What is the current evidence on promoting employment for people with intellectual and developmental disabilities?

Equity Depth Local Relevance Feasibility
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Question & problem

There is a sparse evidence base of employment interventions that specifically focus on people with intellectual and developmental disabilities (IDD). The little research available has indicated that the perceived benefits of employment for persons with IDD are similar to that of the non-disabled population in terms of their relationships with co-workers, increased income and opportunities, feeling of being busy and productive and self-worth.  Low employment rates among people with IDD have been reported globally. This brief explores the evidence of the possible causes and issues regarding interventions to increase employment of persons with IDD.

Quote

“One of the organisational issues that might negatively impact employment for individuals with ASD is a tendency of employers to focus on perceived limitations without recognising the importance of building a supportive workplace.”
- Hedley, Darren, et al, Autism, 2017

Recommendations

Provide training on inclusive employment practices to employers and co-workers to ensure that people with IDD experience supportive working environments.

Key recommendation

Provide training on inclusive employment practices to employers and co-workers to ensure that people with IDD experience supportive working environment.

Action

Employers and staff who work with employees with IDD need to receive training on how to build a supportive workspace, and teach strategies that would produce positive inter-personal relationships.

Evaluate the fit of the individual to the job position as well as customise the job description to promote better mental health of the individual.

Key recommendation

Evaluate the fit of the individual to the job position as well as customise the job description to promote better mental health of the individual.

Action

Optimal jobs are when all four factors; job demands and complexity, perceived job security, job control, and fair compensation are rated adaptively by the employee. Job fit criteria need to be established to avoid any potential negative impact of employment on the health of people with IDD.

Interventions need to be adequately adapted to the realities of persons with intellectual disabilities

Key recommendation

Interventions need to be adequately adapted to the realities of persons with intellectual disabilities

Action

Interventions need to be adequately adapted to the realities of persons with intellectual disabilities

Increase knowledge and awareness about assistive products and technology and the need thereof for people with IDD.

Key recommendation

Increase knowledge and awareness about assistive products and technology and the need thereof for people with IDD.

Action

Set up assistive technology advocacy groups on local and national levels for persons with intellectual disabilities to increase awareness and knowledge as well as offering educational and training programmes on the issue. These groups are also recommended to promote and advocate for increased funding and state grant programmes to purchase and make assistive products more affordable.

A multi-sectoral approach e.g. job coaches, co-workers, managers, and families are needed to create more work participation and promote supported employment.

Key recommendation

A multi-sectoral approach e.g. job coaches, co-workers, managers, and families are needed to create more work participation and promote supported employment.

Action

Work environment-related factors related to employer’s decisions and opinions, job content, requirements and performance, interaction and workplace culture, and support from job coaches are needed to create an inclusive workplace for people with IDD.

Challenges

Challenge #1: Employers have a tendency to focus on the often perceived limitations of employees with Intellectual disabilities (IDD).

    • Although reviews from low- and middle- income countries (LMICs) are lacking, reviews from high-income (HICs) suggest that one of the organisational issues that have a negative impact on the employment of people with IDD is the inability to recognise the importance of building a supportive workplace and their focus on their employees’ limitations.
    • There is a need for (increased) training of employers and staff members who work with people with IDD

Challenge #2: Health has been found to be a predictor of employment; although unemployed persons with disabilities generally have poorer mental health than employed persons with disabilities, some studies have shown that employees with disabilities have poor mental health outcomes when in positions of low psychosocial quality.

    • A recent review found that people with IDD participating in paid employment experience better mental health compared to those participating in sheltered workshop or unpaid employment or unemployed.
    • Research indicate that people with disabilities who are in employment may experience poorer mental health outcomes if they are in jobs of low psychosocial quality which consists of four factors; job demands and complexity; job control; perceived job security; and fair compensation. These factors are often not considered in employment interventions for people with IDD.
    • This suggests that the impact employment has on health may be mediated by the fit of a worker to the job and the type of work environment, e.g. supported or sheltered employment.

Challenge #3: Despite interventions, low rates of employment among persons with intellectual disabilities have been reported globally. Even in HICs such as England, the latest data indicate that only 5.1% of people with IDD, aged 18 – 64 years, are in paid employment, however, detailed data is largely absent in LMICs.

    • Research indicate that the format and type of secondary school education can influence whether people with IDD can gain paid employment or not e.g. formal structured education, lack of work experience opportunities as part of the curriculum have been identified as barrier to employment.
    • Some studies propose that the low employment rates are due to the approaches of interventions not being adjusted to the realities of people with IDD. Furthermore, traditional indicators such as satisfaction with life and quality of life not always being adapted to the realities of people with IDD.
    • Additionally, employment specialists appear to not always apply the recommendations provided by best practices guidelines

Challenge #4: Persons with intellectual disabilities face a variety of barriers to access and use assistive products and technology which are key to their path to and retaining employment

    • The most commonly reported barriers faced by people with IDD in accessing assistive products and technology are a lack of funding, high costs of products and a lack of awareness and knowledge.by employers
    • There is a great gap in research regarding the general access of assistive technology for people with IDD and even more so in LMICs illustrating the need for increased awareness and knowledge building as well as funding interventions of assistive technology.

Challenge #5: Although supported employment has become popular in HICs in recent years, several factors and complexity, lack of resources and evidence makes it difficult to adopt in LMICs.

    • Despite the benefits of supported employment, sheltered employment remains dominant in LMICs
    • Evidence suggest that people with IDD in supported employment reported higher levels of leisure activities, self-esteem, and mobility. Additionally, people with IDD were found to have more favourable perceptions of their jobs skills, and changes.
    • Supported employment programme are complex interventions that need multi-sectoral collaborations between stakeholders such as employers, people with IDD and their caregivers, and job coaches.

Finding the answers

We conducted a review of reviews, examining systematic and scoping reviews of evidence on the topic of employment interventions focussing on people with intellectual and development disabilities. All recommendations are based on reviews of literatures from high-income countries, where the recommendations made were transferable to low-resource settings. This evidence brief is based on the findings of 5 systematic reviews, 1 scoping review and 1 study which covered literature from a range of settings, aspects of life and factors contributing to the employment, or the lack of, interventions for people with IDD.

Recommendations & actions

Provide training on inclusive employment practices to employers and co-workers to ensure that people with IDD experience supportive working environments.

Key recommendation

Provide training on inclusive employment practices to employers and co-workers to ensure that people with IDD experience supportive working environment.

Action

Employers and staff who work with employees with IDD need to receive training on how to build a supportive workspace, and teach strategies that would produce positive inter-personal relationships.

Evaluate the fit of the individual to the job position as well as customise the job description to promote better mental health of the individual.

Key recommendation

Evaluate the fit of the individual to the job position as well as customise the job description to promote better mental health of the individual.

Action

Optimal jobs are when all four factors; job demands and complexity, perceived job security, job control, and fair compensation are rated adaptively by the employee. Job fit criteria need to be established to avoid any potential negative impact of employment on the health of people with IDD.

Interventions need to be adequately adapted to the realities of persons with intellectual disabilities

Key recommendation

Interventions need to be adequately adapted to the realities of persons with intellectual disabilities

Action

Interventions need to be adequately adapted to the realities of persons with intellectual disabilities

Increase knowledge and awareness about assistive products and technology and the need thereof for people with IDD.

Key recommendation

Increase knowledge and awareness about assistive products and technology and the need thereof for people with IDD.

Action

Set up assistive technology advocacy groups on local and national levels for persons with intellectual disabilities to increase awareness and knowledge as well as offering educational and training programmes on the issue. These groups are also recommended to promote and advocate for increased funding and state grant programmes to purchase and make assistive products more affordable.

A multi-sectoral approach e.g. job coaches, co-workers, managers, and families are needed to create more work participation and promote supported employment.

Key recommendation

A multi-sectoral approach e.g. job coaches, co-workers, managers, and families are needed to create more work participation and promote supported employment.

Action

Work environment-related factors related to employer’s decisions and opinions, job content, requirements and performance, interaction and workplace culture, and support from job coaches are needed to create an inclusive workplace for people with IDD.

Policy priorities

HICs have experienced a major shift and push from policy makers to move away from sheltered employments towards supported employment. As mentioned above, in LMICs, sheltered employment remains the dominant model of employment for people with IDD. Policy makers and relevant stakeholders in LMICs need to actively promote, collaborate and work towards providing supported employment. Assistive products are necessary to help persons with IDD on their path to employment and in the workplace. Policy makers are therefore recommended to push for the increase of funding and initiate state grant programmes in order to purchase as well as advocate to make assistive products more affordable.

Conclusion

People with IDD have lower employment rates. Based on evidence from HICs, multi-sectoral approach such as supported employment programmes should be adopted to increase employment participation of people with IDD. Further research is needed to assess the effectiveness of supported programmes for people with IDD in LMICs as well as identify new QoL tools to adequately measure employment indicators.

Gaps & research needs

None of the reviews included studies from LMICs. Hence, the recommendations that we made in this brief is based on the sparse evidence coming from high income countries.

The reviews identified several methodological issues that needs to be addressed in future research studies. For e.g. the relationship between employment and health is unclear, i.e.  whether participation in employment leads to better health or people with better health have an advantage to gain and or retain employment.

One review reported that employment research in the intellectual disability field has focused on access of employment as an outcome, documenting employment status, hours worked, and wages at a single point in time. There is a need to know the core set of outcome measures that would adequately assess with certainty whether the employment interventions work or not. Similarly, future research should explore the health benefits of participation in employment.

Acknowledgements

Publication details: © London School of Hygiene & Tropical Medicine, January 2022.

Suggested citation: Liändrie Steffens, Lambert Felix. Evidence Brief: What is the current evidence around employment interventions that specifically focus on people with intellectual and development disabilities?  Disability Evidence Portal, 2022.

Disclaimer: The views expressed in this publication are those of the author/s and should not be attributed to Disability Evidence Portal and/or its funders.