Encouragement toward employment for those with disabilities



This commentary is on the original article by Verhoef et al. on pages 722–728 of this issue.

Employment for people with physical disabilities has been and continues to be a global challenge permeating all cultures of both the developed and developing world. New interventions to improve work participation of young adults with disabilities are being sought and developed with encouraging success at this time.[1] Reported rates of employment of 20–30% are common in the literature for those with developmental motor disabilities; possibly better recently with modern technology and support services.[2, 3] As individuals with developmental disability in general are living longer, issues of optimal transition, aging, community living, and workplace participation are becoming paramount.

Much is to be learned from Verhoef et al. [1]regarding their new intervention improving work participation of young adults with physical disability. Barriers to work participation were addressed both on the individual and group level including issues of transportation, accessibility of buildings and toilet space, personal care assistance, employer attitudes, lack of support, and low self-esteem. By converging rehabilitation and vocational services with group and individual assessments alongside job coaching, success was achieved. This approach, with emphasis on the individual and functional abilities within the workplace setting, is both refreshing and novel. Any pathway to employment success for those with significant physical disability would seem to require the major components of the intervention well outlined in this article. It would seem that individuals with motor disabilities are too complex in their abilities to be channeled effectively into employment success by more general and un-individualized programs.[4] A post intervention employment success percentage with 2- and 3-year follow-up of 67% is double the rates of employment mentioned above with a ratio of paid to unpaid employment of 7–1. The authors should be given kudos for their appreciation of unpaid employment and its value for social participation, psychological well-being, daily rhythm, work experience, and potential for future entrance into paid employment. Benefits from workplace participation outside of the employment setting to self-care, toileting, mobility, and leisure are also supported by this article.

Controversy may arise over how to implement interventions like this into mainstream society. At present, healthcare funding is stressed and high team-staffing to patient ratios may be hard to sustain financially. Because of this, individuals more able to succeed with the intervention may need to be prioritized over others. A careful selection process to determine who may be the most likely participant to succeed with the intervention may need to be developed. The intervention appears to be cost-effective with two individuals no longer requiring a disability pension and others with substantial reduction in their disability pension. Any true overall costs to society would have to include the individuals who dropped out of the intervention, particularly any who had been in the program for an extended time. Sex issues are not clarified in this study and one wonders if differences in sex may have an influence in outcome measurements.[5] Careful data interpretation is advised in the absence of a control group and with small sample size.

Given appropriate intervention and transition programs, one has to wonder how high employment rate can rise for young adults with physical disabilities within a sensitive and tolerant community. In addition, with improving interventions and transition into employment, our positive expectations for workplace participation and productivity may need to be elevated for this population of people.

A mutual goal of maximal workplace and community participation with associated benefits of quality of life and personal fulfillment should be one we all seek. Verhoef et al. have provided an excellent framework for future research to accomplish this goal over time.