- Under the label “Supported Employment,” services that promote competitive, integrated employment (CIE) for working-age adult with intellectual and developmental disabilities have been federally funded since the 1980s, alongside other more traditional day habilitation and segregated or sub-minimum wage employment services. However, since the early 2000s, over 30 states have adopted “Employment First” policy, prioritizing competitive, integrated employment (CIE) as the preferred outcome, and in some states, restricting alternative service options. And while researchers have made a considerable effort to understand system-level determinants of participation in CIE-focused services, little attention has been paid to the political factors driving these major changes in the overall policy mix. Moreover, the Employment First changes, which have attracted little public attention or controversy, vary considerably across states in timing, form and content.
What do these policy changes look like, and how can we explain both the occurrence of major policy changes and the variations in timing? Using a three-manuscript format, the study applies a mixed method approach to two cases, Washington and Pennsylvania. The study uses the Advocacy Coalition Framework (ACF) as the primary theoretical framework, informed by the practitioner-oriented Systems Change framework, and extended by concepts from the Theory of Gradual Institutional Change. The overall results suggest that in both Washington and Pennsylvania, a process of policy “layering” that began in the 1980s with the expansion of the status quo service mix, was followed by a subsequent period of “displacement,” in which major policy changes prioritized CIE-focused services while restricting non-CIE services. These major policy changes stemmed from the activities of two competing advocacy coalitions, “Choice” and “Employment First.” While the Choice coalition sought to maintain the status quo, or a full menu of service options, the reform-oriented Employment First coalition pursued prioritization of CIE-focused services.
These shifts in the policy mix were associated with similar combinations of subsystem attention and coalition-based activity, including stakeholder mobilization and strategic use of framing and narrative, as well as heightened political attention and bureaucrat advocacy. Washington’s major policy changes began in the 2000s, while in Pennsylvania, no major policy changes occurred until the 2010s. Despite the similar conditions for overall policy change, differences in the timing of major policy changes were associated with service provider coalition membership and antecedent service levels. In Washington, which experienced high levels of CIE service participation by the late 1990s, the defection of most service providers from the Choice coalition in the early 2000s was a key condition related to major policy change, even though a small contingent of service providers continued to pursue a Choice-oriented policy mix. By comparison, in Pennsylvania, where CIE service participation remained low through the 2010s, there was no public mass defection of service providers from the Choice coalition, and major policy changes were only achieved in the context of federal guidance. The evidence additionally suggests that minor policy changes in Washington during a period of policy layering in the 1980s and 1990s contributed to the service provider defection from Choice to Employment First.
This study takes an iterative and integrative approach to explaining major policy change. In addition to offering a rich explanation for the major policy changes experienced in both states, the study offers a contextualized ACF application to a low salience issue area, thus extending the framework’s range beyond its usual application in high salience and contentious policy settings. Relatedly, the study substantiates key ACF propositions related to the role of coalition-based activity and pathways to major policy change. Moreover, the study highlights key complementarities between the ACF and the Systems Change model, providing a future pathway for integrating the findings with practitioner-oriented change models. Finally, the study illustrates the benefits of extending the ACF with concepts from the Theory of Gradual Institutional Change, thus illuminating the transition from one policy process period to the next.