Abstract
BACKGROUND:
The benefits of successful integrated employment for people with intellectual and developmental disabilities (IDD) are immense. However, barriers contributing to high rates of unemployment among people with IDD, such as lack of appropriate training for employers and inadequate supports, are still widespread. Ensuring access to technology in the workplace is one method to support employees with IDD and mitigate those barriers. Furthermore, assistive technology may provide a simple and cost-effective intervention in the vocational setting.
OBJECTIVE:
In this study, we conducted a series of focus groups with adults with IDD and their family members to explore the use of technology by individuals with IDD in vocational contexts.
METHODS:
We used a qualitative descriptive approach to frame the study design. Data were analyzed using a multi-cycle thematic coding process.
RESULTS:
Four major themes emerged from the analysis: participants’ wireless/wearable technology use, benefits and facilitators of technology use at work, barriers and challenges to technology use at work, and expectations for and outcomes associated with technology supports in the workplace.
CONCLUSIONS:
Findings have the potential to impact employer education and training on benefits of appropriate technology use for individuals with IDD at work, onboarding and training of individuals with IDD when using technology at work, and funding responsibility for technology in the workplace.
Introduction
Employment can serve as the cornerstone of life for people with intellectual and developmental disabilities (IDD) and provide multiple physical and emotional benefits throughout the life course (Wehman et al., 2018). Indeed, integrated employment is an essential component of community living and can influence positive outcomes in independent living for people with IDD (TASH National Agenda, 2016). Many individuals with IDD want to enter the workforce and strive for success and achievement as employees (Larson et al., 2021). Nevertheless, the rate of integrated employment of people with IDD in the US is low; about 8 out of every 10 persons with IDD reports not having a paid job in the community (Larson et al., 2021). A movement to remove systemic barriers to employment in the community and increase effective supports for people with IDD working in individual jobs is emerging (Association of People Supporting Employment First, 2017). Policies such as the Workforce Innovation and Opportunity Act (WIOA), enacted in 2014, draw attention to and allocate funding for employment disparities for people with IDD. Programs nationwide that are funded through WIOA seek to improve the employment prospects and outcomes of people with IDD by focusing on ensuring youth and younger adults have access to job training and supports when they exit high school to help strengthen their employment trajectories (The Arc of the United States, 2015). Despite such progress, major barriers remain in the planning and provision of employment services and support for people with IDD (Butterworth et al., 2016).
Overview of technology usage in vocational settings for individuals with IDD
For people with IDD, access to technology supports in the workplace may be vital for success, and may provide a simple and cost-effective intervention in the vocational setting (Job Accommodation Network, 2020). Assistive technology for people with IDD can range from personal hand-held devices to communication devices to wheelchair physical support. For example, prompting systems and more recently, video prompting through mobile applications, have shown to be effective in aiding individuals with IDD transition through vocational tasks (Cihak et al., 2007; Cihak et al., 2008; Van Laarhoven et al., 2009; Walters et al., 2021). Use of vibrating and other “smart” watches is effective in the workplace setting for improving time management skills for this population (Damianidou et al., 2019; Green et al., 2011). In addition to held-held and mobile video prompting devices and vibrating watches, other devices such as iPhones (Randall et al., 2020), audio-visual technologies (Cavkaytar, 2017), computer-based interactive games with augmented or virtual reality (Michalski et al., 2021) have also been proven effective in increasing the success of individuals with IDD in the workplace.
There is potential in technology use to improve many employment-related outcomes for people with IDD (Damianidou et al., 2019). Specifically, technology has the potential to improve task performance and reduce human support (Wehmeyer et al., 2006; Wehymeyer et al., 2008), thereby narrowing performance gaps while attending to the ongoing costs required for human support, which may be burdensome for many businesses. Assistive technology has been successful in increasing the work performance of people with IDD in the domains of productivity, navigation, time management, and task completion (Morash-Macneil et al., 2018). Accordingly, assistive technology has the potential to not only increase workplace independence for people with IDD, but also reduce required human support, which may potentially improve the individual’s self-confidence and reduce costs to employers (Collins & Collet-Klingenberg, 2017).
Barriers to using technology in vocational settings for individuals with IDD
Despite improvements in federal policy (e.g. WIOA) and notable research demonstrating the positive impact of assistive technology for people with IDD (Morash-Macneil et al., 2018), barriers that hinder its broad use among this population remain. Research that comprehensively describes barriers and challenges to the use of assistive technology in the workplace among people with IDD is sparse. Existing literature suggests that about 60% of people with IDD receive minimal information about assistive technology from any source, so they may not be aware that it can help them or that they need to advocate for such support (Carlson et al., 2001). Additionally, the stigma associated with acknowledging a disability and reluctance to request and provide accommodations presents a barrier in the workplace (Driscoll et al., 2001). Employers misconceive that using assistive technology will require a high level of resources and funding on their part (Stumbo et al., 2009), despite considerable research conducted by the Job Accommodations Network (JAN; 2020) that suggests accommodations are valuable to employers and can be easy to implement and low- or no-cost. Indeed, commercial devices can be costly, and if the device is unable to be modified to fit the needs of the individuals, then custom devices may be necessary. Even though assistive technologies have been deemed successful in increasing independence of individuals with IDD (Davies et al., 2002a, 2002b, 2004), custom device costs are much higher because of the individuality of their development, and may not be accessible for some individuals and workplaces.
Present study
In this study, we conducted focus groups with adults with IDD and family members of adults with IDD. The purpose of the focus groups was to answer the following research questions:
RQ1: How do individuals with IDD use technology in vocational settings?
RQ2: What barriers or challenges do individuals with IDD report when using or attempting to use technology in vocational settings?
RQ3: What benefits or facilitators do individuals with IDD report when using or attempting to use technology in vocational settings?
Materials and methods
We implemented a series of focus groups with adults IDD and family members of adults with IDD to address our research questions. Much research addressing issues faced by individuals with IDD includes the perspectives of professionals and providers, but excludes the voices of individuals with IDD and their family members and other supports. Thus, we included individuals with IDD and family members in our sample to honor their lived experience, and to triangulate and diversify perspectives about the ways wireless technology is used to enhance vocational outcomes among people with IDD.
Study context and design
The study used a qualitative descriptive approach (Kim et al., 2017; Lambert & Lambert, 2012). The qualitative descriptive approach is suitable for researchers attempting to (a) gain firsthand insights from key participants (including those with lived experience) regarding a new or under-explored phenomenon, and (b) analyze and report findings in a straightforward manner involving less interpretation by the research team than is used in other qualitative approaches (Kim et al., 2017; Neergaard et al., 2009).
Participants
Individuals were invited to participate in the study if they: identified as an adult with IDD or parent of an adult with IDD; were 18 years of age or older; were able to provide informed consent; and agreed to keep all focus group comments and information shared by other participants private. A total of 13 individuals participated across three focus groups, including: adults with IDD (n = 10) and parents of individuals with IDD (n = 3). The ages of participants ranged from 18 to 61 years, with a mean age of 33.9. The participants varied in age, race, gender, occupation, employment status, and level of education (see Table 1 for complete participant demographic information).
Participant characteristics
Participant characteristics
The research team was comprised of three faculty representing the disciplines of special education (one male, one female) and public health with a focus in disability health disparities (one female), and graduate students in education and communication sciences (three female). No members of the research team identified as having any disabilities. All participant interaction including recruitment, scheduling, and interviewing was conducted by two team members.
Materials
The focus group facilitator engaged with the participants in discussions about their use of wireless technology at work or to obtain work. Focus group discussions were guided by a semi-structured focus group protocol. In addition to the main questions, the focus group guide also included sub-prompts designed to enhance the participants’ descriptions of their experiences and ideas to allow for a more thorough exploration of and discussion about emerging concepts (see Table 2 for focus group guide).
Semi-structured focus group guide
Semi-structured focus group guide
Note: For family member interviews, the word “you” in these questions was replaced by the phrase, “individuals with IDD in your family.”.
Participant recruitment and consent
Ethical approval was obtained from the (blinded for review) University Institutional Review Board prior to study initiation. Participants were recruited through the research team’s professional colleagues and networks who were asked to share the study flier with relevant individuals or groups. Any interested individuals were instructed to contact the research team for more information and to enroll. During the time of the focus groups, consent forms were read out loud to all participants and explained and/or paraphrased in plain or more concise language to ensure access to the information. Participants were asked to restate the procedures in their own words prior to providing consent to ensure comprehension. Caregivers or guardians were not asked to provide consent for adult participants because the participants recruited were able to give consent independently.
Focus group processes
Focus groups were used to elicit information from participants. To enhance the study’s rigor by allowing triangulation of findings, focus groups were conducted with multiple groups, including participants with IDD and family members (Lincoln & Guba, 1985). Each focus group began with a ‘priming’ session during which the participants were provided definitions of key terms and provided specific examples of wireless technologies such as a smartphone or tablet. Following key term and example review, participants viewed videos showing various forms of wireless technologies and wearables to maximize comprehension for adults across all learning styles. Following the video presentation, the facilitator initiated the focus group questioning using the study interview guide.
Data analysis
Following the completion of the focus group protocol, audio recordings were sent to a third party for verbatim transcription. The coding process included four cycles. During the first cycle (i.e., open coding to develop the codebook), two members of the research team independently reviewed the transcripts and interview guides, then engaged in an inductive open coding process to generate initial codes by attaching descriptors to sentences and phrases they deemed meaningful. This step established the initial codebook. In the second cycle (i.e., deductive coding using the codebook), the data were independently coded by graduate student coders using QSR NVivo Version 10. All transcripts were coded by both coders to allow for peer debriefing (Lincoln & Guba, 1985) and discussion of all analytic decisions. Inter-rater reliability was not quantitatively assessed; rather, coders met to discuss all coding decisions and resolve discrepancies until consensus was reached.
Following the completion of second cycle coding, all coders met for a third cycle that involved reviewing codes and grouping codes into meaningful categories. A final round of coding review, theming, and interpretation was conducted by a novel faculty member with expertise in qualitative methods. This final round served to enhance the study’s credibility by including the perspectives of a team of coders with various levels of training and multiple disciplinary perspectives (Maher et al., 2018).
Data presentation
Quotations presented in this manuscript are intended to illustrate emergent themes found in the data (Lingard, 2019). We selected three or more quotations to illustrate each theme or subtheme with the exception of the first theme (Participants’ wireless/wearable technology use) because that theme did not encompass lengthy participant quotations or descriptions. We did not modify participants’ grammar or delete filler phrases (e.g., “um,” “uh”) from quotations, as these phrases may indicate a participant is searching for a certain word or phrase or are spending time deciding what to say next, which can provide valuable context (Clark & Fox Tree, 2002).
Results
Four main emergent themes were found in the focus group data: Participants’ wireless/wearable technology use, benefits and facilitators of technology use at work, barriers and challenges to technology use at work, and expectations for and outcomes associated with technology supports in the workplace.Table 3 shows each of the major themes and their subthemes.
Major themes and subthemes
Major themes and subthemes
Participants discussed their general use of technology prior to discussing the topic of technology use at work for individuals with IDD. They reported varying levels of knowledge about technology, with some reporting being “tech savvy,” some reporting having just “some technical know-how,” and some reporting being somewhere in the middle. Participants (both those employed and those not employed at the time of the study) reported frequency of technology use between 6-8 hours and about half of their day. Participants reported regularly using hardware such as tablets, Bluetooth speakers/headphones, wireless mouse, Braille displays, digital assistants (e.g., Amazon Alexa), and smartphones; they reported using software including computer applications, messenger, LinkedIn, Alexa app, GroupMe, and calendar apps.
Benefits and facilitators of technology use at work for individuals with IDD
Participants discussed benefits of technology use at work for individuals with IDD. Most of the benefits identified related to increasing work productivity; for example, several participants mentioned using technology to take notes at work was helpful for them or for the individuals with IDD in their family to be able to do their jobs well. They also mentioned that technology is good for staying focused on work (e.g., using timers) and planning/scheduling (e.g., using calendars). One participant mentioned that technology helps to “tune out all the noise around so that people can work and not deal with distractions.”
Participants also discussed facilitators of technology use in the workplace. They mainly described supportive individuals or systems that helped them to more effectively use technology to enhance their vocational outcomes. One participant described the importance of accessible tech support for their phone:
Especially when I first got the phone and hadn’t ever used a cell phone. They set everything up for me. (laughing) They really earn their money because they don’t charge me anything for all that extra help. I just pay my bill each month and they answer all my questions. They’ve set up all kinds of things on my phone for me.
Another participant described the importance of supportive and understanding employers: “I’m thinking employers, some of them being willing and understanding of the need for these things so that people are able to do their best job and being supportive.”
Barriers and challenges to technology use at work
Despite the benefits and facilitators mentioned, participants described barriers to effective use of technology to support them and their loved ones with IDD in the workplace. Barriers mentioned were categorized under the subthemes of employer rules, financial barriers, and lack of employer/coworker training.
Employer rules
Another subtheme frequently mentioned by participants in both groups was that employers often have rules that prevent people with IDD from using the technologies they need in a way that allows them to succeed at work. One main example was employers that prohibit bringing in personal or outside technologies or using company WiFi for devices that are not issued by the company. As one participant summarized, “[this] puts some people at a great disadvantage where they could be a better worker if they could utilize it.” Another participant described specific technology her daughter uses:
If she was in some sort of office setting, her Braille pad would be invaluable to her, but if it needs WiFi and you’re not allowed to use any WiFi, then that’s...You’ll have to bring a braille writer and that’s uggghh.
Another example of an employer rule that can be a barrier to effective use of technology in the workplace for people with IDD is that many employers have rules that prohibit the use of recording. As one participant described, “Some places are really funny about you recording. They don’t allow it.” Many individuals with IDD may benefit from recording other people performing a task or providing explanations or instructions so that they can refer to the recording when they need it; broad sweeping rules that prevent video recording in work settings may therefore prevent some employees with IDD from reaching their maximum potential at work.
Financial barriers
The cost of accessing and using technology supports in the workplace was mentioned as a barrier for people with IDD. One issue raised was whether the employer should pay for all or part of an individual’s technology accommodations. One participant pointed out that the costs to the employer could be burdensome: “I feel like if the company pays for it then that would cost them a lot of money, [and] that may not be good for the company.” Another described that even when employers pay for some of the technology, there may be monthly bills associated with data use that are still not feasible for an individual and/or their family to pay for: “They only gave him $75. You can’t buy a phone and pay for the bill.” Another participant, who was a parent and someone who employs people with disabilities, mentioned the costs to employers: “You know, you have to hire disabled people and you have to supply them all of these things and they can mandate that all day long, but within the corporate structure, that creates a speed bump for hiring people with disabilities. They’ll give lip service all day long, but in the end you know that costs us a lot of money.”
Lack of employer/coworker training
The last challenge that was mentioned by participants was the lack of training among employers and coworkers about working with people with disabilities. One participant offered that there needs to be more “Training people to be a bit more patient and understanding that this person may, like you just said, need some additional assistance.” Another participant shared a similar sentiment: “I think they need more training for people that support people and that would help them as well transcend higher up as well.” Another participant told a story that particularly described the barriers with coworkers’ perceptions and lack of understanding:
I was working at the bank and I have to be on time to do certain things or whatever, that particular company was cool and understanding that they need to be accessible and accommodating to that individual that has a need. Then, on the other end, the lovely coworkers or employees. ‘Why does he get to use that?’ I can see the barriers of human interaction and not understanding why they need to use it or that being strange, not understanding that it’s just another way. We all need different things to cope and to live.
Expectations for and outcomes associated with technology supports in the workplace
Participants described their expectations for and positive outcomes associated with people with IDD having access to technology support in the workplace. One participant described benefits that enhance employment and also extend beyond employment into their social lives: “Right, because that can help them in their life socially, but also what you were talking about with more of that more interactive, independent employment, that can help them there, too.” Two participants described even broader impact. First, that “[assistive technology] opens up a whole new world to them,” and second:
I think it opens up an opportunity, a world of when we say we want everyone to have real friends, real jobs, real lives, all that. It opens that up, so it’s important that they have it.
Discussion
This study provided an overview of technology use in vocational settings for individuals with IDD, barriers and facilitators to technology use in vocational settings for individuals with IDD, and expectations and outcomes associated with technology supports in vocational settings. Overall, study findings support and extend those of previous research including information about general use of technology, barriers and challenges, and supports and facilitators. Participants in the present study report using a range of technologies in vocational settings, which is consistent with prior research demonstrating that individuals with IDD benefit from the use of audio-visual technologies, hand-held devices, vibrating watches, and various mobile devices in education and employment settings (Cavkaytar, 2017, Cihak et al., 2007; Cihak et al., 2008; Green et al., 2011; Randall et al., 2020; Van Laarhoven et al., 2009). Our research demonstrated additional details about how individuals connect to and between these devices (e.g., through wireless and Bluetooth connections), and suggested that people with IDD are benefiting from emerging hardware and software technologies (e.g., Amazon Alexa, Alexa app, GroupMe) in addition to devices and programs with a known history of success in supporting individual with IDD in the workplace.
Additionally, the individuals with IDD and their families in our study qualitatively reported an increase in productivity and focus when using technology in the workplace, which confirms and extends the findings from several prior quantitative and meta-analytic studies (Damianidou et al., 2019; Morash-Macneil et al., 2018; Wehmeyer et al., 2006; Wehmeyer et al., 2008). Our study’s qualitative reports of success with assistive technology from the perspectives of individuals with IDD and family members complement and explain findings from previous quantitative research. For example, the previous research demonstrated that people with IDD find success in employment settings using various types of assistive technologies (Damianidou et al., 2019); however, the research lacks participant voice and perspective specifically about what works and what needs to be improved regarding the use of these technologies at work.
Finally, the participants in this study report a lack of training and support related to their technology use on the job as has been discussed in previous research (e.g., Carlson et al., 2001). Assistive technologies are complex and have evolved with increased capability over time, so there may be additional need for training and support for the end user, as well as employers and colleagues, as the field advances. Our findings collectively present implications for policy, practice, and future research.
Implications for policy and practice
The findings of this study point to several implications for policymakers as well as practitioners, employers, and families supporting individuals with IDD who are transitioning into the workforce. Due to the fact that individuals with IDD and families report receiving variable levels of support from employers, it is important that accurate information about the costs and benefits to employers of hiring individuals with disabilities and making accommodations to improve their employment experiences is shared. The Job Accommodations Network (JAN) has been surveying employers about workplace accommodations since 2004; survey results consistently show that the benefits employers report far outweigh the costs associated with providing workplace accommodations for individuals with disabilities (JAN, 2020). These survey findings, as well as information about the technical assistance and other services JAN provides employers free of charge should be widely advertised.
It is also important for organizations like state vocational rehabilitation services (VR) and policymakers to ensure that both families/individuals and employers can access the assistive technology they or their employees need. VR agencies should also guide employers and employees to education and training on appropriate technology use for individuals with IDD in the workplace. Resources should be allocated to provide onboarding and training for both individuals with IDD and other employees, specific to their place of employment (Jette, 2017). This training may include explicit instruction for individuals with IDD on how to navigate job-specific applications and platforms, explicit instruction on any individualized assistive technologies that may benefit them in their job, and training on appropriate and inappropriate use of technology in their workplace. For other employees, training may involve understanding individualized supports and accommodations for individuals with IDD. In addition to the JAN resources described above, several trainings on the Americans with Disabilities Act and its amendments are available free of charge (e.g., ADA National Network ADA Basic Building Blocks course: https://www.adabasics.org) and could serve as a foundation for employers and colleagues to gain understanding of individualized accommodations and modifications in the workplace. More specific training based on the job type, setting, etc. could then be provided by JAN, a VR agency, or another source. Lastly, due to the potential positive impact of technology use in vocational settings, policymakers should consider who is responsible for funding the technology that individuals with disabilities need to access to be successful in the workplace. JAN’s technical assistance services could be a valuable resource for employers to figure out their options for funding assistive technology needs for their employers.
Implications for future research
Our findings indicate that there is a need for additional research in this area to extend our knowledge about how best to apply and support the technology use of individuals with IDD in vocational settings. For example, individuals with IDD and their families report increased productivity and focus when using technology at work. However, more research is needed on actual engagement levels and productivity for individuals with IDD across different job types and settings. Additionally, individuals with IDD report already using some applications and platforms that are widely used with employers including messenger apps, calendar/schedule apps, and social media (i.e., LinkedIn). More research is needed to determine actual usage and proficiency with work-based applications for individuals with IDD. Finally, more research is needed on the accessibility of various applications and platforms that could be beneficial in vocational settings for individuals with IDD.
Limitations
Although our findings have a number of implications for future research and practice, we acknowledge limitations of our approach. First, we acknowledge that we were only able to recruit individuals with IDD who had the capacity to provide consent independent of a legal guardian. Therefore, our study inadvertently excluded participants with IDD who do not have the legal authority to provide consent for themselves and/or have legal guardians. Individuals who do not have the legal authority to provide consent for themselves may have different needs and perspectives, which may have resulted in different findings if they were included. Second, our demographic data collection did not ask about participants’ relationships to one another (i.e., whether family members included were parents or siblings of one or more of the participants with IDD) nor about participants’ geographic area of residence. Given the recruitment approach used, it is likely that most participants represented the southeastern region of the US. Therefore, findings may not generalize to individuals and families living in other areas of the country. Generally, the goal of qualitative research is not to generalize findings to a broader group, but to understand a particular phenomenon in one group or setting; results should be interpreted with this in mind.
The research team did not include any individuals who identified as having a disability; this lack of lived experience on the team may present challenges to understanding the experiences shared by participants with IDD. We countered this shortcoming by employing a qualitative descriptive design, which involved more direct reporting of participant quotations and less interpretation of their words and perspectives. Lastly, our study methods study did not include the opportunity to conduct a member-checking process, which would have provided the participants with the opportunity to review the analysis and confirm the reporting of findings.
Conclusion
As individuals with IDD increasingly attend college, seek gainful employment, and live independently in their communities, understanding how to best support this growing population of employees will be of paramount importance. According to the individuals with IDD and family members who participated in our study, the ability to access assistive technologies is a major facilitator of workplace success. Barriers and challenges identified, such as employer rules that prevent the use of certain technologies in the workplace and the issue of financial inaccess can be resolved by top-down and bottom-up approaches, including enactment and clarification of broad employment policies, trainings for employers and staff, and increased workplace-specific self-advocacy training for individuals with IDD.
Footnotes
Acknowledgments
The authors have no acknowledgments.
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
Institutional Review Board approval was obtained for this study (#H18099 10/24/2018). All procedures included in this study were done in accord with the Declaration of Helsinki 1975.
Funding
The data for this study were collected under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RE5025-01-00). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS).
Informed consent
Informed consent was obtained for all participants prior to enrollment.