials especially if individual positions are described, therefore participants were assigned a number identifier. The final report does not use identifiers that offer clues to the identity of the originator. 77 Standard data storing conventions are being utilized. Member checking, also known as participant or respondent validation, is a method to validate credibility of results. Data or results are returned to participants to check for accuracy and resonance with their experiences. The study was shared with the organization and the document was reviewed for the purpose of determining factual accuracy. There was an objective reviewer of the final draft document. This case study was instrumental in nature and used a single, specified study to identify and conceptualize emerging, promising and best practices within a successful community rehabilitation organization leading to the creation of an environment that promotes innovation and high performance. Instrumental case studies are used to gain insight into an issue and to generalize beyond the case under study (Stake, 2006). The research design used a primary analysis technique, Thematic Analysis, to obtain the findings. The study engaged in rigorous methods to assure validity and reliability of the findings. 78 CHAPTER FOUR RESULTS The purpose of this study was to identify the organizational and service delivery practices used within a successful community rehabilitation organization to improve and increase quality employment outcomes of workers with disabilities. This qualitative study also investigated the promising practices, policies, and procedures of CROs that promote innovative workplace practices that appear to be effective and potentially transportable to other community rehabilitation organizations. Persons with disabilities often require the supports and services provided by CROs to engage in employment. During this unprecedented time of rising awareness of social injustice and strong criticism of traditional institutions, it is advantageous to establish and share the strategies used by successful ‘woke’ organizations to improve outcomes for persons with disabilities who comprise a marginalized population. The identification of promising, emerging and best practices can generate interest in researching evidence based practices which can promote equitable outcomes for workers with disabilities. While there is some research on social enterprise businesses in general, there is minimal research conducted on social enterprises that function as community rehabilitation organizations. This study was needed to assist in alleviating the paucity of research in this area. The chapter begins with a comprehensive description of the data obtained by document review and through conducting and transcribing semi structured interviews with staff at three levels of the organization. The thematic analysis process is briefly reviewed followed by an examination of the research questions. This chapter then presents the findings of the research case study. The findings describe the organization, present major themes and identify specific organizational and service delivery practices concluding with a summary. 79 Revisiting the Data The qualitative data consisted of 6 documents (2017-2018, 2018-2019, 2019-2020 Annual Reports, CARF Accreditation Report February 2020, Listing of Awards and Annual Calendar 2021) and 32 interview transcripts from informative interviews. An organizational chart was described but not shared. A total of thirty individual interviews were conducted with two group interviews consisting of three participants in each group representing 32 audio hours. This included interviews of 9 persons at the executive level of the organization including two retirees, 12 persons designated middle managers or supervisors and 15 persons considered Vocational Services Specialists (VSS) or otherwise interacting directly with team members. A team member is differentiated from staff as an employee who works in the organization’s business lines and is a person with a disability. Primary business lines include manufacturing including sewing apparel, call centers, warehouses and distribution and environmental services. Revisiting the Analysis Process A thematic analysis was conducted. Analyzing the data required an immersive review of recorded and transcribed participant responses gathered through Zoom interviews averaging an hour in length. The analysis process was conducted both as an individual interpretative exercise and facilitated by using Dedoose, a software application for analyzing qualitative and mixed methods research and offering data management, excerpting, coding, and analysis. Following a rigorous coding exercise and theme identification, an additional analysis was conducted to validate the themes through consideration of each individually and within the context of the central organizing ideas. This process resulted in determining the final themes used to accurately represent the study results. Each theme was summarized into brief descriptions with the intent of capturing the essence of each in as few words as possible and with enhanced clarity (Fereday & 80 Muir-Cochrane, 2006). The fundamental concepts within each theme were used to create a summary that defines the theme and is reflective of associated comments. Themes attain full significance when they are linked to form a coordinated picture or an explanatory model. Making connections between themes to build a coherent argument supported by data results in an explanatory model or construct (Bazeley, 2009). Responses to the Research Questions The results of the semi structured interviews and analysis of documents reflect intentional policies and practices that result in successful employment outcomes for individuals with disabilities and result in the creation of an environment that promotes innovation and high performance. 1. What are the best models of effective practice, policy and procedures within a successful community rehabilitation organization that assist individuals with disabilities achieve employment outcomes? This study identified the intentional application by leadership of effective policies, practices and procedures in a community rehabilitation organization. These practices constitute a model for successful service delivery that achieves satisfactory outcomes and upward mobility for persons with disabilities. The model is a holistic approach to individual and organizational wellbeing using strategies that prioritize incentivizing the behavior of team members and staff in the achievement of desirable outcomes. Promising practices in use at the organizational level are the Mission Engagement Experience (MEE), the availability of mini grants, flexible work schedules and staff expectations for work/life balance, quarterly business planning processes founded on accountability, inclusive celebratory achievement practices, personnel investment practices and investment and structural 81 components with team-based management. Promising practices at the service delivery level are positions and mechanisms that address a range of worker needs, tools and strategies that promote holistic wellness, specialized personnel, targeted training for upward mobility, Dream to Drive, I-Strive and AVAIL. 2. Do the models of effective practice, policy and procedures result in the creation of an environment that promotes innovation and high performance? The findings clearly demonstrated an environment characterized by high performance and innovation in the achievement of its mission and goals. The study identified effective policies, practices and procedures in a community rehabilitation organization that promotes innovation and high performance within a culture that is mission driven, healthy, psychologically safe, continuously improving, people focused and accountable. Leadership and culture are drivers of organizational wellbeing and innovation. Findings Description of the Organization The community rehabilitation organization that is the focus of this inquiry is Peckham, a non-profit organization with headquarters located in Lansing, Michigan, the capital city and an urban Midwestern city surrounded by mixed urban and rural suburbs. City population is 120,921 with a metropolitan statistical area population of 464, 036 (worldpopulationreview.com) in 2021. As a non-profit organization, the agency can lobby legislators and is not bound by the constraints placed upon state vocational rehabilitation agencies. Incorporated in 1976, it was originally created in collaboration with the financial support of Michigan Rehabilitation Services, the state vocational rehabilitation agency that provided a development grant. Currently the organization is financially stable with revenues in the millions and a separately incorporated substantially 82 resourced foundation (Annual Report, 2020). Contributing to the financial viability are federal contracts targeted to hire persons with disabilities awarded as part of the Ability One program and a roster of five separate robust business lines. In 1975, the initial staff consisted of three people, one of whom recently retired after leading the agency as Executive Director since 1994. Today, the employee numbers are as follows: C-Team Middle Management VSS (Human Services) Others with Direct Interaction (Supervisor, AmeriCorps, etc.) Team Members Clients (not working at Peckham but receiving services) Other Staff Total 7 135 70 153 2245 582 193 3385 The CARF Report lists six Michigan locations and a Phoenix location. Notably, the headquarters building in Lansing, referred to as the Greenhouse, is a newer building, built expressly in response to an unusual RFP that requested a “respectful” building plan. The resultant building expresses the visionary leadership of the organization in intentionally creating an environment that is visually welcoming, light filled, LEED certified and includes unusual features such as extra wide hallways to allow wheelchair users to meet and chat, a prayer room created to respond the needs of the diverse employee base and an art filled manufacturing floor. This organization has a long history of successful outcomes, has achieved the highest degree of CARF accreditation and has won many workplace and other awards attesting to its 83 primacy (Appendix C). It enjoys widespread community recognition, is an employer and community resource with locations in Flint, a city that claims a majority minority population and is economically depressed as well as out of state locations in Arizona and Kentucky. The original purpose in creating the organization was to provide vocational rehabilitation services to clients of the state vocational rehabilitation agency. Today, clients of the state vocational rehabilitation agency continue to be served. The programs and services offered are extensive and include community employment services, job development, comprehensive vocational evaluation services and organizational employment services. The organization itself has diversified business lines and as of April 2019 is the 8th largest employer in the region according to the Lansing Area Economic Partnership (LEAP), continuing to offer vocational rehabilitation services as well as employment in a seamless approach. Peckham promotes itself as a unique business and human services agency that values quality, diversity and performance. The mission of the agency is to provide a wide range of opportunities to maximize human potential for persons striving for independence and self-sufficiency. The values of the agency are: Compassion Diversity, Opportunity, Excellence, Pride, Community, Balance. Figure 5: Peckham Community Partnership Foundation Financial Status 2018-2019 $2.5 Million Donations $35.9 Million Assets Peckham Community Partnership Foundation $1.8 Million Grants 20 Mini grants Awarded 21 Major Grants awarded (2.9 Million) Investment Gains/Loss 84 Due to the re-investment model and steady growth over time, this CRO organization is unique in the scope of what they have been able to accomplish. Figures: 2018-2019 Annual Report. Figure 6: Peckham Revenues and Impact 2018-2019 $106.2 Manufacturing $77.6 Contact Center Solutions $8.9 Human Services $69.2 Team Member Wages Upward Mobility 518 Job Placements 785 Clients Served 6774 $3.9 Other Revenue $7.4 Environmental Services This chart demonstrates the revenues in millions from the business lines, wages paid to team members and measurable impacts. Figures: 2018-2019 Annual Report. Interdependent Major Themes Analysis of codes and subsequent categorization resulted in primary theme identification as evidenced in Table 7 and discussed in Chapter 3. Executive level managers, mid managers and non-management service delivery staff identified shared codes across organizational and service delivery areas. The practices, codes, categorizations and themes contributed predominantly to the findings. The major themes are defined and discussed in detail in the remainder of the chapter as well as their interaction with identified effective practices, policies and procedures. 85 Table 7: Progression from Practices and Codes to Categories and Major Themes. Practices Targeted Training Mini Grants AVAIL iSTRIVE MEE VSS Staff Talent MEE Mini Grants Staff capacity Staff strengths Staff retention Staff recognition Business Planning MEE Business Planning Staff capacity Staff strengths Staff retention Staff recognition Targeted Training Mini Grants AVAIL iSTRIVE VSS Work Life Balance Targeted Training Mini Grants AVAIL iSTRIVE Staff Talent Work Life Balance MEE Codes Balancing internal demands Community Placement Performance Incentives Staff Talent MEE Data Driven Continuous improvement Operational planning Client Centered Balance Mission Staff Talent Authenticity Management Style Communication Intentionality Flexibility Inclusion Diversity Autonomy Communication Holistic Individual Well being Staff Talent Risk Taking Diversity Financial Stability Psychological Safety Mini-grants Problem Solving Risk Taking Incentives Technology Staff Talent Client Centered VSS Holistic health Inclusion Categories Client Centered Upward Mobility Performance Investment for Success Leadership Style Culture Performance Balance Safety Culture Culture Continuous Improvement Investment in People Individual Wellbeing Main Themes Mission Mission Alignment Leadership Healthy Workplace Innovation People/Humanistic 86 The major themes are: Mission and mission alignment, leadership and performance, a healthy workplace, a humanistic or people focused culture and innovation. Table 8: Major Themes: Description and Primary Code Contributor Major Themes Description Contributors The Mission, Adherence to the Mission Healthy Workplace & Employee Well being Leadership Humanistic, People Oriented Innovation A demonstrated understanding of adherence to and positive personal satisfaction with the purposes of the organization. A work environment characterized by an emphasis on promotion of holistically healthy and safe behavior and positively experienced by the worker The ability to influence, guide and direct others in the pursuit and achievement of the organization’s mission and goals A primary and priority emphasis on valuing the person and engaging in behaviors that positively demonstrate Making a change to an established process or introducing a new problem solving process, program or techniques that benefits individual workers and the organization MEE Mini grants Talent Client Centered Autonomy Communication Holistic Individual Well being Authenticity Communication Intentionality Inclusion Talent Culture Mission Alignment Individual Well being Mini Grants Continuous Improvement Leadership Psychological Safety Table 8 identifies the study major themes and provides a working definition of the theme and the primary code contributors to the theme. 87 The Mission “At the end of the day, our core values and our mission is the filter or the lens that we use when we're making those gray decisions, that are going to help us to decide” (P101, supervisor). A consideration when identifying effective practices is the continuous push and pull of a social enterprise workplace that needs to balance the demands of its mission with the demands of its business. Defined as the use of nongovernmental, market-based approaches to address social issues, social enterprise often provides a “business” source of revenue for many types of socially oriented organizations and activities ( Light, 2008). A continuous refrain running through the interviews was the acknowledgement of the organization’s mission as a daily presence, a liberating and lived influence on the everyday policies, practices and procedures, an active stimulus in the culture and a guiding principle impacting intentionality, decision making and every aspect of the organization. According to Agin and Gibson, the mission and vision of an organization sets the tone for the culture that eventually develops. The mission and vision should be communicated daily and should foster openness in communication in all directions. Many organizations give lip service only to the mission, open communication or open-door policies resulting in a lack of trust and dismal levels of creativity within the culture (2010). A participant states I like to go into the mission periodically to make sure that I am on track with the mission, that I am living the mission, that I am working toward the mission, that whatever I do from the time of entry until the time I leave the building that I carry out tasks according to the mission. (P125, direct service) Peckham does more than pay lip service to the mission. How they accomplish this extraordinary adherence to the mission is described in more detail in the Mission Engagement Experience (MEE) practice. At the same time, the organization recognizes the competing demands of the goals of the business lines and navigates the balance of priorities through education of staff, open 88 acknowledgment of the needs and clear decision making. Decision making is informed by the organizational values which act as a moral compass for behavior. “This organization has always been a very mission focused organization and one that is always managing the balance between the mission and operating the businesses, the social enterprises, so that we're always living in this ‘AND’ environment”. (P101, mid manager) As a company, we’ve always been focused on the mission, and that is even more true during the pandemic. We’ve used our mission to guide all our decisions as we’ve struggled to support both our team members and our business lines. If we come at decisions from a vocational rehabilitation mindset, we find there isn’t a conflict between our mission and our business. The two are mutually supportive! (P109 executive staff) A Healthy Workplace and Employee Well Being This holistic emphasis on valuing the whole being is expressed throughout the organization in very tangible polices, practices and procedures. The HR function arguably has the primary impact on the establishment of organizational policies, practices and procedures. Up until recently, the human resources executive title was Chief of People and Culture reflecting the personality and long-term organizational emphasis on culture. The current title of Chief Human Resource Officer was chosen to reflect the strategic contribution of HR to the operations with an expectation of culture shaping and continued flexibility based on thoughtfulness and adherence to the mission. These core values are operationalized in the emphasis on physical health and wellness and support for a health and safety czar and team. “ From the board of directors on down, there is a just a real significant focus on how everybody is doing from a health perspective, from a financial perspective, from a childcare perspective, from a mental health perspective” ( P116, mid manager). Peckham does a really good job of again looking at the holistic person and they offer art classes and workout classes and there's a fitness center and we did, I helped organize a walking program that had prizes, right? And everybody earned raffle entries. So if you walked you got a raffle entry, right? And the more you walked the more you got. I think 89 just seeing some of my team members engage in a way that when you can see somebody that's really excelling in art class, but is really struggling with focus and attention in the call center, you can start by looking at, "Hey is there a way that we can get whiteboard coloring sheets for this person to build them up? ( P 107, direct service) In healthy organizations, culture, climate and practices create an environment conducive to employee health and safety as well as organizational effectiveness (Lowe, 2010). Positive organizational health calls for early interventions aimed at increasing well-being of workers at different levels (individual, group, organization, and inter-organization) to promote healthy organizations (Jiménez et al., 2016). At Peckham, the physical environment is one that promotes an atmosphere of respect and value for the individual employee and for the visitor. Attention to detail, acceptance of stakeholder input and support for innovation have resulted in the creation of a building that is experienced as welcoming, open and pleasant. It is functional with fully equipped and flexible training rooms, a colorful, light filled manufacturing floor replete with a team member story wall, a peace chapel for individual workday worship and easy to navigate, especially with built in accommodations such as all accessible stalls, braille signage, hands free controls and various devices to transport individuals with mobility issues. One participant describes it this way: I believe that universal design is a central tenant in the facility's philosophy. The greenhouse aka headquarters building is definitely designed to accommodate a host of different disabilities. It's easy to move through the building, it's easy to navigate. The materials that are used are very sensitive to people that might have sensory disorders or have mental illness. The work floor, natural light, they made a very intentional practice to get natural light into every room in this building. There's been a lot of thought put into how to make people comfortable. (P110, direct service staff) Another says: The building is designed so that people walk around all the time and they walk for their health. We're now talking about whether or not we should set aside a room for telehealth so that team members don't have to take the day off work, but they can go to their 15 or 20 minute appointment in a private space connected with their health professional (P100, executive). There's so much intentionality in the way we build our buildings, to feel inclusive the moment you walk in, you feel like you're supposed to be here, that's designed into our architecture. (P122, executive staff) 90 Individual physical health is included in a holistic approach to wellness. Medical insurance is offered to everyone with a benefits/incentive system in place for the promotion of better health habits such as maintaining lower cholesterol. In addition, each of the locations has a gym with showers that are available before during and after work to employees and team members. In addition to a safe, respectful, physical environment, a safe psychological environment provides a basis for risk free innovation and the creation of emerging and promising practices. Through the availability of the mini grant awards practice, open to anyone in the organization, the organization has established a culture that is non punishing, rewards problem solving, creates a risk-free zone for innovation, emphasizes the value of all employees and promotes continuous improvement. Staff are motivated to undertake risks to develop and implement innovative practices in an effort to enhance service delivery to both team members and business customers. Psychological safety in the workplace is more than comfort with risk taking. In this context, it is also emotional wellbeing and authenticity, being able to come into the workplace and pretty much be who you are without fear on a daily basis, espousing the belief that ‘different is good’. The city of Lansing is a refugee destination and Peckham serves a large refugee population with over 180 different dialects spoken in the workplace. This diversity is embraced and while English language training is offered, so is sign language training along with a range of electronic translator programs. There is a continuing effort to offer training that supports identified needs such as financial literacy and subjects leading to personal growth and development. Me being able to be authentically myself has allowed me to be even more committed to the organization and I think it's shaped my values. It's shaped who I am. Because I see so many different people thriving in their own unique way. My mind is so much more open 91 now, maybe some of that's age, some of its experience, but I think a lot of it is my own perspective of seeing people thrive in their own unique ways because they're able to be authentically themselves ( P 111, executive staff). A secure financial environment contributes to a holistic model of organizational wellbeing. The organization is financially viable with deep reserves accessed via the Foundation. The acquisition and maintenance of Ability One contracts constitutes a strategic business model and community supports coalesce in a financially secure organizational model. Very few social enterprise organizations have completely rejected the use of the 14C certificates to pay team members a subminimum wage, but Peckham was one of the first to do so in 2014, recognizing the social justice concerns of the issue and continuing to financially subsidize individual employed team members. One participant says: I look at the values, and the values include things like community, being who you are, bringing that self to work and having the right work life balance, I thought, oh, this is great and there's an entire wellness program that goes from physical health to mental and emotional health: incentives around exercising and eating right, and making sure that you are staying up on your medical appointments (P 107, direct service). Wellness is a holistic integration of physical, mental, and spiritual well-being, fueling the body, engaging the mind, and nurturing the spirit. Although it always includes striving for health, it’s more about living life fully, and is “a lifestyle and a personalized approach to living life in a way that… allows you to become the best kind of person that your potentials, circumstances, and fate will allow ( Lagerstrom, 2005). Leadership Characteristics “I truly appreciate when the higher ups in management are able to come out and be visible and interact with the team members directly. That's always a really good feeling” (P107, direct service). The key leadership characteristics driving the organization and culture are authenticity, intentionality, accountability, continuous improvement and accessibility. 92 Authenticity is best described in this context as being who you are and bringing that self to work. The personality of the long term leader was described as open, accessible and accepting. As a potential role model for others, these same traits and a team based decision making process are in evidence by others identified as leaders in the organization. In the context of leadership, intentionality is demonstrated through establishing specific practices that achieve the outcomes of the mission. While the values adoption of eight years ago is one example of this, intentionality is evidenced much earlier in the growth of the organization with the establishment of the Foundation, the creation of the quarterly business planning process and the initiation of the MEE. Establishing strong accountability practices is also in evidence early on. Accountability is broadly defined as the acknowledgment and assumption of responsibility for actions, products, decisions, and policies including the administration, governance, and implementation within the scope of the role or employment position and encompassing the obligation to report, explain and be answerable for resulting consequences. Adherence to the business planning process is reflective of the emphasis on continuous improvement. More than a leadership theme, continuous improvement is interwoven throughout the organizational practices and recognized and embraced by managers as a way of being. There is a prevailing sentiment of “there is still so much more that can be done”. According to one participant speaking about continuous improvement: It's a sense of never assuming that we have it right, there's always a focus on improvement, there's always a way we could do our job better. There's always a team member that wasn't as successful as we'd like them to be. So what could we have done differently to help set that team member up for success? There's always something more that we could do, and it's not that we don't take pride in what we do, I think everyone really does take a lot of pride in the experience that our team members have and the success that they have. There’s always room for improvement and so there's always the sense from the board of directors all the way down to front line staff: ‘what's next, how can we do this better and in a positive way’. I mean, people really want to find solutions and want to find ways to improve our services. I think that's really been critical to our 93 success: never, never being complacent, never thinking, OK, we've got it, we're good. We've got a great working model. There's always a sense of this is great and we're happy that we can serve so many people. But how can we serve more? How can we do it better? How can we make this? What's the next step? Because there's so many issues that are still facing people with disabilities, especially when it comes to employment, we can't be done. The problem is not solved. (P115, executive staff) The leadership characteristics in evidence at Peckham are interconnected to other major themes and contribute to identification of mission, innovation and people as primary domains. The People “One of the main reasons I think the organization is successful, the number one reason is the people. The people here are unbelievable. It doesn't matter if it's staff or team, everyone, and that's why I like Peckham, everyone has something to contribute” (P 121, supervisor). Simplistically, a major theme is the inherent value of the people. “People feel valued. People value others. We treat people like an incredibly valuable resource” (P104, mid manager). Participants are very clear about the values. The organization practices acknowledging individuals, is highly empathic and provides emotional support to employees. It is “focused on making sure that workers have what they need”. Participants cited management’s open-door policy, a communicative family atmosphere, ‘trust’ and comfort with leadership who are always respectful and accessible. “Peckham is encouraging us to take days off. They're encouraging us to take care of ourselves. We're reaching out to each other, somebody got me Biggby today and my entire office wrote me a really nice card and gave me a small gift for becoming a homeowner, which meant a huge amount to me. That would never have happened at another workplace. People here really care and that means a whole lot.” (P 106, Direct service) We’ve got our measures, we know how we are doing and we have the outcomes that we want and expect and that we are driving toward. But what’s really important to Peckham and the management and everybody at Peckham are the people, right? So certainly our team members the people we are serving, that’s important and extends to staff as well. it’s not just knowing how many calls did we answer in the call center. That’s’ important, 94 did we answer them in the metrics we were supposed to have,that’s important but you achieve that by focusing on the people.That’s how we bring it about. (P 109, exec staff ) A humanistic culture that values the individual and is inclusive of all staff is in evidence. Innovation “The lifeblood of Peckham is innovation, that energy, that openness to new ways of doing things and adopting new technologies, adopting new practices, exploring new practices” (P 129, executive). The mission, the culture and the mini grants contribute to high performance and innovation. Innovation means being able to find new solutions quickly and to offer new products and services by considering the dynamics of the environment through high levels of flexibility. The organization is viewed as innovative by participants. We're an innovative company. We started this technology innovation a while ago and I think we try to stay up with the trends. So on top of having the like mindedness with the passion for the mission. We are, like I said, innovative and we try to stay ahead of what's going on in the business world. And so I think that that definitely contributes to getting people and retaining them and our success. (P 117, direct services) The mini grant process stimulated the creativity and ability of staff to contribute to innovation. I was encouraged as a 20-something kid, you want to do something cool with the company write a grant for up to $5 thousand to the foundation and try it. If it works, great. If it doesn't, we're only out $5 thousand. But you get to innovate, you get to try it. ( (P 111, Executive). Innovation occurs without the stimulus of the mini grants and is also reflected in the day to day operations. This participant shared an example of how the IT team was able to create an innovative response to a new problem caused by the need for contact tracing during the pandemic. I’m equating innovation with creativity. And I think those are very similar terms, at least. And so I do think we're creative and you can see that when it comes to… I’ll use an IT example this time. And in the days of COVID, contact tracing is really important. Being 95 able to know who an individual interacted with, without being able to say, hey, so-and-so has COVID who talked to that person lately, you know, you can’t do that. So one of the challenges we had was that a selling team member may sit at three or five different sewing machines throughout the course of a day. Now they're sitting with a whole different group of people. And we're doing social distancing and they're wearing masks and all those types of things. But if somebody comes up positive, how do we know all those different places where they were in the building. And so we've been struggling with this. The next day they had a working prototype of a technology piece that the team member will scan their badge in and then the barcode on the sewing machine and it will link those two. When they move to the next one, they scan the next one. And so it'll track that way. ( P 109, Executive). Emerging and Promising Practices Overview Practices emerged from analysis in two thematic areas: Organizational practices and Service Delivery practices. Organizational practices are systemic, inclusive of the organization and represent the beliefs, attitudes and behaviors that impact upon the culture. They are differentiated from Service Delivery practices by their application to the staff of the organization. Service Delivery practices are reflective of the organizational practices and impact the provision of services supporting the achievement of employment outcomes for persons with disabilities. Summary descriptions of effective emerging or promising practices in both areas follow. Some of these employment services can be viewed as promising practices, while others can be considered emerging practices. Emerging practices are practices that have anecdotal evidence and are consistent with professional wisdom but are not necessarily based on research or theory and have not been studied through the collection of original data. Promising practices are defined as any intervention, program/service, strategy, or policy that has strong quantitative and qualitative data showing positive outcomes but does not yet have enough research or replication to support generalizable positive outcomes for consideration as an evidence-based practice (Anderson, et al, 2014). 96 Organizational Practices Table 9: Organizational Practices, Description and Code Contributors Organizational Practices Description Contributors Mission Engagement Experience Mini Grants Work Life Balance/Flexible Workplace Business Planning Process Talent Investment Acquisition Development Training Retention Recognition Alignment Mission Initiatives Structure Advocacy Communication The organizational practice of tying financial incentives to the practice of mission focused behaviors benefiting team members The organizational practice of awarding individual grants in varying amounts to implement a new practice or problem solving program that benefits team members and the organization The endorsed organizational policy and practice of supporting the use by staff of flexible work time A quarterly organizational practice that assesses progress and achievements within the business plan. It includes broad communication, acknowledgement and celebration of successes. This refers to the Human Resources function that addresses all aspects of organizational staffing, ranging from recruitment and hiring to longevity and retention. This is a newly reconvened internal cross functional structure that addresses root or core problems and substantial issues impacting the success of workers of disabilities. MEE Promising Practices Mission Client Centered Incentivizing Behavior Innovation It’s OK to Fail Problem Solving Resources Continuous Improvement Flex Time Well Being Individual Staff Retention Balance Business Planning Process Intentionality Accountability Operational Planning Fun Culture Leadership Growth Diversity Values of Organization Personal Alignment with Mission Staff Onboarding, Capacity , Strengths, Recognition Retention Promising Practices Continuous Improvement Problem Solving Structures Innovation 97 Table 9 identifies the study organizational practices and provides a working definition based on the primary code contributors to the individual practice. Six primary organizational practices were identified. 1.0 Incentivizing Behavior: Mission Engagement Experience (MEE) “So the mission in a variety of ways is kind of baked into the Peckham cake.” (P107, direct service staff). The mission engagement experience (MEE) program is a strategy that engages virtually every staff person with almost 100% participation in the activity. On a quarterly basis, each employee is expected to engage in an activity that provides service and value to a team member. The options are not prescribed and can range from helping someone navigate a computer to chatting with a team member who's trying to learn the English language to serving mashed potatoes at the holiday party. In order to receive an annual financial bonus, an employee must achieve 95% of the MEE. These activities are shared, communicated and celebrated across the organization. The MEE was initiated approximately 20 years ago and while it has evolved, it continues to incentivize mission and values driven behavior on a regular schedule of engagement. Expectations are clearly communicated as to the priorities of the organization. Incentivizing mission driven behavior assures the communication of organizational values and internalization of those values in an authentic evidence based best practice. As stated by an interviewee, We do have a mission alignment incentive that Peckham does where when people go above and beyond to provide service, and we do this all like a collective group. That's part of why we get a holiday bonus later on in the year is that really looks at what we are giving to be compassionate, what we were doing to show pride, what are we doing to better the organization and the communities that we serve”. ( P 120, direct service) , I think that's an incentive for sure, but the residual outcome is, it creates people who are really engaged in the team member experience and have a mindset of ‘I'm here to serve’. There's incentive there to make sure you're engaging with the mission. It's basically having people drive the culture and drive the mission. (P127, mid-manager) 98 2.0 An Innovation Tool: Mini Grants “So what can we do to support you to make sure that you feel you have what you need?” (P111, Executive level staff). The mini grant process provides for any staff member of the organization to engage in a prescribed process that if successful provides funding in different amounts to be used in support of the organizational goals, including a response to immediate team member needs. The usual amount is $5000 but dependent upon various factors can be a much larger amount. There is a prescribed procedure that involves completing a template to request the funds, an organizational review process, implementation if awarded and a subsequent report to the Board by the requestor. A mini grant was developed and awarded to work with other community partners to provide diapers to working parents with young children Another popular mini grant, Dream to Drive, focuses on helping people get their driver’s license and covers driver’s training costs and testing fees. If getting a suspended license back depends upon money, the cost is shared between the recipient and the grant. Not being able to drive is a barrier to employment and this results in barrier removal. This effective and potentially evidence based practice was initiated, evaluated and has been maintained over a period of years. The mini grant tool was consistently identified as a tool for innovation by participants and a representation of the organization’s commitment to continuous improvement, meeting the needs of team members and fostering a culture of ‘freedom to fail’ and risk taking. As one participant described it: I think the mini grants are probably the most shining example of how Peckham supports people's creativity and innovative ideas (P101, mid manager). The mechanism is effective on different levels of individual and organizational growth and development. It identifies staff strengths, motivations and capacities, addresses organizational improvement and innovation and is responsive to client and employee needs. The mini grant process identifies staff 99 who are motivated to engage in problem solving and creating change and allows leadership to identify staff who are adept at grant writing and potentially can be future leaders within the organization. It offers a mechanism for staff engagement, problem solving and innovation at all levels of the organization, meets the immediate and longer term needs of team members and largely supports a culture of risk taking and freedom to fail. The mini grants were an early application of the Peckham Foundation and have evolved to generate much larger grants dependent upon the magnitude of the identified need. A description of the mini grants program is insufficient without a description of the Foundation that originated in 2000 and financially supports this process. As one organizational leader describes it: The foundation is one of our biggest tools for success. It gives us so much flexibility and so much freedom to be able to try and provide all different kinds of supplemental programs that normal business operations and government contracts just would not support. (P129, executive staff) The establishment of this structure has created a significant stable available funding source. The foundation was and continues to be funded primarily with profits from the organization. In addition to the mini grants, the Foundation supplements CMH funding for supported employment, funds the Veteran Services Specialist position, the Advocacy Coordinator position, provides A plus training for helpdesk applicants, funds the Art from the Heart program and notably subsidizes wages lost as a result of voluntarily eliminating the 14C certificate in 2014. While not a short-term fix for other nonprofits that want to offer comparable programs, the establishment of a foundation is a strategic growth vehicle that offers a base for long term planning and enhanced financial security. 100 One of the other things I really like is in line with making, in achieving the goals and core values, you are allowed to, you are encouraged to try things and make mistakes. So, for example, the mini grant program is money set aside to allow staff to try to make programs and if they work, great. If they don't work then we've learned something which is also a really cool aspect of the company. (P107, direct service) 3.0 Health and Wellness: A Flexible Workplace “I've seen a significant increase in focus on well-being, even though I felt like the organization was a really supportive, flexible employer before, it sort of jumped into hyperdrive” (P 115, mid-manager). Wellness and wellbeing in this context is more accurately work life balance and is acknowledged as important and, in most instances,, characterized as schedule flexibility. There was acknowledgement that flexible work schedules were the strongest representation of management concern and support. While staff often are called upon to do more than their share, they are also encouraged to use leave time in a non-restrictive way that acknowledges life stressors and unanticipated challenges to the workday. Overall a flexible approach for completing and conducting the necessary work without having to be onsite is supported and promoted. Work/life balance has different meanings for different people and often depends upon context. Here it is defined as the dilemma of managing work obligations and personal/family responsibilities; the extent to which an organization’s culture acknowledges and respects the family responsibilities and obligations of its employees and encourages management and employees to work together to meet their personal and work needs (Lockwood, 2003). A workforce survey conducted by IBM acknowledged “the highest performers are the most likely to consider their ability to balance work and personal responsibilities in a decision to stay with the company ( Lockwood, 2003). Peckham staff almost uniformly articulated the benefit of 101 using flexible time to address personal and family responsibilities without undue fear of job loss or censure. Health Canada (2000) developed a Flexible Work Arrangements Guide that was created to assist all employees to better tailor their work schedule so that they can be better prepared to meet their personal and professional commitments. The Guide is intended to encourage managers to show leadership and creativity by considering and promoting different working arrangements to meet specific operational requirements. Studies consistently demonstrate that providing flexibility in the workplace to accommodate work, personal and family needs results in measurable benefits to an organization. Peckham has a written policy on remote work and an unwritten practice that promotes and encourages work life balance through flexible work hours. We've been deemed a great place to work for about six years now. I think that comes from the way we approach work. We're determined to be a flexible space, right? A flexible workspace. So the practice of that to keep our word is to allow people to come to us with what they need and we try to find the accommodation for that and to be quite honest, with feedback from our work with team members, right? So team members, naturally, people with disabilities need certain accommodations to do their job well. What we saw is that same approach can be used for everybody. If they need something to do their job well, whether that's a schedule adjustment or a certain piece of equipment or software and that helps them thrive at their job and not only be more productive but more loyal to the company too, the let's see if we can do that for everybody, right? So it’s that whole idea of universal design. Whatever we can do for people with barriers works for people without them. Organically that climate crossed over to the staff side to make us an organization who does the best we can to provide whatever our employees, whether they're staff or team members, need to do their job well and to work at Peckham. I think that kind of philosophy is what’s kept us going and has kept bringing good people to us: people who want to stay, who come into the organization and if they don't have that mindset already, they develop it and embrace it. (P127, mid-manager) Peckham does a really good job with recognizing that we're all human and we do have challenges. And sometimes the focus needs to be on what's going on in my personal life, how it's recognizing that sometimes personal life does impact employment. And I think that Peckham does a good job with not being punitive when some of those external things, those life challenges do affect employment. So I think our clients recognize that for the most part and I think that it helps them to be successful in the end. ( P107, direct service) 102 4.0 Leadership: The Business Planning Process “I haven't found any other place that really kind of replicates that commitment to mission and values, all while focusing on business excellence”(P111, executive staff). The organization engages in an intentionally created quarterly business plan review that actively communicates the mission, vision, and goals to staff throughout the organization. The energy and communication expended on this process prompts a positive preoccupation with quality outcomes and continuous improvement. It embraces data and program evaluation to help guide decision- making, strategic planning and performance assessment throughout the organization. Started in the 1980’s, this quarterly business plan review and associated sharing practices across the organization have a long history as an accountability tool that also recognizes the successes and achievements across the organization. One leader recommended the business planning process as a best practice for client outcomes because it is at the foundation of a successful organization that provides long term stable employment and diverse job and career options based on client centered intentional decisions. The business planning process was repeatedly identified by managers as a way to assure a balance between the mission and human services emphasis with the business operations emphasis. There is a connectivity to how we do business planning, where people understand what they are working toward and how that contributes to the overall business objectives and mission-related objectives. They're not just financial measures. We're thinking about how to serve clients and serve our community, our broader community, and how to partner with organizations and employers to maximize success. (P122, executive staff) Business planning processes are a real strength of our organization in how we are able to connect mission related objectives and business objectives into a comprehensive plan. That is communicated clearly to the different pieces of the organization. So different human services programs have goals that relate to the broader goals within our business plan. Business lines and, operational teams have goals that relate to the broader goals in our business plan each year. (P124, supervisor) 103 One aspect of the business planning process shared by managers and non-managers alike was the organization wide sharing of achievements and results on a quarterly basis. Communication about mission focused achievements is routinely shared and required. The business planning process in this aspect was described as celebratory, inclusive, and brilliant! Indeed, the culture in the context of this process is described as celebratory. Part of the tradition, history and current culture involves formal and informal story telling. Story telling is not only viewed as marketing but a way to have fun and share positivity. Story telling was also used in the context of staff onboarding techniques and inculcating the values of the organization. As participants shared, There's kind of a celebration and a joy at Peckham where we're storytellers, we like to highlight small successes and big successes, to do that formally through storytelling sessions where we highlight videos and stories, the things that staff are doing and things that team members are doing and clients are doing. So people get a lot of joy out of being able to share those stories no matter how big or small that success was. All of the staff join in that celebration. (P124, supervisor) Transparency is a very core value of the organization. So being aware of how decisions are being made, and what decisions are being made, the emphasis on wellness, the amount of information and support that we get. It really stands out to me. ( P110, direct services) When I first came to Peckham what I was most struck by was that I've worked in several nonprofits where they have stated values and it was maybe brought up once a year. But, in Peckham the values are I feel much more lived and much more reinforced. We don't just talk about it once a year. We have big get ‘togethers’ every quarter to discuss how we're doing as a company and that also benefits transparency. (P106, direct service) As the organization has grown in size, staff continue to be encouraged to participate in the actual business planning process as an educational tool and as a communication and learning vehicle. Staff are also encouraged to become adept with Workday and use this as a vehicle for communication across the organization. Badges of acknowledgment are awarded to peers through an electronic option in Workday, the newer on‑demand financial management and 104 human capital management software system used at Peckham. Workday was frequently identified as an important technology tool, an HR and management and tracking system and as an easy way to communicate across the organization. In addition to case management, Workday provides a means to acknowledge and recognize others in an inclusive way. 5.0 The Right Stuff: Investing in Talent The organization is committed to hiring, training, and retaining qualified personnel to meet organizational goals. A strengths based HR team is invested in talent acquisition and talent development, representing the time period between hire and retire. Talent Acquisition. Talent considers quality and qualifications. Applicants for VSS positions that have a master’s degree in rehabilitation counseling are prioritized. Internships of master’s level students from nearby Michigan State University, home of the number one rated rehabilitation counseling program in the US (US News and World Reports, 2020) provide a mutually beneficial relationship between intern and organization. Internships often result in offers of employment and create a pipeline for acquisition. Acquisition and subsequent organizational career development efforts include diversity as a necessary component. A relatively recent initiative is being launched at Peckham to determine how to increase the acquisition and the visibility of diversity at higher levels within the organization. Talent Development and Training. Newly hired staff engage in an extensive onboarding process designed to teach the job but just as importantly share the commitment to and engage with the mission. Once on the job, staff are engaged in continuous learning and staff development. Continuous learning is necessary for organizations to have the “ability to meet the changing needs in rehabilitation service delivery” (Schultz, 2007). Training is not limited to job 105 related learning. Staff are encouraged to consider potential advancement needs and personal growth. We recently did a series that was provided by the state of Michigan on trauma, informed care, and specifically the adverse childhood events survey information. A big part of that was talking about self-care and because it resonated so strongly with our staff, we’re rolling that out as a separate module to all staff in a variety of different ways over the next several months. It is so critically important to be able to make time and be aware of the need for self-care, especially in a mission based organization where you're providing services to others. (P115, executive staff ) There is strong internal support for promoting from within and recently an internal job shadowing program was implemented. There is also an internal and external leadership development program available to staff. The solid commitment to talent acquisition and talent development supports commitment to talent retention. Talent Retention. Peckham is invested in retaining qualified and committed staff. Participants who identified as being authentically aligned with the core values and mission also identified as being satisfied, experiencing wellbeing and likely to remain with the organization. One mid manager spoke to the core values: “they speak to not what we do but who we are. Our belief is we should hire and fire people according to how we meet and live our core values. If you are not a person that can exist comfortably within the core values, then you're not a good fit for our organization” (P104). ‘Dave’ as an HR person, he really lived and breathed the culture. He wanted people to have a good experience while they were working. He wanted people to thrive. He wanted Peckham to feel like family. He carried that throughout his policies and throughout everything he developed because people need to feel like they want to work here. He would go to the conferences, HR conferences and download and bring all kinds of information back. This is what people are doing, and this is why we need to have a flexible workspace because we have a lot of millennials and they're not going to stay with us if they don't get this right and they don't care about money, they care about social righteousness. (P127, mid manager) 106 Alignment with the Mission. Matching an individual's capabilities, interests and needs with corresponding job demands and characteristics is an established procedure known as job match within vocational rehabilitation. There is a comparable alignment with individual staff temperament and satisfaction with the work. For purposes of this study, this quality is identified as staff alignment and describes stated satisfaction with the work, with the mission and organizational demands. Terminology used by participants includes service driven, mission driven, dedicated, best version of myself, caring people, helping others. This aspect of the compassionate personality is in evidence. One organizational leader described valuing and treating staff as a precious commodity that cannot be replenished. Staff reported feeling valued and described personal alignment with the mission and values of the organization. “We're here because we have a deep connection to the team member on the work floor,” ( P110, direct service staff). Everyone's committed to the mission and committed to be, to what Peckham stands for and they have a passion for their job. I haven't heard anyone, at least in my experience, that's here just for a paycheck. They're here because they're wanting to help individuals or they want to make someone else’s life better or help them to get to that next step. Just passion within the employees to fulfill the mission. (P108, direct service) I don't know if it's chicken or egg, right? It fits, right? My values are shaping theirs or their values are shaping mine, but they're definitely becoming more in alignment and a lot of that to me is that authenticity, that as employees, you're not trying to fit some Peckham mold. That's the beauty of it, it's not a mold, right? They get this, the Peckham ingredients and you get to make the dish the way that you want. (P 111, executive staff) Staff Recognition. “Recognition is a good human resources practice strategically linked with the organization's direction and priorities and used to shape the organization's culture and values through positive reinforcement of desired practices, actions and results” (Treasury Board of Canada Secretariat, 2004, Appendix D. Departmental Recognition Guidelines, Sect. 3 as cited by Lagerstrom, 2005). Most employees want to do a good job. The work ethic in America 107 remains strong, and if employees are given clear expectations and appropriate rewards, they will accomplish their objectives. But when no one cares, trust diminishes and morale erodes. Employees place a high value on personalized, specific, and instant social rewards such as attention, recognition, and sincere appreciation (Luthans, 2000). Notably, one Peckham leader identified appreciation and feeling appreciated as the foundation of a definition of wellbeing. Staff members are recognized for innovative work and ideas while policy aims to ensure that the contributions made by employees are acknowledged through informal and formal ways. 6. 0 Organizational Structure: The Mission Initiatives Team A metaphor is used to describe the impact of this structural team based initiative: I feel the commitment to the mission has always been very strong. Sometimes though, you might feel like when you're working here, we're traveling together in a ship, sometimes the ship is leaning a little bit to one side. Sometimes the ship is leaning a little bit to the other side. Here is really mission focused work and here we really seem to be focused on making these businesses work and be sustainable and still, we're always righting ourselves. I feel like creating this team (the Mission Initiatives Team) was a real stabilizer. ( P101, supervisor) Discussing organizational structure, Chandler’s seminal work, Strategy and Structure (1962) described a functional structure as centrally organized around activities and functions and linked to strategies for growth, process, systems and people. Structure has been identified as one of the most important influences on both processes and outcomes in teams and concerns the specialization of tasks, hierarchical arrangements, as well as formalization of objectives and procedures. Peckham uses team based structures that are organized around specific functions and concern the specialization of tasks, hierarchical arrangements, and formalization of objectives and procedures. An innovative entity formalized in May 2019 is the Mission Initiatives Team. The team draws membership from across different levels of the organization, is led by a Vice President and has as its purpose the enhancement of the team member experience from beginning 108 to end. The actual goals of the team are to address the root causes and difficult problems still to be solved. It expands innovation in the context of the mission and actively pilots new projects to see what is successful. The mission initiatives team focuses on engagement with the community and how to onboard employees. In addition to pilots, such as revising the corrective action system, additional staff, training, support and behavioral health services can be provided. With a VP overseeing the function, the Director of Mission Initiatives works with the Mission Initiatives Team membership. Membership includes the Director of Workforce Planning, responsible for recruitment and hiring of team members into paid job training programs, supporting contract eligibility across the business lines and upward mobility, two Career Pathways staff also responsible for team member training that is not business line specific, the Human Services quality manager who provides data analysis and a range of evaluation services, a Resource Development Manager responsible for obtaining grants and funding and networking and the Full time Advocacy Coordinator, a position funded through the Peckham Foundation. Each of the positions was changed in order to support more time or ‘bandwidth’ to contribute to the assignment. I do think it's a promising practice, it's really very specifically dedicating space to improving the services and in doing it in a way that's data driven, that's using other evidence based or best practice solutions that we can find. The real intention behind the formation of this team, and most of the positions already existed before, we had a recruiting group, we had a team member training group and we had all of those; The reason they're all pulled together is we wanted to be able to have a space, a dedicated space and resources and bandwidth. As an organization, we were constantly trying to improve. We've been trying to work on some of these issues in the past but when you're asking operations or human services folks that have full caseloads and full time jobs just to make sure that garments get out the door or the calls get answered or whatever it is, you don't necessarily have the bandwidth to sit down and say, well, why do we lose a certain group of people in the first 60 or 90 days. (P115, executive staff) 109 Advocacy. Among other innovative team based concentrations are the self-advocacy teams at each of the locations. The Advocacy Coordinator works closely with the teams to support their self-determination, empowerment and choices. Especially in this context, communication is viewed as critically important between the Mission Initiatives team and the Advocacy teams to assure transparency, awareness and understanding of policy direction. Pawlak and Flynn (1990) found that a majority of nonprofit executive directors identified positive consequences for their agency as a result of their advocacy activities, which included representation dimensions of advocacy (testifying at public hearings, etc.), as well as mobilization dimensions (encouraging clients and stakeholders to contact elected officials, etc.). Outcomes included favorable funding decisions, the ability to defend against budget cuts, the adoption of desired legislation or ordinances, and passage of favorable administrative rules that pertain to their agencies or client populations (Pawlak and Flynn 1990). The Foundation funded Advocacy Coordinator position was viewed as instrumental to client and organizational success by participants. Structure and Communication: Differing perspectives. Peckham’s relatively flat organizational structure supports regular conversations at all levels, and the quest to involve, engage and include all staff in formal and informal communication continues. The recognition of communication as a vehicle to not only share critical organizational information but to build a cohesive strong stable organization is a serious endeavor and has resulted in formal efforts to assure communication throughout the agency and its locations. In addition to a conscious effort at formal communication, many respondents cited the open-door policy of management, the comfort level associated with sharing ideas, casual conversations with superiors and the experience of open communication. Communication is a critical component of organizational 110 structure. While many participants praised the amount, quality and transparency of communication, some identified the need for improved and increased communication. It's the constant fine tune of how to communicate, what to communicate, when to communicate. And I'm not saying that we do a bad job, but I'm just saying that in their communication there's always room to improve. (P104, direct service staff) As the organization has grown and added locations, the ability to engage in informal, in person communication is not easily addressed and the pandemic has increased the isolation of offsite staff although technology is used routinely for communication. The CEO especially has been great at frequent open communication. It has been so critical during Covid to have a leader who is regularly communicating with staff at all levels about what's happening and when changes need to happen. Answering questions openly, in a very transparent way that has been very helpful for me and everybody else that works here during a really scary time. She's been holding regular town hall style Q and A sessions virtually. She started as CEO at a difficult time because Covid hit right after and she started doing these town hall style virtual meetings where people can ask questions live and she answers questions live and the whole leadership team is answering questions the best they can live. That really has helped people feel not only connected to her and understand her vision, but also feel security. I think we have always had strong communication, but I've just seen in her especially her commitment during this crisis as a real important strength and something that's helped me feel even more strongly supported. (P101, mid manager) Another participant recognized the complexity of communication and diversity: One of the areas we need to improve is how we communicate with our team members, our clients. And it's complicated by culture differences, language differences, differing abilities. There is no one method that's going to reach everyone in the same way and that’s not so different than other organizations, but in this environment, it can be very, very difficult sometimes. I'll give you an example. We're dealing with coronavirus, right? And so sometimes you have to communicate very time sensitive things that people need to know. There's no one mechanism that our team members can identify as the one official source of Peckham truth. (P100, executive staff) The organization identifies and accepts input and feedback, especially from team members as a critical communication need. There is a commitment to gathering input and using team member contributions to guide decisions. 111 Service Delivery Practices Table 10: Service Delivery Practices, Description and Code Contributors Service Delivery Practices Specialized Personnel VSS Targeted Training Stackable Credentials iStrive AVAIL Team Member Health and Wellness Description Contributors The Vocational Services Specialist is a position that functions as a case manager for team members acting as a conduit between business and human services An intentional organizationally directed strategy to provide specific work training targeted at increasing job providing qualifications for upward mobility and moving into a career progression A targeted work readiness program that uses cognitive behavioral therapy techniques in concert with structured training to address long term effects of unemployment and build work attachment An app based function used to decrease stigma in the workplace through using an electronic job coach function Organizational policies and practices that promote and provide a broad range of wellness and preventions supports to team members VSS Client Centered Balance with Organizational Demands Investment in People Adherence to Values Upward Mobility Career Goal Investment in People Continuous Improvement Promising Practices Training Interventions Innovation Problem Solving Community Placement Holistic Innovation Well Being Individual Adherence to Values of Organization Positive Psychology 112 Table 10 identifies the research study identified service delivery practices and provides a working definition based on the primary code contributors to the individual practices. Five primary service delivery practices were identified. 1.1 Personnel: Vocational Services Specialists (VSS) A position that is inherently unique to community rehabilitation organizations is the Vocational Services Specialist. This position has been described as an inhouse counselor for the team member and is responsible for providing a variety of resources and supports to the team member. The VSS position has a caseload that typically is about 80 team members but has declined during the pandemic to about 60 team members. The VSS acts as a middleman, an ombudsmen in some respects, who is responsible for resolving disputes between the operational business demands and the human service demands of the organization when those come into conflict at the level of the team member. The role of the VSS is one that does not typically exist in for profit businesses and corporations. Descriptions shared by VSS staff offer insight into the role. I think the big piece that makes Peckham really successful is the VSS role. Honestly, employers don't have that, and I know you got a brief introduction to what we do, but I always joke around that we're the dumping ground, right? If it needs to get done, it gets assigned to us. So we're benefit specialists. We're leave specialists. We're crisis intervention. If something's going on pretty much the response is always, "Go to your VSS." The fact that there is a resource for team members is what helps them be more successful. Instead of having to navigate a complicated HR system where they're like, "Oh, I got to go talk to finance. Oh, I got to go find this person. I have to find this person." It's, "Okay, I can go to this one person who's either going to direct me to the person I need to talk to immediately or who is going to be that intermediary. (P107, direct service staff) VSS staff describe themselves: “I'm a vocational services specialist. So I'm kind of like the case worker who works with people with disabilities and ensures that they are successful in work. If they have goals of going outside of Peckham, I work with them on their resume. I can work with them on applying for government assistance. I can work with them with whatever they’re struggling with at work. (P120, direct service staff) 113 An earlier unpublished study by this researcher investigating a smaller Michigan CRO found a similar need for a “go to ‘person known as a success coach that acts as a problem solver/resource person and personal advocate as needed. Technically an employer funded position and function, the success coach is a popular figure and is on the premises meeting with individual workers on a regular basis. The success coach is knowledgeable about community (and in house) options and often provides referrals, addresses budgeting, housing, transportation and responds to specific issues with specific responses. This results in continued maintenance of employment for workers at the CRO. VSS perform similar functions in addressing the team member needs holistically. 2.1 Targeted Training, Stackable Credentials and Upward Mobility “A big piece of the mission is getting people into the employment pipeline and focusing on skill development, asset attainment and providing pathways to upward mobility through skill attainment.” (P122, executive staff). Upward mobility is the capacity or facility for rising to a higher social or economic position. Peckham’s formal and informal program of upward mobility is designed to give team members an opportunity to advance to more challenging, higher paying positions either within or external to the organization. That's kind of a passion area of mine, it isn't enough to get a person with a disability a job, it's a job with another step. And that might not work for everyone but what we need to do is just make sure that whatever job we are training someone in, that we're also giving them the skills to learn the next job and the next job and the next job. That way we can really, truly break that link between poverty and disability by always making sure that whatever we're doing, as a business, we're thinking about the jobs we do have in terms of how people step up from one to another. In some cases that's been taking two jobs and breaking them apart and making an entry level step, the next step up. The formal piece of this was not always research based. While we have always talked about upward mobility probably for the last five or six years, we've actually started to measure and benchmark this. (P129, executive staff) 114 Yes, we have lots of entry-level employment that people can jump into. But we also have pathways to develop real career skills and marketable skills that they can go, they can literally take anywhere. So, you'd start as a sewer and then you can move into a supply chain division or the call center and get more than a living wage. More than that, you actually develop a more marketable skill, whether it's in the IT sector or the supply chain sector. (P122, executive staff) One way to improve upward mobility and career advancement for team members is through the use of a technique described as targeted training intervention. The training intervention focuses on a specific barrier that is interfering with moving from one job into the next higher level. The organization uses its business planning processes to determine future contract position needs. It engages in a very deliberate process of identifying the numbers of positions projected, the number of people interested, the specific barriers interfering and a process of engaging in problem solving strategies to address these barriers. The organization develops a formal targeted training program for workers who are interested and potentially have the capacity to succeed. An example of this is the Intensive English Language Training Program that was offered during work hours one hour a day for 8 weeks to 75 individuals. These workers originally tested between third and fifth grade reading levels. The organization projected a need for Level 3 sewers. There are 1-5 sewer Levels, and the Level 3 position requires a higher reading level and communication and verbal skills. Pretests were conducted and ongoing evaluations occurred during training. Many have met the certification process requirements. A promotion into the Level 3 position means approximately a 20% increase in wages and upward mobility for these workers. So targeted training interventions, that focus on those specific barriers, whether it's a disability related barrier or something like that, there's got to be targeted training interventions and that means you have to know your people well. And you also have to look at, “how do we make their life better at Peckham, because that makes their life better at Peckham, but it also makes their life better overall, it eliminates a barrier for them to leave Peckham. Because now, now that their English language skill has gone up, there's a 115 lot more options for community employment for those individuals as well. (P122, executive staff) Targeted training is one aspect of the organization’s strategy to build marketability of workers through stackable credentials. The Department of Labor (2019) defines stackable credentials as part of a sequence of credentials accumulated over time to build up an individual’s qualifications to help them move along a career pathway or up a career ladder to potentially different and higher paying jobs. Credit is awarded for a range of education, training, and workplace learning and skill building experiences that "stack," and align toward employer needs. At Peckham, this stackable credential program helps team members develop the skills they need to advance on the job and earn credentials through engaging in short term vocational training. Stackable credentials are a framework for organizing skills that position the team member to achieve upward mobility within the organization or external to the organization. 3.1 iStrive Addressing barriers to successful employment often entails providing transportation, resolving childcare and solving other tangible problems. Addressing the root cause of why a person is unsuccessful time after time in the workplace in the face of strong personal motivation to succeed is a critical need in vocational rehabilitation and requires an evidence-based intervention. While cognitive behavioral therapy has been used successfully as a therapeutic technique, it’s efficacy in job maintenance behavior is less researched. The promise of an effective intervention that may change maladaptive behavior in the workplace is an exciting one to contemplate. iStrive as implemented by Peckham is modeled upon a Cognitive Behavioral Intervention (CBI) program customized by the University of Cincinnati. The curriculum integrates cognitive- behavioral interventions with motivational enhancement to attach individuals successfully to the 116 workforce. Heavy emphasis is placed on skill-building activities to assist with cognitive, social, emotional, and coping skill development for the work environment. Peckham is the first organization in the country to implement this specialized CBI curriculum. “It’s very useful for anyone who’s not exactly clear on (how to handle) different situations, and different emotions that you don’t otherwise express. Also, it’s a good place to practice problem solving,” said a participant. “The impact of the iStrive program has been an increase of confidence for the participants and self-awareness for their areas of improvement. Participants build trust within the group, resulting in holding each other accountable for growth. There have been positive changes for individual employment and personal relationships,” said the cognitive behavioral interventions specialist working with team members. Peckham launched iStrive, a targeted work readiness program that helps address the long- term effects of structural unemployment. The Mott Foundation ’s grant award of nearly $300,000 supported Peckham’s ability to offer this program to team members at the Flint Township facility and to pay them wages for their participation in the program which occurs during regularly scheduled work hours. According to a study interviewee, The current CEO has always been a champion of these types of ideas: tools and programs worth trying with some of the individuals that we serve that have the most difficulty attaching to work. They have a desire to work but some clients over and over again, have difficulty retaining employment. We've served them many times. Being able to really develop coping skills and behaviors and identify the reasons why they want to stick with work even when it's hard, has been a challenge for some of these more difficult clients that we serve. (P 101, mid manager) An associated emerging practice related to the implementation of cognitive behavioral interventions is the current review of attendance policies and attempts to change the paradigm to encourage greater job attachment and thus attendance. The significance of attendance to job maintenance is foundational. Once tangible issues such as transportation or family support have 117 been addressed, there must be motivation and regular attendance to maintain a job. There is an authentic need voiced by participants to understand job attachment and the value of work. One participant discussed the importance of the Peckham federal work contracts that support Veterans and how interpreting work as supporting Veterans is a motivator for many. The organization believes that building job attachment is linked to work attendance. The strict policy of termination after three no shows has been relaxed, however, developing a new policy that ultimately is successful in changing the behavior is currently in development. The impetus for this change was the recognition that implementation of the attendance policy was not resulting in desired outcomes for team members and thus a decision to change it was made. A participant described it as “Rather than saying, how can I get out of work tomorrow, what do I have to do to make sure I can get to work tomorrow?” ( P122, executive staff). This emerging practice may be viewed as reflecting a culture of continuous improvement that addresses the health and wellbeing of the individual with the organization often reacting with an innovative response. 4.1 AVAIL According to the AVAIL website, avail® is a mobile program launched in 2017. The application avail® acts as a personal teaching assistant for students with cognitive disabilities and varied learning needs, providing them with discreet, personalized content at the touch of a button. It combines applied behavioral analysis (ABA), technology and evidence-based interventions to deliver Individual Education Plans (IEP), enables skill development and mastery of Pre-Employment Transition Services (Pre-ETS) and offers virtual supports in a variety of domains. Identifying a 30 % improvement rate and 60% increase in independence, AVAIL identifies itself as an evidence based intervention in line with best practice guideline and the achievement of data-driven outcomes. Peckham is initially interested in determining if the 118 service is applicable to the provision of job coaching and has interacted with MSU to coordinate the evaluation of the program. This is a pilot of the Mission Initiatives Team. 5.1 Health and Wellness: Investing in Team Members There is an intentional focus on promoting health and wellness. This long term practice attempts to address different aspects of the wellness experience and team members are empowered to engage in activities viewed as personally important. There is an Employee Assistance Program and there are meditation classes. One popular contribution to team member health is the fresh and free fruit that is available on a daily basis. There are workout facilities and showers in virtually all locations. There are continuous training programs offered ranging from financial and budgeting curriculums to cooking healthy foods to English as a second language. There are also financial incentives offered for healthy lifestyle choices. In fact, Peckham has offered health care insurance to its team members for many years, a groundbreaking practice and still unusual within CROs as shared by an active CARF Surveyor study participant. We spend a lot of effort on happiness and wellness and running classes to teach you how to eat better foods. Here's how you should cook things where you're not using grease and it's better for you. We spend a lot of time on those and a lot of those roll up into our mission, our mission incentives( P103). We finally started being able to get back into our wellbeing classes, which is definitely something that's really appreciated and embraced by not only the team members, but the staff. Literally this morning I had to go and get set up for our meditation class. It was a small group, only about five people in the meditation class, but you can see how much it benefits individuals. Especially team members that deal with certain types of disabilities. (P110, direct service staff) It is important for health care practitioners to provide support for their patients’ autonomy, competence, and relatedness in the context of vocational rehabilitation, as doing so is associated with increases in patients’ autonomous motivation, perceived competence, and psychosocial outcomes (Farholm, et al,2017). The role of the VSS is important in encouraging and promoting autonomy and competence of team members. There are numerous options and 119 choices for engaging in activities designed to promote better health, less stress and meet whole person needs. These may include for example, a program known as Art from the Heart which supports anyone who is interested in painting, drawing or creating art. The art is showcased in one or more annual exhibitions and available for purchase. A highlight is the annual calendar containing original work of team members. Summary of Organizational and Service Delivery Practices The organizational and service delivery practices foster a culture of high expectations and pride in the accomplishment of reaching data driven goals. The organization actively uses data and technology to develop, establish and monitor innovative programs and services. The organization is responsive to the community and establishes strong community partnerships with the employer community, academic institutions, funding resources and other partners. Input especially from team members and families is actively obtained and acted upon through various internal mechanisms. 120 CHAPTER FIVE DISCUSSION This chapter presents responses to the research questions, discussion and conclusions of the present study. A summary of the interpretation of the findings that emerged from the data is provided with a focus on major themes and their implications. The limitations of the study are addressed. Recommendations for educators and identification of areas of future research are described emphasizing the needs of practitioners. Recommendations for community rehabilitation organizations, the vocational rehabilitation system and employers are presented. Community rehabilitation organizations that operate as a social enterprise continue to provide services to individuals with disabilities leading to employment outcomes. As a service provider and partner to the federal vocational rehabilitation system, CROs must address barriers, create and improve available tools and engage in progress through involvement in and commitment to evidence-based practices that result in quality outcomes for individuals with disabilities. This study offered the opportunity to identify the presence of emerging and promising practices within a high-performing community rehabilitation organization that serves and employs persons with disabilities. It examined the contributions of a healthy workplace, leadership, culture and organizational and service delivery practices within the context of a social enterprise and it investigated the processes that facilitate the implementation of promising practices and innovation. By linking model-driven interventions to the practical concerns of rehabilitation professionals and delivery of services to people with disabilities, the application of evidence to practice will become increasingly apparent to rehabilitation practitioners and researchers alike (Bellini & Rumrill, 2002). 121 Addressing the Research Questions In response to the two research questions, the study identified effective practices, policy and procedures that assist individuals with disabilities achieve employment outcomes; these practices, policies and procedures resulted in an environment that promotes innovation and high performance. The first research question was: What are the best models of effective practice, policy and procedures within a successful community rehabilitation organization that assist individuals with disabilities achieve employment outcomes? The best models within a successful CRO leading to high performance outcomes are a humanistic culture, transformational leadership, innovation and a healthy workplace. Consistent with organizational development principles and leadership style are the intentional design and growth of a nonprofit agency operating as a social enterprise with a sound business model, mission, values, operational plan, accountability, qualified staff, and team-based management. The results of the semi structured interview data yielded rich narratives and identified effective evidence based practices which resulted in positive outcomes for team members and clients receiving services. The practices sorted into organizational policies and practices and service delivery practices. The six specific organizational practices were: (1) The Mission Engagement Experience, an organization wide practice that incentivizes and internalizes mission driven behavior by staff ; (2) Mini Grants, a funding allotment available and awarded to any staff member to support team member and organizational goals in response to a successful funding request; (3) Sanctioned flexible work schedules; (4) Consistent application of the Business Planning Process, a quarterly review of the agreed upon annual goals and a celebration of achievement shared by all staff with systemic integration of technology; (5) Talent Investment, 122 the hiring, development and maintenance of a well-qualified, diverse, highly trained, appreciated, workforce that is in good alignment with the mission and values of the organization and (6) The Mission Initiatives Team, a cross functional team charged with solving the difficult and root cause problems impacting individuals with disabilities in the workplace through piloting new practices, engaging with internal self-advocacy teams and improving staff communication. The service delivery practices were: (2.1) Vocational Services Specialists, a position typically reserved to CROs that provides guidance, assistance and support to the team member and acts as a navigator between the business and human services aspects when conflicts arise; (2.2) Targeted Training and Stackable Credentials, an intentional training intervention that builds marketable skills and advances a worker’s resume of credentialed learning; (2.3) iStrive, a training intervention based on cognitive behavioral therapy to address job attachment and job maintenance; (2.4) AVAIL, a mobile app that acts as a personal teaching assistant for persons with learning needs that can be potentially used for successful job coaching; (2.5) Holistic investment in team members toward positive overall individual health and wellness. These evidence based effective policies, practices and procedures in a community rehabilitation organization constitute a model for successful service delivery that achieves satisfactory outcomes and upward mobility for persons with disabilities. The model is a holistic approach to individual and organizational wellbeing using intentional strategies that prioritize incentivizing the behavior of team members and staff in the achievement of desirable outcomes. The second research question was: Do the models of effective practice, policy and procedures result in the creation of an environment that promotes innovation and high performance? 123 The findings clearly demonstrated an environment characterized by high performance and innovation in the achievement of its mission and goals. Specific themes that informed this finding were (3.1) The central emphasis and primary role of the mission and values within the social enterprise while adeptly balancing the business needs of the organization (3.2) A holistic emphasis on the wellbeing of all employees and a healthy, welcoming, positive workplace (3.3) leadership transition and leadership characteristics of authenticity, intentionality, accountability, and accessibility supporting a culture and atmosphere of continuous improvement (3.4) the people; whether articulated as family, other directed, trust and respect, being valued, this belief in the value and contributions of all employees was integral to the ongoing practice of innovation and emerging evidence based practices. Innovation is intertwined with a culture of continuous improvement and premised on a safe environment that rewards risk taking and people centered behaviors. The findings clearly showed that within a social enterprise environment, the likelihood of engaging in innovative practices is influenced by the organization in terms of the mission, culture, leadership, structure, staff development and associated characteristics of intentionality, investment, wellness and client-centered philosophy and services. These observations were validated at all levels of the organization. At its core, an exemplary CRO succeeds through a humanistic culture, transformational leadership, innovation and a healthy workplace in helping workers with disabilities achieve upward mobility. Summary of Major Study Findings A foundational framework for high performance and innovation within a CRO can be conceptualized as incorporating the influencing aspects of leadership, culture, and mission. Unifying these aspects are an intentional, inclusive, operational approach to (1) continuous 124 improvement and growth (2) accountability and balance and (3) holistic health and well-being of all employees. Evidence based practices in use at the organizational level are the Mission Engagement Experience (MEE), the availability of mini grants, flexible work schedules, quarterly business planning processes, inclusive celebratory achievement practices, staff training and investment and structural components with team-based management. These intentional inclusive practices culminate in an organizational culture that is experienced as positive, authentic, caring and continuously improving. Providing employees with a sense of control over their work, creating a positive social climate that demonstrates respect for people, having supportive management, and creating opportunities for learning are valued leadership and organizational practices. Evidence based practices at the service delivery level are positions and mechanisms that address a range of worker needs, tools and strategies that promote holistic wellness, Vocational Service Staff, targeted training for upward mobility, Dream to Drive, I-Strive and AVAIL. Evidence based service delivery practices are associated with evidence based organizational practices and are complementary to each other. These intentional inclusive practices culminate in the achievement of positive performance outcomes achieved through mission driven behavior of staff and the wellbeing of team members. Leadership and Leadership Transition Leadership is one of the most comprehensively researched social influence processes in the behavioral sciences. This is because the success of all economic, political, and organizational systems depends on the effective and efficient guidance of the leaders of these systems (Barrow 1977). A critical factor to understanding the success of an organization, then, is to study its leaders. This study found that leadership is intentional, visionary and achievement oriented in 125 creating and establishing a results-focused environment which leads to the implementation of evidence based, innovative promising and emerging practices. Beyond the identification of specific service delivery practices, the leadership team effectively employs its own individual strengths and the strengths of others in the development and maintenance of a high performing organization. Decisions are routinely made in the lens of the mission with best interests and impacts upon team members at the core. Contributing to the influence of the leadership team is its shared history reflected by staff longevity with the organization, diversity of strengths, openness to input and trust. With consistent leadership since its founding, the recent changeover of three key organizational leadership roles was a relatively smooth transition given the organizational structure and governance, strategic planning, internal leadership training and mentoring and staff recruitment and retention policies. The organization has promoted three individuals who have an average of 19 years employment longevity with the organization and brought in a fourth individual from the community in a key role. The new leadership team is diverse, possesses individual leadership skills and has a history of engaging in innovation and influencing the culture and performance of the organization. These newer executives have been mentored and supported in career growth and are fully committed to the mission and values of the organization. While leadership can be characterized as transformational, it is transformational in its adherence to the concepts described by Bass (1999) and not necessarily in the service of major culture change. The emphasis on a shared vision to marshal all staff toward improving the experiences and outcomes of persons with disabilities employed or receiving services is implicit within the practice of transformational leadership. Vila-Vázquez (2018) states that transformational leaders inspire a ‘higher purpose’ in follower’s work through acknowledging 126 the meaning and significance of their work. In this respect, the transformational leader acts as a role model who is easy to emulate, believe and trust. This idealized influence (II) factor was evident in the long-term leadership team efforts that implemented a quarterly review of achievements on behalf of the mission. It continues with the regular communication meetings designed to assure staff and team members of the organization’s commitment to the mission and goals with a people first vison in place. Bass identifies inspirational motivation (IM) as the second component of transformational leadership and describes this as the easy-to-understand vision (1985). The use of financial incentivizing in support of the mission, the MEE strategy, is intentional, inclusive and presents an unambiguous easy to understand organizational and shared leadership vision. This practice, already in place for many years, is expected to continue as an evidence-based practice and reflection of leadership stability and transition. According to Bass, this ultimately this leads to increased commitment to the mission since motivation results in increased self-engagement. Because self-worth and self-efficacy are contingent on goal attainment, it would be unlikely for the individual to resist commitment to the vision and mission of the leader (1999). The third transformational leadership factor espoused by Bass is individualized consideration (IC) or the demonstration of genuine concern for the needs and feelings and growth of followers resulting in high degree of trust (1985). This high trust level among leaders and followers supports efficient teams and effective team decision making. The leadership led emphasis on holistic wellbeing for all employees, evidenced support and commitment to flexible work schedules and articulated positive respect for leaders and coworkers supports the existence of this third facet of transformational leadership. Finally intellectual stimulation (IS) represents the leaders’ constant challenges to followers for higher levels of performance and innovation. (Bass, 1985). Many statements shared by participants 127 referenced ‘always wanting to be better, not feeling like we have arrived, sometimes building the airplane as we are flying it, always wanting more for team members’ can be viewed as a response and support for innovation and continuous improvement. Performance outcomes are valued as demonstrated through the identified promising practices in place as well as through a review of the lengthy list of awards garnered such as ‘Best Workplace’ over a period of years (Appendix C). Leadership is a key factor in organizational success and reflects intentionality, accountability and meets the framework for being identified as transformational. Transformational leadership is especially important today given the changes community rehabilitation organizations are currently confronting in the face of widespread social unrest and economic injustices for marginalized populations. A vision that includes discarding subminimum wage is strengthened by an organization’s ability to subsidize the cost of this decision through a Foundation created over twenty years ago. The long term strategic and intentional management decisions and leadership style have created an environment reflective of transformational leadership. You look at all the infighting that's happening and all the criticism that Ability One is coming under, all the criticism that CROs are coming under. I would challenge these critics to take a hard look at what's going on and say hey, listen, focus on innovation. The only way out of this thing is to innovate and for organizations that are choosing to innovate like I feel we are doing. (P122, an executive level staff) Organizational leadership has the power to transform organizations in the service of the mission. It is incumbent upon CROs to innovate and to establish and maintain evidence-based practices if they are to remain viable as organizations serving and employing persons with disabilities. 128 Culture Organizational culture is one of the management tools available to leaders of organizations that can shape employee performance (Giberson et al., 2009; Lincoln, 2010; Sherman et al., 2014). Similar to the way mission shapes innovation, culture shapes performance. Productivity and engagement is higher with a culture that is more respectful and trusting, fosters better communication and provides supportive supervisors ( Lowe, 2003). There are aspects of culture that affect the workplace outcomes. One aspect of culture that appears to be common to performance, leadership and workplace health is inclusion although there is little empirical evidence. Inclusion or more accurately inclusive workplaces are those places where not only employees with disabilities benefit from attention for specific support but all others involved in the same workplace as well (Irvine, 2006). Management style, flexibility, sense of belonging, supervision and teambuilding in different workplaces were mentioned as relevant factors that support an inclusive workplace (Ellenkamp, 2016). A culture of inclusion is linked to a healthy workplace (Lagerstrom, 2005). Several common domains that influence the culture of vocational rehabilitation organizations are leadership, support for innovative and promising practices, partnerships, staff training and development, working alliance and client-centered services (Sherman, et al, 2014). Common domains influencing the community rehabilitation organizations are also leadership, support for innovative and promising practices and staff training and development. In addition the culture is influenced by the mission, autonomy and team collaboration. The Peckham culture is experienced as one that highly values continuous improvement, supports flexibility, balance, wellness and self-care and is comfortable with risk taking. This study found the role and impact of the culture can be described as creating value for the individual through the development and 129 implementation of innovative services that meet the team member or client’s vocational rehabilitation needs. A multiple case study of four high performing states providing effective VR services found that management fosters an agency culture of valuing the mission, valuing the individual and collaboration ( Del Valle, et al., 2014). This study supports those findings acknowledging the extraordinary degree of staff alignment with the mission and values of the organization. A Healthy Workplace: Holistic Health and Well Being The National Quality Institute (NQI) and Health Canada (1998) described elements of a healthy workplace: physical environment, health practices, and social environment and personal resources, defining the social environment as the culture of an organization as experienced by its employees. The collected study data describe the determinants of individual and organizational well-being in a community rehabilitation organization and find that organizational wellbeing or a healthy workplace contributes to successful outcomes. An extraordinary commitment to the overall wellbeing of staff and team members contributes to a positive culture and results in greater staff satisfaction and longevity with an organization. These organizational practices aimed at achieving positive work experiences and positive psychological narratives at work are a key part of promoting healthy organizations (Di Fabio, 2017). The Canadian Policy Research Network (CPRN) survey by Hughes, Lowe, and Schellenberg (2003) found practices valued in a job are: (a) people treating you with respect, (b) good communication among co-workers, (c) allowing work-family balance, (d) people are friendly and helpful, (e) receiving training, and (f) receiving recognition for a job well done. Many of the current study themes relate to the conclusions on their study of employment relationships. They suggested that the strength of individuals’ employment relationships largely 130 reflects the healthy and supportive environment in which they work. Strong employment relationships are the result of having helpful and friendly co-workers, interesting work, being supported in balancing work with personal life, and receiving the resources needed to do the job well ( Lowe, 2010). A healthy workplace incorporates an intentional, inclusive approach to establishing practices that support the person as a whole being. An inclusive approach suggests the potential for bringing the whole self to work, that is, family, personal interests, or other issues related to the dimensions of diversity. Senge (1990) stated that in the learning organization “the boundaries between what is personal and what is organizational are intentionally blurred” (p. 311). This holistic framework views the person as a whole being and attempts to address and integrate the different dimensions of individual wellness such as physical, spiritual, emotional, environment, social, occupational-leisure, intellectual, and environmental dimensions (Sixsmith, et al, 2007). This holistic model has potential application to a holistic understanding of organizational health and wellness. Organizational health and well-being can be described as wellness of the body, mind, and spirit or similarly an integration of the cultural, social, and the physical environment. Wellness is holistic and multi-dimensional, and typically includes physical, emotional, social, intellectual, environmental, and spiritual dimensions. This emphasis on all aspects of health resulting in a holistic approach to wellness is one that offers a model for replication. Integration of the cultural, social, and the physical environment at its core occurs through respect and trust, transformational leadership and commitment to values. Diversity and work/life initiatives can be found at the foundation of the new social contract being negotiated between employers and employees. “The basic outline of the social contract, as it has emerged during the past several years, calls for workers to commit their best 131 contributions and greatest energies to the job in return for interesting work, respectful treatment, developmental opportunities and an environment that responds to individual needs (Fineman, 1999). This social contract is one that has application for many organizations and particularly as a model for organizations that employ persons with disabilities. Innovation We know better. We know better than to provide and support sheltered workshops where we're just basically locking people up in industrial cinder block buildings and industrial parks. So, innovation should always be at the forefront of this field. Creativity or innovation in the Peckham workplace? That’s a daily thing. You know, each and every day we have to practice that creativity and innovation and finding solutions to any individual need across the board and we do and that benefits the team member. (P 122, executive level staff) Innovation means being able to find new solutions quickly and to offer new products and services by considering the dynamics of the environment, through high levels of flexibility. The provision of an innovative culture within an organization will lead to the value and utilization of employee creativity, and the capacity of employees to find new solutions and knowledge and to share them. The community rehabilitation organization studied meets the criteria identified by Kanter (1988) as likely to support innovation. It has integrative structures in place, emphasizes diversity, has multiple structural linkages inside and outside the organization, has intersecting territories, exhibits collective pride and faith in people's talents, and emphasizes collaboration and teamwork. Experimentation is an important aspect of innovation. Organizations must be willing to try new things and to learn from failures. Senge (1990) describes the importance of the prototype stage of the innovation process. This stage enables the innovating group to test ideas, identify problems, and develop the innovation into a dependable working model. It is also a vulnerable stage for any innovation as shortcomings are identified and failures occur. 132 Innovation happens when you've got a space where people are encouraged to collaborate and if it doesn't work, okay, what did you learn from it, right? Not that we want people to fail, we want people to learn. Knowing that, learning happens in the environment. (P 111, an executive level staff) Leaders of successful VR agencies emphasize the use of outcome-focused business models by adopting organizational innovations and harnessing advances in information technologies to deliver outcomes that individuals, communities and society at large value (Sherman et al., 2014, p. 151). In addition to the use of the business planning process, the nonprofit organization’s mission is influential in developing and adopting innovations. Managers in nonprofit institutions do not have wealth maximization as a goal or as a tool for motivating their employees. According to McDonald, the organization’s mission or purpose is quite a powerful motivator with regard to innovation. In turn, innovation has been shown as necessary for an organization to adapt to its ever-changing environment. The manager of a nonprofit organization should therefore place a great deal of emphasis on the organization’s mission (2017). This emphasis on the mission at Peckham is very much in evidence. A participant talks about how much they appreciate that aspect and shares. The mission is living as opposed to just being something that sounds really pretty that somebody posts on a website. Part of that mission is balancing. We have flexibility here, but we're also balancing accountability so that we are successful in preparing people for bigger and better, to move on here or to continue to be successful here. (P110, a direct service level staff ) The data demonstrate an all-encompassing theme consistent with organizational development and leadership style. An extraordinary commitment to building and maintaining a high-performing social enterprise organization was shared through the data. This commitment is demonstrated through intentional establishment, design and maintenance of a stable nonprofit 133 501©3 agency with (a) a distinct business model, mission, vision, values and operating principles; (b) a focus on accountability, performance and achievement; (c) communication and community partnerships; (d) investment in staff training and development; (e) teamwork and qualified personnel; and (f) staff recognition and empowerment. Positionality In qualitative research, the credibility of the research depends on the researcher’s skill set, knowledge, competence and life circumstances (Patton, 2002). Researchers using this type of methodology need to be both researcher and learner to be effective (Glesne, 2011). All researchers are susceptible to bias. As the researcher on this study, I bring a career history of 35 years with the state vocational rehabilitation agency including working as a rehabilitation counselor, central office staff development and training supervisor, project manager, facilities/ community rehabilitation organizations consultant, resource development manager, statewide innovations manager for transition and systems change and subsequently a return to the field as a local field office district manager. My own bias was challenged early on as a rehabilitation counselor who did not expect certain program participants to successfully obtain employment. Being proved wrong made me analyze the beliefs and values impacting my judgement and allowed me to consider the factors that contribute to outcomes and develop a more nuanced perspective. As a manager turned researcher, the desire to understand the why and how continues as does the need to address the data in a valid, reliable objective way. Having been in the field of rehabilitation for so long I am aware of my insider position and the potential for bias. There has been a push pull relationship between many CROs and the VR system because of the roles between payee and payer, the power dynamics, the mutual expectations and the partner versus service provider hats. I believe my awareness of this blend of VR insider/CRO outsider coupled 134 with my experience and analytic skills will support a valid and reliable study. As a quasi-insider to CROs with positive long-term relationships within the field of VR, agreement to engage in the study with the selected organization was anticipated. What was not anticipated: the pandemic! The Covid 19 Pandemic The study design planned to use observation as an additional triangulation technique. I was able to triangulate the data but I was unable to engage in research observation. Because of the shift to online communication and the installation of restrictions impacting in person activities at Peckham, on site observation could not occur nor could interviews be conducted in person at the facility. Contextually, this researcher’s past professional experience and history afforded familiarity with the physical location, the structure and hierarchy of the organization and a working knowledge of non-research focused programs, however ,as stated, onsite observation was not conducted in light of the pandemic restrictions. The pandemic created major changes at the organization as Peckham was designated an essential organization and required to continue its business operations. For the organization, this resulted in losing, even temporarily, a large number of staff who were at high risk and unable to continue working. he original intent of the research was to investigate the exemplary performance of this organization and the data was gathered through means other than observation. Limitations One limitation of a qualitative study is the potential for researcher bias. Researcher bias, also called experimenter bias, is a process where the researcher conducting the research influences the results, in order to portray a certain outcome. Within a qualitative study, the researcher brings his or her own bias based on identity, background, experience, demographics and perspectives. There are several techniques to minimize potential bias. One is awareness on 135 the part of the researcher of the potential for bias. With the emergence of positionality statements as shared above and as an expected part of ongoing research, there is an effort to offer readers a lens through which to interpret and understand the results given the researcher’s sharing of position and acknowledgement of potential bias. Another technique is to engage in a rigorous approach to maintaining consistency of design. This study relied primarily on the investigation of one researcher who practiced rigorous adherence to the protocols . Objectivity was always attempted. The data gathering sessions adhered to a semi structured interview process that elicited information that can be confirmed or rejected through a rigorous data analysis process. Member checking consisted of sharing the study results with representatives of the organization for accuracy and resonance. As well, the coding and theme process adhered to a consistent approach. Following the coding assignment that involved assigning a code or codes to passages of each transcribed interview, transcripts were shared with an outside PhD level educator for verification of the data codes through intercoder agreement. According to Hodkinson, limitations of case studies include the amount of data that defies easy analysis (2001). Rigorous adherence to data analysis procedures is expected to address the data amount limitation but it is correct to believe that it is impossible to comprehensively capture the amount of data engendered through interview process and therefore selective winnowing and interpretation must occur. The study relied heavily on the identification of themes. According to Ryan & Bernard, theme identification does not produce a unique solution (2003). Jehn and Doucet (1996, 1997) used three different discovery techniques on the same set of data, and each produced a different set of themes, however, all three theme sets had intuitive appeal, and all three yielded analytic results that are useful. 136 Implications Fiscal Stability Nonprofit organizations that rely on public funding sources as a revenue source for continuation of operations have been traditionally underfunded. Social enterprise organizations are therefore financially reliant upon the income generated by the business line, often manufacturing and or retail. Continuing stigma and perceptions of workers with disabilities has influenced the types, amount and kind of work as well as pay that is generated by many social enterprises. Financial sustainability is a critically important consideration in the creation, development and maintenance of innovative services. Figure 7 The Cyclical Nature of Successful Innovation Business Planning Process Funding of Innovation Expansion and Profits Investment into the Foundation The Peckham 501(c) 3 non-profit agency’s Foundation provides the capacity to underwrite costs associated with innovation, funding new initiatives and emerging and promising practices. Developing, increasing and diversifying the business lines is within the scope of the business 137 plan process. This offers employment opportunities for career planning and upward mobility and financial stability. The success, diversification and growth of the business lines over time has generated substantial revenues that are invested into the Foundation to support further innovation and growth. The creation and continued funding of the Foundation supports the organizational emphases of continuous improvement, holistic well-being and innovation. Within CROs, the development of comparable strategies to build financial security and sustainability as a means of engaging in continuous improvement and innovation may yield positive results. Leadership While culture shapes performance, leadership shapes the culture. In this case study, the leadership team actively established a mission driven results oriented environment that initiated innovative and promising practices supporting workers with disabilities. This was accomplished through using a strengths based, diverse leadership team that actively used the lens of the mission in everyday decision making. The leadership’s transformational influence was reflected throughout the organization in the phenomenal growth from a small 3 person operation to one of the area’s largest employer. Transformational leadership that is intentional, visionary and achievement oriented is required to establish today’s CRO as a 21st century workplace model that can be used to inform the competitive, integrated large private for-profit workplace. Within the midst of a pandemic, the ongoing upheaval of the heretofore accepted order and what appears to be a collective will to change the status quo for marginalized and oppressed populations, the rehabilitation field is and will be reliant upon strong transformative leadership to create the necessary changes and continue to be relevant. Within the field of rehabilitation, helping employees be authentic and find meaning and significance in the work, supporting them through intentional organizational practices and strengthening their sense of worth and competence will 138 contribute to organizational quality and sustainability. Leadership training and education that emphasizes the characteristics of authenticity, intentionality, accountability, and accessibility can support a culture and atmosphere of continuous improvement in CROs and within VR. Transformative change within VR and within CROs require transformational leadership and vision to meet the upward mobility and career needs of workers with disabilities. A Healthy Workplace A healthy workplace has demonstrated its value as a major contributor to productivity. CROs are well positioned to demonstrate the role of workplace well-being and show private employers how to develop into desirable workplaces that support a culture of wellbeing and create good jobs, hire workers with disabilities and offer viable choices for all workers. A healthy workplace has implications for the employer in the context of productivity as well as the larger community in terms of economic growth. The implications of a healthy workplace for persons with disabilities are immense. When workers feel valued by leadership, by staff and peers and by the organization, everyone benefits. Whether at a CRO or within a for profit workplace, a healthy workplace is intentional, inclusive, humanistic, diminishes stigma and is responsive to needs and input of workers. Workers with disabilities can participate as full members of a healthy workforce. Human Resources or the Talent Function in an organization must engage in innovative practices that establish both symbolically and practically the policies and procedures that contribute to and maintain a healthy workplace. A welcoming, light filled, fully accessible environment demonstrates regard, respect and provides a safe secure space that contributes to an overall sense of holistic health and wellbeing. While not all establishments can engage in creating an extraordinary physical workplace environment, establishments can engage 139 in the kinds of activities that demonstrate regard and respect for individuals and provide a safe space for workers. Evidence Based Practices in Community Rehabilitation Organizations Evidence-based practice can be successfully applied in rehabilitation counseling settings with careful planning and collaboration (Bezyak, Kubota, Rosenthal, 2010). Creating an environment that is research friendly is essential to the implementation of evidence-based practice. Support from management and colleagues, attention to teamwork, and available time to devote to evidence-based practice will contribute to this environment (Winch et al., 2005). Organizations that incorporate techniques similar to those identified in this study: support for and attention to data driven practices at the leadership level, a vehicle such as the Mission Initiatives Team existing within the organizational structure and ‘hyper focused’ on the identification and implementation of evidence based strategies and reliance upon a culture of teamwork, will further the creation of a research friendly environment within CROs and social enterprise organizations. In addition, the involvement of practitioners is critical to the implementation of evidence-based practices. The cooperative working alliance between Michigan State University and Peckham was highlighted within interview data as an important contributor to the successful implementation of evidence based emerging and promising practices, particularly those related to service delivery and enhancing employment outcomes for persons with disabilities. As noted by Leahy et al. (2013), although these practices are highly promising in terms of staff and management perspectives, they may lack empirical support at the level needed to refer to them as evidence-based practices. While some of these practices are well documented, others do not meet the expectations of standardized and manualized interventions or services that would support portability to other community rehabilitation organizations. While there are 140 characteristics of the organization that are endemic to its leadership, longevity, growth and location, there are effective organizational and service delivery policies, practices and procedures that can be adapted and replicated in other CROs. The organizational and service delivery practices, policies and procedures are not generalizable to other CROs based on one case study. Successful transferability and implementation of practices, policies and procedures identified in this study may be associated and improved with targets that have comparable populations, comparable environments and comparable implementation conditions. There are facilitators to the implementation of effective practices within and across organizations. One such facilitator is membership within a professional organization that represents similar social enterprise organizations. In Michigan, there is a strong formal network of paid voluntary membership in the professional association representing these entities. High performing organizations such as the subject of the case study participate in staff development opportunities provided by the professional association and many of the aforementioned practices are shared, translated and executed by members in a locally individualized effective manner. Professional organizations, such as Michigan’s Encompass, a professional association representing CROs, recently offered a training event on Creating a Remote Work Policy. Often the training curriculum is informed by successful practices within successful establishments and training events offer an opportunity for inquiry and sharing of replicable practices. Members may identify and implement the interventions, services and trainings that seem responsive to their perceived needs. The characteristics, programs and practices developed and sustained by this high performing community rehabilitation organization provide a real-world context for effective application and for subsequent research. The identified promising service delivery practices can be developed, shared and individualized to meet the need of the local community and client. 141 The Future Similarly to how state federal VR agencies are being pressured to develop evidence- based practices that lead to competitive employment outcomes for people with disabilities and justify continuing program support, so too are CROs being challenged as never before (Del Valle, et al, 2014). Shaw, Leahy and Catalano (2006) noted that “challenges to the profession of rehabilitation counseling have frequently been cited in the rehabilitation counseling literature.” Persons with disabilities are being increasingly included in lists of protected classes. Social justice movements are recognizing the impact of intersectionality and social oppression of individuals with disabilities within society. The confluences of social change and requirements for equitable treatment under the ADA have brought controversies over the sub-minimum and minimum wage for workers with disabilities to the forefront of the rehabilitation field. Long standing federal programs such as Ability One are being questioned as to their legitimacy in the broader workplace. The implementation of promising organizational and service delivery practices that encourage innovation and creativity in the service of positive outcomes for workers with disabilities is necessary. Leadership strategies that foster innovation, create a positive culture and promote flexibility demonstrate commitment to continuous improvement in the service of the mission. Reinvention or reinterpretation as a community based organization with expertise in addressing the needs of disenfranchised workers and acting as a role model and resource for employers is one viable vision for community rehabilitation. A recommendation for building a strong community volunteer contingent within community rehabilitations organizations to work closely with families to enhance the holistic approach and strengthen overall community inclusion is potentially part of a new vision. The use and promotion of evidence based interventions must be intentional and inclusive. It must be a knowledge sharing 142 strategy adopted by the rehabilitation industry in partnership with the larger employer community to incorporate policies and practices that result in successful outcomes for workers. Directions for Future Research There is a continued need for research specific to CROs given the continuing controversies around the AbilityOne program, proposed legislation to increase the minimum wage and eliminate the sub minimum wage and definitions of a competitive integrated employment. The establishment of equitable practices for marginalized workers at this point in our collective history requires a firm grasp of evidence based practices that obtain quality results. As an employer of workers with disabilities, CROs are positioned to act as a research laboratory for supply side and demand side research and partner with educational establishments toward mutual ends. This study has demonstrated the continuing need for and abilities of master’s level staff in all areas of vocational rehabilitation including CROs. Research that supports the continuing need for qualified staff who are able to build the capacity of CROs to develop, implement and test promising practices and incorporate evidence based practices is crucial and timely. Self-care, wellness and well-being have been introduced into the popular culture, often as a panacea for individually experienced stress. Determining how the concept of holistic individual well-being and holistic organizational well-being contributes to successful performance outcomes within other community rehabilitation organizations and within successful for-profit organizations is needed. Further research into strategies for building a cohesive and authentic culture of company safety that entails financial stability, psychological security and physical wellbeing, especially within companies that strive to employ people with disabilities is recommended. 143 Bridging the gap between the identification of successful evidence-based practices and broad implementation of these practices at an operational level continues to require more inquiry in strategies to accomplish that formidable task. More specifically, investigation into organizational structure as a mediator would be useful particularly as a successful community rehabilitation organization becomes larger through broadening its scope of services and operations over time. An article by Meehan (2019) identifies the advantages of a flat organizational structure as follows: elevates the employees' level of responsibility in the organization; removes excess layers of management and improves the coordination and speed of communication between employees. Fewer levels of management encourage an easier decision-making process among employees. When compared to other community rehabilitation organizations and considering the community which includes a mix of rural and urban, this program is a large organization. Size is a factor that conceivably impacts upon communication and the cultural experience including the structural requirements. (Miner 2002). More investigation into the relationship between organizational structure and size would be useful in understanding associated employee behaviors. This case study was conducted on one organization, albeit an exceptional world class community rehabilitation organization and workplace according to an interpretation of the data documents and informal comparison to other community rehabilitation organizations. Findings may be strengthened if compared to comparable research conducted with other large successful community rehabilitation organizations. The replication of effective organizational and service delivery practices can be implemented by other social enterprise organizations providing vocational rehabilitation services. The organizational practices described are portable to other 144 organizations although there may be some inherent challenges in doing so. To determine whether these promising practices are evidence based practices, additional empirical research is needed. Transferability of health interventions is a complex concept which requires systematic consideration of the primary evidence based research and the target context incorporating a study of the population (P), the intervention (I), the environment (E) and the transfer of the intervention (T) all of which impact upon transferability of the intervention. (Schloemer 7Schroder-Back, 2018). Transferability depends on implementation conditions and on the interaction between the intervention and the context into which it is inserted. Further there is a distinction between generalizability and transferability. Generalizability refers to the perspective of the researcher who makes statements about the extent to which the results of a given study are potentially generalizable to a wider or unspecified population, to another setting, or another time. (Schloemer 7Schroder-Back, 2018). While the current study results are not generalizable to other CROs based on an individual case study, targeted research in individual practices and more case studies are required to determine generalizability and potential for transferability. Rehabilitation Counselor Education has the opportunity to purposefully partner with CROs for in depth continuing education. Adding a stronger emphasis on family support research is timely given CACREP and the nature of individual wellbeing requiring a holistic approach. An informed academic partnership with business and HR within education to address cutting edge disability friendly employer policies is timely. Concluding Remarks This study was necessary to better understand how culture and leadership support high performance and desirable outcomes for persons with disabilities within community rehabilitation organizations. A qualitative study is inherently subjective, however with adherence 145 to rigorous standards, the case study method extends existing knowledge, advances theory and generates new, useful and accurate information in the service of improved practice and outcomes. There is evidence that intangibles that impact upon employee perceptions of individual value, and consistency with core values contributes to a better performing successful organization (Miner 2002). A culture within a community rehabilitation organization that communicates and demonstrates that it values the individual will build a culture of satisfied, valued employees who are able to act innovatively and influence the development and success of the organization. As a high performing community rehabilitation organization, the leadership of Peckham are truly committed to the mission of the organization and have prioritized a “people first” approach. While skilled in traditional organizational functions that include human resource management, marketing, partner and community development, at the core or perhaps more eloquently, at the heart of the organization is its heart, the people that serve and are served. Community rehabilitation organizations that are exceptional performers engage in a conscious planned strategy to create a workplace that respects all individuals. While evidence-based practices are known to improve and achieve successful outcomes for individuals with disabilities, in order to be routinely successful, these practices must be established, developed, implemented and integrated within the framework that comprises the culture of vocational community rehabilitation programs. 146 APPENDICES 147 APPENDIX A Research Participant Information and Consent Form Study Title: An Exploration of the Factors Contributing to High Performance and Best Practices in Vocational Community Rehabilitation Organizations Researcher and Title: Rosanne Renauer, M.S., L.L.P., Doctoral student, Rehabilitation Counseling Education Department: Department of Counseling, Educational Psychology and Special Education, Institution: Michigan State University Contact Information: Rosanne Renauer, renauerr@msu.edu, 517-862-1650 Sponsor: Michael J. Leahy, Ph.D., LPC, CRC, University Distinguished Professor Director, Office of Rehabilitation and Disability Studies, Department of Counseling, Educational Psychology and Special Education, College of Education, Michigan State University Contact Information: Michael Leahy leahym@msu.edu , 517-432-0605 BRIEF SUMMARY You are being asked to participate in a research study. Your participation is voluntary. Researchers are required to provide a consent form to inform you about the research study, to convey that participation is voluntary, to explain risks and benefits of participation including why you might or might not want to participate, and to empower you to make an informed decision. You should feel free to discuss and ask the researcher any questions you may have. You are being asked to participate in a research study of best practices of community rehabilitation organizations. Your participation in this study will take about 1 - 1.5 hours. You will be asked to respond to questions that will be provided to you in advance, during an individual or group interview. There are no known risks to participating in this study. You will not directly benefit from your participation in this study, however, your participation in this study may contribute to the understanding of what factors in community rehabilitation organizations support high performance and use of best practices. PURPOSE OF RESEARCH The purpose of this research study is to investigate the characteristics, including culture, of high performing organizations that work with persons with disabilities and engage in best practices from the perspective of staff/employees. The project will interview one or more staff persons representing three levels of the organization: executive, middle management and direct service staff. The study will collect the responses, synthesize the data collected and develop a qualitative report on the findings. This information has not been previously investigated or obtained from community rehabilitation organizations. 148 WHAT YOU WILL BE ASKED TO DO You will be asked to participate in approximately a one-hour interview. The interview will be recorded with your permission to allow for accurate recall by the researcher. Questions to be discussed will be provided a minimum of one week in advance to allow you an opportunity to read and consider your responses. If you choose to take notes or create a written response in advance, you may do so but this is not required. You are free to skip any questions or refrain from answering any questions you prefer not to answer. Ordinarily I would travel to your location and meet with you on site for the interview, however, due to Corona virus safety considerations, interviews will be conducted via electronic transmission using Zoom or similar technology. POTENTIAL BENEFITS You may not benefit personally from being in this study. In the future, other people might benefit from this study because they may be able to use the information to develop happier and more productive workplaces that support a positive culture for everyone, including persons with disabilities. POTENTIAL RISKS There are no foreseeable risks to you if you participate in this study. PRIVACY AND CONFIDENTIALITY Your signed consent forms are valid for the interviews conducted as part of this study. The signed consent forms will be electronically archived on my personal secure server until the study is completed and deleted after a period of three years. Your written or taped interview responses will not be attributed to you personally. Individual responses and comments, whether verbal, written or taped, will not be shared with anyone other than the researchers. Comments shared in the final report will be anonymously attributed and information will be grouped so that it cannot be attributed back to you personally. The data will be maintained during the project and for a period of 3 years afterwards. YOUR RIGHTS TO PARTICIPATE, SAY NO, OR WITHDRAW You have the right to say no to participate in the research. You can stop at any time after it has already started. There will be no consequences if you stop and you will not be criticized. You will not lose any benefits that you normally receive. COSTS AND COMPENSATION FOR BEING IN THE STUDY There are no costs to you for participating in this study and you will not receive money or any other form of compensation for participating in this study. 149 CONTACT INFORMATION If you have concerns or questions about this study, such as scientific issues, how to do any part of it, or to report an injury, please contact the researcher Rosanne Renauer, renauerr@msu.edu, (517) 355-1838 Office of Rehabilitation and Disability Studies College of Education Michigan State University 620 Farm Lane Room 455 If you have questions or concerns about your role and rights as a research participant, would like to obtain information or offer input, or would like to register a complaint about this study, you may contact, anonymously if you wish, the Michigan State University’s Human Research Protection Program at 517-355-2180, Fax 517-432-4503, or e-mail irb@msu.edu or regular mail at 4000 Collins Rd, Suite 136, Lansing, MI 48910. DOCUMENTATION OF INFORMED CONSENT. Your signature below means that you voluntarily agree to participate in this research study. ________________________________________ Signature _____________________ Date Please read before initialing your consent. A copy of this form is yours to keep. I agree to allow my identity to be disclosed in reports and presentations. Yes No Initials____________ Recording/Audio/videotaping of the interview is required. The interview tapes will be maintained by the researcher in a secure location until the study is completed and for three years afterwards before erased. I agree to allow recording/audiotaping/videotaping of the interview. Yes No Initials____________ 150 APPENDIX B Participant Interview Question Protocol Study Title: An Exploration of the Factors Contributing to High Performance and Best Practices in Vocational Community Rehabilitation Organizations Contact Information: Rosanne Renauer, renauerr@msu.edu, 517-862-1650 Primary Research Questions 1. What are the best models of effective practice, policy and procedures among community rehabilitation organizations that assist individuals with disabilities achieve employment outcomes? 2. Do the models of effective practice, policy and procedures result in the creation of an environment that promotes innovation and high performance? 3. Are the models of effective policies, practices and procedures transportable to other community rehabilitation organizations? Interview Semi -Structured Question Protocol Question Protocol Interviewees are asked to complete the demographic section of this form for data gathering, sorting and validating taped interview comments. Assigned Interview # Name Position Years employed at org Education If willing to disclose: Disability Ethnicity Age Gender M F Other Association 151 Organizational Structure, Roles and Experience 1. Can you tell me a little about your job? How does it interact and communicate with others in your program area and with others in the organization? 2. How does the organization meet the mission? What is the priority of this organization? How or does the organization’s priority fit your personal priorities? 3. What do you think contributes to your organization being successful? What would you say are the top three to five things that make you successful? What do you/the org do well? Are there things you could do better? 4. What is your definition of well- being? How does the organization promote well-being? How do you experience well -being? Organizational Promotion of Promising Practices 1. How does the organization support, encourage, and reward staff for creating and implementing promising practices? 2. What are the key factors from an organizational perspective that lead to innovation and success in innovation? 3. How does leadership help you to do your job? 4. Thinking about the concept of individual leadership, defined loosely as acting autonomously and engaging in decision making, how or does it apply to you and to this organization? Best Practice Interventions 1. How would you describe your organization’s promising practices in achieving employment outcomes with the clients you serve? 2. Tell me about one or more practices that you would describe as promising or best practice. 3. How did you identify the need for the development of this specific service or intervention? 4. Describe the process involved in designing the service or intervention and implementation? 5. How do you know it is effective? How do you evaluate the success of the program? 152 6. If you could go back and do it again, what would you do differently? 7. Is the practice generalizable or transferable to other physical locations? What do you believe are the possibilities of other community rehabilitation organizations implementing this promising or best practice? Open ended Questions 1. Any thoughts about the impacts of physical environment ? 2. Any thoughts about the role of technology? 3. Any thoughts about culture? 4. Other comments? 153 APPENDIX C Peckham Awards & Recognitions • Highlighted as a top 50 Companies that Care by People Magazine (#36) • Peckham was named a Winner for Michigan’s Best and Brightest in Wellness, 2019 • Recognized by the United States Interagency Council on Homelessness (USICH) as achieving the criteria and benchmarks of “effectively ending” homelessness among Veterans, 2019 • Awarded by the Mayor of Lansing for our participation in ending Veteran Homelessness, 2019 • Awarded the Gold Level Veteran Friendly Employers Award which is the State of Michigan’s highest award for Veteran Recruitment and Retention, 2019 • Named employer of the year by the Arizona Governor’s Council for the Blind and Vision Impaired for the second year in a row • Great Place to Work Certified 2018, 2091 this certification is based on employee feedback, revealing that Peckham employees trust their supervisors and have pride in what they do. Certification helps with recruitment, brand recognition, and employee retention. • When Work Works Award 2018, this award highlights that effective and flexible workplaces can yield positive business results and help employees succeed at work and at home) • Recognized as a Silver Level Veteran Friendly Employer in the State of Michigan by the Michigan Veterans Affairs Agency. • Awarded a new 5-year DLA OCIE North 3PL contract to continue storing and shipping Organizational Clothing and Individual equipment. • Dart Foundation Grant & Out Community Foundation grants to support Tools for the Trade program, 2017 • Defense Logistics Agency awarded Peckham Supply Chain Solutions, Supplier of the year award, for the second time in the last 3 years, 2017 • Greatest Places to Work certified 2017 154 • Defense Logistics Agency – Troop Support, Gold Level Supplier Awarded to Peckham Apparel Manufacturing, 2017 • 10 consecutive years for winning 'when work works’, 2017 • National winner of best and brightest for wellness, 2017 • Peckham was honored as a recipient of the Center for Positive Organizations, University of Michigan, 2017 • Successful CARF Accreditation Survey and received the highest 3-year accreditation level, 2016 • World’s Greatest: Place to Work (Ion Network TV Show) - 2016 • Peckham, Inc. Day declared by Lansing Mayor, Virg Bernero (June 28, 2016) - 2016 • Great Place to Work: Flexibility - 2016 2020-2021 TITLE: BUSINESS PLAN OWNER: PRESIDENT & CEO DATE: OCTOBER 1, 2020 • Great Place to Work: Giving Back - 2016 • Great Place to Work Best Small & Medium Workplace - 2015 (Featured in Fortune Magazine) • Defense Logistics Agency (DLA) Gold Level, Superior Supplier of the year, 2015 • Governor’s Fitness Awards: Healthy Workplace Program, Michigan - 2015 • 101 Best and Brightest Companies to Work for Winner, Elite National Winner, Mid- Sized Organization, 2014, 2015 • 101 Best and Brightest in Wellness Winner, 2013, 2014, 2015, 2016, 2017, 2018, 2019 • 101 Best and Brightest in Sustainability Winner, 2013, 2014, 2015 • Alfred P. Sloan Award for Business Excellence in Workplace Flexibility, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016 155 APPENDIX D Executive Summary and Accreditation Decision of CARF Report 2020 156 REFERENCES 157 REFERENCES Agin, E., & Gibson, T. 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