Background
Methods
Results
Characteristics of the included studies
Design and methods
Authors, year, country | Study design, methods | Population, definitions/terms | Intervention/rehabilitation/personally tailored/length of intervention/personal or environmental measures | Outcome measures | Findings |
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Arvidsson et al. [50], Sweden | A cohort study. Regression analysis of register data from Halmstad University Register on Pupils with Intellectual Disability (based on complete national survey of students who graduated from Upper Secondary School for Pupils With Intellectual Disability in Sweden) merged with data from two national registers, the Integrated Database for Labor Market Research (LISA; which includes all people in Sweden over the age of 15) and the LSS register (which includes all those who receive services under the Act Concerning Support and Service for Persons with Certain Functional Impairments) | N = 2745 (71% M/29% F) gainfully employed pupils with intellectual disability (22.4% of 12,269 students who graduated from Upper Secondary School for Pupils with Intellectual Disability between 2001 and 2011) | Upper Secondary School for Pupils with Intellectual Disability programs: national program, specially designed program, vocational training, training activities, or graduated with incomplete grades | Gainful employment i.e. work full- or part-time and have either unsubsidized or subsidized employment (they all had a job during 2011 that generated a salary reported to the Swedish tax agency and they neither had daily activities according to LSS nor were registered as students. The variable gainful employment is dichotomous and states whether a person was gainfully employed or not in 2011, according to the LISA register | 339 people (72% M/28% F) were gainfully employed without any type of subsidies. 195 (57.5%) had attended a Upper Secondary School for Pupils With Intellectual Disability programs, 90 (26.5%) attended a specially designed program, 46 (13.6%) graduated from USSID with incomplete grades, and 8 people (2.4%) attended an individual program/vocational training Of the 96 women, 70.8% worked in the private sector and 24% in the public sector. The most frequent occupation (36.5%) was “personal care and related work.” The 243 men worked primarily in the private sector (93.4%), with the largest proportion (18.9%) in professions described as “other service work” (e.g. janitors, garbage collectors, newspaper and package deliverers) Probability of being gainfully employed: OR: 3.84 national program, OR: 2.87 specially designed program, and OR: 0.31 vocational training program, compared to those who graduated with incomplete grades. Men (OR: 4.06) were more likely to be employed than the women (OR: 3.51) |
Beyer and Kaehne [46], UK | A cohort study. Carried out in six local authority areas in England, Scotland and Wales. A total of 14 special schools took part in this study. Logistic regression | N = 87 (61%M/39%F), Dg: LD, additional diagnoses/problems: Autistic spectrum disorder (9%), Asperger’s syndrome (1%), emotional or behavioral difficulties (5%) IQ: nr Age:17.8 years Occupation: nr | Work awareness training (e.g. watching videos showing work, talking about presenting one’s self at work, health and safety instruction), vocational qualifications courses, work experience (In special schools provided within the school e.g. assisting in class for younger children, helping the janitor, working in the kitchen and in external transition organizations primarily gained in the community with or without a job coach), vocational profiling, practical project placement (e.g. café, sandwich-making, and furniture-making enterprises) | Full- or part-time employment six month post graduation | Employment 18 (21%) of the young people were employed (56% from mainstream schools, 33% from colleges and 11% from special schools). 2 variables were significantly related to employment. Persons that had work experience (provided by external transition support organizations) were 1.01 times more likely to be employed, and those that had work awareness training (provided by the schools/colleges) were also 1.01 times more likely to be employed. These 2 variables explained 19.2% of the variance in predicting employment post graduation |
Bouck and Chamberlain [51], USA | Secondary data analysis of the National Longitudinal Transition Study-2 (NLTS2). The data collection occurred from 2000 to 2009. This study included postschool data, including postschool services received and postschool outcomes. Survey via telephone, mailed survey. Frequency counts, F tests, cross-tabulations, logistic regression analyses | N = 121,335 Age: 20.2 years (17–25). Gender: nr. Dg: mild ID. IQ: nr. Ethnicity: White 66.7%, African American 23.6%, Hispanic 8.8%, Asian/Pacific Islander 0.1% | Postschool services: postsecondary education institution accommodations and services, job training services, and life skills services | Paid employment, full-time employment | Significantly more (p < .0.1) individuals who did not receive job training services were employed full-time (62.7%) compared with those who received job training services (16.5%). No significant differences were between those who did (56.2%) or did not (65.3%) receive job training services with regard to paid employment |
Cimera [47], USA | Cohort study, two cohorts, matched pairs 2002–2006. Data comes from the Rehabilitation Services Administration’s 911-database. Two groups of supported employees were compared | N = 9808. Sheltered workshops cohort: N = 4904 (41.7% F/58.3% M). Age: 38.93 years. Not in sheltered workshops cohort: N = 4904 (41.7% F/58.3% M). Age: 31.56 years | Sheltered workshops | The rate of competitive employment | Employment There was no difference in the rates of employment for these two groups. 59.6% of sheltered workshop supported employees were competitively employed compared to 60.4% for individuals who did not participate in shetered workshops prior to entering supported employment. This difference was not statistically significant |
Cimera et al. [49], USA | Cohort study. Matched pairs 2006–2009. Two groups were compared | N = 15,040 (7520 in both groups) (54.6–56.7% M/43.3–45.4% F). Age (average): 20.28–20.33 years. Dg: Significant ID. Multiple disability 6.7–13.6%. IQ: nr. Ethnicity: White 46.8–50.6%, African American 48.5–52.3%, Asian 0.3–0.75, Native American 0.4–0.5%, Pacific Islanders < 0.1%, Hispanic 2.4–3.7%. Occupation: nr | Transition services. Early transition group: transition services were addressed in individualized educational programs by age 14. Later transition group: transition services were addressed by age 16 | Successful employment (e.g. employment in the community paying at least minimum wage) | Employment Individuals from the early transition states were significantly more likely to become employed than their matched peers from the later transition states. For example, in 2006, 74.3% of young adults from the early transition states were employed compared with 57.8% for the later transition states |
Goldberg et al. [43], USA | A randomized controlled trial (RCT). A Functional Assessment Scale. Chi square. Spearman correlation coefficient | N = 49 (M 24/F 25), experimental group N = 24, control group N = 25 Age: mean 31.2 years (experimental group), 30 years (control group) Dg: DD since birth | Experimental group (supported employment program): placement agents who made contacts with employers in the community, clients were immediately prepared for competitive employment with a variety of supportive services (i.e., job monitoring, social work with families). Control group (conventional workshop services): placement agents who made contacts with employers in the community, staff waited until clients were considered ready before placing them outside the workshop | Employment in the competitive labor market (employed for 60 days) and in three categories: no work, some work (work at least 2 weeks), and currently working. Performance (Functional Assessment Scale) | Employment Persons in the experimental group (supported work program) had a better change of obtaining employment than the control group X2 (2, N = 49) = 8.5, p < 0.02. of 24 persons in the experimental group, 20.8% were currently working, and 8.3% worked at some time. None of the control group had worked in competitive employment Performance There were no significant differences in performance between the groups. Pretest/posttest results were in the experimental group 54.2 (6.4)/51.4 (8.0), and in the control group 53.3 (7.6)/53.6 (7.4) |
Gray et al. [45], USA | Cohort study. The data were provided by a State agency (South Carolina Department of Disabilities and Special Needs) and by the local boards. Registers, written survey. Logistic regression | Employed in 1997: N = 431, 59.6%M/40.4%F, Age: 19–30 years 44.3%, 31–50 years 49.0%, 51–64 years 6.7%. Ethnicity: White 42.5%, nonwhite 57.5% IQ: 20–29 3.7%, 30–39 15.1%, 40–49 20.2%, 50–59 24.8%, 60–69 31.6%, 70–74 4.6% Unemployed in 1997: N = 6659, 48.7% M/45.3%F. Age: 19–30 years 35.1%, 31–50 years 51.3%, 51–64 years 13.7% Ethnicity: White 51.9%, nonwhite 48.1% IQ: 20–29 16.5%, 30–39 24.9%, 40–49 14.3%, 50–59 17.8%, 60–69 22.2%, 70–74 4.3% | Number of job coaches | Employment (earning at least $50 per week in a competitive job or enclave for at least six months in 1997) | Employment The number of coaches varied from 0.00 to 2.48 per 100 individuals. Most individuals (82.6%) were served between 0.5 to 1.5 job coaches per individuals. Significant, positive effects of job coaches on employment were found as follows: The risk of employment as a function of coaches was approximately two times greater for individuals with low than for high IQ, approximately three times greater for individuals in counties with low or intermediate employment, and approximately ten times greater for individuals located in highly urban counties |
Joshi et al. [48], USA | Cohort study. A study utilized data collected in the National Longitudinal Transition Study-2. Telephone interview, mail survey. Descriptive analysis, frequency counts, multiple regression and logistic regression analysis | N = 62,513 (61.7%M, 38.3%F). Age: Average age for students in school was 18 years, average age for students out of school was 20.1 years. Dg: Mild ID. Ethnicity: Caucasian 70.2%, African American 24%, Hispanic 5.2% | Students received special education services between 13 and 16 years of age. Employment-related transition activities identified in NLTS2 data were vocational assessment, career counseling, prevocational education, career technical education or vocational education, prevocational or job readiness training, instruction looking for jobs, job shadowing, job coach, special job skills training, placement support, internship or apprenticeship programs, tech prep programs, work experiences in school, and other paid work experiences | Postschool employment (e.g. whether they ever engaged in employment, their current employment status, and whether they worked part- or full-time) | 75.9% of the students reported they engaged in employment sometime after leaving school. 62.1% were currently employed and 42.6% were engaged in full-time employment. Participation in one additional transition activity represented within the employment activities summation variable resulted in students being 1.2 times likely to be currently employed post school. Students were 5.704 times as likely to ever engage in employment after school if they engaged in paid-employment experiences while in school, and 3.489 times as likely to ever engage in employment after school if they experienced a school-sponsored job. However, vocational education was not found to be significantly related to postschool employment |
Kilsby and Beyer [44], UK | Intervention study. An independent groups design (a baseline and two intervention phases, three months each). Direct observations, questionnaire, taster sessions, job review forms. A one-way ANOVA | N = 35. Three groups matched. Baseline: N = 12 (M 58%/F 42%). Age: 32 years (mean). Dg: 58% ID borderline, 33% mild, 8% moderate Intervention 1: N = 12 (M 50%/F 50%) Age: 26 (mean) Dg: 22% borderline, 45% mild, 33% moderate Intervention 2: N = 11 (M 50%/F 50%) Age: 32 (mean) Dg: 54% borderline, 38% mild, 6% moderate | A job taster program (a two phase self-determination package) for adults with LD entering the job market for the first time. Job tasters were short, unpaid, time-limited work experiences which took place in the workplace in order to allow people to sample a variety of different jobs and work cultures. In each group, each participant was required to attend 3 job tasters for 6 sessions. Baseline: No specific instructions were provided to agency staff about how to conduct the job tasters. Intervention 1: Introduction to self-determination and systematic job taster reviews. A one-day package was implemented to introduce job coaches to the concepts of self-determination using Wehmeyer’s definition as a conceptual base; and job reviews were introduced. Job reviews were short meetings where job seekers were encouraged to evaluate the job taster sessions and overall program. Intervention 2: Introduction of pictorial job review profile. A second one-day package was implemented: job coaches were encouraged to support the job seekers to complete the job review forms for themselves. In order to help those who could not read, a pictorial questionnaire replaced the written version | The rate of overall job coach assistance (instructions and questions). An average rate of assistance per minute was calculated by dividing the frequency of job coach assistance by the duration in minutes | Performance Intervention 1 led to a reduction in rates of job coach assistance for both sessions and reviews. The rate of assistance fell significantly between Baseline (0.83 per min) and Intervention 1 (0.51 per min). The introduction of intervention 2 led to a further drop in rates of assistance during the reviews. The reviews in intervention 1 and 2 were generally accurate, and job seekers were consistent with their statements. This indicate that the job seekers had an awareness of their surroundings and a realistic grasp of their personal limitations and abilities |
Sannicandro et al. [52], USA | A secondary data analysis of the RSA-911 datasets from 2008 through 2013. A quasi-experimental design Multilevel modeling, propensity score matching techniques. Multilevel logistic regressions and multilevel linear regressions, depending on whether the outcome was binary or continuous | N = 11,280. Experimental group: N = 5640, (M 46.9%/F 53.1%). Age: 20.9 years. Dg: ID. Ethnicity: White 57.6%, Black 31.1%, American Indian 1.5%, Asian 2%, Native Hawiian or Pacific Islander 0.5%, Hispanic 7.3%. Control group: N = 5640, (M 57.2%/F 42.8%). Age: 20.4 years. Dg: ID. Ethnicity: White 52.6%, Black 36%, American Indian 1.3%, Asian 1.4%, Native Hawiian or Pacific Islander 0.4%, Hispanic 8.3% | Postsecondary education was comprised of positive response to the following variables from the RSA-911 dataset (1) postsecondary education with no degree, (2) associate degree or vocational/technical certificate, (3) bachelor’s degree or, (3) master’s degree or higher | Employed at closure (yes/no) | Individuals who participated in postsecondary education were more likely to be employed (OR: 2.00, 95% CI:1.82–2.20) than their counterparts who had not participated in postsecondary education |
Authors, year, country | Methods, study design | Population, definitions, terms | Intervention | Findings, barriers and facilitators |
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Alborno and Gaad [56], Dubai | Observation, semi-structured interviews, document analysis. Data triangulation | N = 27 (100% M) Age: 19–37 years Dg: ID and physical disabilities (nine with Down syndrome) IQ: nr. Average mental age 4–15 years. Most had attended rehabilitation centers where they had learned some basic life skills | Employment either in administrative jobs in the head office or as gardeners in the nursery. Functional and vocational training programs, productivity monitoring, recreational and sports activities, support in psychological and behavioral issues by documenting the development of the behavioral, psychological, and professional skills of the employees with disabilities, and regular provision of individualized and group sessions for the employees to address any behavioral or psychological issues, and transportation services in dedicated buses supplied for the group | All were successfully and fully integrated into their jobs: data entry, public relations, photography, and office mail distribution. Among their peers and the company’s management, they were recognized as loyal, efficient, and reliable staff The employer recognized that certain barriers between their employees with disabilities and the work environment had to be overcome The employees felt they were valued and respected, which resulted in higher self-esteem and self-confidence. They were also trusted through an open-door policy with management which allowed them to voice their opinions and needs. High job satisfaction Facilitators Recruitment with no formal testing of abilities Training: efficient, staged training programs Workplace accommodations (shading the area from the sun, shorter working hours in summer, fully paid two-month summer holiday, special chairs, modified equipment, absence allowed for rehabilitation/treatment, first aid training workshops, transportation services with company busses) Management, supervision, and performance monitoring (support of staff and management, behavioral tally sheets, positive behaviors such as greeting peers, cooperation, following orders, and speech) as well as negative behaviors (such as rude words, violence, disobedience, or stubbornness) were recorded, which enabled early detection of problems and effective problem-solving involving all stakeholders Incentives such as adequate remuneration, professional development, and recreational and social programs resulted in empowerment and positive attitudes, creating a friendly work environment Professional progress: opportunities for developing new skills |
Christensen and Richardson [55], USA | Semi-structured interviews. Inductive content analysis approach | N = 10 (M = 6) Age: 25–51 years Dg: ID IQ: nr | Project SEARCH is a licensed transition-to-work model, which features total workplace immersion, and facilitates a seamless combination of classroom instruction, career exploration, and on-the-job training and support. The goal was the transition of individuals out of sheltered workshops to competitive employment | Eight persons completed the course and five of them were employed. The program emphasized learning about other job opportunities in the community (e.g., touring local businesses). Individuals with significant disabilities can imagine themselves working in the community when they are exposed to a variety of career opportunities and can directly see and under-stand what the job entails The cohort model of Project SEARCH allowed ten individuals to exit the workshop and transition into a community setting with familiar peers. This alleviated some of the initial fears of losing friends as a result of leaving the workshop. During the course the participants became more independent and lived in the community, and their views about the meanings of employment changed. Participants demonstrated an increased awareness of employment as a means to take greater responsibility as a productive member of their house-hold and the community. Competitive employment represented the means to earn wages in order to pay their own bills and not have to rely on Medicaid benefits The sample size is small and localized. While the results of this study provide some level of insight regarding the experiences of individuals with IDD who are transitioning from a sheltered workshop into competitive, integrated employment, the views expressed by program participants are limited to their own unique experiences |
Devlieger and Trach [57], USA | Ethnographic study. Extensive life history interviews with focal people, parents, and agency or school personnel | N = 6 (M = 4) Age: 18–24 years Dg: Mild mental retardation IQ: nr | Intervention not described, instead the impact of different actors (school, agency, parents, other people) on the transition process and employment was analyzed | The involvement of parents and focal people was disproportionate to that of school and agency personnel. School and agency efforts most often resulted in sheltered employment, while personal or parent mediation resulted more often in self-employment and continuing education outcome |
Donelly et al. [58], Australia | Ethnographic study. Interviews of participants and their social networks. On average, five people in each network were interviewed. Interviewees included parents, other family members, members of various support circles, support workers, friends and allies. Participant observations were conducted of the three participants’ work or work preparation environments. The fourth participant provided information about her work in interviews | N = 4 (M = 1) Age: 21–48 years Dg: Intellectual disability IQ: nr | No intervention was described | The meaning of work to participants. A range of meanings including experience of meaningful occupation, the development and recognition of skills, experiences such as travelling to and from work, relationships with co-workers, financial remuneration and access to opportunities that extended beyond the workplace The meaning of work to families included skill development, time use (participant’s days filled with meaningful activity), the choices (or interests) of participants as indicators of potential employment opportunities; quality of performance was linked to level of interest; interests and skills were not always valued or recognized. Vocational preparations that failed: formal service providers fitting people into existing programs that did not meet their needs. Classroom-based vocational preparation vs. actual work experiences (failing in classroom may prevent work experience opportunities); Effective vocational preparation: helped the person get a job based on personal interests, skills and choices and provided on-the-job training and support Barriers to employment Inadequate identification of support needs Lack of responsiveness to individual needs Emphasis on fitting people into existing support models Loss of vocational skills or failure to develop vocational skills in sheltered employment Difficulty moving from sheltered to competitive employment Classroom-based vocational preparation Use of classroom-based learning experiences and written examinations as pre-requisites for more meaningful, effective employment opportunities Failure of employment agencies to find opportunities for work experience and on-the-job training |
Fashing [54], Austria | Grounded theory, biographical interviews | N = 3 (F) Age: nr Dg: ID Women who have similarly difficult post-school vocational orientation phases despite having been successful in their transition to vocational training or employment on the regular labor market | ‘What experiences do women with intellectual disabilities have in their transition from school to vocational training and employment?’ The interviewed women initially went from compulsory school to a vocational preparation measure or directly into a sheltered workshop or occupational therap. | Main category: ‘coming to terms with disability through vocational participation’ was formed on the basis of two key categories: discrimination at school due to learning difficulties and post-school orientation phase as a process of self-determination |
Winsor et al. [56], USA | Multimethod study. Structured and in-person interviews, focus groups, register data | N = 1452 Participants in PP countries, N = 390 (2008 N = 160, 2009 N = 230) Comparison groups: Non-participants in PP counties N = 656 (2008 N = 315, 2009 N = 341), no PP county students, N = 406, 2008 N = 212, 2009 N = 194) Sex: nr Age: 21 years IQ: nr High school students who were eligible for developmental disability services and had turned 21 during their year of graduation, and participated the project Dg nr. Division of Developmental Disability eligible students. Informants were staff members, stakeholders (county developmental disability staff, school administrators, teachers, employment vendors, family member, and young adults who had obtained jobs) | The starting point of the ‘Jobs by 21 Partnership Project’ (PP) was, that postgraduate employment outcomes seem to be related to employment experiences prior to graduation. The aim of the project was to provide high school students with ID and their families with information about and experiences of employment and the adult service system prior to their graduation, thus making the transition from school to adult life more seamless. The project was implemented in 11 counties (9 in 2008 and 11 in 2009) by local Developmental Disability offices. The local offices gathered different stakeholders to collaborate: Division of Vocational Rehabilitation, the Work Source Center, adult employment vendors, local community colleges, and local businesses Partnership project (PP) goals: 1) a post-school outcome plan for students, 2) expansion and improvement of collaboration in country between Division of Developmental Disability Counties and schools to enable students to make use of available support, 3) establishment of a statewide partnership, 4) to make use of job training and job preparation opportunities, labor market guides, workforce development trends, and post-graduation outcome reports to achieve post-school employment for transition-aged students with developmental disabilities | Research questions 1) What was the impact of connecting young adults with employment vendors prior to graduation? 2) How were resources maximized across the school and adult service systems? 3) What strategies were most effective in encouraging collaboration between school and adult service systems? Results Employment outcomes: PP participants were more likely to be employed following school exit (after three months) and had stronger employment outcomes (mean hours and mean wages) than students who were not participants. In 2008, 45% of participants were employed, compared to 6% of non-participants; in 2009 11% participants were employed, compared to 05% and 5.7% of non-participants System outcomes: The availability of project funds encouraged stakeholders from the school and adult service systems to contribute additional dollars and resources in-kind to the project Collaborative relationships: The process of leveraging resources helped bring together stakeholders to collectively commit to achieving employment outcomes and problem-solving |
Authors, year, country | Study design, methods | Population, definitions/terms | Intervention/rehabilitation/personally tailored/length of intervention/personal or environmental measures | Outcome measures | Findings |
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Allen et al. [76], USA | Quantitative case study. Interrupted time-series design. Observation | N = 3 Ned: M, 18 years, dg: mild MR. Tracey: M, 17 years, dg: moderate MR Emma: F, 16 years, dg: moderate MR | The two interventions (video modeling and audio cuing) were evaluated in an interrupted time series withdrawal design during training and then again in an actual job setting (at the factory and warehouse). During video modeling, the participants watched standard training videos on a laptop computer For the Audio Cuing condition, the participants wore a (Radio Shack TRC-508 s FM) transceiver with microphone and earphones that allowed hands-free operation. During Audio Cuing, the participants were told to ‘Listen to the attendant, who will give you ideas of things you can do to entertain and interact with customers’ | Percentage occurrence of multiple skill during 2-min work samples across baseline, video modeling, audio cuing, and 10-min work samples while actually working in the job at 1 and 3 months | Job skills Video modeling was not effective whereas audio cuing produced job performances well above the designated criteria At baseline, Tracey showed a decreasing trend in multiple skills use, Ned showed no evidence of multiple skill use, and Emma showed some evidence of multiple skill use. During video modeling, Tracey showed no evidence of multiple skill use, Ned showed an initial but unsustained increase, and Emma showed a modest increase in multiple skill use. With the introduction of audio cuing, the rates of multiple skills use changed immediately and substantially for Tracey (100%), Emma (90%), and Ned (80%) |
Bennet et al. [72], USA | Experimental case study. The design consisted of three conditions including baseline, intervention Covert Audio Coaching (CAC) and follow-up (five consecutive data collection sessions followed by weekly probes. The study was conducted at the participants’ job sites | N = 2 Andy: M, 30 years, dg: ID, IQ: 38 Language summary: speaks in partial sentences in Creole and English Worked as a custodial assistant at a public school Daniel: M, dg: ID, IQ: 55 Language summary: speaks in complete sentences Worked at a food bank | Supported employees received feedback delivered via CAC, which consisted of delivering praise, guidance and correction statements The tasks selected for Andy were washing the windows of automatic sliding glass doors and collecting trash in the schoolyard, and for Daniel stacking bread crates. All the tasks were part of their regular job duties | Work performance (intervention fidelity and impact of CAC on accuracy, durability and fluency): Rate of praise, guidance and corrections delivered to the worker; percentage of task steps completed, pieces collected (in trash collection), rate of correct responses per minute | Work performance Accuracy, durability and fluency: Andy, window washing: baseline < 38%, final sessions 97–100%, slight reduction after intervention. Rate increased by 10.9%. Andy, trash collecting: baseline stable but low, final sessions 66–79%, slight reduction after intervention. Rate increased by 17.4%. Daniel, crate stacking, high but inconsistent, final sessions > 95%, maintained same level after intervention. Rate increased by 78.3% The CAC intervention was effective in increasing the work performance of supported employees. The changes lasted for several weeks after the end of the intervention. The intervention was effective across different participants and work tasks |
Carson et al. [71], USA | Case study. Observation | N = 3 Tim: M, 18 years, dg: moderate ID and ADHD Brian: M, 20 years 10 months, dg: moderate ID Hope: F, 20 years 3 months, dg: mild ID | Participants worked using functional skills (e.g., meal preparation) and functional academics (e.g., telling time, using a calculator). The photo activity schedule book (PASB) was used to increase the number of independent task changes in vocational tasks and the rate of vocational task completion. Five color photographs were placed in the album: four showed the individual tasks to be completed and the last depicted the finish location | Number of independent task changes and rate of vocational task completion | Performance The use of the PASB resulted in high levels of independent task changes among all participants. It also increased the rate of completion for two of the three students: In Wal-Mart, for Brian from 1.75 to 1.83 and for Tim from 1.10 to 1.52, and in the cafeteria, for Brian from 5.25 to 7.54 and for Tim from 7.92 to 9.78. In both places, the use of the book had little effect on Hope’s rate of performance |
Chang et al. [74], Taiwan | Quantitative experimental case. Observation, tape recording | N = 1, Yvonne: F, 27 years, dg: IDD | The Location-based task prompting system (Locompt) was used in a short-order snack shop. The smart phone was fastened onto the participant’s lower arm. The system was programmed to be able to generate task cues in text, sound, picture, or a combination of these. Three sets of task sets were performed by the participant. Each task set had nine task steps to carry out an order with desserts, beverages and cookies. Baseline: Task set was performed with no assistive technology Intervention phase: Task set was performed with assistive technology (Locompt) | Percentage of correct task steps | Performance During the intervention phase, the percentage of correct task steps was significantly greater (99%) than at baseline (55%). The results indicate that the Locompt system in conjunction with operant conditioning strategies may facilitate autonomous functioning of vocational jobs across multiple workstations |
Devlin [75], USA | Case study. Data were collected at baseline, during the intervention phase, and during the maintenance phase | N = 4, Fred: M, 32 years, dg: moderate ID Mat: M, 20 years, dg: moderate ID, attention deficit disorder Kevin: M, 21 years, dg: mild ID, gross motor deficits Steve: M, 30 years, dg: mild cerebral palsy All worked 20 h per week and had been employed for between 2 and 4 months. They had general cleaning duties on different floors of the designated buildings | The Self-Determined Career Model was developed to enable adult service providers to help individuals become self-regulated problem-solvers, to self-direct in the career decision-making process, and to gain enhanced self-determination. The model included three phases: 1) set a career/job goal, 2) take action, and 3) assess/adjust goal or plan. The model used a generic set of questions, which represent steps in the problem-solving sequence. Questions that followed the basic framework allowed individuals to modify their own behavior and thus become self-directed in reaching their goal | Job performance (percentage of correct responses) | Job performance Fred: baseline 50–53%, during intervention session 70–80%, and during maintenance condition 77–96% Matt: baseline 34–48%, during intervention session 72–93%, and during maintenance condition 93–100% Kevin: baseline 14–36%, during intervention session 32–100%, and during maintenance condition 77–91% Steve: baseline 44%, during intervention session 64–88%, and during maintenance condition 79% The work-related performances of all four employees improved after the three phases of the Self-Determined Career Model. Positive changes were evident between baseline and intervention conditions and continued in the maintenance phase. |
Dotson et al. [77], USA | Case study, observation | N = 3, Candy: F, 23 years, dg: MR Leah: F, 21 years, dg: Down syndrome Ethan: M, 27 years, dg: Down syndrome | Transition academy provided instructions for independent living and vocational skills as well as community-based opportunities to practice these skills through activities such as volunteering at a local food bank and going out to eat and shopping. Self-employment job skills were evaluated within the context of the recycling program. The Transition academy team created an analog business that the Transition Academy students were responsible for running. Participants were paid with tokens. The aim of the intervention was not to teach all the skills required to run a business without help or supervision, but to teach worker job skills (how to do the job), supervisor skills (how to supervise someone else doing the job), and office skills (how to keep records of work completed) | Job skills: Percentage of job steps performed correctly and independently | Candy performed job skills at levels well below 20% on average at baseline, improved substantially during teaching, and maintained a high level of performance of job skills during maintenance and while working shifts in the natural environment. Leah and Ethan performed job skills at lower levels at baseline, improved during teaching, and maintained a generally high level of performance of job skills during maintenance and while working shifts in the natural environment |
Furniss et al. [69], UK | Quantitative case study, observation, interview of the co-workers and carers | N = 6 Mr. P: M, 35 years, dg: severe DD, job: assembling and packing nut/bolt/washer kit for classic cars Mr. W: M, 31 years, dg: severe DD, job: assembling of box and packing with forage caps Ms. R: F, 34 years, dg: severe DD, job: assembling and packing nut/bolt/washer kit for classic cars Mr. V: M, 43 years, dg: severe DD, job: preparing clock cards (attaching name sticker, sorting by dept., date stamping) Mr. H: M, 36 years, dg: severe DD, assembling aqualung pillar valve Mr. S: M, 47 years, dg: severe DD, assembling aqualung pillar valve | VICAID, palmtop-based job aid for workers with severe developmental disabilities. The system was controlled by a single large key that the worker used and a second, inconspicuous key that the supporting job coach or co-worker used. Three user prompt devices were used: a small free-standing loudspeaker unit, a smaller, portable device to which the user listened via an ear-piece, and a vibrating prompting device carried by the user on their belt or in their pocket. For each job task, a sequence of pictorial instructions created on a desktop PC was downloaded to the palmtop. The system enabled the worker to access pictorial instructions designed to help them accurately complete their tasks. It also provided reminders to access instructions, and/or alerted a job coach or supervisor if the workers had difficulty with a task | The percentage of task steps correctly completed, total time taken by the participant to complete the task, amount of time during each session that the participant spent actively engaged in the task | Job performance The computer-aided VICAID system was effective in enabling participants to perform work tasks with a high degree of accuracy following relatively brief periods of intensive training. The transition of intensive training by a job coach in the VICAID-supported maintenance condition, together with limited job coach input, led to four of the six participants showing further improvements in performance accuracy at or beyond the levels achieved with intensive training. Practice in job tasks with the computer-aided system led to both maintenance of previously learned skills and learning new job competencies |
Gilson and Carter [79], USA | Quantitative case study. Single-case experimental design | N = 1 Braxton, M, 20 years, dg: ID, IQ: nr. Ethnicity: African American. Previous volunteer and employment experiences at the thrift store, restaurant, and his local church | The study was conducted the participant’s individual jobsite. Braxton worked 4 h weekly at a market within a residence hall on campus. Tasks included stocking grocery shelves, refilling supplies at the coffee station and breakfast buffet line, and marking items with price tags and expiration dates. Braxton typically had one direct supervisor, about 3 co-workers and 4–6 customers. The intervention package was comprised of a) reduced proximity, b) use of CVC (convert audio coaching, c) social-focused coaching, and d) task-related proximal coaching as needed. The participant and the coach were linked through a two-way radio with accompanying earpiece. CAC job coach was trained to focus majority of the prompts on encouraging the participant to seek assistance from others when completing a task, rather than relying on the job coach. In addition, she/he was taught to give explicit social prompts when someone was in proximity for an interaction | Percentage of intervals with task engagement and interactions. | Performance. At baseline, Braxton’s levels of social interaction were consistently low with a flat trend. He rarely initiated or responded to interactions with anyone except his job coach. After he was coached on initiating conversations with his co-workers an accelerating trend and change in level was observed (from 0.7 to 27%), and it maintained at 27% after completely removing the coach Task engagement. Braxton’s task engagement level was 98% at baseline and it slightly increased to 98 and 99% during CAC and withdrawal phases respectively |
Kemp and Carr [67], USA | Quantitative, experimental case | N = 3 (2 M/1F) dg: Autism and severe mental retardation; Severe problem behavior (aggressive, self-injury) Age: 26–30 years | The intervention included three factors: a) Interventions were chosen on the basis of the hypotheses regarding the maintaining variables for problem behavior; b) the multicomponent intervention package included some combination of functional communication training, building rapport, making choices, embedding demands, and building tolerance of delay of reinforcement; c) Measures of latency of problem behavior and percentage of work steps completed were used as outcome measures. At the end of the intervention phase, the job coach trained the regular employees in the implementation of the intervention and gradually reduced their supervisory time while the regular employees increased theirs | Outcomes | Results/Outcomes: All three employees (participants) were able to complete tasks (a planting sequence in a community greenhouse) with no significant problem behavior following multicomponent intervention, and were able to work four hours at a time. In addition, the greenhouse managers reported considerable confidence in the job coach’s ability to deal with any behavior difficulties, keeping both coworkers and property safe from harm; reported that problem behavior was almost never severe following the intervention, and acknowledged the employees as productive members of the greenhouse team |
McGlashing-Johnson et al. [70], USA | Quantitative case study. A multiple baseline across students was used to evaluate the effects of the intervention. Task analyses. Observations by trained observers 2–4 times per week. The students recorded their behaviors using self-monitoring cards. The Goal Attainment Scaling (GAS). Likert scale | N = 4. Jessica: F, 17 years, dg: moderate MR Sam: M, 17 years, dg: moderate MR Lindsay: F, 20 years, dg: moderate/severe MR Milo: M, 16 years, dg: moderate/severe mental retardation | All students were involved in a work-based learning program in the community, which was operated by the school district. The program involved a self-regulated problem-solving process in which students set their goals, developed and implemented action plans to enable them to achieve their goals, and evaluated their progress in achieving these goals. A job coach accompanied all students to their respective sites. Jessica: packing bread/buns for patients in the hospital, work in the dish room. Lindsay and Milo: work in the garage of a small metropolitan bus station and cleaning the interiors of the buses. Sam: work at a gardening center. He priced items, swept the floors, shoveled snow, and counted inventory | The percentage of correct responses in the task analysis for each task | Job performance The Self-Determined Learning Model of Instruction (SDLMI) represents an effective method for teaching problem-solving to people with cognitive disabilities. During baseline, after training sessions and during maintenance, the respective percentages of correct responses were for Jessica 50%, 80%, 93%, Sam 31%, 70%, 80%, Lindsay 15%, 79%, 80%, Milo 6%, 46% |
McMahon et al. [78], USA | Quantitative case study. Navigation checks, interview | N = 3 Catelyn: F, 23 years, IQ: 45 Jon: M, 24 years, IQ: 56 Arya: F, 20 years, IQ: 64 | The students completed a postsecondary education program. Three treatment conditions were implemented: navigation skills including a) a paper map, b) a Google Map, and c) augmented reality (AR). During each navigation session, each student was randomly assigned to one of the three treatment conditions using a spinner. This study occurred in a downtown area of a city. Participants navigated city streets to locate businesses that offered potential employment opportunities. The starting and ending localities were within a 12- to 20-minute walking distance of one another | The percentage of correct independent navigation decisions within 30 s during ‘navigation checks’ while walking to a targeted unknown business location. Responses Yes/No | Functioning/performance The AR treatment condition was the most effective. At baseline, with a paper map, a Google map, and AR application, the respective percentages of correct responses were for Catelyn 11.5%, 20.14%, 45.75, 75%, Jon 16.13%, 20.47%, 40.95%, 75%, and Arya 13.6%, 19%, 31.4%, 85.7% |
Renzaglia et al. [65], USA | Quantitative case study | N = 1 Phil: M, 23 years, dg: Down syndrome, low-moderate level of functioning. Occupation: animal carer in a university vivarium (competitive employment) | A five-stage process included job task analysis, pre-baseline assessment, baseline assessment, treatment, and post-treatment follow-up. 1) Task analysis involved direct observation of co-workers performing the job tasks, performance of the tasks by the principle investigator (i.e., job coach), and reviewing the recorded task sequences with Phil’s supervisor. 2) The second state was to evaluate Phil’s current performance and to identify the specific skill areas in which training and retraining was needed. 3) The baseline data on the nine skills were collected for a five-day period. 4) Instruction in the nine skill areas identified as deficient in baseline assessment. Systematic instruction procedure using a least-to-most intrusive prompt system. 5) Post-training assessment of the subject’s performance under the same non-training conditions as those in the baseline assessment | The percentage of job tasks performed correctly in a nine-item task analysis | Job performance The percentage of correct performance in the nine designated tasks was 44% across the five days baseline, 68.7% during treatment, and 92.5% in the post-treatment assessment |
Simmons and Flexer [66], USA | Quantitative case study.Observation. | N = 2 Sandy: F, 27 years, dg: moderate MR Donna: F, 30 years, dg: severe MR | The intervention was conducted in a janitorial and maintenance supported employment program at a restaurant/hotel complex. The training was carried out by a community employment specialist employed by the supported employment program to perform individualized placement and training (on Monday through Friday, 9–11 am, weekly). The training tasks were those of cleaning a restroom | The percentage of steps performed independently during baseline, training and follow-up (two months after training had ceased) | Job performance Both participants increased their performance to the criterion performance of 80%. Sandy: Performance increased from baseline (13% in Phase 1.15% in Phase 2, 54% in Phase 3) to training (81, 83, and 81%, respectively) Donna: Performance increased from baseline (46% in Phase 1, 40% in Phase 2, 54% for Phase 3) to training (89, 92, and 88%, respectively) |
Taber et al. [68], USA | Case study, quantitative. Video tape, observation. Wilcoxon Matched Pairs Signed-Ranks Test | N = 5 Student 1: M, 18 years, dg: moderate MR, IQ: 41 Student 2: F, 17 years, dg: moderate MR, IQ: 43 Student 3: M, 18 years, dg: moderate MR, IQ: 42 Student 4: M, 16 years, dg: moderate MR, IQ = 41 Student 5: M, 18 years, dg: moderate MR, IQ = 40 | A self-operated single-word auditory prompting system and a self-operated multiple-word (3 words) prompting system. Both systems were delivered via a tape recorder and headphones using separate, prerecorded cassette tapes with cues specific to each worker’s chain of vocational tasks in two vocational settings (church, pet store) | Number of independent task transitions across sessions in two vocational settings Performance duration | Performance A statistically significant difference was found between baseline and both auditory prompting systems in both vocational settings. The number of independent task changes ranged at baseline from 0 to 3, during intervention from 2 to 6 with the single-word and from 3 to 6 with the multiple-word prompting system. Performance duration differences between prompting systems were significant for Student 3 (T = 1.00, p < .05, N = 7) and Student 5 (T = 0.00, p < . 05, n = 7). They transitioned through tasks in significantly less time using the multiple-word auditory prompts in the pet store |
Van Laarhoven et al. [80], USA | Quantitative case study. Observation | N = 2 Gerald: M, 17 years, dg: Autism and moderate ID, IQ: 44 Nick: M, 18 years, dg: Autism and moderate ID, IQ: nr | The study was conducted within the faculty conference room. The participants were responsible for cleaning and preparing the room for different meetings: configure tables and chairs, clean the white board, and throw away garbage or place important items in the lost and found. The work comprised 3 decision points. Universally-designed prompting systems presented on iPads and HP Slates were compared to improve the independent vocational performance of participants | Percentage of correct responses, percentage of media options selected by participants, the percentage of decision points correctly selected by participants across baseline and intervention phases | Performance Both participants increased their vocational skills using mobile devices. There was not a large difference in correct responding when devices were compared, but participants performed slightly better when using their preferred device. The participants selected video prompts more often than other media prompts (i.e. picture prompts) during initial sessions, except Nick during the first session. The participants effectively self-selected and self-faded their reliance on media-prompts as they became more independent with the task |
West and Patton [73], USA | Quantitative case study | N = 4 Adam: M, 41 years, dg: severe ID Gena: F, 38 years, dg: ID and Rhett syndrome Alex: M, 35 years, dg: moderate ID Kylie: F, 34 years, dg: severe ID | Participants attended a community-based habilitation agency for six hours a day, Monday to Friday. The setting contained several activities including vocational tasks (i.e., sorting and assembly) and other activities such as listening to music, reading books, watching television, and kitchen and laundry tasks | The number of independent correct responses for each client during each job training session | No independent correct responses were observed for any participant during baseline sessions across task and procedures. Gena performed all five steps independently and correctly in Session 15, Kylie in session 14, Adam in Session 15, and Alex in Session 15 |
Authors, year, country | Methods, study design | Population, definitions, terms | Intervention | Findings, barriers and facilitators |
---|---|---|---|---|
Aspinall [62], UK | Qualitative case study. Interview, questionnaire | N = 10 (5 M/5F) Dg: Learning disabilities Age: nr IQ: nr | The TATE project of assistive technology and telecare to improve quality of life, especially employment | Assistive technology supported the independence of people with learning disabilities |
Grossi et al. [60], USA | Case study. Observation | N = 2 Dana: F, 28 years, dg: mild ID, IQ: 64 Rick, M, 28 years, dg: borderline, IQ: 70 | The workplace was a restaurant. The aim was to enhance social interaction. The social interaction situations were tape-recorded prior to and during the work shifts. The recordings were analyzed together with the participants, and during these analysis sessions the participants received guidance in social interaction skills | Prior to the intervention Dana did not pay attention or reacted negatively to her supervisor and workmates; she also had difficulties accepting critique Rick was very sensitive to critique. He tried to avoid other people and also behaved obsessively and was paranoid After the intervention Both Dana and Rick were more responsive to the initiatives of the others and in a socially acceptable manner |
Hagner and Davies [53], USA | Case-study, interviews of entrepreneurs and support people | N = 7 Rhonda: F, age: nr, dg: ID Pat: F, age: nr, dg: ID, physical disability. Jenny: F, age: nr, dg: ID, physical disability Paul: M, age: nr, dg: ID Maxwell: M, age: nr, dg: ID Peggy: F, age: nr, dg: ID Richard: M, age: nr, dg: ID, physical disability | People with ID as entrepreneurs. Entrepreneurship was built according to each person’s own interests and values. Rhonda, Pat, Jenny and Maxwell received business training. The established firms had no personnel other than the entrepreneur. Each entrepreneur had their own support person, who took responsibility for the firm’s practical issues | Factors enhancing employment: Only a small monetary investment was needed to start the business. Most of these people only worked part-time. Some of them had the support person with them all the time, others only occasionally. Work as an entrepreneur was flexible, independent, and they could do work that was interesting Barriers to employment: The income from the business was low, so other sources of income were needed. The support people did not have enough expertise or interest in business. It was difficult to obtain support for running a business, and to make social contacts |
Ham et al. [64], USA | Case study | N = 1 Kristen: F, age: nr (young adult), dg: Down syndrome, autism, and hearing disability | Kristen worked in the hospital delivery ward. Her jobs were cleaning the babies’ nursing room, cleaning computers, phones and kitchens, and taking care of blankets and clothes in the nursery. The aim of the positive behavior program was to decrease her disruptive behavior and to help her better complete her duties. The program included self-assessment, a timetable in pictorial form and auditive reminders. The program was planned by a positive behavior support person and her workmates took part in its implementation | Prior to the intervention: Kristen behaved disruptively at the workplace, and was unable to carry out her duties. She was in danger of being dismissed After the intervention: Kristen was more self-regulative and independent. In three months her refusals to comply with the timetables decreased by 79%, refusals to follow instructions decreased by 59% and refusals to handle the alarms decreased by 67%. Her workmates felt it was more comfortable to work with her. Kristen continued to work in the hospital for two more years. After that she moved to another city and obtained another job |
Jarhag et al. [63] | Case study | N = 2 Anna: F, 30 years, dg: ID (50% disability allowance), IQ: nr, had attended to a school for children with ID Adam: M, 21 years, dg: ID, IQ: nr, had attended to a school for children with ID | Model for special support and follow-up. The support person helped the employee plan work tasks and gave individual support to the person with ID according to the plan. The support person was present at the workplace and supervised the tasks, and also helped the employee modify working conditions. The amount of support given by the support person gradually diminished, and when the employee succeeded in their tasks independently, the support ended. The maximum duration of support was six months | Prior to intervention: Anna worked as a wage-subsidized cleaner for two years. When she moved to another city the wage-subsidy ended. A year later, after her maternity leave, Anna enrolled as a job-seeker, and temporarily attended a sheltered workshop until a job was found for her. However, she did not find employment. The employees felt that Anna could not be employed because of her shyness, lack of initiative and low stress tolerance Adam was registered as a job-seeker in the employment office After the intervention Anna was employed with a wage subsidy in the hotel and restaurant industry. Her job tasks were tailored according to her skills. Later Anna returned to being a customer of the employment office. The support person helped her and again she obtained a wage-subsided job Adam: The support person helped him while he was in his last year of school for people with ID. After school, Adam worked as a trainee, but this did not lead to employment. The support person arranged another job for him, but this did not last very long. Following discussions with the support person, Adam again obtained a place as a trainee, which later turned into a wage-subsided post The factors enabling employment were sufficient duration of support, individually tailored tasks and wage subsidies |
Wehman et al. [61], USA | Qualitative case study, observations | N = 2. Karen, F, 18 years, dg: severe ID, autism, communication deficits, IQ: nr, at school Lisa, F, 22 years, dg: moderate/severe ID, IQ: nr | Employment with support of family, job coach and workmates. The employees’ performance was evaluated at home and in job tasks, and on the grounds of these evaluations, suitable job tasks and workplaces were defined. The intervention included choosing the workplace and the employee, getting to know these; and guidance, training and support at the workplace | Both Karen and Lisa obtained employment. Karen worked at a restaurant, where her tasks where first spreading flour and later also handling dirty dishes. Lisa’s first workplace was at a café at school, and after that a grocer’s, where she had simple tasks such as towel folding Factors promoting employment and work performance: support from family and job coach, support and opportunities to develop at work |
Participants
Interventions
Outcomes
Study quality
Effectiveness
Outcome | Percentage and/or comparative risk (95% Confidence Interval) | Number of subjects | Evidence (GRADE) | Study | |
---|---|---|---|---|---|
Intervention | Control group | ||||
Employment in open labor market | Supported work 21% | Sheltered employment 0% | 49 | Moderate | High quality RCT study [43] |
Employment to supported work after sheltered work 59.6% | Employment to supported work without sheltered work 60.4% | 9,808 | Low | High quality cohort study [47] | |
Employment after postsecondary education (OR 2.0) | Employment without postsecondary education | 11,280 | Low | High quality cohort study [52] | |
Support of work coach 6.1% | No control group | 7,090 | Very low | Moderate quality cohort study [45] | |
Transfer from school to open labor market | Support services and work training during secondary education 22.4% | No control group | 12,269 | Low | High quality cohort study [50] |
Support activities during education 75.9% One transition activity during education (OR 1.2) Work period during education (OR 3.5) Work experience during education (OR 5.7) | No control group | 62,513 | Very low | Moderate quality cohort study [48] | |
Work experience and training of work awareness 21%, (OR 1.01) | No control group | 87 | Very low | Moderate quality cohort study [46] | |
Work briefing and work training during secondary education 45%/2008, 11%/2009 | No work training or work experience during education 6%/2008, 5%/2009 | 1452 | Very low | Moderate quality multimethod study [59] | |
Personal educational program and transition services at age of 14 years 74.3% | Personal educational program and transition services at age of 16 years 57.8% | 15,040 | Low | High quality cohort study [49] | |
Work performance | Supported work Before intervention: 54 (SD 6) After intervention: 51 (SD 8) | Sheltered work Before intervention: 53 (SD 8) After intervention: 54 (SD 7) | 49 | Moderate | High quality RCT study [43] |
Short work tastings, self-evaluation, education of job coaches. Need for job coaches decreased: at beginning 4.79 > 4.04 or 2.80. | No control group | 35 | Very low | Moderate intervention study [44] |