Vocational interventions effectively help unemployed adults with long-term health conditions or disabilities find and maintain employment, according to a new study presented this week at the Association of Academic Physiatrists Annual Meeting in Orlando.
While a number of systemic reviews suggest that vocational programs can help unemployed people with health conditions or disabilities find work, the quality of the evidence remains unknown. How effective are these interventions? A group of researchers set out to analyze and synthesize existing evidence for this new study, which was initiated by the New Zealand government in order to learn how best to support people with disabilities as they sought to find and maintain employment.
“Internationally, people with disabilities and chronic health conditions often face similar problems with accessing paid work. These problems arise from a number of complex factors: stigma, poorly-informed judgements about what makes somebody ‘work-able’, workplace health and safety concerns, and challenges in negotiating work arrangements that are outside the norm,” says Prof. William Levack, Dean of the University of Otago in Wellington, New Zealand, and the study’s co-author. “Work placement is a win-win situation when successful. It reduces the financial burden of disabilities and health conditions on governments and communities, while at the same time, it supports people to do what most people want to do in life: be productive, connect with others and lead meaningful lives.”
Prof. Levack and his team undertook an overview of all current systematic reviews to collate the best international evidence and identify any gaps. They searched for relevant articles in the following databases: Cochrane, MEDLINE, EMBASE, PsychINFO, AMED, CINAHL, Proquest, Evidence Search, Business Source Complete and ERIC. They included reviews if they were about unemployed adults with long-term health conditions and/or disabilities, and if they investigated the effectiveness of vocational interventions compared to controls in terms of the rate of successful uptake or maintenance of new jobs.
Two reviewers independently screened 2,841 article titles for inclusion and then critically appraised and extracted data from articles selected for the study. Researchers extracted relevant data about review characteristics, quality and findings.
Out of 23 data reviews included in the study, 11 out of 23 focused on work interventions in mental health rehabilitation with an emphasis on individual placement and support. Other reviews focused on vocational interventions for individuals with brain injury, autism, multiple sclerosis, spinal cord injury and mixed populations.
They found that the quality of these reviews was low to moderate, with higher-quality reviews published by Cochrane. While there was evidence to support individual placement and support, little evidence exists to show whether vocational rehabilitation in other clinical areas is effective.
“It’s surprising how little high-quality research has been conducted on this topic given the number of government initiatives that exist internationally to assist people with disability and health conditions with gaining employment,” says Prof. Levack. “Our work highlights that, outside of the area of severe mental health conditions, a great deal of research still needs to be conducted to examine the effectiveness of different types of vocational support for people with disability and health conditions who are out of employment.”
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