Using the Independent Monitoring for Quality (IM4Q) Program to Examine Employment in Integrated Settings in the Community for People with IDD over Time


Background: Community-based employment is a key step for many adults with intellectual and developmental disabilities (IDD), a group prone to high unemployment, poverty, and dependency. It is also important in order to avoid poverty and progress toward economically stable and independent lifestyles. Increases in community-based employment for individuals with IDD meet the expectation of the HCBS final rule as well as state-wide transition planning requirements and other compliance indicators.

Objective: The current study explores changes in employment over time before and after the final rule was issued and other initiatives (e.g., Employment First policy) were adopted. This method provides an important way to detect if the effort is impacting services users with IDD as intended. By comparing three waves of data from the state of Pennsylvania (2013, 2016, and 2019), we can gain insight into changes in employment rates over time among HCBS services users with IDD in light of policy initiatives.

Method: We used three waves of IM4Q data to compare the growth in employment among 9,486 individual services users with IDD in the state of Pennsylvania. Repeated measures regression using generalized estimating equations (GEEs) was used to examine employment in an integrated setting in the community over time after controlling for age, support needs, residence type, and community type.

Results: Controlling for the effects of demographic and environmental characteristics, there was a significant increase in community-based employment among IDD service users in Pennsylvania between 2013 and 2019. Other variables were also associated with employment.

Conclusion: This study was the first to our knowledge to consider changes in community-based employment across three waves of data for individuals with IDD. The data wave collection periods in Pennsylvania coincided with significant policy changes relevant to services users with IDD. These changes in policy may be effective and warrant both continued exploration of its effect and ways to maximize policy to further integrate adults with IDD into the community.

Suggested Citation

Houseworth, J., Feinstein, C., Pettingell, S. L., Bershadsky, J., Tichá, R., Lemanowicz, J., & Zhang, A. (2023). Using the independent monitoring for quality (IM4Q) program to examine employment in integrated settings in the community for people with IDD over time. Journal of Vocational Rehabilitation, 1–11.


Peer-Reviewed Article 
IOS Press


  • Community life
    • Quality outcomes
  • Employment and postsecondary education
    • Employment and workforce development
  • Specific disability
    • Intellectual/developmental disability (IDD)