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11
Use of Welfare Technology to Increase Employment of Individuals with Intellectual
Disabilities
Sofie Wassa, Carl Erik Moeb, Elin Thygesenc, Silje Hauglandd
aDepartment of Health and Sport Sciences, University of Agder, Grimstad, Norway
bDepartment of Information Systems, University of Agder, Kristiansand, Norway
cDepartment of Health and Nursing Science, University of Agder, Kristiansand, Norway
dDepartment of Psycosocial Health, University of Agder, Grimstad, Norway
Abstract
Welfare technology can be applied to increase the involve-
ment and independence of individuals with disabilities. While
it is mainly applied for elderly, there are also initiatives for
persons with intellectual disabilities, for different purposes.
This group is currently marginalized in the labour market
and there is a need to increase the support for employment.
In this study, we provide an overview of previous literature
reviews on intellectual disability and employment. Based on
these findings, we discuss in which areas welfare technology
could support employment of individuals with intellectual
disabilities. The results show that employer attitudes, job
coaches and support programs are important for employ-
ment. Drawing on prioritised areas within welfare technolo-
gy, we recommend to study how technology can be support-
ive within these areas, focusing on social inclusion in work-
ing life, a structured working life and public service delivery.
Keywords:
Intellectual Disability, Employment, Technology.
Introduction
Welfare technology is seen as an important concept and in-
novation policy in the Scandinavian countries [1]. With an
increasing need for welfare services, and with fewer people
to provide those services, technology is viewed as an im-
portant step in managing that challenge. Welfare technology
can be applied to maintain or increase involvement and/or
independence of individuals with disabilities [2, 3]. It en-
compasses services for clients, healthcare professionals, rela-
tives, industries and the society [2] and is seen as a heteroge-
neous group of technologies ranging from communication
support, assistive technology, disease management, technol-
ogy for everyday tasks, entertainment and social support [4,
5]. In Norway, welfare technology is often defined as
“…technological assistance that contributes to increased
security, social participation, mobility and physical and cul-
tural activity, and strengthens the individual's ability to
manage himself in everyday life despite illness and social,
psychological or physical impairment. Welfare technology
can also serve as support for next-of-kin and otherwise help
improve accessibility, resource utilization and quality of ser-
vice” [3]."
Welfare technology is mainly applied for elderly living at
home, for instance as safety and fall alarms and different
kind of sensors implemented in the home environment. Other
examples include technology that provides medication re-
minders and the use of tablets and mobile phones to reduce
social isolation and to increase efficiency [2, 3, 5]. However,
there are also initiatives for applying welfare technology for
persons with intellectual disabilities, both in Norway [3, 6]
and in other Scandinavian countries [2]. These initiatives
include sensors and alarms [2] but also technologies for lo-
calisation, communication, structure and time management
and information exchange between different actors [7].
Today, a majority of Norwegian individuals with intellectual
disabilities either have placements at day-centers (48%) or in
workplaces provided by social care services (41%). In addi-
tion, almost all individuals receive social support at the age
of 26 [8] and compared to other OECD countries there is a
high rate of incapacity-related support [9]. A Norwegian re-
port shows that individuals with disabilities are marginalized
in both the traditional labor market and in segregated work-
places within the state labor market initiative [8]. A similar
situation is also the case for other Scandinavian countries
[10, 11]. This is a challenge as an active working life is de-
scribed as one of the foundations for inclusion in society.
Apart from earning livelihood, it has a positive impact on
establishing a social network and identity, increasing self-
esteem, providing structure and increasing health and well-
being [10, 12-14]. Hence, we argue that there is a need to
increase the support for employment of individuals with in-
tellectual disabilities.
The work market is changing, it is becoming more unstable
and complex, and also asks for flexibility of workers – and
this makes it important to understand how individuals with
intellectual disabilities can be supported in the work market
[15]. The aim of this paper is to present an overview of pre-
vious literature reviews on intellectual disability and em-
12
ployment and to identify areas that are of importance for ob-
taining and maintaining employment. Based on these find-
ings, we aim to discuss in which areas welfare technology
could support the employment of individuals with intellectual
disabilities.
Methods
The databases of Academic Search Complete, MedLine,
PsycINFO, CINAHL and EMBASE were scanned for re-
views focusing on intellectual disability and employment.
The following keywords were used: intellectual disability
AND employment AND review, and these were searched for
in the abstract, with no restriction for included years. In total,
123 articles and book chapters were obtained. We included
both systematic and scoping reviews, that investigated barri-
ers and enablers for employment of individuals with intellec-
tual disabilities. In addition, one review article was retrieved
based on back tracking references, hence; we started with a
total of 124 articles and book chapters.
After removing duplicates (n=76) and book chapters (n=4),
the abstracts of 44 articles were read to determine an inclu-
sion or not. This resulted in the exclusion of 39 articles due
to a focus on the situation of individuals with disabilities in
specific countries (n=5), specific approaches or interventions
(n=8), cost analysis (n=4), quality of life or social inclusion
(n=7), not providing a review of existing literature or lacking
a description of the search strategy (n=11), other focus (n=4)
or not being accessible (n=3). In total, 5 review articles were
included for further analysis (Figure 1).
Figure - Flow diagram of the search process.
As a second step, the articles were read in detail. The cited
studies, included in the reviews, that reported barriers and
enablers for employment were classified in four main
themes; the workplace context, the individual context, the
societal context and the use of technology or techniques. The
cited studies were assessed to determine the outcome of the
investigated enablers/barriers. For example, in the review by
Cheng, Oakman [16], a study by McInnes et al. [2010] re-
ported that “following job coaching, participants are three
times more likely to be employed”. Hence, a positive impact
was coded for the area individual context – job coaches.
Studies that stated that employment of individuals with disa-
bilities was low, but with no further explanation were not
included in the analysis. Table 1 shows an overview of how
the barriers and enablers were classified into different areas
(a detailed overview can be obtained from the lead author).
Table 1: Areas that influence the employment of individuals
with intellectual disabilities.
Area Study
[17]
[16]
[18]
[19]
[20]
Total number of studies
27
20
50
28
55
Workplace context = 35 articles
Co-workers' support
10
4
4
-
6
Employer attitudes
4
-
-
7
-
Individual context = 51 articles
Job training & Job search
assistance
5
6
14
1
3
Job matching
1
1
2
3
7
Job coaches
3
4
1
-
-
Societal context = 8 articles
Welfare benefits
1
-
-
3
4
Welfare technology & techniques = 18 articles
Technology
-
3
9
-
-
Techniques
3
2
1
-
-
Studies not focusing on
factors for employment
0
0
19
14
35
Results
The workplace context
The workplace context included issues connected to support
from co-workers and opinions of employers regarding indi-
viduals with intellectual disabilities. The largest number of
studies relating to the workplace context was included in the
review by Ellenkamp, Brouwers [17] (n=14). While it was
found that support from co-workers was important for inte-
gration and interaction in the workplace (n=10), it seems
unclear how it affects the possibilities of obtaining or main-
Papers identified
through database search
(n = 123)
Included
Screening/Eligibility
Identification
Papers identified through
reviewing bibliography (n = 1)
Papers screened and as-
sessed for eligibility (n =
44)
Papers excluded (n = 39)
Papers included in the
review (n = 5)
Duplicates and book chap-
ters
removed (n = 4 + 76)
13
taining employment. Only two studies found support for
maintaining work. The results in the review by Cheng,
Oakman [16] were varied, one of the studies cited found that
support from co-workers can increase job placement rates
while the other three studies found no support for such rates.
Similar findings were indicated in the review by Hedley,
Uljarevic [18] in which one study identified that a supportive
workplace fosters the success of individuals with autism
spectrum disorder. In two other studies, employees with in-
tellectual disabilities stressed the importance of support and
understanding in the workplace but the effect on the quality
of the employment was unclear. Six studies in the review by
Lövgren, Markström [20] suggested that peer support im-
proves the opportunities to obtain and keep an employment
but with no ascertained evidence. Two of the studies did
stress that simply providing support is not enough, there is
also need for some form of education, for instance mentor-
ing, and for financial support. This was explored in another
study. The study showed that while education in mentoring
for staff members who work with job training for individuals
with intellectual disabilities improved the feedback provided
by staff members, the behavior of the individuals with disa-
bilities remained unchanged [18].
Employers’ attitudes towards employing individuals with
disabilities were identified as an important enabler in two of
the reviews [17, 19]. Two studies found that safety, produc-
tivity, attendance, availability of supportive services, no be-
havioral problems and punctuality are of importance to em-
ployers [17]. In addition, employers with previous experienc-
es of staff with intellectual disability are more likely to em-
ploy individuals with disabilities compared to those without
previous experiences [17]. The review by Cavanagh, Bartram
[19] focused on human resource management and identified
seven studies which reported that employer attitudes are a
barrier towards employment of individuals with intellectual
disability.
The individual context
A large number of articles focused on support for the indi-
vidual. This included job training, job search assistance, job
matching and job coaches. The review by Hedley, Uljarevic
[18] found 14 studies which explored the importance of em-
ployment support programs and services, such as job search
assistance and on-the-job training. The impact of such sup-
port was reported to have a positive effect on obtaining em-
ployment in all fourteen studies and one of the studies re-
ported positive influence on increased working hours and
wages. Four out of five studies in the review by Ellenkamp,
Brouwers [17] found that job training was an important ena-
bler for obtaining employment. The review by Cheng,
Oakman [16] included six articles that focused on different
kind of job support in which job search assistance and on-
the-job training were found to be helpful in gaining and re-
taining an open employment. A small case study found sup-
port for the combination of off-the-job training and on-the-
job training for individuals with autism for quicker skill up-
take and gaining experience of a work context. While it
made the participants work ready it is unclear if it had any
effect on employment [19]. Alternatives to early placement
for on-the-job training were presented in one review (n=3)
[20]. This included short periods at different workplaces for
individuals with autism in order to foster an understanding of
work. However; the connection to obtaining or maintaining
employment was not reported.
The importance of matching the interests of the individual
with the employment was mentioned in all the reviews [16-
20]. One study found positive support for the use of person-
centered planning to determine employment preferences [16]
and another study found that matching interests and abilities
increased the possibility to maintain employment [17]. Two
studies recommended that matches should be more strategic
and focus on occupations where individuals with intellectual
disabilities are well-represented [20]. Ten additional studies
recommended matching of interests and work, still it seems
unclear how it affects the possibilities of obtaining or main-
taining employment.
Four studies in the review by Cheng, Oakman [16] focused
on job coaches. Three of them showed that coaches have a
positive effect on obtaining and retaining an employment.
This was also indicated by four other studies which found
that job coaches were important for employers’ decision to
hire individuals with intellectual disabilities and for main-
taining employment [17, 18]. However, one study showed
that a decrease of job coach support can have positive out-
comes on work productivity for individuals with severe intel-
lectual disability [16].
The societal context
One study related to welfare benefits showed that subsidies
for employers as well as individually placed persons in-
creased the salary of individuals with intellectual disabilities
[17]. The role of welfare programs was also mentioned in the
review by Cavanagh, in which three studies reported on the
need for increased support from such programs. A call for
more coordinated work around welfare programs was men-
tioned in four other studies [20]. However, the negative im-
pact on employment due to current programs was not de-
scribed.
Welfare technology and techniques
Concerning completion of work tasks, three of the reviews
included studies that focused on the use of instructional ap-
proaches (n=6) and welfare technologies (n=12) [16-18].
Different kind of non-technological approaches included
training for work tasks with the use of specific words, career
development tasks [17] and checklists [16] which all showed
to increase the work performance of individuals. One study
discussed an assessment instrument [17] and two articles ex-
plored behavior techniques including incidental teaching,
discrete-trail teaching and social stories [16, 18]. These re-
sults seemed promising but due to limited research, the ef-
fects on employment outcomes had not been identified.
The use of welfare technology to assist individuals with disa-
bilities included teaching of tasks through e.g. video instruc-
tions and audio coaching [16] which both showed to improve
work performance. Hedley, Uljarevic [18] also reported on
positive outcomes of implementing a personal digital assis-
14
tant which increased working time and using virtual jobs
which improved interviewing skills. The use of an iPad at
work was also shown to increase independence, confidence,
time management and organizational skills. However, the
effects of video self-modelling to learn work tasks [16] and
the impact of other applications could not be ascertained
[18]. In total, half of the studies did not report a positive im-
pact on improved work performance while the other half did.
Discussion
The reviews included in our study focused on barriers and
enablers for employment of individuals with intellectual dis-
ability. The reviews showed limited support for positive out-
comes on employment for areas such as co-workers’ support
and job matching. While these areas were stressed as im-
portant in several studies, few studies reported on actual im-
pact on either obtaining or maintaining employment. On the
other hand, the support from co-workers did however in-
crease the integration of individuals with intellectual disabili-
ties and their interaction with colleagues. A few studies dis-
cussed welfare benefits and criticized current initiatives but
lacked support for its’ negative impact on employment.
The reviews and the cited studies focusing on employer atti-
tudes showed that their attitudes towards individuals with
disabilities are important for obtaining and maintaining an
employment. While there were few studies focusing on job
coaches, seven out of eight studies supported the positive
influence of job coaches. In addition, the majority of the
studies on support programs (22/27) reported positive evi-
dence related to employment. The studies of applications of
different approaches and technologies to support employment
of individuals with intellectual disabilities, reported mixed
results, showing either positive effects on work performance
or the need of more research. To summarize, the following
areas seem to be important for the ability to obtain and main-
tain an employment: (1) employer attitudes, (2) job coaches
and (3) support programs.
It appears that the employment of individuals with intellectu-
al disabilities depends on several initiatives and that there is
a need to work within several areas. In view of the current
discussion on the potential of welfare technology [21] it is of
vital importance to explore if and how welfare technology
can be applied within these areas. In Norway, an influential
white paper argued to focus on three main technology areas:
safety alarms, technology that increases social inclusion and
technology that supports an active and structured everyday
life [3]. For individuals with intellectual disabilities, the last
two areas are of interest due to the current exclusion from
working life [8, 9, 15] and due to the individuals’ disability,
limiting their actions that are performed within a societal
environment [22, 23]. Drawing on these recommendations
and the results in our study, we recommend to explore the
potential of welfare technologies in the following areas:
• Technologies that support social inclusion in working
life, targeting employer attitudes, activities provided
by job coaches and activities performed in support
programs.
• Technologies that support a structured working life,
targeting activities provided by job coaches and activ-
ities within support programs.
Apart from the three main areas, there is a need to invest in
technologies that support the delivery of public services and
the exchange of information between all involved actors in
the welfare system [3]. This is similar to what is described as
back-office technologies for public e-services, i.e. the parts
of the service process which is not visible to citizens but
connected to the technology in the supplying organization
[24]. With the wide range of actors involved in the use of
public e-services and its complexity, it is important that in-
formation can be communicated and shared without disrup-
tion [25]. We therefore propose to study technologies that
support the internal components of public services that are
offered to individuals with intellectual disabilities. This in-
cludes technologies used by other users, for instance those
who are employed in social services, schools and healthcare
services, who are in contact with individuals with intellectual
disabilities.
Limitations
This study included English language reviews published in
peer-reviewed outlets, which neglects findings presented in
white papers and in other languages. Further, only a small
number of reviews were identified, however; we believe that
the included reviews cover many studies and that our study
presents a synthesis of the literature.
Conclusions
Our synthesis of the reviews and the included articles pre-
sents a number of areas that are of importance for employ-
ment of individuals with intellectual disabilities. Employer
attitudes, job coaches, support programs and, to some extent,
technology appear to play an important role for the possibil-
ity to obtain and maintain employment. With this back-
ground, it should be further explored how welfare technolo-
gies can be applied within these areas, focusing on social
inclusion, a structured working life and public service deliv-
ery.
Acknowledgments
This work was supported by the Norwegian Research Coun-
cil, through the project InnArbeid [grant number 269019].
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Address for correspondence
Sofie Wass, sofie.wass@uia.no
