Feelings About Work: A Review of the Socio-emotional Impact of Supported Employment on People with Intellectual Disabilities

Resilience in the face of neurodivergence: A scoping review of resilience and factors promoting positive outcomes

Neurodivergent individuals, including a range of conditions impacting neurological function, are at an increased likelihood of poor life outcomes, such as in functional adaptation, mental health, and well-being. Yet, many live meaningful and fulfilling lives. Resilience may provide some explanation for the heterogeneity in outcomes observed in neurodivergent populations. We conducted a scoping review embedded in a neurodiversity-affirmative approach to provide an understanding of resilience in neurodivergent populations. A total of 176 articles were included in this review and were synthesized using a two-phased process. First, findings were synthesized narratively to examine how resilience has been conceptualized and explored in neurodivergent populations. Second, to identify the bio-psycho-social factors important for resilience in neurodivergent individuals, we converted concepts identified in articles to the nomenclature of the World Health Organizations' International Classification of Functioning, Disability and Health (ICF) using a standardized linking process. We find considerable variability in how resilience is conceptualized and measured in neurodivergent populations. We identified 83 unique ICF categories representing resilience factors, of which only 20 appeared in more than 5% of the articles. Identified ICF categories highlight the importance of support systems such as families and friends, community participation and acceptance, and individual capabilities for resilience.

Good mental health in people with intellectual disabilities: a systematic review

While mental disorders have been broadly researched in people with intellectual disabilities (ID), comparatively less attention has been given to the conceptualisation of good mental health for this population. To capture existing concepts, definitions and measurement approaches of good mental health a systematic literature review was conducted following PRISMA guidelines. The search was carried out in eleven databases, using various synonyms of (i) intellectual disability, (ii) mental health, (iii) wellbeing, (iv) definition, and (v) assessment. A total of 2,046 datasets were identified, of which 37 met the inclusion criteria and were analysed using reflexive thematic analysis and content analysis. Results show four main themes: (1) environment, (2) absence of mental illness, (3) physical health, and (4) psychosocial functioning. The fourth was the most dominant theme and was further divided into five sub-themes: (1) emotionality, (2) interpersonal relations, (3) realise own potential, (4) personal resources, and (5) overall appraisal of life. Our findings reveal different conceptualisations of wellbeing, which is a vital part of good mental health, but highlight a notable research gap in the actual definition and conceptualisation of good mental health for people with ID.

Disability, recruitment and job retention: Identifying barriers and facilitators from the employers' point of view

BACKGROUND

Despite increased public awareness of the professional, integration of people with disabilities, they encounter more difficulties than their non-disabled counterparts in accessing employment.

OBJECTIVE

The aim of this study was to gain a better understanding of the barriers and facilitators to hiring and retaining people with disabilities from the perspective of employers in the private and public sector in France.

METHODS

This was a qualitative study using semi-structured interviews with forty-two employers from public structures or private companies. The Consolidated Criteria for Reporting Qualitative Research was used as a guideline to secure accurate and complete reporting of the study.

RESULTS

Among barriers we found that 1. Stereotypes persist about disability, still associated with lower productivity and dangerous behaviour; 2. Disabilities were associated with costs that were considered too high; 3. Disabilities management was seen as an administrative burden. 4. The bumps of inclusion. We also highlighted facilitators such as 1. A public sector is a more favourable environment 2. Employer's personal motivation to hire people with disabilities; 3. The support by Job Coaches was seen as a powerful facilitator.

CONCLUSIONS

The decision to hire people with disabilities depends on many personal, societal and organisational factors. This study has contributed to a better understanding of their interrelationships and could be useful in developing more effective strategies for the inclusion of people with disabilities.

Well-designed manufacturing work improves some cognitive abilities in individuals with cognitive impairments

Introduction

Employment is recognized as a fundamental human right, which correlates with better physical and mental health. Importantly, well-designed work, which considers the physical, social, and psychological impacts of work, can serve to enhance the cognitive abilities of workers. Although often overlooked, work for individuals with disabilities, including cognitive impairments, is equally important for their physical and mental well-being. What has not been established, however, is whether well-designed work can also enhance the cognitive abilities of individuals with cognitive impairments.

Methods

Using a longitudinal study design, we investigated the impact of well-designed work on the cognitive abilities of 60 participants (operators) at the AMIPI Foundation factories, which employ individuals with cognitive impairments to produce electrical cables and harnesses for the automobile industry. The same operators were assessed at three different time points: upon hiring (n = 60), and after working in the factory for 1 year (n = 41, since 19 left the factory) and 2 years (n = 28, since 13 more left the factory). We used five cognitive tests evaluating: (1) finger and manual dexterity, bimanual dexterity, and procedural memory using the Purdue Pegboard; (2) sustained and selective attention using the Symbol Cancellation Task; (3) short- and long-term declarative verbal memory and long-term verbal recognition memory using Rey's Audio-Verbal Learning Test; (4) short- and long-term visual recognition memory using the Continuous Visual Memory Test; and (5) abstract reasoning using Raven's Standard Progressive Matrices.

Results

We observed improvements in procedural memory, sustained and selective attention, and short- and long-term visual recognition memory after working in the factory for 1 or 2 years. We did not observe improvements in finger or manual dexterity or bimanual dexterity, nor short- or long-term declarative verbal memory or verbal recognition memory, nor abstract reasoning.

Discussion

We conclude that, in addition to improving physical and mental well-being, well-designed manufacturing work can serve as a training intervention improving some types of cognitive functioning in individuals with cognitive impairments.

Individual, interpersonal and environmental correlates of sedentary behaviours in adults with intellectual disabilities

BACKGROUND

Sedentary behaviours have adverse health outcomes and adults with intellectual disabilities are at a higher risk of unhealthy lifestyle behaviours. The lack of knowledge relating to sedentary behaviours in adults with intellectual disabilities has impeded the development of effective interventions. This study aimed to investigate individual, interpersonal and environmental correlates that are associated with sedentary behaviours in adults with intellectual disabilities.

METHOD

A secondary analysis of data from The UK Household Longitudinal Study (Understanding Society; collected 2011-2013) was conducted. Twenty-two predictor variables were included in a stepwise logistic regression, with TV hours during weekdays (≤3 and >3 h/day) used as a proxy for sedentary behaviours. A sample of 266 adults, with mean age of 37.9 and range from 18 to 49 years old, with intellectual disabilities were identified. Because 63.9% were female, 62.4% had children and 28.2% were employed, the sample is likely to be most representative of more able adults with intellectual disabilities.

RESULTS

A significant interaction term between having children and neighbourhood status was found in the initial model so separate models for good and poor-quality neighbourhoods are reported. Having children only had a significant effect to lower the odds of high TV time among participants living in good quality neighbourhoods (OR 0.10, 95% CI 0.03, 0.25). However, for people living in poor quality neighbourhoods it was better quality leisure services that was associated with lower odds of high TV time (OR 0.48, 95% CI 0.23, 0.90). Being employed only significantly reduced the odds of high TV time in the good quality neighbourhood model (OR 0.35, 95% CI 0.12, 0.78). These effects highlight the importance of environmental effects on lifestyle behaviours of adults with intellectual disabilities.

CONCLUSIONS

Future research should aim to expand our understanding of environmental effects on the sedentary behaviours and other lifestyle behaviours of adults with intellectual disabilities.

Caregivers' Experiences with School-Work Transitions for Their Children with Disorders of Intellectual Development

During the period of school-work transition, caregivers of young adults with disorders of intellectual development (ID) often play an extended and leading role in supporting their children. This article explores caregivers' overall experiences with their children's school-work transition. Ten qualitative in-depth interviews were carried out with eleven parents/guardians of ten young adults with disorders of ID. Through reflexive thematic analysis, the following themes emerged: (i) varying degrees of preparation for employment during school years; (ii) the experience of transition collapse; (iii) struggling to navigate the system; (iv) caregivers' ambitions and high expectations; and (v) positive meetings with professionals. All caregivers in our study had clear ambitions about employment for their children, and they supported them by advocating for their rights and by collaborating as best as possible with the support system. However, their experiences bring to light how the transition process often appears random and without an overarching implementation strategy. The overall picture of the transition process is a time of concern and stress for caregivers, with room for improvement in most areas.

People with intellectual disability and employment sustainability: A qualitative interview study

BACKGROUND

Swedish employment rates are disproportionately low among people with intellectual disability and research on employment sustainability in this group is scarce. This study investigated employment sustainability among people with intellectual disability, with a focus on identifying facilitators.

METHOD

Fifteen persons with intellectual disability who were gainfully employed and had been so for at least 1 year during the last 3 years, and 10 representatives from their employers, were interviewed.

RESULTS

Five facilitators were identified: (1) having tried various types of work, (2) liking to be at work, (3) balance concerning expectations and adaptations, (4) mutual engagement and flexibility, and (5) wage subsidies.

CONCLUSION

Employment sustainability needs to be understood at individual as well as environmental and societal levels. In addition, both duration and progress should be considered regarding employment sustainability in this population.

Transition Planning: Knowledge and Preferences of Latinx Families of Youth With Intellectual and Developmental Disabilities

Due to systemic barriers, Latinx parents of youth with intellectual and developmental disabilities (IDD) report having limited involvement in transition planning. To facilitate parent involvement in transition planning, it is critical to solicit feedback from Latinx families to inform the content and mode of a transition planning intervention. The purpose of this study was to explore Latinx parents' knowledge and preferred mode for a transition planning intervention. Twenty-eight Latinx parents of transition-aged youth with IDD completed surveys and focus groups. Participants reported wanting an intervention to focus on school-based transition planning and adult services; to a lesser extent, participants wanted information about natural supports. Regarding modality, participants desired in-person or online training (versus a brochure). Implications for research and practice are discussed.

Barriers to work-based learning experiences: A mixed methods study of perceptions from the field

BACKGROUND: Work-based learning experiences (WBLEs) are significantly associated with improved postschool employment outcomes for students with disabilities; however, little is known about the specific barriers affecting implementation of WBLEs. OBJECTIVE: The purpose of this study was to identify community-and school-related barriers to implementing WBLEs. METHODS: This study used a mixed methods approach to analyze survey data from 170 secondary transition staff providing WBLEs to students with disabilities in three states. RESULTS: Findings provided a broader understanding of critical barriers as perceived by transition staff implementing WBLEs, including limited availability of resources, transportation, and lack of willing employers. CONCLUSIONS: Collaborative partnerships between vocational agencies and school districts have the potential to address some of these barriers and improve the delivery of employment supports and WBLEs in an effort to help students achieve their postschool employment goals.

A thematic analysis into the experiences of people with a mild intellectual disability during the COVID-19 lockdown period

Background. The COVID-19 pandemic is expected to have a substantial impact on people with an intellectual disability. The goal of the current study was to explore the experiences and needs of people with a mild intellectual disability during the COVID-19 lockdown period in the Netherlands. Method. A descriptive qualitative methodology was conducted, using semi-structured individual interviews with six people with a mild intellectual disability. Data were analysed thematically. Results. Three overarching themes were found: (i) Missing social contact and having people close; (ii) Being housebound has changed my daily life; and (iii) Hard to understand the preventive measures. Conclusions. Important insights into the experiences and needs of people with a mild intellectual disability during the COVID-19 lockdown period were gained. These insights are valuable with respect to a potential second COVID-19 wave or a future infection-outbreak.

Factors affecting labour market transitions, sustained employment and sustained unemployment in individuals with intellectual disabilities

BACKGROUND

Studies have reported difficulties in job acquisition and retention as well as unstable employment status among individuals with intellectual disabilities.

METHOD

Chi-square, one-way ANOVA, and binary logistic regression analysis were employed to investigate the factors that affect the labour market transition of 374 individuals with intellectual disabilities.

RESULTS

There were significant differences in sex between the sustained unemployment group and the sustained employment groups; in educational level, between sustained employment and other groups; and in basic living security assistance received, between sustained unemployment and other groups. All psychological factors in the sustained employment group were higher than in the sustained unemployment group. Communication ability significantly affected sustained employment.

CONCLUSIONS

Greater family support was associated with a lower turnover probability, and a higher educational level and greater family support increased the probability of retention. Developing family support systems may decrease the possibility of turnover and increase retention.

Value-Based Payments: Intellectual and Developmental Disabilities Quality Indicators Associated With Billing Expenditures

Although managed care is expanding into the intellectual and developmental disabilities (IDD) service system, there is little agreement about measurable and meaningful outcomes for people with IDD, including for use in value-based payments (VBP). In this study, we examined potential VBP metrics for people with IDD-relationships between quality and costs. We analyzed Basic Assurances data and long-term services and supports billing data from 68 human service organizations that supported 6,608 people with IDD. Our final hierarchical regression model predicted 66.40% of the variance of annual long-term services and supports (LTSS) billing per person. Our findings suggest quality assurance indicators can account for a significant portion of cost variance-quality metrics represent a potential for cost savings and efficient service delivery.

Employment for persons with intellectual disability in the Nordic countries: A scoping review

BACKGROUND

Persons with intellectual disability remain largely excluded from the labour market in the Nordic countries. A review of the existing knowledge base may inform policymakers who try to address this challenge.

METHOD

The study uses a scoping review of 23 articles to summarize three decades of research on employment for persons with intellectual disability in the Nordic countries.

RESULTS

Persons with intellectual disability value employment, but school-related factors may form barriers to labour market participation. Support at the workplace is important but variable. There is a paucity of intervention studies, and few studies focus on supports to bridge the gap between personal capacity and environmental demands.

CONCLUSIONS

A better coordination between the educational system and the labour market may facilitate higher levels of employment for persons with intellectual disability. Intervention studies that emphasize individualized supports and follow-up of older employees with intellectual disability are welcomed.

Assessment of Occupational Health and Job Satisfaction in Workers with Intellectual Disability: A Job Demands-Resources Perspective

In the contexts where people with intellectual disability work, there are factors that determine their job satisfaction. The objective of this study was to test the adequacy of the central assumptions of the Job Demands–Resources (JD-R) theory in workers with intellectual disability employed in different work alternatives. Data from 362 workers in sheltered workshops and 192 workers in supported employment were utilized. The model was contrasted using a structural equation model and a multi-group analysis. The results supported the suitability of the model and confirmed that job demands and job resources evoke two relatively independent processes such as health impairment and motivational process. The multi-group analysis confirmed the invariance of the model between the two work alternatives. Thus, the JD-R model offers a useful framework to explain the job satisfaction of workers with intellectual disability. Implications for the improvement of personal and job results are discussed.

Employment and attendance in day care centres for people with mild intellectual disabilities - do age, gender, functional level or hospital admissions matter?

BACKGROUND

Workforce inclusion is an important political goal in many countries. However, nearly 70% of Norwegians registered with mild intellectual disabilities (IDs) are not registered employed or attending in day care centres. This study investigates the association between age, gender, functional level and hospital admissions with employment or attendance in public financed, community-based day care centres for adults with mild IDs in Norway.

METHOD

This study is based on data from a linkage of the national population-based registries from 2013 to 2015: Statistics Norway (SSB), the Norwegian Information System for the Nursing and Care Sector (IPLOS) and the Norwegian Patient Registry (NPR). The sample consisted of 2370 adults registered with a mild ID, receiving disability pension in Norway, aged 18-67 years. Binary and multinomial logistic analyses, adjusted for age, gender, functional level and hospital admissions, were performed.

RESULTS

In 2015, 45.7% and 19.6% of the samples aged 20-31 and 52-63 years, respectively, were registered as employed or in day care centres. Participation in day care is a public service registered in IPLOS, which requires registration of functional level, while attendance in employment support is registered in SSB, where functional level is not registered. Compared with people registered with a high functional level, the probability of being employed or in day care centres was lower for people without registration of functional level. People with hospital admissions were less likely to be employed, especially if they had both psychiatric and somatic hospital admissions. People were less likely to attend day care and open employment only if they had a combination of both types of hospital admissions. Attendance in day care centres was less likely for men than women.

CONCLUSIONS

Older people with mild ID, without registered functional level (meaning not receiving public community-based services) and with a history of hospital admissions were significantly less likely to be employed or participate in day care centres. The clear association between not being employed or attending day care centres and not having one's functional level registered implies there is a need for increased focus on how to enhance work participation among people with mild IDs who are not within the system of receiving public services.

Inclusive management for social entrepreneurs with intellectual disabilities: "how they act"

BACKGROUND

Social entrepreneurship is a growing trend that reflects a shift in contemporary policy towards entrepreneurship and self-employment as viable employment option for people with disabilities. Entrepreneurship is intended to promote autonomy and reduce dependence on entitlement-based services as well as reduce employment disparities while stimulating business and job creation.However, it is not well understood what exactly this means for people with intellectual disabilities (ID) involved in social entrepreneurial ventures.

METHODS

Dyadic interviews were conducted with people with ID participating in social entrepreneurship (n = 7) as well as with the person they identified as instrumental in providing support (n = 7). Interviews focused on understanding the management processes used by people with ID, or "how they act" in negotiating between formal and informal systems of services and supports and barriers encountered.

RESULTS

Themes that emerged include the main barriers they experienced, how their businesses are organized; and the use of formal and informal services and supports.

CONCLUSIONS

This research expands upon our understanding of social entrepreneurship and the management processes involved in customized employment for people with ID. It offers new insights and information for practitioners, policymakers, and researchers to inform the expectations we set for entrepreneurship as a sustainable employment option, from the perspective of social entrepreneurs with ID themselves.

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.

Prioritizing barriers and solutions to improve employment for persons with developmental disabilities

Purpose: Persons with a developmental disability have the lowest rate of labour force participation relative to other disabilities. The widening gap between the labour force participation of persons with versus without disability has been an enduring concern for many governments across the globe, which has led to policy initiatives such as labour market activation programs, welfare reforms, and equality laws. Despite these policies, persistently poor labour force participation rates for persons with developmental disabilities suggest that this population experiences pervasive barriers to participating in the labour force.Materials and methods: In this study, a two-phase qualitative research design was used to systematically identify, explore and prioritize barriers to employment for persons with developmental disabilities, potential policy solutions and criteria for evaluating future policy initiatives. Incorporating diverse stakeholder perspectives, a Nominal Group Technique and a modified Delphi technique were used to collect and analyze data.Results: Findings indicate that barriers to employment for persons with developmental disabilities are multi-factorial and policy solutions to address these barriers require stakeholder engagement and collaboration from multiple sectors.Conclusions: Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities. Policy and decision makers need to address barriers to employment for persons with developmental disabilities more holistically by designing policies considering employers and the workplace, persons with developmental disabilities and the broader society. Findings call for cross-sectoral collaboration using a Whole of Government approach.Implications for RehabilitationPersons with a developmental disability face lower levels of labour force participation than any other disability group.Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities.Decision and policy makers need to address barriers to employment for persons with developmental disabilities holistically through policies guiding employers and broader societal behaviour in addition to those aimed at the individuals (such as skill development or training).Due to multi-factorial nature of barriers to employment for persons with developmental disabilities, policy solutions are wide-ranging and fall under the responsibility of multiple sectors for implementation. This calls for cross-sectoral collaboration using a "Whole of Government" approach, with shared goals and integrated responses.

Job satisfaction of people with intellectual disabilities: the role of basic psychological need fulfillment and workplace participation

PURPOSE

Knowledge on what contributes to job satisfaction of people with intellectual disabilities is limited. Using self-determination theory, we investigated whether fulfillment of basic psychological needs (i.e., autonomy, relatedness, competence) affected job satisfaction, and explored associations between workplace participation, need fulfillment and job satisfaction.

METHOD

A total of 117 persons with intellectual disabilities, recruited from a Dutch care organization, were interviewed on need fulfillment at work and job satisfaction. Data on workplace participation was obtained from staff. Questionnaires were based on well-established instruments.

RESULTS

Basic psychological need fulfillment predicted higher levels of job satisfaction. Level of workplace participation was not associated with need fulfillment or job satisfaction.

CONCLUSIONS

Allowing workers with intellectual disabilities to act with a sense of volition, feel effective, able to meet challenges, and connected to others is essential and contributes to job satisfaction. It is needed to pay attention to this, both in selection and design of workplaces and in support style. Implications for rehabilitation Knowledge on factors that contribute to job satisfaction is necessary to improve employment situations and employment success of people with intellectual disabilities. In order to achieve job satisfaction, it is essential that workplaces allow for fulfillment of the basic psychological needs for autonomy, relatedness, and competence of people with intellectual disabilities. People with intellectual disabilities are able to report on their needs and satisfaction, and it is important that their own perspective is taken into account in decisions regarding their employment situation.

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.