Steps towards employment for disabled people: What works?

This blog focuses on research which considers promoting meaningful employment opportunities for disabled people and people with mental health problems. The study is set within the context of the previous ebb and flow of policy initiatives, such as Condition Management Programmes, which have often focused on a deficit model. The research reflects on how these often do not account for people’s social context, the barriers to opportunity they may face or incorporate an understanding of individual experiences.

In this exploration of a move away from rehabilitative, biomedical and deficit models of enablement and employment, it is interesting to reflect on the concept of ‘reintegration’ (Sainsbury et al, 2008). The term ‘reintegration’ can be used as a gate keeping term and is an interesting word in how it promotes the values of conditional acceptance which again is often ‘deficit-led’.

The research looks at the ways government Condition Management Programmes (DWP, 2006) have created a limited approach to issues around access to employment opportunities for disabled people. This approach is critiqued in how its biomedically infused perspectives still underpin a model of ‘adjustment’, which is focused on individual deficits.

The evaluation of such programmes is also covered in the work of Barnes et al (1998). They discuss how programmes should move to a more person-focused model based on strengths. This paper builds on this work and

presents the results of a large-scale evaluation of a non-medicalized approach in the UK which concentrated on careful job matching, intensive support and barrier reduction.

‘Reintegration’ as a gate-keeping term? Interesting to consider how it can promote the values of conditional acceptance which is often ‘deficit-led’

Method

The evaluation looked at 13 projects funded by the Department of Health employment support programme. These focused on the employment needs of 257 people with ‘enduring mental health issues and people with “moderate to severe” learning difficulties’. There were 144 research participants from this group in total.

The methodology benchmarked insights against the views and perspectives of project staff and the views of service users. The researchers describe their methodological approach as ‘multi-stage and multi-method approaches which included focus groups, questionnaires, interviews, site visits and data triangulation’.

Research tools were both pictoral and text based, to enable participation of people with learning disabilities. The areas the researchers were interested in discovering were around ‘barriers, achievements and facilitators of employment and employment-related gains’.

Questionnaires used to evidence the experience of project leads and participants and these utilised Likert scales to measure gains made in relation to employment. The author states that the methodology was chosen so that

the study could explore naturalistically project staff and disabled participants’ perceptions and experiences en route to finding paid employment.

The 13 project leads completed questionnaires on the overall employability impact of their project. Thirteen project staff were interviewed face-to-face, and three people were interviewed by telephone. Thirteen employment site visits were completed. There was a use of a formative focus group and the study looked to explore the views of all within the differing areas.

The study methodology designed evaluate the initiatives used ‘purposive sampling’. For me, there could have been more clarity of what this ‘purposive sampling’ was and how the potential participants experiences and viewpoints were considered.

Findings

The research results combine the differing data types which were obtained. The findings state that 27 out of 144 participant responses obtained paid work and 24 out of 144 participants, voluntary work. The authors state that ‘staff and participants thought that “employment success” should include not simply paid work, but also steps to paid work and that both were inherently important in absolute terms’.

The research showed that following factors were all important for creating opportunities for steps towards or entering into paid employment:

providing a range of supports,
understanding participant impairment diversity,
person-centred practice,
job tasters,
real jobs opportunities (where participants were job ready),
careful job matching,
general skills and educational development.

The results consider the need for people to receive tailored support which develops practical skills for managing health in and outside of the workplace and cites the example of the Wearhealth initiative. The move from a deficit led model is reflected on, in the quote from a project lead who states, ‘before the starting the course [education, training and work experiences] the organisation got a referral form which laid out types of disabilities…’

The research considered how participant impairment diversity was explored without a dominant focus on a deficit model. The example of applying the strengths and skills of people identifying as being on the autistic spectrum is given, through the work of Autlife.

There is further contemplation to be offered on how such fixed expectations of groupings can still be seen in newer innovations. The research reveals the benefit of person-centred planning and indicates the value of job tasters for people with enduring mental health problems or a label of autism/Aspergers, based on the work of (Crowther et al, 2001). There was also the discussion of evidence of how sharing knowledge and information on barriers at a peer level developed confidence and networking, which worked towards improving options and accentuating strengths.

Sharing knowledge and information on barriers at a peer level can help develop confidence and networking skills

Conclusions

The authors conclude that

flexible personalized approaches will afford greater employment success than a focus on deficits and welfare dependency reduction.

The research conclusions relate to the understanding of supporting people as part of their wider ecological contexts. It also communicates the key findings that paid work is much higher in this programme than previous initiatives. The paper reflects that though the sample size was small, there was a consistent value offered to confidence and experience through participation in the initiatives and through the provision of ‘personalised support’.

It was also noted within the paper that access to transport was seen as key and such additional supports are vital to sustaining confidence and participation. It is then important to reflect and critique, that the reduction in concessionary travel often articulated in political circles is short termist and could impact on the employment prospects of disabled people.

Flexible personalized approaches will afford greater employment success than a focus on deficits and welfare dependency reduction

Strengths and limitations

The authors consider that there are limitations on how the findings of such study are applied generally due to the 44% of participants who did not respond to invitations to participate. The strengths and limitations are in how the voice and experience of people accessing employment supports are facilitated and their wishes are considered. In my reflections, such a move to a new way of thinking and its evidence base, is questioned in the methodology used. The transferability of the data is limited because of the small sample of the people accessing such initiatives and the high level of non-respondents.

This is a major consideration, as the sample is low and it does not clearly articulate the variability between differing experiences and indeed how certain labels are socially appraised. It is important to consider this in relation to stigma and discrimination. There is an evidenced need to move towards a more strengths led model in order to challenge societal attitudes and expectation.

However, in the context of true ‘person centredness’, the measured outcomes only consider the narrow options of paid work and steps to paid work. This means that there may be additional limitations. There is also a need for reflection regarding the use of Likert scales as a measurement of complexity and how these truly represent the contextual information of individual experience.

The use of ‘purposive sampling’ and the limited generalisability is a potential weakness of the study

Summing up

This study offers important insights into how employment initiatives for disabled people must remain underpinned by the strengths and skills of participating individuals.

There is a need to reflect on the methodology and its low response rate and how this data was partially facilitated by use of a Likert questionnaire approach.

The use of ‘purposive sampling’ and the limited generalisability that may be applied can also be considered.

There is still a presence of a biomedical approach regarding deficits and this has shifted to a focus on the these being more fluidly defined within the context of skills relating to confidence and workplace interaction. The new initiatives still rely on generalised groupings such as ‘enduring mental health problems’ and the expectation of fitting within the structures and outcomes of ‘paid work’.

It is important to consider, that where such initiatives operate in a heavily politicised context and impact on social perspectives, there is perhaps a need for a greater richness of data and sampling. This for me, is important in how the methodologies which were present should be able to evaluate, the sustainability of ‘paid work’ and ‘steps to paid work’, the types of tasks and their satisfaction, the rate of remuneration, as well as longevity and job progression. If such contextual richness is not achieved with such a relatively small sample, there may be a danger that such findings to be over generalised in their application for political change.

Link

Roulstone, A., Harrington, B and Kwang Hwang, Se (2014) Flexible and personalised? An evaluation of a UK tailored employment support programme for jobseekers with enduring mental health problems and learning difficulties Scandinavian Journal of Disability Research, 16 (1) pp.14-28 [Abstract]

References

Barnes, H., Thornton, P and Maynard-Campbell, S (1998) Disabled People and Employment: A Review of Research and Development Work. York: Joseph Rowntree Foundation.

Crowther, G., Marshall, M., Bond, G. and Huxley, P. (2001) Helping People with Severe Mental Illness to Obtain Work: Systematic Review, British Medical Journal, 322: 204. [Full Text]

Department for Work and Pensions (2006) Pathways to Work: Qualitative Research on the Condition Management Programme. Department for Work and Pensions Research Report No 346. Leeds: DWP. [Full Text]

Roulstone, A .and Barnes, C. (eds.) (2005) Working Futures: Disabled People, Employment and Social Inclusion. Bristol: Policy Press.

Sainsbury, R., Irvine, A., Aston, J., Wilson, S., Williams, C. and Sinclair, A. (2008) Mental Health and Employment, DWP Research Report 513, London: Department for Work and Pensions. [Full Text]