Employing Strength: A Scoping Review of Customized Employment Practices to Support Inclusive Employment for People with Intellectual Disabilities

Abstract

Background

Inclusive employment offers advantages for both employers and individuals with intellectual disabilities. However, high unemployment rates persist for people with intellectual disabilities, underscoring the need for alternative approaches. Customized employment (CE) has emerged as a promising strategy by tailoring job opportunities to align with individual strengths and employer requirements.

Objective

This review answers the question, “What does the literature say about the use of customized employment practices to facilitate paid employment for people with intellectual disabilities?”

Methods

We conducted a scoping review of the literature. Eight databases were searched, including APA PsycInfo, Medline, CINAHL, Scopus, Web of Science, Business Source Ultimate, Social Services Abstracts and Social Science Abstracts.

Results

Fifty-seven articles were deemed relevant to the research question, revealing clear trends and key characteristics of CE. The literature suggests that CE can lead to improved employment outcomes, greater self-determination and independence, and increased employer satisfaction. However, lack of evaluative measures has led to inconsistencies in delivery and quality of support. CE practices may demand more time and higher costs compared to other types of supported employment.

Conclusions

When implemented effectively, CE practices can be a valuable method for supporting individuals with intellectual disabilities in securing inclusive employment.

Keywords

customized employment supported employment intellectual disabilities inclusive employment competitive integrated employment

Introduction

When engaged in inclusive employment, often referred to in the literature as competitive integrated employment (CIE), people with intellectual disabilities experience many recognized benefits including an increased quality of life, financial independence, autonomy, empowerment, and socialization (Schall et al., 2024; Taylor et al., 2021). In addition, employers are increasingly sharing the positive economic outcomes and business case measures experienced when hiring people with intellectual disabilities (Hernandez & McDonald, 2010; Kaletta et al., 2012; Morris et al., 2024). Subsequently, governments across North America have implemented legislation and policy designed to promote CIE for people with intellectual disabilities (Callahan et al., 2011; Christianson-Barker et al., 2025; Dispenza, 2021; Taylor et al., 2021). With legislative support and funding, programmatic efforts to support CIE have demonstrated promising results (Beyer et al., 2016; Harker & Desenberg-Wines, 2017; Inge et al., 2024), namely programs centered on the tenants of supported employment (SE).

SE first emerged in the 1980s as an alternative to sheltered work and day programming (Riesen et al., 2023c). Predicated on the belief that individuals with intellectual disabilities can “with availability of adequate support services, maintain competitive employment in the community in an environment where they interact with employes who are not disabled” (Rosenthal et al., 2012, p. 74). The model moves away from pre-vocational training and preparation and instead supports a “place-then-train” model (Rosenthal et al., 2012). With economic and social justice concerns driving the push for CIE outcomes, alongside the initial success of the SE model, the Employment First movement and related legislation has gained momentum in the United States (Ouimette & Rammler, 2017).

Despite these efforts and early success, the focus has not translated into extensive adoption of CIE programming and practices, with the number of people with intellectual disabilities engaged in CIE remaining low (Remund et al., 2022; Riesen & Morgan, 2018; Taylor et al., 2021). Identifying a troubling trend, Butterworth et al. (2014) noted a 6.2% decline in CIE for people with intellectual and developmental disabilities engaged in day programming. Callahan et al. (2011) discusses this regression in progress, noting that policy and sector leaders may have underestimated “the strength of the traditional service system, limited incentives for agencies and systems to change,” and “the attitudes of employers and conﬂicting policies and values within the systems associated with employment of persons with disabilities” (Callahan et al., 2011, p. 163). This holds true in Canada, where sheltered work persists, sometimes within organizations providing both sheltered work and SE programming (Institute for Research and Development on Inclusion and Society, 2021).

Responding to this persistent inequity, customized employment (CE) was created as a strategy to support individuals who were unsuccessful in SE programming seeking “readymade” jobs but were capable of work when jobs are customized around skills, strengths, and support needs (Pickens & Dymond, 2022; Wehman et al., 2018). As a subcategory of SE, CE (defined more below) has emerged as a promising practice to support people with intellectual disabilities towards CIE (Inge et al., 2018; Kim et al., 2024; Riesen et al., 2015; 2023c). While CE strategies have been in use for several decades, confusion around defined best practices and clear evaluative measures have resulted in a limited understanding of CE's potential in supporting CIE of people with intellectual disabilities (Smith et al., 2015).

In Canada, SE and CE programs have been delivered in a patchwork of practices across the country, with both federal and provincial programs seeking to encourage CIE. For example, the national, federally funded Ready, Willing and Able program has led to more than 4000 CIE opportunities for people with intellectual disabilities and autism since its start in 2014 (Employment and Social Development Canada, 2024). On a provincial level, provinces across Canada have developed various ways of addressing employment support gaps. For instance, British Columbia's WorkBC Customized Employment stream seeks to provide one stop supported and customized employment services to people with intellectual disabilities (Government of British Columbia, 2024). In addition, many community living agencies and non-profit organizations provide specialized employment programming. Although CE practices are woven into many of these initiatives across Canada, they are not always explicitly identified, leaving the lack of clarity noted by Smith et al., 2015 exasperated by the fragmented landscape of federal and provincial funding and policy frameworks.

Given this lack of defined practice, this broad scoping review answers the question, “What does the literature say about the use of customized employment practices to facilitate paid employment for people with intellectual disabilities?” Previous comparable reviews, such as Riesen et al. (2023c), focused on articles with “a clearly stated research question or objective related to customized employment, and a summary of qualitative and/or quantitative data regarding customized employment outcomes and/or procedures,” (p. 31). Instead, this scoping review seeks to broadly identify CE practices across studies that included information relevant to our research question, CE did not have to be the sole focus of the study, instead seeking to identify CE practices taken up under the broader SE umbrella. Four key objectives guided the review: 1) Identify defining tenants of customized employment, 2) Identify if and how customized employment practices improve access to paid employment for people with intellectual disabilities, 3) Identify known barriers to using customized employment approaches, and 4) Identify how customized employment practices have been implemented in Canada compared to other jurisdictions.

Methods

Given the nature of the review question, scoping review methods were identified as the best fit (Peters et al., 2020). Scoping review methods can be helpful when the objective is to map the breadth and depth of literature on a topic, especially where concepts are complex or heterogeneous (Arksey & O’Malley, 2005; Levac et al., 2010). Further, scoping reviews are particularly useful for clarifying definitions and conceptual boundaries in emerging fields, which can inform future research agendas or policy developments (Peters et al., 2020). The PRISMA Scoping Review (PRISMA-ScR) and PRISMA for Searching (PRISMA-S) extensions were both used to guarantee accurate reporting of methods and analyses (Rethlefsen et al., 2021; Tricco et al., 2018). The research question and protocol were vetted amongst the team, with consultation from AL, the university's research librarian, on the design of the search strategy, search terminology, and databases used. Two related reviews (Riesen et al., 2015; Riesen et al., 2023c) were evaluated to refine the search strategy. The inclusion criteria are detailed in Table 1.

Table 1.

CE Scoping Review Inclusion Criteria.

Criteria	Inclusion	Exclusion
Year of Source	2010–2024	2009 and prior
Language of Source	English	Non-English documents
Type of Source	Peer reviewed published articles	Grey lit, Book chapters Theses/dissertations Conference presentations (abstracts and proceedings)
“Customized Employment”	Customized employment or components of customized employment practices	Vocational rehabilitation and supported employment practices that do not include customized employment
“Intellectual Disabilities”	Intellectual disability or multiple disabilities including intellectual	Pan disability where intellectual disability is not named, all other disability types
“Competitive Integrated Employment”	Paid employment in an integrated setting alongside non-disabled peers.	Unpaid work, volunteerism, sheltered employment, vocational training and pre-employment programs

The search was conducted on eight databases including APA PsycInfo, Medline, CINAHL, Scopus, Web of Science, Business Source Ultimate, Social Services Abstracts and Social Science Abstracts. A search strategy is detailed in Table 2. The returned studies were exported into a cloud-based research tool called Covidence for review. Given the range of terms used to describe “Competitive Integrated Employment”, the team decided it was best to screen for this criterion in the full-text phase of the review. To reduce bias and ensure the inclusion criteria was followed, three reviewers JCB, AF, RM completed the title and abstract screening, while JCB and AF completed the full text review. If there was a conflict in reviewer assessment, the lead reviewer screened the article again and decided on its relevance. JCB and AF extracted the data of studies meeting the inclusion criteria using a template prepared by JCB. JCB then reviewed each extraction to ensure consensus. The remaining included studies were then analyzed to better understand their characteristics. Quality appraisal was not conducted for the included studies, as it is considered an optional component in scoping review methodology according to the PRISMA-ScR guidelines (Tricco et al., 2018). This decision aligns with the broad and exploratory nature of the research question, which aimed to map the existing literature rather than assess the effectiveness or rigor of specific interventions. NVivo, a qualitative research program, was used to analyze and extract qualitative findings. Each article was coded by JCB to explore and identify connecting points of interest. Emerging results were shared, discussed and refined with the full research team.

Table 2.

Customized Employment Lit Review Search Strategy.

Database	Date of Search	Search String	Limiters	No. of Results
CINAHL Complete	6/19/2024	(“custom* employ” OR “custom work” OR “custom job” OR “custom role” OR “job development” OR “job carving” OR “job creation”) AND (“intellectual disab” OR “intellectually disab” OR “developmental disab” OR “developmentally disab” OR “intellectual and developmental disab” OR “developmental delay” OR “developmentally delay” OR “IDD” OR “intellectual limit” OR “intellectually limit” OR “complex needs” OR “complex support needs” OR “complex health needs” OR “special needs” OR “extra support needs” OR “mental disab” OR “mentally disab” OR “mentally handicap” OR “mental handicap” OR autis* OR neurodivers* OR neurodevelopmental* OR “learning disab” OR “learning difficult” OR “learning disorder” OR “cognitive disab” OR “cognitive impair” OR “multiple disab” OR “multiple handicap”)	Limiters - Publication Date: 20100101-20240731; English Language; Peer Reviewed	34
Medline (EBSCO)	6/19/2024	(“custom* employ” OR “custom work” OR “custom job” OR “custom role” OR “job development” OR “job carving” OR “job creation”) AND (“intellectual disab” OR “intellectually disab” OR “developmental disab” OR “developmentally disab” OR “intellectual and developmental disab” OR “developmental delay” OR “developmentally delay” OR “IDD” OR “intellectual limit” OR “intellectually limit” OR “complex needs” OR “complex support needs” OR “complex health needs” OR “special needs” OR “extra support needs” OR “mental disab” OR “mentally disab” OR “mentally handicap” OR “mental handicap” OR autis* OR neurodivers* OR neurodevelopmental* OR “learning disab” OR “learning difficult” OR “learning disorder” OR “cognitive disab” OR “cognitive impair” OR “multiple disab” OR “multiple handicap”)	Limiters - Publication Date: 20100101-20240631; Language: English; Peer Reviewed	17
PsychInfo	6/19/2024	(“custom* employ” OR “custom work” OR “custom job” OR “custom role” OR “job development” OR “job carving” OR “job creation”) AND (“intellectual disab” OR “intellectually disab” OR “developmental disab” OR “developmentally disab” OR “intellectual and developmental disab” OR “developmental delay” OR “developmentally delay” OR “IDD” OR “intellectual limit” OR “intellectually limit” OR “complex needs” OR “complex support needs” OR “complex health needs” OR “special needs” OR “extra support needs” OR “mental disab” OR “mentally disab” OR “mentally handicap” OR “mental handicap” OR autis* OR neurodivers* OR neurodevelopmental* OR “learning disab” OR “learning difficult” OR “learning disorder” OR “cognitive disab” OR “cognitive impair” OR “multiple disab” OR “multiple handicap”)	Limiters - Scholarly (Peer Reviewed) Journals; Publication Date: 20100101-20240631	28
Web of Science Core Collection	6/19/2024	(“custom* employ” OR “custom work” OR “custom job” OR “custom role” OR “job development” OR “job carving” OR “job creation”) AND (“intellectual disab” OR “intellectually disab” OR “developmental disab” OR “developmentally disab” OR “intellectual and developmental disab” OR “developmental delay” OR “developmentally delay” OR “IDD” OR “intellectual limit” OR “intellectually limit” OR “complex needs” OR “complex support needs” OR “complex health needs” OR “special needs” OR “extra support needs” OR “mental disab” OR “mentally disab” OR “mentally handicap” OR “mental handicap” OR autis* OR neurodivers* OR neurodevelopmental* OR “learning disab” OR “learning difficult” OR “learning disorder” OR “cognitive disab” OR “cognitive impair” OR “multiple disab” OR “multiple handicap”)	\| Timespan: 2010-01-01 to 2024-12-31 (Index Date)	55
SCOPUS	6/19/2024	(“custom* employ” OR “custom work” OR “custom job” OR “custom role” OR “job development” OR “job carving” OR “job creation”) AND (“intellectual disab” OR “intellectually disab” OR “developmental disab” OR “developmentally disab” OR “intellectual and developmental disab” OR “developmental delay” OR “developmentally delay” OR “IDD” OR “intellectual limit” OR “intellectually limit” OR “complex needs” OR “complex support needs” OR “complex health needs” OR “special needs” OR “extra support needs” OR “mental disab” OR “mentally disab” OR “mentally handicap” OR “mental handicap” OR autis* OR neurodivers* OR neurodevelopmental* OR “learning disab” OR “learning difficult” OR “learning disorder” OR “cognitive disab” OR “cognitive impair” OR “multiple disab” OR “multiple handicap”)	All fields Language: English Range: 2010–2024	765
Social Service Abstracts	6/19/2024	(“custom* employ” OR “custom work” OR “custom job” OR “custom role” OR “job development” OR “job carving” OR “job creation”) AND (“intellectual disab” OR “intellectually disab” OR “developmental disab” OR “developmentally disab” OR “intellectual and developmental disab” OR “developmental delay” OR “developmentally delay” OR “IDD” OR “intellectual limit” OR “intellectually limit” OR “complex needs” OR “complex support needs” OR “complex health needs” OR “special needs” OR “extra support needs” OR “mental disab” OR “mentally disab” OR “mentally handicap” OR “mental handicap” OR autis* OR neurodivers* OR neurodevelopmental* OR “learning disab” OR “learning difficult” OR “learning disorder” OR “cognitive disab” OR “cognitive impair” OR “multiple disab” OR “multiple handicap”)	Additional limits - Date: From January 2010 to June 2024; Language: English	37
Social Science Abstracts	6/19/2024	(“custom* employ” OR “custom work” OR “custom job” OR “custom role” OR “job development” OR “job carving” OR “job creation”) AND (“intellectual disab” OR “intellectually disab” OR “developmental disab” OR “developmentally disab” OR “intellectual and developmental disab” OR “developmental delay” OR “developmentally delay” OR “IDD” OR “intellectual limit” OR “intellectually limit” OR “complex needs” OR “complex support needs” OR “complex health needs” OR “special needs” OR “extra support needs” OR “mental disab” OR “mentally disab” OR “mentally handicap” OR “mental handicap” OR autis* OR neurodivers* OR neurodevelopmental* OR “learning disab” OR “learning difficult” OR “learning disorder” OR “cognitive disab” OR “cognitive impair” OR “multiple disab” OR “multiple handicap”)		55
Business Source Ultimate	6/19/2024	(“custom* employ” OR “custom work” OR “custom job” OR “custom role” OR “job development” OR “job carving” OR “job creation”) AND (“intellectual disab” OR “intellectually disab” OR “developmental disab” OR “developmentally disab” OR “intellectual and developmental disab” OR “developmental delay” OR “developmentally delay” OR “IDD” OR “intellectual limit” OR “intellectually limit” OR “complex needs” OR “complex support needs” OR “complex health needs” OR “special needs” OR “extra support needs” OR “mental disab” OR “mentally disab” OR “mentally handicap” OR “mental handicap” OR autis* OR neurodivers* OR neurodevelopmental* OR “learning disab” OR “learning difficult” OR “learning disorder” OR “cognitive disab” OR “cognitive impair” OR “multiple disab” OR “multiple handicap”)	LimitersPeer ReviewedPublication Date: 20100101-20240631Language: English	2

Results

The search returned 993 studies, with one additional study added in following citation review. Of these, 194 duplicates were removed, and 800 were reviewed against title and abstract. Following the title and abstract screening, 213 studies were assessed for full-text review, with 57 identified as relevant to the research question, analysed below in the included literature. The search PRISMA chart is included as Figure 1.

Figure 1.

PRISMA Chart for Customized Employment Lit Review.

It should be noted, given the comparability to the Riesen et al. (2023c) literature review “An updated review of the customized employment literature,” that our review returned a larger quantity and had some differences in included studies. As noted above, Riesen et al. (2023c) focused on articles with a stated research question related to customized employment. Our study instead included articles that provided information on customized employment practices, customized employment did not have to be the sole focus of the study. In addition, our study was focused on the inclusion of people with intellectual disabilities in CE practices, several of the included studies in Riesen et al. (2023c) did not specifically include people with intellectual disabilities.

Characteristics of Included Studies

Of the 57 included studies, the large majority originated from the United States (84%). Surprisingly, only one study was included from Canada (Ho et al., 2022). Given the known use of CE practices across Canada, this result was not expected. This will be explored more below. Another interesting finding regarding the origin of included studies, 40% (n = 23) of authors are affiliated with two universities: Virginia Commonwealth University (n = 13) and Utah State University (n = 10). This emphasises the concentration of expertise and research efforts within these institutions, indicating that they may play a significant role in advancing knowledge in CE and the broader SE sector.

Regarding methods and types of studies included, most used qualitative (n = 20) or mixed methods (n = 14) with an increase of quantitative studies (n = 11) in recent years, with eight of the eleven published in the last five years. Additionally, this review incorporates insights on CE practices from twelve comparable literature reviews, some of which directly address CE while others offer relevant information from related perspectives and topics. Table 3 includes the full list of included literature, their key characteristics, and summary of the study objective.

Table 3.

Characteristics of Included Literature.

First Author	Year	Title	Origin	Aim of Study	Study Design
Almalky, H.	2020	Employment outcomes for individuals with intellectual and developmental disabilities: A literature review	United States	Literature review on the employment outcomes for adults with intellectual and developmental disabilities (IDD) within the United States.	Literature Review
Brooke, V.	2018	Employes with Autism Spectrum Disorder Achieving Long-Term Employment Success: A Retrospective Review of Employment Retention and Intervention	United States	Retrospective review of records to determine retention rates of individuals with ASD.	Mixed Methods
Brown, L.	2016	An integrated work skill analysis strategy for workers with significant intellectual disabilities	United States	Outlines an integrated work skill analysis strategy for individuals with significant disabilities	Qualitative
Butterworth, J.	2023	Supporting Employment Consultants to Implement Supported and Customized Employment	United States	Data collection from CE practitioners in the hopes of enhancing implementation of evidence-based practices of CE.	Mixed Methods
Caldwell, K.	2020	Inclusive management for social entrepreneurs with intellectual disabilities: “how they act"	United States	Exploration of the experiences of social entrepreneurs with intellectual disabilities	Qualitative
Callahan, M.	2011	Twenty years of employment for persons with significant disabilities: A retrospective	United States	Retrospective of twenty years of employment for persons with significant disabilities detailing trends, short-comings and promising practices	Qualitative
Cheausuwantavee, T.	2021	Employment for Persons with Disabilities in Thailand: Opportunities and Challenges in the Labor Market	Other: Thailand	Examine the current situation of the enforcement of employment equity laws for the employment of persons with disabilities (PWDs)	Mixed Methods
Dispenza, F.	2021	Empowering the Career Development of Persons With Disabilities (PWD)	United States	Review of career development facilitators and barriers for PWD, provide an overview of self-determination theory (SDT) as a framework to use in career development interventions with PWD	Literature Review
dos Santos Rodrigues, P.	2013	Improving workforce outcomes among persons with disabilities in Brazil through youth apprenticeships and customized employment	Other: Brazil	Presents an approach to address low workforce participation in people with disabilities in Brazil	Qualitative
Fleming, C.	2019	Social Role Valorization and Employment of People with the Most Significant Disabilities	United States	Identify and explore key elements of Social Role Valorization and supported employment (SE)	Literature Review
Harker, B.	2017	Iowa Coalition for Integrated Employment	United States	Explores Iowa Readiness for Partnerships in Employment and the collaborative strategies leading to employment outcomes for individuals with IDD	Mixed Methods
Harvey, J.	2013	Understanding the competencies needed to customize jobs: A competency model for customized employment	United States	Develop a CE competency model embodying the knowledge, skills, abilities and other characteristics necessary to provide CE solutions	Qualitative
Ho, J.	2022	Representative-negotiated i-deals for people with disabilities	Canada	Explores a proactive process, representative-negotiated idiosyncratic work arrangements (i-deals), that can create the conditions for long-term employment for people with disabilities	Qualitative
Inge, K.	2018	Defining customized employment as an evidence-based practice: The results of a focus group study	United States	Begin the development of a research-based description that agencies can use to replicate customized employment when supporting individuals with significant disabilities	Qualitative
Inge, K.	2023b	The Essential Elements of Customized Employment: Results From a National Survey of Employment Providers	United States	Results of online survey asking U.S. rehabilitation providers who implement these services to describe the current status of CE service delivery	Mixed Methods
Inge, K.	2023a	Effects of Customized Employment on the Independence of Youth With Intellectual and Developmental Disabilities	United States	Examine the impact of customized employment on the support needs of youth with IDD with a significant disability compared to those receiving treatment as usual	Quantitative
Inge, K.	2024	The impact of customized employment on the competitive integrated employment outcomes of transition age youth with intellectual and developmental disabilities	United States	Examine the impact of CE on the employment outcomes, hours worked per week, and wages of transition-age youth with intellectual and developmental disabilities	Quantitative
Ishii, K.	2010	Job development activities for individuals with intellectual disabilities in Japan	Other: Japan	Investigate job development activities for individuals with ID employed in large companies in Japan	Mixed Methods
Jones, K.	2020	State vocational rehabilitation counselors’ knowledge of the discovery process in customized employment	United States	Survey of state vocational rehabilitation counselors (VRCs) working with job seekers receiving Customized Employment (CE) services	Mixed Methods
Kim, J.	2024	Customized employment for transition-age youth in state vocational rehabilitation program PY2017 - PY2020: Analysis of service outcomes and related factors	United States	Examines the employment outcomes and related factors for transition-age youth with disabilities who received CE services through state vocational rehabilitation agencies	Mixed Methods
Kim, J.	2023b	Customized employment as a pathway to competitive integrated employment: An analysis of RSA 911 data of state vocational rehabilitation agencies with the highest use of this intervention	United States	Expand the analysis of US data from 2017–2020 to determine customized employment service patterns and outcomes	Quantitative
Kim, J.	2023a	Use of Customized Employment in State Vocational Rehabilitation Programs: A Retrospective Study 2017–2020	United States	Examine the outcomes of customized employment via an analysis using the U.S. Rehabilitation Services Administration Case Service Report	Quantitative
Luecking, R.	2011	Connecting employers with people who have intellectual disability	United States	Examine contemporary employer perspectives on employment of people with disabilities generally and people with intellectual disability specifically	Literature Review
Maebara, K.	2020	Case Study on the Employment of a Person with Intellectual Disability in Childcare Work in Japan	Other: Japan	Analyze the case of a person with an intellectual disability employed in childcare work	Qualitative
Migliore, A.	2012	Implementation of job development practices	United States	Test the effectiveness of customized-employment training on employment consultants	Quantitative
Migliore, A.	2023	Supporting employment consultants leveraging data to deliver quality services and outcomes	United States	Results of nine employment programs pilot of ES-Coach, a tool designed to help employment consultants and managers visualize the implementation of supported and customized employment	Mixed Methods
Molina, L.	2016	The Right to a Better Life: Using an Work Camp to Create Customized Employment Opportunities for Rural High School Students with Severe Disabilities.	United States	Illustrate that customized employment opportunities can be created for students with severe disabilities in a rural high school setting	Qualitative
Muller, E.	2018	Employer satisfaction with Project SEARCH interns, hires, and support received from Project SEARCH teams	United States	Evaluates employer satisfaction with Project SEARCH interns, hires at the host business site, and support received from Project SEARCH teams	Mixed Methods
Murphy, S.	2014	TransCen, Inc.'s WorkLink program: A new day for day services	United States	Discusses approach to braiding funding resources, describing TransCen, Inc.'s approach to braiding services to promote employment and support customized job placement.	Mixed Methods
O'Brien, J.	2010	Employment support as knowledge creation	United States	Presents Discovery as a qualitative alternative to quantitative assessment and discusses how employment supports can serve to create useful knowledge for job seekers with disabilities.	Literature Review
Ouimette, M.	2017	Entrepreneurship as a means to Employment First: How can it work?	United States	Describes one non-profit's success in meeting the goals of Employment First initiatives for individuals with significant disabilities through entrepreneurship as a means of customized employment	Qualitative
Pickens, J.	2022	Keys to the employment services castle: Needed skills and experiences	United States	Examine the types of skills and experiences rehabilitation services providers believe impact the ability of students with severe intellectual disability to obtain employment services	Qualitative
Remund, C.	2022	Preparing community rehabilitation providers to deliver a provision of employment supports: A tiered training approach	United States	Describe the training structure for employment specialists and job coaches who implement supported and customized employment	Qualitative
Riesen, T.	2023b	An Analysis of the Rehabilitation Service Administration 911 Supported and Customized Employment Outcome Data for Fiscal Years 2017–2020	United States	Analysis of Rehabilitation Service Administration (RSA-911) to determine the outcomes at the exit for individuals receiving SE and CE services	Quantitative
Riesen, T.	2015	Customized employment: A review of the literature	United States	Identify the underlying conceptual and empirical basis for CE and to make recommendations for future research	Literature Review
Riesen, T.	2018	Employer views of customized employment: A focus group analysis	United States	Identify the perceptions of employers about barriers and facilitators to the customized employment process	Qualitative
Riesen, T.	2019	Customized employment discovery fidelity: Developing consensus among experts	United States	Generate consensus about what experts believe are acceptable and not acceptable tenets of a discovery fidelity scale	Mixed Methods
Riesen, T.	2021	Building Consensus Among Experts Regarding Customized Job Development Fidelity Descriptors: A Delphi Study	United States	Designed to be the first step to validate a fidelity scale for customized job development	Quantitative
Riesen, T.	2022	Linking Process and Outcome Measures to Improve Employment Support Programs for Individuals With the Most Significant Disabilities	United States	Describe how employment programs can link proximal and distal outcomes to specific processes for employment using a customized employment framework	Qualitative
Riesen, T.	2023a	Internal Consistency of the Customized Employment Discovery Fidelity Scale: A Preliminary Study	United States	Examined outcomes for individuals engaged in the discovery process	Quantitative
Riesen, T.	2023c	An updated review of the customized employment literature	United States	Describe published literature on CE and to make recommendations on the best methods for establishing CE as an evidence-based practice	Literature Review
Rosenthal, D.	2012	Facilitators and barriers to integrated employment: Results of focus group analysis	United States	Qualitative analysis to examine facilitators and barriers to integrated employment, as identified by stakeholders at each level of the VR process serving consumers living in Wisconsin	Qualitative
Rumrill, S.	2023	A scoping literature review of transition-related research involving youth with autism spectrum disorder	United States	Examine the clinical and vocational aspects of ASD	Literature Review
Schall, C.	2024	Employment Interventions for People With Intellectual and Developmental Disabilities: A Delphi Study of Stakeholder Perspectives	United States	Examine the social validity of five different evidence-based and emerging pathways to employment	Quantitative
Seva, R.	2020	A productivity assessment of PWD employes in a philippine company	Other: Philippines	Assessed and compared the work capability of persons with disabilities (PWDs) and their able counterparts that covered multiple aspects of work	Qualitative
Shogren, K.	2017	Promoting change in employment supports: Impacts of a community-based change model	United States	Describes the development and preliminary outcomes of implementation of a model of employment systems change in three rural sites in a Midwest state	Qualitative
Smith, P.	2019a	Transitioning Australian Disability Enterprises to open employment community hubs using the Australian legislative framework	Australia	Examine the policy drivers for change and findings from work undertaken to promote provider transformation to integrated employment settings	Qualitative
Smith, T.	2017	Implementation of Customized Employment Provisions of the Workforce Innovation and Opportunity Act Within Vocational Rehabilitation Systems	United States	Provide state VR systems with tools and guidance in implementing the provisions of WIOA regarding the inclusion of CE strategies to promote CIE	Literature Review
Smith, T.	2019b	Achieving competitive, customized employment through specialized services (ACCESS)	United States	Present lessons learned during the implementation of the Phase I open trial of ACCESS intervention protocols for customized employment (CE)	Quantitative
Smith, T.	2015	Integrating customized employment practices within the vocational rehabilitation system	United States	Provide an overview of integrative customized employment practices implemented within the State of Florida Vocational Rehabilitation system	Qualitative
Taylor, J.	2021	Cost-benefit analyses of employment services for individuals with intellectual and developmental disabilities: A scoping review	United States	Scoping review was to analyze and synthesize micro and macroeconomic analyses of various types of vocational services which promote the employment outcomes of individuals with IDD	Literature Review
Voermans, M.	2023	Informal Network Members’ Perspectives and Experiences on Work for People with Intellectual Disabilities: A Thematic Synthesis	Other: Netherlands	Synthesize of existing research for the purpose of examining how informal network members perceive the meaning of employment or daytime activities for their relatives with ID	Literature Review
Wehman, P.	2016	Employment for adults with autism spectrum disorders: A retrospective review of a customized employment approach.	United States	Retrospective analysis of individuals with ASD who recieved employment support, assessing how many individuals required CE to attain CIE	Quantitative
Wehman, P.	2012	Supported employment for young adults with autism spectrum disorder: Preliminary data	United States	Examine the effects of supported employment in securing and maintaining competitive employment for people with autism spectrum disorder	Quantitative
Wehman, P.	2018	Toward Competitive Employment for Persons with Intellectual and Developmental Disabilities: What Progress Have We Made and Where Do We Need to Go	United States	Discuss what we know about supporting the employment of people with more significant disabilities through specific models that serve as pathways to CIE	Qualitative
Weld-Blundell, I.	2021	Vocational interventions to improve employment participation of people with psychosocial disability, autism and/or intellectual disability: A systematic review	Australia	Systematic reviews of vocational interventions that aimed to improve employment outcomes of people with psychosocial disability, autism, and/or intellectual disability	Literature Review
Williams, B.	2019	Employment supports in early work experiences for transition-age youth with disabilities who receive Supplemental Security Income (SSI)	United States	Investigated the effects of various employment supports, practices, and youth perceptions on early work experience outcomes for transition-age youth	Quantitative

Defining Customized Employment

As noted in the introduction, CE evolved as a subset of SE programming. Callahan et al. (2011) discusses the origin of CE:

Throughout the 1990's this approach was referred to unofﬁcially as “individualized supported employment” in that the demands, and the barriers they created, of open jobs were by-passed through an intentional process that sought to identify speciﬁc needs and beneﬁts rather than job openings. These efforts were to provide the foundation for the concept of customized employment that emerged from the newly formed Ofﬁce of Disability Employment Policy (ODEP) within the US Department of Labor in 2001. (p. 166)

Callahan et al. (2011) further notes that these early adaptions led to a new understanding of employment and how supported employment professionals identify opportunity, with CE extending “beyond traditional job carving and restructuring and establish(ing) a fundamentally new conceptualization of the employment relationship” (p. 166). As practice progressed, specifically in the US context, government policy sought to define its use. Inge et al. (2018) shares:

Customized employment was initially deﬁned in the Federal Register as a blending of services and supports and may include — job development or restructuring strategies that result in job responsibilities being customized and individually negotiated to ﬁt the needs of individuals with a disability. Customized employment assumes the provision of reasonable accommodations and supports necessary for the individual to perform the functions of a job that is individually negotiated and developed. (p. 155)

The CE definition was further clarified in the US context when the Rehabilitation Act was amended in the Workforce Innovation and Opportunity Act (WIOA) in 2014 (Kim et al., 2023b; Inge et al., 2018). This is the predominant definition used in the included literature, which defines CE as:

Competitive integrated employment, for an individual with a signiﬁcant disability that is based on an individualized determination of the strengths, needs, and interests of the individual with a signiﬁcant disability, and is designed to meet the speciﬁc abilities of the individual with a signiﬁcant disability and the business needs of the employer. (Kim et al., 2023b, p. 90)

The WIOA further outlined specific strategies included in CE practice, including:

a) exploring jobs with the individual; (b) working with employers to facilitate placement, including customizing a job description based on current employer needs or on previously unidentiﬁed and unmet employer needs; (c) developing a set of job duties, a work schedule, and job arrangement, along with speciﬁcs of supervision (including a performance evaluation review), and determining a job location; (d) representing a professional chosen by the individual, or self-representation of the individual in working with an employer to facilitate placement; and (e) providing services and supports at the job placement. (Kim et al., 2023b, p. 90)

The practices listed above can be further segmented into four phases of CE: 1) Discovery, 2) Job Search and Employment Identification, 3) Job Development and Negotiation, and 4) Post-Employment Support (Harvey et al., 2013). Through these four phases, CE practices emphasize the relationship with both job seeker and employer, seeking to intentionally personalize outcomes for both, resulting in a “win-win” employment relationship (Ouimette & Rammler, 2017). Smith et al. (2019b) identifies the foundation of CE practice being grounded in “social-ecological theory in that it acknowledges the complex interplay between a person and the environment. It emphasizes the importance of person-environment ﬁt as well as the diverse systems that inﬂuence human functioning,” (p. 251). Riesen et al. (2023b) states,

While the efficacy of supported employment for individuals with disabilities is well documented, there were, and continue to be concerns that individuals with the most significant disabilities were not engaging in SE programs and were not achieving similar employment outcomes to individuals with less intensive support needs. Customized employment (CE) emerged as a strategy to engage individuals with significant disabilities to find and maintain customized jobs in competitive integrated settings. (p. 115–116)

The term “significant disability” is used to describe the target CE job seeker throughout the included literature (n = 31). Significant disability is defined in the US Rehabilitation Act, “as an individual with a severe physical or mental impairment that seriously limits one or more functional capacities in terms of an employment outcome and may include individuals with autism, intellectual disabilities, and comorbid disabilities,” (Riesen et al., 2023b, p. 116). Inge et al. (2024) further explain that CE is a practice used to support individuals who have a history of being unemployed or previously excluded from receiving employment support. Pickens and Dymond (2022) states that CE is targeted towards individuals who have not found success in SE services, needing more tailored supports. While, Riesen et al. (2023c) note that CE is often utilized by individuals who have low employment expectations and instead have been in segregated facility-based programs or sheltered workshops.

Understanding CE as a distinct practice separate from SE is important as legislative and sector leaders seek to allocate funding and resources. While the above noted (WIOA) law legislates the difference in the US, the literature points to the ongoing confusion in distinction and limited evidence-based practices. In the Canadian context, we do not have a clear or centralized definition to work from, and variance in delivery and understanding persist. A key distinction between SE and CE is the driving factor of the employment outcome, where SE is driven by available positions within a local labor market, CE is driven by the best fit between individual strengths and business needs (Molina & Demchak, 2016). Wehman et al. (2016) shares that many “vocational rehabilitation professionals have found anecdotally that it is rare to identify a job that is a perfect ﬁt without some modiﬁcations or changes, which is at the very core of CE” (p. 63). CE practices are key to understanding both individual and business strengths and need. These distinctions do not point to improved practice or outcomes, rather they highlight differences in approach and more specifically, may provide strategies for facilitating CIE for those who did not find success within the SE model.

Phases of Customized Employment

Discovery

Discovery is an essential component of CE, in fact this was the practice most noted by included articles (n = 30). Butterworth et al. (2023) noted that “90% of experts rated discovery as critical for job seeker success” (p. 468). Callahan et al. (2011) detailed the perspectives which inform the discovery process describing the discoveryprocess as designed to uncover existing, meaningful information about a person's life to inform employment possibilities, rather than to evaluate or diagnose based on normative standards or predictive assessments. Discovery emphasizes ecological validity, ensuring employment directions align with the individual's real-life experiences and uses this information to guide personalized job matching (Callahan et al., 2011).

Shifting the perspective from traditional vocational rehabilitation tactics of evaluating employment readiness towards a person-centered, non-comparative approach opens employment to those who have previously been excluded (Shogren et al., 2017; Smith et al., 2015; Wehman et al., 2012). Instead, discovery identifies and celebrates the capabilities, skill sets, and interests of people with intellectual disabilities (Dispenza, 2021). This takes time and requires the employment specialist to build rapport with the job seeker (Inge et al., 2018). O’Brien and Callahan (2010) compare the role of the employment specialist to a qualitative researcher, seeking quality and robust information to inform themes and subsequent potential opportunity. It was noted that this begins with a visit to the job seekers home (Inge et al., 2018; O’Brien & Callahan, 2010; Riesen et al., 2022; Smith et al., 2017; Wehman et al., 2016).

A critical discovery services process is to conduct home and neighborhood observations and observe the job seeker engaged in task-based activities. From the information gathered during these observations, the qualiﬁed employment specialist and the job seeker identify emerging vocational themes (i.e., career identity). Once themes are identiﬁed, the qualiﬁed employment specialist develops a list of potential employers that align with the identiﬁed vocational themes. (Riesen et al., 2022, p. 3)

The collection of information and thematic findings culminate in the development of a vocational profile, which seeks to provide a strengths-based, accurate description of the job seekers employment potential. Smith et al. (2017) notes of the vocation profile,

It is a robust, narrative report that provides a foundation for effectively negotiating personalized potential job opportunities with employers. The profile is a living document that can be amended as new information is uncovered, making it a particularly useful tool for students transitioning from school to the community and workforce. (p. 197)

The final component of discovery is a planning meeting, which includes the employment specialist, the job seeker, their support network (which may include family, friends, advocates, service providers, etc.) to validate the vocational profile and begin planning pathways forward (Smith et al., 2017). This step bridges the discovery process to the next phase of CE.

As noted above and seen through the robust nature of discovery activities, the process takes time. Riesen et al. (2019) note that the discovery phase should be implemented during a “35 h or seven-week period,” (p. 24). In a later study, Riesen et al. (2023a) find that the average time taken to complete the discovery process is 58.31 h.

Job Search and Employer Identification

In this next phase of CE, the employment specialist shifts their attention towards identifying and building relationship and rapport with employers. The vocational themes identified in the discovery phase are used to identify businesses that represent related opportunity (Kim et al., 2023b), articulating lists of twenty potential employers per vocational theme (Riesen et al., 2022). Similar to the discovery phase, the employment specialist approaches employers with the intent of qualitatively collecting information (O’Brien & Callahan, 2010), using informational interviews to collect information about business activities, working conditions, and potential opportunity. Smith et al. (2019a) notes that this phase is “not about looking for a job, but about building a relationship” (p. 270).

One way to identify opportunity includes conducting a workplace task analysis. Brown et al. (2016) defined various categories of tasks that represent opportunity; these included “assigned high frequency tasks,” which can be reallocated to save the assigned employe valuable time; “put off tasks,” which are not being completed in a timely manner by the employe they are assigned to; and “unassigned high frequency tasks,” which are not currently allocated to any employe but need to be completed. Identifying and defining these tasks can help an employment specialist assess the potential fit with the job seekers skills and strengths. Riesen and Morgan (2018) sought employer opinions on CE job development finding, “when employers discussed each of the questions posed to them during the focus groups, they frequently articulated that engaging/partnering with a business in various capacities to learn about business needs would improve the customized employment process,” (p. 37). Luecking (2011) elaborates on this point:

Because employers have various operational and economic stakes in hiring the most productive employees, it is essential to understand employers’ needs, circumstances, and perspectives before the field can fully apply the promise of presumptive employability to all job seekers with intellectual disability. Improved and effective connections with employers are essential to any effort to facilitate employment opportunities for people with intellectual and developmental disabilities. (p. 263)

In addition to identifying and articulating opportunities, employment specialist’ may need to prepare employers new to inclusive employment. These tasks are similar to those completed in a traditional SE model and include “educating employers of the value, knowledge, and skills people with disabilities could bring to their organization. Job developers stressed the importance of conversations as a vehicle to education and attitude change, paving the way for further negotiations” (Ho et al., 2022, p. 685).

Job Development and Negotiation

At this point in the process the employment specialist has a clear understanding of the skills and strengths of the job seeker as well as the business needs and related employment tasks to create an informed match, presented to the employer as a job proposal (Brown et al., 2016). Depending on the makeup of skills compiled in the proposal, the customized role may be created by job carving, job sharing, or job creation (Migliore et al., 2012; Smith et al., 2017). Job carving involves deconstructing a job and removing, or carving off, any tasks outside of employe area of strength, job sharing allows two or more individuals to divide a position according to their respective strengths, and job creation entails developing a new job to address the employer's unmet needs (Smith et al., 2017). The proposed role is then negotiated with the prospective employer and may include the negotiation of tasks assigned, working hours, wages, and supports needed (Dos Santos Rodrigues et al., 2013). Ho et al. (2022) identifies the complexity of this stage, noting that it is a dynamic process that includes planning, bargaining, implementation, and refinement.

Job Supports

Similar to the SE model, the CE model includes onboarding support as well the support needed to retain and thrive in the new role (Brooke et al., 2018). Given the overlap in practice, the included literature did not extensively focus on this area (n = 20), but did provide an overview of the types of support needed, including initial onboarding and training (Dos Santos Rodrigues et al., 2013; Inge et al., 2024; Wehman et al., 2016), communication support (Riesen & Morgan, 2018), wrap-around community supports (Brooke et al., 2018; Riesen et al., 2022), and job retention and growth (Ho et al., 2022; Migliore et al., 2012; Wehman et al., 2016). In addition, the support most frequently noted (n = 12) was the facilitation and movement towards natural supports. Callahan et al. (2011) note that natural support refers to “the relative access to the support strategies available to all individuals rather than to an artiﬁcial source of support that might not actually be “natural” in some settings,” (p. 168). Support strategies to facilitate connection to natural support include facilitating relationships with coworkers, setting up workplace mentorships, and training coworkers on support strategies (Migliore et al., 2012). Voermans et al. (2023) highlights the importance of establishing natural supports to ensure long-term sustainability of the employment outcome.

Potential Impacts of Customized Employment

When implemented successfully, CE has the potential to make significant impact.

Employment Outcomes

Employment outcomes were listed most frequently in the included literature (n = 23) as an impact of CE programming. Murphy et al. (2014) found that individuals with intellectual disabilities participating in CE programming achieved CIE at a higher rate than those enrolled in SE. Similarly, Inge et al. (2023a) conducted a randomized control trial to measure the CIE rates of those enrolled in CE programs and a control group participating in other forms of vocational support, the CE group were almost four times as likely to achieve CIE. Wehman et al. (2016) found in their retrospective review of vocational rehabilitation programming results that of those who achieved CIE, 72.2% had customized positions.

In addition to outcomes, the variety of positions included in CIE outcomes were greater when using a CE model as compared to SE models of support, with Riesen et al. (2023b) speculating that “the fact that CE occupations at exit are slightly more dispersed across occupations may be attributed to the differences between service implementation approaches,” (p. 121). Several included studies shared examples of outcomes and position types, with CIE positions in a variety of sectors and locations, such as hospitals and healthcare settings, restaurant and food services, business and financial occupations, architecture and engineering occupations, building and grounds cleaning and maintenance occupations, sales or related occupations (Luecking, 2011; Maebara, 2020; Molina & Demchak, 2016; Riesen et al., 2023b).

There was some analysis of the rate of pay and hours worked when CIE was achieved through CE. Almalky (2020) found that individuals with intellectual disabilities who achieved CIE through CE “worked signiﬁcantly more than individuals in sheltered workshops,” (p. 3). While Inge et al. (2023b) found that individuals with intellectual disabilities who achieved CIE through SE worked on average more hours than those engaged in CE, Taylor et al. (2021) states that CE led to higher wages and more hours worked than those supported through SE. Riesen et al. (2023c) found that CE and SE resulted in similar range of working hours, however CE results in higher wage and benefits packages.

Movement Away from Sheltered Employment and Day Programming

Importantly, several studies noted CE as an effective model for movement away from sheltered work and day programming (n = 17). Harker and Desenberg-Wines (2017) explored efforts in Iowa to transition supports from segregated to community-based employment, finding individuals who had previously been deemed “unemployable” were indeed employable with support from the CE model. Working through hesitation and the difficulties of system change, it was noted that sharing the “successful achievement of individual CIE outcomes seemed to have the greatest impact on raising expectations across stakeholders” (Harker & Desenberg-Wines, 2017, p. 326). Luecking (2011) shared the success of one individual with intellectual disabilities who had been working in a sheltered workshop for 15 years:

This work did not match his strong interest in video and media or his longstanding dream of working in the media field. For a long time it was presumed by the sheltered employment facility staff that Jonathan's intellectual disability; his mobility disability, for which a power wheelchair was necessary; and his free use of only one hand would preclude integrated employment in this or any other field. Jonathan's referral to participate in a customized employment initiative changed that belief. (p. 268)

Significant shifts in sector change and supports can be difficult for families, Rosenthal et al. (2011) shared how deeply engrained segregated programming remains “evidenced by the continued success of facility-based employment versus the continued growth of community-based, integrated employment, a trend that is pronounced in rural areas” (p. 80). In their study Smith et al. (2017) eased parental concern by providing them an abridged version of the CE training that employment specialist were undertaking.

In addition to sharing success and providing information to support change, Inge et al. (2018) note that the very nature and practice of CE pushes perspective forward. They share,

Often, people with disabilities are observed in special programs or segregated settings where there are limited opportunities for them to demonstrate personal interests and skills. The resulting perception is that they are unable to achieve integrated employment. These preconceived views or expectations can be changed when a person is seen where he or she is most comfortable and participates in typical community activities. Participants in the focus groups were clear that customized employment practices must occur in the community and not at agencies that support people with disabilities: It's not in the job coach ofﬁce. It's in the community. (p. 159)

Enhanced Self-Determination and Independence

When CIE is achieved, studies note enhanced self-determination and independence of people with intellectual disabilities (n = 10). Ho et al. (2022) share that, unlike other models of employment support, CE includes the job seeker with intellectual disabilities throughout, with self-determined and self-directed processes ensuring they are leading the process and direction taken. Similarly, Inge et al. (2023a) note the importance of the person-centered nature of the discovery process, leading to increased self-advocacy skills. In a later study, Inge et al. (2024) highlight the impact of CE support for transition-age youth, who “experienced signiﬁcant increases in independence in three domains when compared to the control group on the Supports Intensity Scale -Adult Version, including Home Living, Employment, and Protection and Advocacy” (p. 727). O’Brien and Callahan (2010) capture the impact of the person-centered process,

Putting people at the center of a process that pulls them into integrated employment has a better chance of supporting those alienated from the possibility of work than trying to fit them into a process designed to push them to a job. (p. 37)

Employer Satisfaction

Finally, employer satisfaction with the CE process and outcomes was noted (n = 8). In their study assessing the productivity of people with intellectual disabilities in CE generated CIE outcomes, Seva (2020) found that individuals were well liked, completed tasks efficiently, and had good attendance and reliability. Similarly, in their examination of employer opinions of CE, Riesen and Morgan (2018) found that the “customized employment process met employer needs, helped meet production goals, and improved customer satisfaction” (p. 34). Dos Santos Rodrigues et al. (2013) share of the impact positive working relationships through CE:

… including an approach that pairs customized employment strategies with company operational needs will not only open doors for the so-called hard-to-place, but it will also expand the value employers see in disability employment programs generally. Indeed, if disability employment programs are seen by employers as helping them identify operational needs and ways to meet them, the possibilities are considerable to create unique and lasting hiring initiatives that meet the spirit of hiring quota requirements. (p. 190)

Luecking (2011) states that this impact extends beyond the initial satisfaction of the employer, leading to positive shifts in perception of employes with intellectual disabilities and their potential in the workplace, opening future opportunity for others.

Potential Challenges with Customized Employment

Despite these positive impacts, several key challenges were identified in the included literature and should be considered. In addition to the systematic barriers experienced across models of employment support, including employer perceptions (Ho et al., 2022; Luecking, 2011; Riesen & Morgan, 2018), potential loss of benefits (Kim et al., 2023a; Rosenthal et al., 2012), and large caseloads of service providers (Jones et al., 2020; Smith et al., 2017), some key issues unique to the CE model were shared.

Lack of Evaluation

Riesen et al. (2021) noted, “while CE has shown promise as a strategy that leads to im- proved employment outcomes for people with significant disabilities, the extant research on CE practices has not met necessary standards to be considered an evidence-based vocational rehabilitation practice” (p. 23) Specifically, there are calls within the included literature to both focus on descriptive research to articulate the essential practices and procedures of CE (Kim et al., 2023b; Riesen et al., 2015) as well as objective measures of CE outcomes using experimental controls to establish evidence-based models of practice (Harvey et al., 2013; Riesen et al., 2021). Without such evidence, variance in delivery models and efficacy persist (Dispenza, 2021).

More recently, fidelity scales have been developed as a means to measure both CE practice and CIE outcomes (Butterworth et al., 2023; Kim et al., 2023a; Riesen & Morgan, 2018). The Discovery Fidelity Scale, Job Development Fidelity Scale, and Consultative Employment Training and Supports Fidelity Scale “can play a key role in improving the implementation of quality supported and customized employment” (Butterworth et al., 2023, p. 469). Riesen and Morgan (2018) stated the importance of measurement and use of fidelity scales in pushing practice forward and ensuring employment specialist are accurately and fully implementing CE practice.

Quality of Support Provided

Related to the above, a key concern cited frequently in the included text (n = 17) was the lack of qualified CE practitioners. Practitioners are often not prepared or knowledgeable about evidence informed CE practices (Migliore et al., 2023; Wehman et al., 2018). In their exploration of the competencies needed to implement CE, Harvey et al. (2013) identified:

CE takes a different approach and requires different KSAOs (knowledge, skills, abilities, and other characteristics) such as “Skill in determining how a system, business, or job should work to identify operational improvements as potential negotiating points for a customized position,” “Knowledge of self-employment and resource acquisition strategies and micro-enterprise centers,” and “Skill in negotiating a win-win solution.” (p. 87)

Training to address these concerns were discussed in the included literature as a potential solution to this barrier (Butterworth et al., 2023; Jones et al., 2020; Migliore et al., 2023; Remund et al., 2022), yet it was noted that training is not a sure fix. Riesen et al. (2022) found that “while it appears that qualiﬁed employment specialists are trained to implement critical components of CE, they are not implementing the components to ﬁdelity” (p. 3). Kim et al. (2023a) finds that gaps in CE practitioner knowledge and implementation raise questions about capacity to “implement elements of CE with a high degree of fidelity that maximize outcomes for persons with disabilities in terms of obtaining CIE and the quality and durability of this prime outcome in vocational rehabilitation services,” (p. 187). Inge et al. (2023b) further explains:

This issue of knowledge translation is not a novel finding with respect to employment support professionals, and it aligns with calls to build the capacity of employment specialists to possess an array of highly sophisticated skills related to promoting positive employment outcomes for people with disabilities. (p. 183)

Length and Cost of Service

One potential reason CE practices are not being fully implemented to their potential is the time required to do so. Migliore et al. (2023) shares that even after adequate training, employment specialists may fail to effectively implement CE strategies because of the time needed to do so. The lack of time, and the associated cost was discussed by Murphy et al. (2014) “providers cannot afford to invest the upfront time it takes for discovery and to research and negotiate with targeted employers” (p. 126). Further, some found that funding frameworks did not align with established CE practices. Butterworth et al. (2023) explains, “For example, a manager reported engaging in cold calling because funding was tied to documenting a minimum number of phone calls per year to employers. Other managers struggled to identify resources for the professional development of their team members” (p. 475). Inge et al. (2018) shares one employment specialists concern about taking short cuts in service provision,

I think [interests] is the trickiest. I think it is the one that we often do mostly at a surface level by just kind of asking people either what kind of work they want to do or what's their favorite activity and stuff like that. And really trying to get an intrinsic interest, those things that people do that really bring them personal satisfaction is terribly important, terribly complex, and so discovery obviously has to spend some time ﬁguring that out at a deep enough level that it makes sense. (p. 160)

Smith et al. (2017) note that job seekers and families could become frustrated and impatient with CE if not warned about the length and depth of the process.

Discussion

This review seeks to answer the question, “What does the literature say about the use of customized employment practices to facilitate paid employment for people with intellectual disabilities?” Four key objectives guided the review: 1) Identify defining tenants of customized employment, 2) Identify if and how customized employment practices improve access to paid employment for people with intellectual disabilities, 3) Identify known barriers to using customized employment approaches, and 4) Identify how customized employment practices have been implemented in Canada compared to other jurisdictions.

As for the first objective, clear defining tenants of CE were included in the literature, allowing for robust understanding of the four phases of CE. With the known challenges in consistency of implementation, the CE fidelity scales included above may advance the literature and practice to ensure measurable and fully implemented results; it may be beneficial to include these tools in future studies.

A significant limitation of the study related to research objectives one and four is the lack of Canadian literature. The included literature has largely defined CE practices around related US policy, legislation and funding. Additional study is needed to explore understandings of CE in a Canadian context, as well as the influence of Canadian and provincial policy and funding systems on practice fidelity.

Regarding objective two, while there was evidence of the success of CE outcomes as compared to SE outcomes for people unable to previously achieve CIE, the evidence regarding wages and hours worked was mixed (Inge et al., 2023a; Riesen et al., 2023b; Taylor et al., 2021) and additional study is needed. Further, additional documentation and description of the experiences of those who were deemed as having “significant disabilities” may provide further clarity on who is best supported by CE practices and expand our collective understandings of the nature and potential of customized CIE. Although individuals with intellectual disabilities are included within the “significant disabilities” population, their consistently low employment rates (Christianson-Barker et al., 2025; Morris et al., 2024; Remund et al., 2022; Riesen & Morgan, 2018; Taylor et al., 2021) highlight the need for more targeted research that centers their specific experiences. In Canada, community living organizations are well established nationwide and play a central role in advancing inclusive CIE. As such, studies conducted within the Canadian context have the potential to contribute meaningfully to the growing body of literature focused specifically on this population.

A potential challenge not fully explored in the included literature is the potential for CE to perpetuate limited expectations and views of people with intellectual disabilities. As a practice outside of normalized labor market practices, CE has the risk of perpetuating assumptions that people with intellectual disabilities will not be qualified or able to compete for labor market driven jobs. While the persistently low employment outcomes and clear continued exclusion of people with intellectual disabilities from labor market systems demand a need to rethink models of support for individuals with more complex need, caution is needed in creating “special systems” which operate outside of the norms of community expectations. While these “special systems” have great potential to open new pathways to CIE, questioning normalized experiences and expectations in the workplace, if not implemented and messaged well, they could instead perpetuate negative perceptions and limited views on the capabilities of people with intellectual disabilities. Additional study on perspectives informing and influenced by CE is needed.

Importantly, there is a clear lack of self-advocate voice present in the included literature. Only one article included self-advocate perspective on CE, with Cheausuwantavee and Keeratiphanthawong (2021) noting that people with intellectual disabilities believe work should be customized to their strengths and abilities. Additional study is needed to better understand the lived experience from those who have benefited and participated in CE models of support.

Finally, this review did not include an analysis of self-employment as an outcome of CE practice. While some of the included studies did note and explore CE's ability to facilitate self-employment outcomes (Caldwell et al., 2020; Callahan et al., 2011; Ouimette & Rammler, 2017), it was determined that a full analysis was not possible given the design of the study and the exclusion of self-employment terminology in the search terms used. Additional study into the use of CE practices to facilitate viable business ownership of people with intellectual disabilities is needed, particularly within a Canadian context.

Conclusion

Applying a broad research question and inclusion strategy, this scoping review provides important insights and reveals critical gaps in the literature on CE practices with attention to the Canadian context and the specific experiences of individuals with intellectual disabilities.

While Riesen et al. (2023c) conducted an updated systematic review of the CE literature with a focus on implementation fidelity and outcomes, this scoping review differs in its broader exploratory approach and its emphasis on mapping the full landscape of CE literature, including definitions, conceptual frameworks, and contextual implementation practices. The scoping review complements Riesen et al. (2023c) by highlighting variability in the definitions and phases of CE, the importance of ecological rather than predictive validity in practice, and the potential utility of CE fidelity scales to enhance consistent implementation.

It also surfaces underexplored areas, such as the absence of self-advocate perspectives and the potential for CE to unintentionally reinforce low expectations if not carefully framed and implemented. Although CE is often applied to individuals with “significant disabilities,” this review emphasizes that individuals with intellectual disabilities continue to experience the lowest rates of employment (Christianson-Barker et al., 2025; Morris et al., 2024; Remund et al., 2022; Riesen & Morgan, 2018; Taylor et al., 2021), pointing to a need for research that centers their unique experiences. The review found mixed results regarding CE's impact on wages and hours worked, even though CE appears to provide access to CIE for individuals who were previously excluded from traditional SE models. Further research is needed to explore who benefits most from CE, how it shapes employer and societal expectations, and how it can be implemented in ways that empower individuals with intellectual disabilities rather than isolate them in alternative systems. The lack of self-advocate voice in current literature is a significant gap; future studies should prioritize participatory methods to ensure that lived experiences directly inform both research and practice. Finally, studies examining CE practices in Canada are needed and have the potential to make a meaningful contribution to the expanding body of literature focused specifically on individuals with intellectual disabilities.

Footnotes

Acknowledgement

The authors would like to acknowledge the ongoing work and contributions to the Canadian employment landscape of the national Ready, Willing and Able team.

ORCID iD

Jennifer Christianson-Barker

Ethical Considerations

Ethics approval was not required for this study as no human participants were involved.

Informed Consent

Not applicable.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded as a building block project of the Ready, Willing and Able initiative, which is funded by the Government of Canada's Opportunity Fund. (The authors declare no funding number.)

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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