The online version of this article (https://doi.org/10.1007/s10926-019-09837-2) contains supplementary material, which is available to authorized users.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Purpose This systematic review analyzed the effectiveness of rehabilitation interventions on the employment and functioning of people with intellectual disabilities (ID), as well as barriers and facilitators of employment. Methods This was a systematic review of quantitative, qualitative, and mixed methods studies. The outcomes were employment, transition to the open labor market and functioning. The review included qualitative studies of employment barriers and facilitators. The population comprised people with ID aged 16–68 years. Peer-reviewed articles published in English between January 1990 and February 2019 were obtained from the databases Cinahl, the Cochrane Library, Embase, Eric, Medic, Medline, OTseeker, Pedro, PsycInfo, PubMed, Socindex, and the Web of Science. We also searched Google Scholar and Base. The modified selection instrument (PIOS: participants, intervention, outcome, and study design) used in the selection of the articles depended on the selection criteria. Results Ten quantitative (one randomized controlled, one concurrently controlled, and eight cohort studies), six qualitative studies, one multimethod study, and 21 case studies met the inclusion criteria. The quantitative studies showed that secondary education increases employment among people with ID when it includes work experience and personal support services. Supported employment also increased employment in the open labor market, which sheltered work did not. The barriers to employment were the use of sheltered work, discrimination in vocational experience, the use of class teaching, and deficient work experience while still at school. The facilitators of employment were one’s own activity, the support of one’s family, job coaching, a well-designed work environment, appreciation of one’s work, support form one’s employer and work organization, knowledge and experience of employment during secondary education, and for entrepreneurs, the use of a support person. Conclusions The employment of people with ID can be improved through secondary education including proper teaching methods and personal support services, the use of supported work, workplace accommodations and support from one’s family and employer. These results can be utilized in the development of rehabilitation, education, and the employment of people with ID, to allow them the opportunity to work in the open labor market and participate in society.
Test DW, Carver T, Ewers L, Haddad J, Person J. Longitudinal job satisfaction of persons in supported employment. Educ Train Mental Retard Dev Disabil. 2000;35(4):365–73.
Howarth E, Mann JR, Zhou H, McDermott S, Butkus S. What predicts re-employment after job loss for individuals with mental retardation? J Vocat Rehabil. 2006;24(3):183–9.
Dean EE, Shogren KA, Hagiwara M, Wehmeyer ML. How does employment influence health outcomes? A systematic review of the intellectual disability literature. J Vocat Rehabil. 2018;49(1):1–13.
Eggleton I, Robertson S, Ryan J, Kober R. The impact of employment on the quality of life of people with an intellectual disability. J Vocat Rehabil. 1999;13(2):95–107.
Siperstein GN, Parker RC, Drascher M. Natl Snapshot Adults Intellect Disabil Labor Force. 2013;39(3):157–65.
Vesala HT, Klem S, Ahlsten M. Kehitysvammaisten ihmisten työllisyystilanne 2013–2014 (Employment of people with intellectual disabilities 2013–2014). Kehitysvammaliiton selvityksiä 9/2015.
Emerson E, Hatton C. Residential provision for people with intellectual disabilities in England, Wales and Scotland. J Appl Res Intellect Disabil. 1998;11(1):1–14.
Emerson E, Hatton C, Robertson J, Roberts H, Baines S, Evison E, Glover G. People with learning disabilities in England 2010. Learning Disability Observatory: Improving health and lives; 2011.
Randell M, Cumella S. People with an intellectual disability living in an intentional community. J Intellect Disabil Res. 2009;53(8):716–26.
Beyer S, Meek A, Davies A. Supported work experience and its impact on young people with intellectual disabilities, their families and employers. Adv Ment Health Intellect Disabil. 2016;10(3):207–20.
McKenzie K, Milton M, Smith G, Ouellette-Kuntz H. Systematic review of the prevalence and incidence of intellectual disabilities. Current trends and issues. Curr Dev Disord Rep 2016; 3: 104–115.
Maulik PK, Mascarenhas MN, Mathers CD, Dua T, Saxena S. Prevalence of intellectual disability. A meta-analysis of population-based studies. Res Dev Disabil. 2011;32(2):419–36.
Patja K, Iivanainen M, Vesala H, Oksanen H, Ruoppila I. Life expectance of people with intellectual disability. A 35-year follow-up study. J Intellect Disabil Res. 2000;44(5):591–9.
Westerinen H, Kaski M, Virta L, Almqvist F, Iivanainen M. Prevalence of intellectual disability. A comprehensive study based on national registers. J Intellect Disabil Res. 2007;51(9):715–25.
Austin BS, Lee C-L. A structural equation model of vocational rehabilitation services. Predict Employ Outcomes Clients Intellect Co-occurring Psychiatr Disabil. 2014;80(8):11–20.
European Intellectual Disability Research Network. Intellectual disability in Europe. Working papers. University of Kent, Canterbury 2003.
Ratti V, Hassiotis A, Crabtree J, Deb S, Gallagher P, Unwin G. The effectiveness of person-centred planning for people with intellectual disabilities. A systematic review. Res Dev Disabil 2016; 57:63–84.
Kaehne A, Beyer S. Person-centred reviews as a mechanism for planning the post-school transition of young people with intellectual disability. J Intellect Disabil Res. 2014;58(7):603–13.
Vornholt K, Villotti P, Muschalla B, Bauer J, Colella A, Zijlstra F. Disability and employment–overview and highlights. Eur J Work Organ Psychol. 2018;27(1):40–55.
Sechoaro EJ, Scrooby B, Koen DP. The effects of rehabilitation on intellectually-disabled people. A systematic review. Health SA Gesondheid. 2014;19(1):9.
Rosen M, Bussone A, Dakunchak P, Cramp J. Sheltered employment and the second generation workshop. J Rehabil. 1993;59(1):30–4.
Hsu T-H, Huang Y-J, Ososkie J. Challenges in transition from sheltered workshop to competitive employment. Perspectives of Taiwan social enterprise transition specialists. J Rehabil. 2009;75(4):19–26.
AAIDD. Intellectual disability. Definition, classification, and systems of supports. The 11th edition of the AAIDD definition manual. Washington D.C.: AAIDD, 2010.
Damianidou D, Foggett J, Arthur-Kelly M, Lyons G, Wehmeyer ML. Effectiveness of technology types in employment-related outcomes for people with intellectual and developmental disabilities: an extension meta-analysis. Adv Neurodev Disord. 2018;2(3):262–72.
WHO, World Health Organisation. ICF, International Classification of Functioning, Disability and Health. Geneva, 2001.
Bauer SM, Elsaesser L-J, Arthanat S. Assistive technology device classification based upon the World Health Organization’s, International Classification of Functioning, Disability and Health (ICF). Disabil Rehabil. 2011;6(3):243–59.
Anner J, Schwegler U, Kunz R, Trezzini B, de Boer W. Evaluation of work disability and the international classification of functioning, disability and health. What to expect and what not. BMC Public Health. 2012;12(1):470.
Khan F, Ng L, Turner-Stokes L. Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis. Cochr Collab. 2011;12(1):1–24.
Higgins JPT, Green S, (Eds.) Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration, 2012. Available: http://onlinelibrary.wiley.com/doi/10.1002/9780470712184.fmatter/pdf.
Nevala N, Pehkonen I, Teittinen A, Vesala HT, Pörtfors P, Anttila H. Kuntoutuksen vaikuttavuus kehitysvammaisten toimintakykyyn ja työllistymiseen sekä sitä estävät ja edistävät tekijät (The effectiveness of rehabilitation on the functioning and employment of people with intellectual disabilities and barriers or facilitators: A systematic review). Järjestelmällinen kirjallisuuskatsaus. Kela, Työpapereita 133, 2018. Available: https://helda.helsinki.fi/bitstream/handle/10138/230842/Tyopapereita133.pdf?sequence=l.
O’Connor D, Green S, Higgins JPT. Defining the review question and developing criteria for including studies. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. England: Wiley & Sons Ltd; 2008. p. 83–94.
Van Tulder M, Furlan A, Bombardier C, et al. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine. 2003;28(12):1290–9.
Turner-Stokes L, Nair A, Sedki I, Disler PB, Wade DT. Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database of Systematic Reviews 2005, Issue 3.
Khan F, Turner-Stokes L, Ng L, Kilpatrick T. Multidisciplinary rehabilitation for adults with multiple sclerosis. Cochrane Database of Systematic Reviews 2007, Issue 2.
Nevala N, Pehkonen I, Koskela I, Ruusuvuori J, Anttila H. Workplace accommodation among persons with disabilities. A systematic review of its effectiveness and barriers or facilitators. J Occup Rehabil. 2015;25(2):432–48.
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Available: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
Critical Appraisal Skills Programme (CASP). Qualitative research checklist. Public Health Resource Unit & U.K. Centre for Evidence Based Medicine, 2017. Available: http://www.casp-uk.net/checklists.
Kärki A, Anttila H, Tasmuth T, Rautakorpi U-M. Lymphoedema therapy in breast cancer patients - a systematic review on effectiveness and survey of current practices and costs in Finland. Acta Oncol. 2009;48(6):850–9.
The Joanna Briggs Institute. Critical Appraisal tools for use in JBI Systematic Reviews. Checklist for Case Reports. Joanna Briggs Institute 2016. Available: http://joannabriggs.org/research/critical-appraisal-tools.html.
Foley KR, Dyke P, Girdler S, Bourke J, Leonard H. Young adults with intellectual disability transitioning from school to post-school. A literature review framed within the ICF. Disabil Rehabil. 2012;34(20):1747–64.
Cieza A, Fayed N, Bickenbach J, Prodinger B. Refinements of the ICF linking rules to strengthen their potential for establishing comparability of health information. Disabil Rehabil. 2019;41(5):574–83.
GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490–4.
Goldberg RT, McLean MM, LaVigne R, Fratolillo J, Sullivan FT. Transition of persons with developmental disability from extended sheltered employment to competitive employment. Ment Retard. 1990;28(5):299–304.
Kilsby MS, Beyer S. Enhancing self-determination in job matching in supported employment for people with learning disabilities: An intervention study. J Vocat Rehabil. 2002;17(2):125–35.
Gray BR, McDermott S, Butkus S. Effect of job coaches on employment likelihood for individuals with mental retardation. J Vocat Rehabil. 2000;14(1):5–11.
Beyer S, Kaehne A. The transition of young people with learning disabilities to employment. What works? J Dev Disabil. 2008;14(1):85–94.
Cimera RE. Does being in sheltered workshops improve the employment outcomes of supported employees with intellectual disabilities? J Vocat Rehabil. 2011;35(1):21–7.
Joshi GS, Bouck EC, Maeda Y. Exploring employment preparation and postschool outcomes for students with mild intellectual disability. Career Dev Transit Exceptional Individ. 2012;35(2):97–107.
Cimera RE, Burgess S, Bedesem PL. Does providing transition services by age 14 produce better vocational outcomes for students with intellectual disability? Res Pract Persons Severe Disabil. 2014;39(1):47–54.
Arvidsson J, Widén S, Staland-Nyman C, Tideman M. Post-school destination. A study of women and men with intellectual disability and the gender-segregated Swedish labor market. J Polic Pract Intellect Disabil. 2016;13(3):217–26.
Bouck EC, Chamberlain C. Postschool services and postschool outcomes for individuals with mild intellectual disability. Career Dev Transit Exceptional Individ. 2017;40(4):215–24.
Sannicandro T, Parish SL, Fournier S, Mitra M, Paiewonsky M. Employment, income, and SSI effects of postsecondary education for people with intellectual disability. Am J Intellect Dev Disabil. 2018;123(5):412–25.
Hagner D, Davies T. Doing my own thing. Supported self-employment for individuals with cognitive disabilities. J Vocat Rehabil. 2002;17(2):65–74.
Fasching H. Compulsory school is over and now? Vocational experiences of women with intellectual disability. Creat Educ. 2014;5(10):743–51.
Christensen JJ, Richardson K. Project SEARCH workshop to work: participant reflections on the journey through career discovery. J Vocat Rehabil. 2017;46(3):341–54.
Alborno N, Gaad E. Employment of young adults with disabilities in Dubai. A case study. J Polic Pract Intellect Disabil. 2012;9(2):103–11.
Devlieger PJ, Trach JS. Mediation as a transition process. The impact on postschool employment outcomes. Exceptional Child. 1999;65(4):507–23.
Donelly M, Hillman A, Stancliffe RJ, Knox M, Whitaker L, Parmenter TR. The role of informal networks in providing effective work opportunities for people with an intellectual disability. Work. 2010;36(2):227–37.
Winsor JE, Butterworth J, Boone J. Jobs by 21 partnership project. Impact of cross-system collaboration on employment outcomes of young adults with developmental disabilities. Intellect Dev Disabil. 2011;49(4):274–84.
Grossi TA, Kimball JW, Heward WL. What did you say? Using review of tape-recorded interactions to increase social acknowledgments by trainees in a community-based vocational program. Res Dev Disabil. 1994;15(6):457–72.
Wehman P, Gibson K, Brooke V, Unger D. Transition from school to competitive employment. Illustrations of competence for two young women with severe mental retardation. Focus Autism Dev Disabil. 1998;13(3):130–43.
Aspinall A. How can assistive technology and telecare support the independence and employment prospects for adults with learning disabilities? J Assist Technol. 2007;1(2):43–8.
Jarhag S, Nilsson G, Werning M. Disabled persons and the labor market in Sweden. Soc Work Public Health. 2009;24(3):255–72.
Ham W, McDonough J, Molinelli A, Schall C, Wehman P. Employment supports for young adults with autism spectrum disorder. Two case studies. J Vocat Rehabil. 2014;40(2):117–24.
Renzaglia P, Wheeler JJ, Hanson HB, Miller SR. The use of extended follow-along procedures in a supported employment setting. Education and Training in Mental Retardation 1991; March:64–69.
Simmons TJ, Flexer RW. Community based job training for persons with mental retardation. An acquisition and performance replication. Educ Train Mental Retard. 1992;27(3):261–72.
Kemp DC, Carr EG. Reduction of severe problem behavior in community employment using an hypothesis-driven multicomponent intervention approach. J Am Soc Hypertens. 1995;20(4):229–47.
Taber TA, Alberto PA, Fredrick LD. Use of self-operated auditory prompts by workers with moderate mental retardation to transition independently through vocational tasks. Res Dev Disabil. 1998;19(4):327–45.
Furniss F, Ward A, Lancioni G, Rocha N, Cunha B, Seedhouse P, Morato P, Waddell N. A palmtop-based job aid for workers with severe intellectual disabilities. Technol Disabil. 1999;10:53–67.
McGlashing-Johnson J, Agran M, Sitlington P, Cavin M, Wehmeyer M. Enhancing the job performance of youth with moderate to severe cognitive disabilities using the self-determined learning model of instruction. Res Pract Persons Severe Disabil. 2003;28(4):194–204.
Carson KD, Gast DL, Ayres KM. Effects of a photo activity schedule book on independent task changes by students with intellectual disabilities in community and school job sites. Eur J Special Needs Educ. 2008;23(3):269–79.
Bennett K, Brady MP, Scott J, Dukes C, Frain M. The effects of covert audio coaching on the job performance of supported employees. Focus Autism Dev Disabil. 2010;25(3):173–85.
West EA, Patton HA. Positive behaviour support and supported employment for adults with severe disability. J Intellect Dev Disabil. 2010;35(2):104–11.
Chang YJ, Wang TY, Chen YR. A location-based prompting system to transition autonomously through vocational tasks for individuals with cognitive impairments. Res Dev Disabil. 2011;32(6):2669–73.
Devlin P. Enhancing job performance. Intellect Dev Disabil. 2011;49(4):221–32.
Allen KD, Burke RV, Howard MR, Wallace DP, Bowen SL. Use of audio cuing to expand employment opportunities for adolescents with autism spectrum disorders and intellectual disabilities. J Autism Dev Disord. 2012;42(11):2410–9.
Dotson WH, Richman DM, Abby L, Thompson S, Plotner A. Teaching skills related to self-employment to adults with developmental disabilities: an analog analysis. Res Dev Disabil. 2013;34(8):2336–50.
McMahon D, Cihak DF, Wright R. Augmented reality as a navigation tool to employment opportunities for postsecondary education students with intellectual disabilities and autism. J Res Technol Educ. 2015;47(3):157–72.
Gilson CB, Carter EW. Promoting Social Interactions and Job Independence for College Students with Autism or Intellectual Disability: a Pilot Study. J Autism Dev Disord. 2016;46(11):3583–96.
Van Laarhoven T, Carreon A, Bonneau W, Lagerhausen A. Comparing mobile technologies for teaching vocational skills to individuals with autism spectrum disorders and/or intellectual disabilities using universally-designed prompting systems. J Autism Dev Disord. 2018;48(7):2516–29.
Mank D, Cioffi A, Yovanoff P. Supported employment outcomes across a decade. Is there evidence of improvement in the quality of implementation? Ment Retard. 2003;41(3):188–97.
Ellenkamp JJ, Brouwers EP, Embregts PJ, Joosen MC, van Weeghel J. Work environment - related factors in obtaining and maintaining work in a competitive employment setting for employees with intellectual disabilities: a systematic review. J Occup Rehabil. 2016;26(1):56–69.
A concept paper on digitization, employability and inclusiveness. The role of Europe. DG communications networks. Content & Technology (CONNECT). European Comission, 2017. https://ec.europa.eu/newsroom/document.cfm?doc_id=44515
- The Effectiveness of Rehabilitation Interventions on the Employment and Functioning of People with Intellectual Disabilities: A Systematic Review
Hannu T. Vesala
- Springer US
Journal of Occupational Rehabilitation
Print ISSN: 1053-0487
Elektronische ISSN: 1573-3688