Supported employment, which uses behavioral training techniques and systematic instruction in real work environments, works very well to assist adults with Down syndrome in obtaining and maintaining employment in real jobs in their own community. There are five major components to supported employment:

Consumer assessment: This process identifies interests and attributes of the adult with Down syndrome that may facilitate or inhibit job performance. It includes an interview of the adult and significant others, observation in a variety of settings, and review of educational, vocational, psychological and medical evaluations.
Job development: A job coach contacts employers who may have suitable positions available, and discusses the employer’s attitude, job requirements, and duties.
Job placement: The consumer’s abilities and interests are matched with a particular job opening, and an employment decision is made.
Job training: Generally, job site training is facilitated by the job coach, who uses behavior analysis, counseling, and cognitive strategies to help the adult with Down syndrome learn the required job skills.
Ongoing support/follow-along services/extended services: The job coach contacts both the adult with Down syndrome and the employer at agreed-upon intervals to make sure both parties are satisfied that the job placement is working. Long-term support to the adult may also address mobility, communication, adaptive equipment, wages, co-worker relationships, and changes in work routine.

Nurses working with adults with Down syndrome often have significant interactions with job coaches and employers. Skilled in assessment and knowledgeable about health issues, the nurse can be a valuable asset to the employment team.

When an adult with Down syndrome has a knowledgeable job coach, the nurse has no role in the supported employment process.