Cost-benefit analyses of employment services for individuals with intellectual and developmental disabilities: A scoping review

Employment Interventions for People With Intellectual and Developmental Disabilities: A Delphi Study of Stakeholder Perspectives

The purpose of this study was to examine the social validity of five different evidence-based and emerging pathways to employment (i.e., supported employment, customized employment, internships, apprenticeships, and postsecondary education) from the perspective of multiple stakeholders. A Delphi method was used to determine whether stakeholders are in consensus regarding the accessibility, affordability, acceptability, efficacy, and the cost-benefit ratio of these interventions. Findings indicated that all pathways were deemed socially valid via stakeholder consensus except for apprenticeships, which could not be determined as a result of limited stakeholder knowledge and experience with the pathway. Future efforts to improve employment outcomes for people with intellectual and developmental disabilities (IDD) should focus on better training for service providers and increased access to services.

Cost-benefit analysis of a non-government organization and Australian government collaborative supported employment program for autistic people

We present a cost-benefit analysis of an Australian Government sponsored 3-year supported employment program for autistic adults—the DXC Dandelion Program—in the information and communications technology sector. We explored the range of direct costs associated with running the program, benefits to participants, and avoided costs to the government. Estimates were based on data from 56 (86% men; Mage = 25.28, standard deviation [SD]  = 8.36 years) autistic participants in the program. The program generated a high benefit ratio for government, mainly driven by increases in wage rates and hours worked and avoiding welfare and unemployment benefit payments. Participants received the largest benefit through wages and access to the labor market, with most participants transitioning into productive, open employment following program completion. The results from the model are robust; the benefit ratio remained above 1.0 even when higher discount rates were applied. In sum, our analysis identifies potential economic savings associated with supported employment programs that provide pathways for otherwise unemployed or under-employed autistic adults to enter the workforce.

Lay abstract

Relative to the size of the population, there are fewer autistic people than non-autistic people in the workforce. Employment programs that provide extra support to autistic people may help them to gain and keep jobs that are suited to their skills and expertise. In this study, we reviewed the DXC Dandelion Program. This is a supported autism employment program run in partnership with the Australian Government. The program provided jobs to autistic people who worked in information and communications technology roles, such as software testing and cyber security. In this study, we examined some of the benefits of the program for the autistic people who participated in it. We also examined the benefits of the program to the government. We found that there are many savings to government when autistic people are employed in jobs that are matched to their skills and abilities, compared to being unemployed or working in jobs that are below their level of education, training, or skills.

Community employment, facility-based work, and day activities for working age people with intellectual and developmental disability

BACKGROUND: Individuals with Intellectual and Developmental Disability (IDD) participate in a variety of day/employment activities including community-based activities and work and facility-based activities and work. These different activities have important implications for community inclusion and economic independence. OBJECTIVE: The purpose of this study is to use the National Core Indicators-In person Survey (NCI-IPS) to explore the prevalence of day/employment activities for adult service users with IDD and to determine what personal and environmental factors are related to each type of activity. METHODS: The data analyzed in this study come from the 2018-19 National Core Indicators (NCI), a survey of adult services users with IDD in the U.S. We used descriptive statistics and multinominal logistic regression to explore how the various covariates differentially relate to the four day/employment activity types. RESULTS: A variety of personal and environmental characteristics were associated with each type of activity. Characteristics related to equity (e.g., race and gender) and support needs (e.g., mental health) were associated with less community-based work. CONCLUSIONS: This study was the first, to our knowledge, to describe the complexity of day/employment activities individuals with IDD experience in terms of prevalence and overlap. Further, this study provides evidence that certain profiles are leading to different experiences and that services do impact service users employment opportunities.

The impact of competitive integrated employment on economic, psychological, and physical health outcomes for individuals with intellectual and developmental disabilities

BACKGROUND

Although competitive integrated employment (CIE) has been established as a goal of employment research, policy, and practice for individuals with intellectual and developmental disabilities, the secondary benefits of CIE are rarely discussed.

AIMS

The purpose of this systematic review was to analyze and synthesise research related to the association between CIE and improved economic, psychological health, and physical health outcomes for individuals with intellectual and developmental disabilities.

MATERIALS & METHODS

Our review searched peer-reviewed literature from seven electronic databases and screened 1110 peer-reviewed articles based on inclusion criteria established following PRISMA guidelines.

RESULTS

Our search procedures produced a final sample of 17 studies.

DISCUSSION

Implications of these findings for future research, policy, and practice are provided.

CONCLUSION

Our findings showed strong evidence associated with economic outcomes of CIE, moderate associated with psychological health outcomes, and limited evidence related to physical health outcomes.

Interventions for improving employment outcomes for persons with autism spectrum disorders: A systematic review update

BACKGROUND

The incidence of autism spectrum disorders (ASD) is on the rise. Currently, 1 in 59 children are identified with ASD in the United States. ASD refers to a range of neurological disorders that involve some degree of difficulty with communication and interpersonal relationships. The range of the spectrum for autism disorders is wide with those at the higher functioning end often able to lead relatively independent lives and complete academic programs even while demonstrating social awkwardness. Those at the lower functioning end of the autism spectrum often demonstrate physical limitations, may lack speech, and have the inability to relate socially with others. As persons with ASD age, options such as employment become increasingly important as a consideration for long-term personal planning and quality of life. While many challenges exist for persons with ASD in obtaining and maintaining employment, some research shows that, with effective behavioral and social interventions, employment can occur. About 37% of individuals with ASD report having been employed for 12 months or more, 4 years after exiting high school. However, several studies show that individuals with ASD are more likely to lose their employment for behavioral and social interaction problems rather than their inability to perform assigned work tasks. Although Westbrook et al. (2012a, 2013, 2015) have reviewed the literature on interventions targeting employment for individuals with ASD, this review is outdated and does not account for recent developments in the field.

OBJECTIVES

The objective of this review is to determine the effectiveness of employment interventions in securing and maintaining employment for adults and transition-age youth with ASD, updating two reviews by Westbrook et al. (2012a, 2013).

SEARCH METHODS

The comprehensive search strategy used to identify relevant studies included a review of 28 relevant electronic databases. Search terminology for each of the electronic databases was developed from available database thesauri. Appropriate synonyms were used to maximize the database search output. Several international databases were included among the 28 databases searched. In addition, the authors identified and reviewed gray literature through analysis of reference lists of relevant studies. Unpublished dissertations and theses were also identified through database searches. The programs of conferences held by associations and organizations relevant to ASD and employment were also searched. In sum, the search strategy replicated and expanded the prior search methods used by Westbrook et al. (2012a, 2013).

SELECTION CRITERIA

Selection criteria consisted of an intervention evaluation using a randomized controlled trial or quasi-experimental design, an employment outcome, and a population of individuals with ASD.

DATA COLLECTION AND ANALYSIS

We updated the search from Westbrook et al., replicating and broadening the information retrieval processes. Our wide array of sources included electronic databases, gray literature, and conference and organization websites. Once all potentially relevant studies were located, pairs of coders evaluated the relevance of each title and abstract. Among the studies deemed potentially relevant, 278 were subjected to full-text retrieval and screening by pairs of coders. Because many intervention studies did not include employment outcomes, only three studies met our inclusion criteria. Given the small number of included studies, meta-analytic procedures were not used; rather, we opted to use more narrative and descriptive analysis to summarize the available evidence, including an assessment of risk of bias.

RESULTS

The systematic review update identified three studies that evaluated employment outcomes for interventions for individuals with ASD. All three studies identified in the review suggest that vocation-focused programs may have positive impacts on the employment outcomes for individuals with ASD. Wehman et al. indicated that participants in Project SEARCH had higher employment rates than control participants at both 9-month and 1-year follow-up time points. Adding autism spectrum disorder supports, Project SEARCH in Wehman et al.'s study also demonstrated higher employment rates for treatment participants than control participants at postgraduation, 3-month follow-up, and 12-month follow-up. Smith et al. found that virtual reality job interview training was able to increase the number of job offers treatment participants received compared to control participants.

AUTHORS' CONCLUSIONS

Given that prior reviews did not identify interventions with actual employment outcomes, the more recent emergence of evaluations of such programs is encouraging. This suggests that there is a growing body of evidence regarding interventions to enhance the employment outcomes for individuals with ASD but also greater need to conduct rigorous trials of vocation-based interventions for individuals with ASD that measure employment outcomes.