Authors:
Isabelle Weld-Blundell, Marissa Shields, Alexandra Devine, Helen Dickinson, Anne Kavanagh, Claudia Marck
Published In:
International Journal of Environmental Research and Public Health, 2021
Introduction
This systematic review aims to evaluate the effectiveness of various vocational interventions designed to enhance employment outcomes for individuals with psychosocial disabilities, autism spectrum disorder (ASD), and intellectual disabilities (ID). By synthesizing evidence from randomized controlled trials (RCTs), the study seeks to identify which interventions are most effective in increasing open (competitive) and non-competitive (sheltered) employment rates among these populations.
Methods
1. Search Strategy and Study Selection:
Databases Searched: MEDLINE, Embase, PsycINFO, Web of Science, Scopus, CINAHL, ERIC, and ERC.
Time Frame: Studies published from 2010 to July 2020.
1.2. Inclusion Criteria:
-Study Design: Randomized Controlled Trials (RCTs).
Participants: Adults (aged 16-64) with psychosocial disabilities, ASD, and/or ID from high-income countries (
Interventions: Vocational interventions aimed at increasing employment participation.
Outcomes: Employment status post-intervention, including open and sheltered employment.
1.3. Exclusion Criteria: Studies focusing solely on substance use disorders, medical interventions without vocational components, and non-peer-reviewed publications.
1.4. Final Selection: 26 unique RCTs studies were included, covering 23 studies on psychosocial disabilities, 3 on ASD, and none specifically targeting ID.
2. Types of Interventions:
2.1. Individual Placement and Support (IPS):
Description: IPS is a client-centered approach that integrates employment services with mental health services. It focuses on rapid job placement in competitive employment settings without pre-employment training, followed by ongoing support tailored to the individual’s needs.
Key Features:
Personalized Support: Continuous, individualized assistance to address job-related challenges.
Integrated Services: Collaboration between vocational and mental health professionals.
Client Choice: Employment goals are driven by the client’s preferences and strengths.
2.2. Supported Employment (SE):
Description: SE encompasses a range of services that assist individuals with disabilities in finding and maintaining employment. Unlike IPS, SE may include various models, some of which provide more structured training before job placement.
Key Features:
Job Coaching: On-the-job support to help individuals adapt to workplace demands.
Skill Development: Training in job-specific and general workplace skills.
Ongoing Support: Assistance with workplace accommodations and problem-solving.
2.3. Project SEARCH:
Description: Project SEARCH is an internship-based program designed to help young adults with disabilities transition from school to employment. It combines classroom learning with hands-on work experience in a real-world setting. Project SEARCH has been shown to be particularly effective for young adults with ASD, helping them achieve higher rates of employment compared to traditional education or vocational programs.
Key Features:
Internship Rotations: Participants engage in multiple short-term internships to explore different career paths.
Workplace Skills Development: Emphasis on practical skills like teamwork, communication, and task management.
Individualized Coaching: Personalized support to guide participants through their work experiences.
Employment Transition: Aiming to secure competitive, integrated employment upon program completion.
2.4.Work Readiness Programs:
Description: These programs focus on preparing individuals with disabilities for the workforce by developing essential skills needed for employment.
Key Features:
Career Counseling: Guidance on job searching
Skill-Building Workshops: Training in areas such as time management, communication, and problem-solving.
Job Placement Assistance: Support in finding suitable job opportunities and facilitating connections with employers.
Findings
4. Psychosocial Disabilities:
4.1. Individual Placement and Support (IPS):
Effectiveness: IPS consistently outperformed traditional vocational rehabilitation (TVR) in achieving open employment across multiple studies.
Examples:
- Bejerholm et al. (2015, Sweden): 46.3% of IPS participants secured employment versus 10.9% in TVR.
- Bond et al. (2015, USA): 31.0% IPS participants achieved open employment compared to 7.0% in control.
- Multiple Studies: Across various settings and populations, IPS demonstrated significantly higher employment rates.
4.2. Enhanced IPS Models:
Description: Combining IPS with additional supports like motivational interviewing or cognitive skills training.
Effectiveness: Enhanced IPS showed improved employment outcomes over standard IPS in some studies.
4.3. Non-IPS Interventions:
- Job Coaching and Skill Development: Generally less effective unless integrated with comprehensive support systems.
4.4. Supported Employment (SE):
Effectiveness: SE programs, particularly when combined with additional supports, were effective but generally less so than IPS.
5. Autism Spectrum Disorder (ASD):
5.1 Project SEARCH with ASD Supports:
Effectiveness: Highly effective in securing open employment for young adults with ASD.
Examples:
- Wehman et al. (2014, USA): 74.2% of Project SEARCH participants gained employment versus 5.6% in control.
- Wehman et al. (2020, USA): 31.6% of Project SEARCH participants were employed compared to 4.8% in control.
5.2. Virtual Reality (VR) Job Training:
Effectiveness: Promising results in improving job readiness and interview skills (though limited by small sample sizes and lack of extensive RCTs).
6. Intellectual Disability (ID):
Research Gap: No RCTs were identified specifically targeting individuals with intellectual disabilities.
Implications: Highlights a critical need for developing and evaluating vocational interventions tailored to this population.
Discussion
Effectiveness of IPS for Psychosocial Disabilities:
- Strengths: IPS’s personalized and integrated approach effectively bridges the gap between mental health services and employment support, leading to higher rates of competitive employment.
- Enhanced Models: Adding elements like motivational interviewing can further improve outcomes by addressing individual motivational factors and skill deficits.
Project SEARCH as a Model for Autism Support:
- Success Factors: The combination of classroom-based learning, real-world internships, and individualized coaching makes Project SEARCH particularly effective for young adults with ASD.
- Adaptability: The structured yet flexible nature of Project SEARCH allows for adaptation across different settings and can be expanded to include a broader age range within the autism community.
Need for Interventions for Intellectual Disability:
- Research Necessity: The absence of RCTs for ID underscores the need for focused research to develop evidence-based vocational interventions for this group.
- Potential Approaches: Customized employment strategies, job carving, and ongoing workplace support are promising areas for future study.
Conclusions
In summary, this systematic review highlights the effectiveness of Individual Placement and Support (IPS) and Project SEARCH in improving employment outcomes for individuals with psychosocial disabilities and autism, respectively. Despite these successes, there remain significant research gaps, particularly concerning vocational interventions for individuals with intellectual disabilities, underscoring the need for tailored programmes and rigorous research in this area. The review advocates for adopting evidence-based programmes like IPS and Project SEARCH, along with the development of comprehensive support systems and advanced technologies, to promote meaningful and sustained employment for all individuals with disabilities.
The JOBS4ALL project, which includes VR interventions aimed at employment support for individuals with disabilities, aligns closely with the review’s findings. VR shows potential as an effective training tool, particularly for individuals with ASD, who may benefit from virtual environments to develop essential skills such as job interview techniques, social interactions, and adaptive behaviours critical for real-world employment. Given the promising early outcomes for VR-based training, JOBs4ALL could serve as a model for VR job-readiness programmes. By complementing Project SEARCH’s hands-on approach with VR simulations, JOBs4ALL provides an opportunity to build participants’ confidence and competence before entering actual workplace settings, paving the way for smoother transitions to competitive employment.
RESOURCES:
https://www.mdpi.com/1660-4601/18/22/12083
Full Reference: Weld-Blundell, I., Shields, M., Devine, A., Dickinson, H., Kavanagh, A., & Marck, C. (2021). Vocational Interventions to Improve Employment Participation of People with Psychosocial Disability, Autism and/or Intellectual Disability: A Systematic Review. International journal of environmental research and public health, 18(22), 12083. https://doi.org/10.3390/ijerph182212083