For many 20-somethings about to leave school and enter the current labour market, finding a stable job with good career prospects can be a challenge. For young adults who also have a disabling health condition, the difficulties are all the more daunting. Indeed, according to data from Statistics Canada, young adults with a disability are only half as likely to participate in the labour force as their peers without a disability.
That was why Institute for Work & Health (IWH) Associate Scientist Dr. Arif Jetha set out to examine the research evidence for programs or interventions that are effective in helping young people with disabilities find work once they leave school.
His systematic review found that work placement programs, offered in tandem with a suite of tailored employment supports, do help.
For young adults with chronic disabling health conditions, tailored supported employment interventions are recommended, says Jetha, who conducted the review as part of the Canadian Disability Participation Project.
The evidence suggests that young adults with mental health conditions in particular may benefit from these types of programs.” The open-access review was published online in January by Occupational and Environmental Medicine (doi: 10.1136/oemed-2018-105454).
Type of support can vary
Tailored supportive employment refers to job training programs in which people with disabling health conditions are integrated within a workplace. Program participants receive tailored vocational coaching in a number of areas, including working with others, self-monitoring behaviours, solving problems, asking for help, getting to and from work, and understanding workplace policies and procedures. As well, disability-awareness training is conducted within the workplaces in which participants are placed.
The approach is collaborative and involves a multidisciplinary support team (e.g. vocational rehabilitation service providers, health-care professionals, families, educational agencies and employers).
Pointing to similar findings from other reviews focused on supporting work outcomes for adults with an injury or a health condition—including a systematic review on return to work by IWH—Jetha says the multidimensional nature of these programs may be the key to their effectiveness.
These programs integrate different components that, together, help young people with disabilities address the physical or psychosocial barriers they may face, he says.
I think that’s why they work.
Research to date highlights the importance of work experiences in early adulthood in laying a foundation for future employment.
Promoting employment at this stage has long-term benefits, says Jetha, who also shared findings at an IWH Speaker Series presentation in November.
Besides examining which work-focused interventions are effective in improving the labour market integration of young adults with disabilities, the team also wanted to learn whether program effectiveness varied across different disabling health conditions and across different phases of the transition into employment.
The team conducted a search of the literature published from January 1990 to July 2018 on work-focused interventions aimed at young adults, aged 18 to 35 years, living with a disability. The team ended up with 10 studies that met the criteria for inclusion and were of sufficient quality in the way they were conducted—three of high and seven of medium quality. Six were conducted in the U.S., two in Australia, and one each in the United Kingdom and Japan—none in Canada. Six focused on young people with a mental health condition, and three on young adults with an intellectual disability such as autism. The duration of studies ranged from six months to three years.
Of the 10 studies, all were interested in the early phases of preparing to enter the labour market or being hired; none looked at sustaining employment or advancing in a career, for example. Eight were interested in what’s called
competitive employment. That refers to
meaningful, integrated employment that is consistent with a person’s career interests and skills, and where wages are at the market rate, explains Jetha. Two studies were interested in any type of employment at all.
The review found strong evidence—based on three high-quality and four medium-quality studies—for the use of tailored supported employment to help young adults with a disability enter competitive employment.
It found moderate evidence—based on two studies of high quality and one of medium quality—for the use of tailored supported employment to help young adults with a disability get any job at all.
And it also found moderate evidence—based on two high-quality and three medium-quality studies—for the use of tailored supported employment to help young adults with mental health conditions gain competitive employment.
Due to a lack of studies, the review team could not answer the question about the effectiveness of interventions for different disabilities or health conditions (except for the finding noted above about young adults with mental health conditions) or the question about the effectiveness of interventions at different phases in the careers of young adults.
Research gaps identified
The systematic review highlighted important gaps in the research literature, Jetha adds. “I was surprised by the absence of research on policy-level interventions to help support employment across this transitional life phase,” he says, citing as an example incentive programs such as income support waivers, which would allow income-support recipients to earn income up to a certain amount before clawbacks come into effect.
Jetha says he is also surprised by the absence of research on at-work experiences and career advancement. “We know the barriers young people face are not just about getting hired, but also about being successful and advancing within a job,” he says.
He also notes the lack of research on the ability of existing programs to offer the support needed for young people with disabling health conditions to navigate the changing, and increasingly precarious, labour market.