How employment support and social integration programmes are viewed by the intellectually disabled

Supported employment, quality of jobs and employment typicalness: The experience of the Engage to Change project

BACKGROUND

Paid employment represents a challenge for people with an intellectual disability and/or autism. This paper analyses the quality of jobs offered by the Engage to Change project and their relationship to the 'typicalness' of the employment offered.

METHOD

Data on the quality of 384 paid jobs were collected, including hours worked and wages earned, and reported social integration at work. The typicalness of the employment experience was assessed for 141 young people, using the Index of Typicalness of Placement Questionnaire.

RESULTS

The Engage to Change project offered a wide range of jobs. There is no difference in the typicalness of the employment experience in relation to the interactions in the workplace, but there are some differences in the recruitment process for men and women.

CONCLUSION

Job coaches should make sure that, despite the procedures being 'atypical' for the workplace, the outcome is 'a typical employment experience' for each employee.

Facilitators of Sense of Belonging Among People With Intellectual and Developmental Disabilities: A Systematic Review

Background: This review synthesizes the available literature regarding factors which facilitate a sense of belonging in people with intellectual and developmental disabilities, and provide a comprehensive integrative view of the subject. Methods: Four electronic databases were searched, and 13 studies met inclusion criteria for review. The "standard quality assessment criteria for evaluating primary research papers from a variety of fields" indicated satisfactory quality. Factors which facilitate a sense of belonging in people with intellectual and developmental disabilities were analyzed into themes. Results: Sense of belonging is enhanced by feeling respected, accepted, and valued (Subjectivity). These experiences are more likely to be achieved in a familiar and safe environment (Dynamism), and with access to platforms for social interactions (Groundedness), where a sense of relatedness and connectedness achieved by shared experiences with others (Reciprocity). Sense of belonging is associated with committed action of people with disability, taking assertive action or being agentic (Self-determination). Conclusion: Sense of belonging is a unique concept that should be addressed in disability research and practice.

Barriers to employment of people with intellectual disability

BACKGROUND

People with intellectual disability are likely to face long-standing employment barriers in finding and keeping jobs, for a variety of reasons. This study, therefore, investigated barriers to employment of people with intellectual disability. The participants in this study were made up of sixty-five stakeholders who were recruited from six different categories.

OBJECTIVE

The objective of the study was to determine barriers to employment of people with intellectual disability.

METHODS

A qualitative and quantitative research design was used in the study. The qualitative method was used to systematically identify barriers to employment for people with intellectual disability while the quantitative method was used to rank the barriers.

RESULTS

Findings indicate that barriers to employment for people with developmental disabilities are discrimination, stigma, employers' attitude, and management style, feeling unappreciated, and working environment such as culture to accommodation, understanding and strengths. Moreover, results shows that discrimination was ranked the highest while feeling unappreciated was ranked the least of the barriers to employment of people with intellectual disability.

CONCLUSION

The paper provides information about barriers to employment of people with intellectual disability in Nigeria that is required to initiate change in policy development.

Worker roles in the open labor market: The challenges faced by people with intellectual disabilities in the Western Cape, South Africa

BACKGROUND

Work holds great meaning and benefits beyond just monetary gain for people with intellectual disabilities. It gives these individuals the opportunity to engage in meaningful occupation.

OBJECTIVE

The purpose of the study was to explore challenges that people with intellectual disabilities (PWID) experience when adapting to their worker roles in the open labor market.

METHODS

The study used grounded theory as the research design. Five male participants and two key informants participated in the study. Two semi structured interviews were conducted with each one of the seven participants (five PWID and two key informants).

RESULTS

Three core concepts emerged: 1) Unforeseen challenges of change; 2) A well-planned work preparation program enables success and 3) Crossing the bridge into the workplace: "Do I belong here?"

CONCLUSIONS

This indicated that with sufficient external support, PWID are able to gain a sense of social belonging and develop the necessary skills to cope with challenges that arise in the workplace when PWID transition from protective/sheltered workshops to the open labor market. The findings of the study also indicated that work preparation programs and supportive employment approaches helped PWID transition to the open labor market.

Belonging and reciprocity amongst people with intellectual disabilities: A systematic methodological review

BACKGROUND

Social inclusion has been explored using a wide range of theories and methods. Belonging and reciprocity have been identified as key components of social inclusion. This systematic methodological review identifies and evaluates the theoretical frameworks and qualitative approaches adopted to explore belonging and reciprocity in the lives of adults with intellectual disabilities.

METHOD

A systematic search was conducted across ten databases. Screening and quality appraisal were carried out independently by two researchers, and data were extracted to provide detailed accounts of the theories and methods employed.

RESULTS

Seventeen papers met inclusion criteria. Clear conceptualisations of belonging and reciprocity were lacking, and these concepts were rarely the focus of the research. Theoretical and methodological shortcomings across this literature were identified and discussed.

CONCLUSIONS

More nuanced conceptualisations of belonging and reciprocity may be helpful in future research, to better capture the context and meaning of individual lives and relationships.

The value of competitive employment: In-depth accounts of people with intellectual disabilities

BACKGROUND

Increasing the societal participation of people with intellectual disabilities via competitive employment requires a full understanding of what this means to them. This paper aims to provide an in-depth examination of the lived experiences of people with intellectual disabilities in competitive employment.

METHOD

Interviews were conducted with six participants with mild intellectual disability or borderline functioning and good verbal communication skills. Interviews were analysed according to the guidelines of interpretative phenomenological analysis (IPA). Member checks were conducted.

RESULTS

Analysis yielded three main themes: (a) Building on my life experiences, (b) My place at work and (c) Being a valuable member of society, like everyone else.

CONCLUSIONS

Competitive employment could make a substantial contribution to the sense of belonging to society and quality of life of people with intellectual disabilities. Nevertheless, they must cope with stigma-related obstacles and feelings of being dependent on others in the work environment.

Differentiating care for persons with mild intellectual disability or borderline intellectual functioning: a Delphi study on the opinions of primary and professional caregivers and scientists

BACKGROUND

The demand for support for persons with mild intellectual disability or borderline intellectual functioning is growing rapidly. These persons often encounter individual and familial limitations that influence their human functioning, and often have difficulty coping with the demands of modern society. Although in the areas of policy, research and practice, people with mild intellectual disability or borderline intellectual functioning are generally approached as one group, important differences between them have been reported. Current support seems to be both suboptimal and insufficiently differentiated.

METHODS

In this Delphi study we aimed to explore the need for appropriate and differentiated support for individuals with mild intellectual disability or borderline intellectual functioning. The study was based on five unique profiles of persons with mild intellectual disability or borderline intellectual functioning that are associated with individual and environmental variables. The opinions of expert primary caregivers, professional caregivers and scientists were analysed for potentially appropriate types of support for each of the five profiles.

RESULTS

A total of 174 statements, divided over the five profiles, were presented to the participants. For 74 statements, consensus was reached between the expert groups. For each profile, these consensual statements represented specific items (e.g. concrete personal goals) and non-specific items (e.g. the attitude towards persons with mild intellectual disability or borderline intellectual functioning, and the coordination of health care) related to the support needs.

CONCLUSION

This Delphi-based study generated consensual opinions contributing to a more differentiated system of support for individuals with mild intellectual disability or borderline intellectual functioning. Although these findings need additional investigation, they address actions that might enhance the support programmes for these individuals into more personalized support.

Factors affecting the acquisition and retention of employment among individuals with intellectual disabilities

This study analyzed factors affecting the acquisition and retention of employment among individuals with intellectual disabilities (ID). These factors were verified according to job type and were classified into general characteristics, family-related factors, psychological factors, and abilities. Data from 398 individuals with ID were analyzed using chi-square tests, independent t-tests, and regression analyses using the second wave of the first year Panel Survey of Employment for the Disabled in Korea. We found significant differences in sex, education level, receipt of basic living security assistance, transportation use, household income level, and family support between employed and unemployed participants. Additionally, the employed (vs. unemployed) ID group had significantly higher scores for all variables related to psychological factors and abilities. Factors affecting employment among individuals with ID included age, education level, receipt of basic living security assistance, family support, and vocational ability. Older age, higher education level, absence of basic living security assistance, greater family support, and higher vocational ability were associated with a higher probability of current employment. Transportation use and parents' education were associated with a high probability of non-manufacturing-type jobs. Being married, absence of basic living security assistance, greater householder income level, family support, and manufacturing industry work were associated with increased job retention. Consequently, modifying the benefit system and developing family support systems may promote employment acquisition and retention among people with ID. Efforts are also needed to expand the job types available to individuals with ID.

Supported Decision-Making: Implications from Positive Psychology for Assessment and Intervention in Rehabilitation and Employment

Purpose This article reviews existing literature on positive psychology, supported decision-making (SDM), employment, and disability. It examines interventions and assessments that have been empirically evaluated for the enhancement of decision-making and overall well-being of people with disabilities. Additionally, conceptual themes present in the literature were explored. Methods A systematic review was conducted across two databases (ERIC and PsychINFO) using various combination of keywords of 'disabilit*', work rehabilitation and employment terms, positive psychology terms, and SDM components. Seven database searches were conducted with diverse combinations of keywords, which identified 1425 results in total to be screened for relevance using their titles and abstracts. Database search was supplemented with hand searches of oft-cited journals, ancestral search, and supplemental search from grey literature. Results Only four studies were identified in the literature targeting SDM and positive psychology related constructs in the employment and job development context. Results across the studies indicated small to moderate impacts of the assessment and interventions on decision-making and engagement outcomes. Conceptually there are thematic areas of potential overlap, although they are limited in the explicit integration of theory in supported decision-making, positive psychology, disability, and employment. Conclusion Results suggest a need for additional scholarship in this area that focuses on theory development and integration as well as empirical work. Such work should examine the potential utility of considering positive psychological interventions when planning for SDM in the context of career development activities to enhance positive outcomes related to decision-making, self-determination, and other positive psychological constructs.

What is important at the end of life for people with dementia? The views of people with dementia and their carers

BACKGROUND

Approaching end of life is often a time of vulnerability; this is particularly so for people with dementia and their families where loss of capacity and the ability to communicate, make assessment and shared decision-making difficult. Research has consistently shown that improvements in care and services are required to support better quality and more person-centred care for people with dementia towards and at end of life. However, the views of people with dementia about what factors contribute to high-quality care at this time are a neglected area.

AIM

The aim of this study was to identify the aspects of end-of-life care for people with dementia that are most important to them and their carers.

DESIGN

Q-methodology, a mixed method combining qualitative and quantitative techniques to study subjectivity, was used to identify the views of people with mild dementia, their family carers and bereaved carers on end-of-life care for people with dementia. Fifty-seven participants were included in the study.

RESULTS

Four distinct views were identified: family involvement, living in the present, pragmatic expectations and autonomy and individuality. Some areas of consensus across all views included compassionate care, decisions being made by healthcare professionals and information availability when making decisions.

CONCLUSION

Our findings reveal several different views on what is important about end-of-life care for people with dementia; therefore, a 'one-size-fits-all' approach to care is unlikely to be most appropriate. Notwithstanding the differing viewpoints could provide a framework for service providers and commissioners for future care. Copyright © 2016 John Wiley & Sons, Ltd.

Towards Employment: What Research Says About Support-to-Work in Relation to Psychiatric and Intellectual Disabilities

This article presents an overview of research about support-to-work in relation to psychiatric and intellectual disabilities. The overview shows that support-to-work services are multifaceted, and that work can be seen as a tool for individual rehabilitation or as a set of goals to achieve. Providers are presented with specific components, which are characterized by systematic, targeted, and individualized interventions. The overview illustrates a need for long-term engagement and cooperation of and between welfare services and agents within the labor market to dissolve the Gordian knot that the transition from welfare interventions to employment seems to be.

Graphic support resources for workers with intellectual disability engaged in office tasks: a comparison with verbal instructions from a work mate

BACKGROUND

Research into workplace adjustments for people with disabilities is a fundamental challenge of supported employment. The aim of the present work is to investigate the effect of several graphic resources as natural support for workers with intellectual disability.

METHODS

Two case studies were conducted to assess the performance of five workers engaged in office tasks, with three different support conditions.

RESULTS

Results reveal a 20% increase in quality of performance of the tasks undertaken with graphic support as compared to support in which the participants received verbal instructions (VIs) from a work mate; and between 25 and 30% as compared to a control condition which included no help of any kind.

CONCLUSIONS

These findings are consistent with previous studies which support the possibility of generating, at low cost, iconic materials (with maps or simple graphics), which progressively facilitate workers' autonomy, without dependence or help from the job trainer. We observed that the worst performance is in the support condition with VIs, this shows the limitations of this type of natural support, which is provided on demand by work mates without specialist knowledge of work support. Implications for Rehabilitation We studied the use of various types of natural support for people with intellectual disability in their workplace. The findings suggest that, with some brief training, the simple use in the workplace of graphic help on a card can increase between 20 and 30% the quality of performance of certain work tasks carried out by workers with intellectual disability. This advantage contrasts with the high cost or lower "manageability" of other material resources of natural support based on the use of technology.

Participation and Intellectual Disability: A Review of the Literature

Participation is a central aspect of human functioning and a key focus of research and practice in the intellectual disability field. However, there is not an accepted definition of participation that guides research and practice. To inform the development of a definition, a scoping review of the intellectual disability literature from 2001-2015 was conducted. Findings suggest that existing research rarely uses definitions of participation, but does examine participation across multiple domains and addresses issues of access and inclusion. Less focus was placed on individual aspects of participation such as meaning, responsibility, and choice. Based on the findings, implications for future research and practice are provided.

Work Environment-Related Factors in Obtaining and Maintaining Work in a Competitive Employment Setting for Employees with Intellectual Disabilities: A Systematic Review

BACKGROUND

People with an intellectual disability value work as a significant part of their lives, and many of them want to participate in regular paid employment.Current estimates show that the number of people with ID who have some form of paid employment are very low, ranging from 9 to 40% across different countries,despite legislations. This review examines papers published in the past 20 years in an attempt to answer the following research question: ‘What work environment-related factors contribute to obtaining or maintaining work in competitive employment for people with an intellectual disability?’

METHOD

The databases of PubMed, PsycINFO,CINAHL, Embase and Web of Science were searched for relevant papers published between 1993 and 2013. All papers were independently screened by two researchers.Methodological quality of the studies was evaluated, and data on work environment-related factors stimulating employment for people with intellectual disabilities were extracted and grouped into categories.

RESULTS

A total of 1932 articles were retrieved. After extensive screening for relevance and quality, 26 articles were included in this review. Four themes/categories with work environment related factors that could influence work participation were distinguished. Five studies were conducted on employers’ decisions and opinions. Eight focused on job content and performance, and eight on workplace interaction and culture. Five studies evaluated support by job coaches.

CONCLUSION

Despite ongoing legislation to promote participation of people with intellectual disabilities in the paid workforce, research in this area is still extremely scarce. In the past 20 years, very few studies have focused on work environment-related factors that can enhance competitive work for people with intellectual disabilities.This review shows that relevant work environment-related factors for obtaining and maintaining work in competitive employment include supporting the employers by paying specific attention to: employer’s decisions, job content, integration and work culture and job coaches.

Eliciting perceptions of satisfaction with services and supports from persons with intellectual disability and developmental disabilities: a review of the literature

BACKGROUND

Assessing the perceptions of individuals with intellectual disability (ID) and developmental disabilities (DD) is an essential part of evaluating and planning services and an important component of respect for self-direction and autonomy. It can be difficult, however, to assess satisfaction in such a way that individuals with disabilities' actual perceptions of satisfaction are accurately represented because of intellectual and communication difficulties they may have, the restricted range and nature of service systems, and the limitations of strategies used by some researchers.

METHOD

The purpose of this literature review was to systematically examine research studies designed to solicit personal satisfaction information from individuals with ID and DD. We reviewed 29 studies that met inclusion criteria to determine (1) who were participants in the studies, (2) what processes researchers used to obtain opinions and perspectives of persons with ID and DD, and (3) how researchers ensured the credibility, accuracy and voluntariness of participants' responses.

RESULTS

Findings revealed that most of the research participants had ID with higher IQs and limited needs for supports. Researchers utilised a variety of processes to elicit perceptions of satisfaction. Most studies employed individual interviews; researchers addressed comprehensibility of questions in a number of ways (e.g. use of visuals, adjusting wording of questions, providing clear examples). Few studies reported training interviewers or taking into account participants' primary language or cultural background. No studies reported educating participants about how to understand the satisfaction information data or how to use it in advocating for more appropriate supports.

CONCLUSIONS

Assessing the satisfaction with supports and services of individuals with ID and DD is complex particularly for persons with extensive support needs. Continued research using varied conceptual frameworks and new technologies is needed. Also helpful will be teaching persons with disabilities about the assessment process and how to use its results.

The ideal neighbourhood for ageing in place as perceived by frail and non-frail community-dwelling older people

Due to demographic changes and a widely supported policy of ageing in place, the number of community-dwelling older people will increase immensely. Thus, supportive neighbourhoods enabling older people to age in place successfully are required. Using Q-methodology, we examined older people's perceptions of the comparative importance of neighbourhood characteristics for ageing in place. Based on the World Health Organization's Global Age-friendly Cities guide, we developed 26 statements about physical and social neighbourhood characteristics. Thirty-two older people in Rotterdam, half of whom were frail, rank-ordered these statements. Q-factor analysis revealed three distinct viewpoints each among frail and non-frail older people. Comparisons within and between groups are discussed. Although both frail and non-frail older people strongly desired a neighbourhood enabling them to age in place, they have divergent views on such a neighbourhood. Older people's dependence on the neighbourhood seems to be dynamic, affected by changing social and physical conditions and levels of frailty.

Exploring the issue of employment for adults with an intellectual disability in Ireland

BACKGROUND

The benefits of being in employment are well documented; however, underemployment is a critical issue for people with intellectual disability (ID). Some individuals perceive themselves as being in employment when in fact they are attending a non-work site such as a day service. The impact that this perception of employment has on other areas in life has not been investigated and research into this area could have implications for both policy makers and service providers.

MATERIALS AND METHODS

The first wave of the intellectual disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) included a series of questions on employment that yielded data for a representative sample of 753 participants with intellectual disability aged 40 and over randomly selected from Ireland's National Intellectual Disability Database (NIDD).

RESULTS AND DISCUSSION

Overall, 6.6% of the population were in real paid employment, 7.4% in perceived employment, 12% in sheltered employment and 73.5% were unemployed. Differences were identified between these two groups in relation to social activities, levels of depression and self-rated health. Further investigation is needed into the area of perceived employment.

Life satisfaction in persons with intellectual disabilities

We appraised life satisfaction using the Satisfaction with Life Scale (SWLS), and analysed its psychometric properties in persons with intellectual disability (ID). Ninety-nine persons with ID from four services in Spain participated. A battery of subjective assessments was used, including the SWLS, a Quality of Life measure (WHOQOL-BREF), and health status and sociodemographic information. Psychometric properties of the SWLS were investigated using standard psychometric methods. Overall, our results showed that persons with ID were satisfied with their life (SWLS score 25-29). Internal consistency (Cronbach's alpha) was .79. A factor analysis using principal components method, showed a one factor structure accounting for 55.7% of the variance. Associations, using Spearman's rho correlation coefficients, were confirmed between SWLS with the overall QoL, satisfaction with health and WHOQOL-BREF total score. Regarding 'known group' differences, persons living in residential institutions had lower life satisfaction compared to persons living in community facilities or living at home, though differences were not statistically significant. Student t-tests showed that SWLS scores significantly discriminated between healthy and unhealthy; and those reporting higher satisfaction with their relationships, home environment and their jobs compared to participants with lower satisfaction levels. To our best knowledge, this study is the first to report on the psychometrics properties of the SWLS in persons with ID, both in Spain and internationally. It might be a promising tool to use, with other outcome measures, in appraising persons with ID in different services and types of care; also, it might guide policymakers on the implementation of policies for persons with ID.

Perceptions of team workers in youth care of what makes teamwork effective

In youth care, little is known about what makes teamwork effective. What is known mostly reflects the view of managers in care organisations, as objective outcome measures are lacking. The objective of this article was to explore the views of youth care workers in different types of teams on the relative importance of characteristics of teamwork for its effectiveness. Q methodology was used. Fifty-one respondents rank-order 34 opinion statements regarding characteristics of teamwork. Individual Q sorts were analysed using by-person factor analysis. The resulting factors, which represented team workers' views of what is important for effective teamwork, were interpreted and described using composite rankings of the statements for each factor and corresponding team workers' explanations. We found three views of what makes teamwork effective. One view emphasised interaction between team members as most important for team effectiveness. A second view pointed to team characteristics that help sustain communication within teams as being most important. In the third view, the team characteristics that facilitate individuals to perform as a team member were put forward as most important for teamwork to be effective. In conclusion, different views exist on what makes a team effective in youth care. These views correspond with the different types of teams active in youth care as well as in other social care settings.

Participation in daytime activities among people with mild or moderate intellectual disability

BACKGROUND

Community participation has been defined as performing daytime activities by people while interacting with others. Previous studies on community participation among people with intellectual disability (ID) have mainly focused on the domestic life aspect. This study investigates the variation in community participation in the domains work, social contacts and leisure activities among people with ID in the Netherlands. A number of categories of people with ID were distinguished by: (1) gender; (2) age; (3) type of education; (4) severity of ID; and (5) accommodation type.

METHODS

Data were gathered on 653 people with mild or moderate ID, of whom 513 by oral interviews and 140 by structured questionnaires filled in by representatives of those who could not be interviewed. Pearson chi-square tests were used to test differences between categories of people with ID in the distributions of the participation variables. Additional logistic regression analyses were conducted to correct for differences between the categories in other variables.

RESULTS

Most people with mild or moderate ID in the Netherlands have work or other daytime activities, have social contacts and have leisure activities. However, people aged 50 years and over and people with moderate ID participate less in these domains than those under 50 years and people with mild ID. Moreover, people with ID hardly participate in activities with people without ID.

CONCLUSION

High participation among people with a mild or moderate ID within the domains of work, social contact and leisure activities does not necessarily indicate a high level of interaction with the community, because the majority hardly interact with people without ID. Furthermore, older people with ID and people with a more severe level of ID seem to be more at risk for social exclusion.