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

'They don't think I can do it': Experiences of self-advocates, employment specialists, and employers on employment of adults with intellectual disability

BACKGROUND

A multi-phase Canadian study was conducted as part of a large-scale community and academic research partnership focused on understanding and improving the employment experiences of people with intellectual disabilities.

METHOD

This multi-method study utilized a sequential approach, using findings from qualitative interviews (n = 28) to inform an online survey (n = 149). Participants were invited to share their experiences with paid employment or with persons with intellectual disabilities.

RESULTS

Thematic analysis of data across interview and survey findings resulted in six themes: (1) assumptions and attitudes, (2) knowledge and awareness, (3) accessibility of processes, (4) use of accommodations, (5) workplace relationships, and (6) supports and resources.

CONCLUSIONS

A holistic and systemic approach has the potential to improve inclusive employment experiences of people with intellectual disabilities. Action is needed mainly at the policy and employer level to reduce barriers and improve on facilitating measures reinforced by the themes shared in this study.

Informal Network Members' Perspectives and Experiences on Work for People with Intellectual Disabilities: A Thematic Synthesis

PURPOSE

The level of participation of people with intellectual disabilities (ID) in various forms of work, including daytime activities, appears to be suboptimal. Informal networks of people with ID constitute crucial forms of support, as they can significantly influence occupational choices and opportunities. This review aims to synthesize existing research for the purpose of examining how informal network members perceive the meaning of employment or daytime activities for their relatives with ID.

METHODS

Following the PRISMA guideline, a systematic search of scientific literature published between 1990 and July 2022 was conducted. The qualitative results from twenty-seven studies (qualitative and mixed-method) were analyzed using thematic synthesis.

RESULTS

Four overarching themes and several subthemes were identified: (I) Ensuring customized work for my relative; (II) The ongoing need to collaborate and share care responsibilities with professionals; (III) The meaning of work for both my relative and myself; and (IV) Achieving full work participation for my relative is neither straightforward nor self-evident.

CONCLUSIONS

Informal networks place great value upon customized and sustainable work opportunities for their relatives with ID, particularly community-based work. While network members play an important role in creating these opportunities, they encounter obstacles resulting from both collaboration difficulties with professionals and employers and public and structural forms of stigma. Researchers, professionals, policy makers, and employers are encouraged to collaborate with individuals with ID as well as their networks to increase the meaningful work opportunities available to them.

The efficacy of competitive integrated employment versus segregated employment for persons with disabilities: A systematic review

BACKGROUND: Although competitive integrated employment (CIE) has been established as a goal of employment policy and practice for individuals with intellectual and developmental disabilities (IDD), many still receive segregated vocational services for subminimum wage. This persistence of segregated vocational services has occurred despite substantial previous research recommendations and policy directives to encourage CIE. OBJECTIVE: The purpose of this systematic review was to examine whether recent research might provide further evidence of the role of segregated vocational services in contributing to or detracting from positive outcomes. METHOD: Our review searched peer-reviewed literature from seven electronic databases and screened 589 peer-reviewed articles based on inclusion criteria established following PRISMA guidelines— resulting in a final sample of five studies. In the second phase of our analysis, we provide a comparison of segregated and integrated vocational services in terms of individual outcomes. RESULTS: Our findings provide further evidence against the use of segregated vocational services for individuals with IDD. CONCLUSION: Implications of these findings for future research, policy, and practice are provided.

The relationship between subjective socioeconomic status and health in adults with and without intellectual disability

BACKGROUND

This study investigated if subjective socioeconomic status (SSS) is related to self-rated health (SRH) and objective indicators of health in people with and without intellectual disability.

METHODS

Participants were 217 adults with, and 2350 adults without intellectual disability in Jersey. In the intellectual disability sample, 85 (39.2%) participants consented independently, while 132 (60.8%) participants consented through proxy procedures. The MacArthur Scale of Subjective Social Status was used to measure SSS. The Euro-Qol EQ-5D-5L and a five-point scale ranging from poor to excellent health were used to measure SRH.

RESULTS

Higher SSS and younger age were predictors of better SRH for the proxy-report intellectual disability group. Being employed was associated with higher EQ-5D-5L index values for all intellectual disability groups.

CONCLUSION

As SSS was only related to SRH in the proxy intellectual disability group, further research with a larger intellectual disability sample is needed to explore its utility further.

Assessment of work ability decline in workers with intellectual and developmental disabilities

BACKGROUND: People with intellectual and developmental disabilities (IDD) experience work ability decline through aging and disability (WADAD), conceptualized as the process of deterioration in work ability resulting from the interaction between disability and aging, which has a direct impact on their job. OBJECTIVE: There is a need to focus on how this decline can be detected and to identify the main areas and indicators of WADAD in people with IDD, in order to build a targeted prototype assessment tool to determine a prevention protocol that extends people’s positive working lives for as long as possible. METHODS: We employed a literature review, Delphi panel, and working group through Modular Object-Oriented Dynamic Learning Environment (MOODLE). RESULTS: We created a tool, composed of 76 items, 6 dimensions, and 17 indicators, to assess WADAD in people with IDD. CONCLUSIONS: The indicators identified can be used to develop prevention and/or intervention protocols for WADAD and to produce guidance for the transition toward retirement, specifically for people with IDD. This tool helps extend the satisfying working lives— with support— of people with IDD, promoting social inclusion and participation as workers and not as pensioners.

Dutch forensic patients with and without intellectual disabilities: A comparison of demographic, offence, and diagnostic characteristics

BACKGROUND

Patients with an intellectual disability (ID) and offending histories constitute a challenging clinical group. The present study examined commonalities and differences in demographic, diagnostic and offence characteristics in patients with and without intellectual disabilities who were either convicted for violent or sexual offences and who resided in mandated care in the Netherlands.

METHOD

We compared 165 offenders with an ID to 249 offenders without an ID. We compared both groups by type of offence (i.e., sexual versus violent offence) using Mann-Whitney U-test or independent samples t-tests for continuous variables and Chi-square tests for categorical variables.

RESULTS

In general, forensic patients with an ID were younger at admission (U=357, z = -12.668, p < .001), had more prior convictions for violent offences (χ²(1)= 6.175, p = .013) and more prevalent diagnoses of substance abuse disorders (χ²(1)= 9.266, p = .002) than those without an ID. Similar results were found for patients with IDs with sexual offence histories.

CONCLUSION

A clear understanding of distinct characteristics of forensic patients with intellectual disabilities is crucial in understanding (sexual) violent behavior in this population as it mayassistclinicians in prioritizing interventionstrategies.

Predictors of Productivity and Leisure for People Aging with Intellectual Disability

Background. Adults aging with intellectual disability (ID) face barriers to engagement in occupation. Greater understanding of factors that affect engagement in work and leisure occupations is required to support occupational engagement in this population. Purpose. Identify predictors of engagement in work and leisure occupations for adults aging with an ID, and consider implications for occupational therapy practice. Method. Data from wave 2 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Aging (IDS-TILDA) was analyzed using regression analysis to identify predictors of engagement in work and leisure occupations for adults aging with an ID. Findings. Adults who had difficulty getting around their home environment, poor physical health, or older age were less likely to engage in work and leisure activities. Implications. Occupational therapists can support adults aging with ID to age in place. Occupation-focused health promotion could enhance well-being through engagement in occupation.

Transition Program from School to Employment in Youths with Intellectual Disability: Evaluation of the Irish Pilot Study E-IDEAS

AIM

The purpose of this pilot was to evaluate the effectiveness of the E-IDEAS curriculum, specifically designed for workplace inclusion of youths with intellectual disabilities (ID) and aimed to transfer social, communication, independent living and employment skills.

METHOD

The curriculum was attended by 5 participants, and it was provided concurrently with five different work-placements across a period of six months. Two assessment tools were used to demonstrate the acquisition of such skills and an evidence-base improvement of their quality of life. Pre and post-intervention standardized assessments were also taken for measuring the improvement in quality of life (through the San Martín Scale) and adaptive behavior (through the Vineland-II Adaptive Behavior Scale).

RESULTS

The data collected showed increases in the acquisition of such skills. Evidence of maintenance and generalization were also demonstrated.

CONCLUSION

Implications for practice and further research are discussed.

Nature and extent of intellectual disability nursing research in Ireland: a scoping review to inform health and health service research

OBJECTIVES

To capture the extent and nature of intellectual disability nursing publications in Ireland.

DESIGN

Scoping review using Arksey and O'Malley approach.

DATA SOURCES

Six databases (PsycINFO, CINAHL, Medline, Academic Search Complete, Scopus, Embase) were searched along with a web-based search of the eight academic institutions delivering intellectual disability nurse education in Ireland for publications indexed from the earliest available date to the 31 December 2020.

ELIGIBILITY CRITERIA

Publications by an academic, practitioner or student working in intellectual disability practice or education in Ireland relating to intellectual disability nursing, care or education.

DATA EXTRACTION AND SYNTHESIS

Data pertaining to type of paper/design, authors (academic/professional/student), year, collaboration (national/international), topic/content area and title were extracted from each paper. Data were analysed by two authors using Colorafi and Evans content analysis steps where data was tabulated, and a narrative synthesis undertaken.

RESULTS

The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and PRISMA extension for Scoping Reviews Checklist. Database and web-based searching resulting 245 articles meeting the criteria for this review. Through content analysis the 245 articles were mapped onto six themes: supporting inclusion, future planning, aspects of health, interventions, education, professional development and research, and personal and professional accounts of caring.

CONCLUSIONS

This review highlights the extent and nature of intellectual disability publications by academic, practitioner or student working in intellectual disability nursing in Ireland together with opportunities for future growth and development. From the findings it is apparent that there is an ongoing need for intellectual disability nurses to define their role across the full trajectory of health provision and to make visible their role in person-family centred support, inclusion, and contributions in health education, health promotion and health management.

Quality of life and vocational education service quality in students with intellectual disability

The aim of the study was to investigate the relation between subjective quality of life and quality of vocational education services from the view of students with intellectual disability who participate in public special vocational education schools in Greece. The level of quality of life and quality of special vocational education services was explored. The article presents a functional description of service quality in special vocational education and operationalizes quality of life for students with disability. Instruments were developed and adapted in line with the participatory research paradigm. Convenience sampling was used. Data was gathered from 131 students with intellectual disability. All measures showed good evidence of internal consistency and construct validity. The findings suggest relationship between quality of life and quality of special vocational education services received by students with intellectual disability. Low levels of self-determination are highlighted. Practical implications concerning the application of the instruments in special education settings as measures for the quality assessment and the evaluation of educational interventions are discussed.

Participation in employment and day care for adults with intellectual disabilities: Equal access for all?

BACKGROUND

The employment rate for people with intellectual disabilities is low. This study aims to increase the knowledge about the association between age, gender, diagnosis, functional level, educational level, and daily activities for adults with intellectual disabilities.

METHOD

A multinomial logistic analysis was applied to registry data on 12,735 adults with intellectual disabilities from the Norwegian Information System for the Nursing and Care Sector (IPLOS) and Statistics Norway (SSB).

RESULTS

Higher likelihood of employment and day care participation were associated with younger age but differed between genders and diagnoses. High functional level and lack of a registered functional level decreased the likelihood for employment. Educational level was not associated with employment.

CONCLUSIONS

The systematic differences in employment and day care participation among people with intellectual disabilities indicate that actions are needed to prevent inequalities. Improved individual assessment of personal resources and wishes might promote participation in employment and day care.

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.

In pursuit of meaningful occupation: Employment and occupational outcomes for older Irish adults with an intellectual disability

BACKGROUND

Adults with an intellectual disability (ID) have much lower rates of employment than their counterparts without intellectual disability, which increases their risk of poverty and social exclusion. Differential treatment of people with intellectual disability in welfare and training policies suggests an expectation they will be passive welfare recipients rather than productive employees.

METHODS

This paper aims to examine occupational activities by older people with intellectual disability in Ireland, exploring factors influencing outcomes using data from the IDS-TILDA study (n = 708).

RESULTS

Most people were unemployed but engaged in regular occupational activity. Occupational activity was associated with better emotional/mental health. Activities of Daily Living (ADL) functioning was associated with an active occupational status, while social supports most strongly predicted high occupational engagement across a range of activities.

CONCLUSIONS

A focus on the individual meaning derived from a broad range of engagement may better support people with intellectual disabilities to benefit from regular occupational activity.

The antecedents of loneliness in older people with an intellectual disability

INTRODUCTION

The cognitive discrepancy approach to loneliness is often used to describe loneliness in ageing populations, but to date, it has never been used to explore loneliness in older people with an intellectual disability. An analysis is needed utilising a refined list of causes of loneliness in this population.

METHOD

Using data from a nationally representative dataset of people aged over 40 with an intellectual disability (N = 708), this analysis runs repeated regressions of variables grouped into conceptual blocks, organised from sociodemographic to network quality.

RESULTS

Variables selected predicted 23% of the loneliness variance. Functional limitations, education, working in the community, transport difficulties, pain, stress caused by service change, emotional health problems and confiding were all significant predictors of loneliness.

CONCLUSION

That for those with fewer functional limitations only transport difficulties precipitated loneliness, suggests living a more independent life protects from loneliness, in this group. Those with functional limitations and who lead a more service dependent life appear more exposed to loneliness precipitating variables.

Inclusion Through Work and Productivity for Persons with Intellectual and Developmental Disabilities

BACKGROUND

Employment provides an important avenue to social inclusion for most adults. A range of productivity options exist for persons with intellectual and developmental disabilities (IDD) who wish to work, each offering unique challenges relative to inclusion.

METHODS

This qualitative study examined the productivity experiences of people with intellectual and developmental disabilities in Ontario, Canada. A purposive sample of 74 individuals with productivity experiences spanning the spectrum of no employment to community-based jobs was selected from a pool of volunteers recruited through a mailed survey. Semi-structured interviews were conducted with individuals and family members. Interview transcripts were subjected to a team-based analysis using grounded theory methods.

RESULTS

Varying needs and interests exist in regard to work. Participants revealed a multitude of factors contributing to inclusion and exclusion through productivity.

CONCLUSIONS

Productivity, whether paid or unpaid, can be an avenue to social inclusion. The experience of inclusion, particularly of belonging, depends on a successfully negotiated congruence between worker attributes and the social features and demands of the work environment.

Do inclusive work environments matter? Effects of community-integrated employment on quality of life for individuals with intellectual disabilities

More individuals with an intellectual disability now possess prerequisite skills and supports necessary for successful work force integration than did previous generations. The current study compared quality of life of community-integrated workers with those participating in sheltered vocational workshops and adult day care programs. We considered numerous indices of quality of life, including inclusion and community participation; satisfaction within professional services, home life, and day activities; dignity, rights, and respect received from others; fear; choice and control; and family satisfaction. Our data revealed several important differences in quality of life across daytime activities; participants involved in community-integrated employment tended to be younger, indicated a greater sense of community integration, and reported more financial autonomy than did those who participated in adult day care programs and sheltered workshops. However, individuals reported no differences in overall satisfaction across daytime activities. We discuss generational differences across employment status as well as possible explanations to account for high levels of satisfaction across daytime activities.