Sustainable employability in supported employment and Individual Placement and Support interventions in the context of the characteristics of work and perspectives of the employers: A scoping review

1 Introduction

Employment has several positive effects on individual health, while unemployment is known to be a significant cause of socioeconomic health inequalities (McKee-Ryan, et al., 2005; van der Noordt, et al., 2014). Unemployment rates are high particularly among people with different kinds of disabilities (Eskola et al., 2022; Marwaha & Johnson, 2004; Siperstein, Parker, & Drascher, 2013). At the same time, the demand for labour is growing for example in the Nordic countries as a result of the decrease in working age population and fertility rates (Alsos & Dølvik, 2021). This labour shortage may open up employment opportunities also for people whose ability to work has decreased.

Supported employment (SE) and Individual Placement and Support (IPS) are vocational rehabilitation approaches typically applied to persons with disabilities and which provide aid for searching for competitive employment and health treatments concurrently (Frederick & VanderWeele, 2019). The definition of SE by European Union of Supported Employment is “the provision of support to people with disabilities or other disadvantaged groups to secure and maintain paid employment in the open labour market.” (EUSE). According to the IPS Employment Center IPS is a model of supported employment for people with serious mental illness (e.g., schizophrenia spectrum disorder, bipolar, depression). According to the SE definition, the target group of the activity is wide compared to IPS-service. On the other hand, IPS refers to the evidence-based practice of supported employment. The approaches have been studied from several perspectives focusing especially on employment outcomes, well-being, and cost-effectiveness (Christensen, et al., 2020; Frederick & VanderWeele, 2019; Kinoshita et al., 2013). The evidence suggests that SE and IPS are effective in improving vocational outcomes such as obtaining a job, days in competitive employment and job tenure compared with other vocational rehabilitation approaches or usual treatment (Frederick & VanderWeele, 2019; Kinoshita et al., 2013). It has also been discovered that IPS saves costs better when compared to usual care (Christensen et al., 2020; Sinnott et al., 2014). SE has been shown to be cost-efficient from the workers’s and taxpayers’perspective (Cimera 2000 and 2010) and cheaper to society than sheltered employment (Cimera 2008 and 2012). When it comes to non-vocational outcomes, there are also indications that IPS can have positive effects on, for example, the quality of life (Christensen et al., 2020; Frederick & VanderWeele, 2019; van Rijn, et al., 2016).

Although the SE and IPS have been studied extensively, the integration of interventions as part of the vocational rehabilitation service system seems still to be challenging in many countries. Some of the identified main barriers are related to disability policies and the lack of a simple funding mechanism (Bonfils, et al., 2017; Braun, 2022; Drake, et al., 2016; Jordán de Urríes & Verdugo, 2012; Moe et al., 2021).

In summary, there is comprehensive evidence that the interventions support the employment of those in a weak labour market position due to illness or disability, when carried out according to the values, standards, and principles of SE/IPS and quality criteria of IPS. However, in addition to individual factors, employment is affected by factors related to the labour market, employers and work. These factors are included in the comprehensive concepts of work ability and sustainable employability (Tengland, 2011; van der Klink et al., 2016). In Tengland’s (2011) concept of specific work ability one main factor is the meaningfulness of the average daily tasks in the work. Sustainable employability means the ability and opportunity to get a job, keep a job and advance in a career, and the conditions in which an employee has the opportunity to make a full contribution to the work, and at the same time, secure their health and well-being (van der Klink et al., 2016). Also, work should create value both for the organisation and the worker as well (van der Klink et al., 2016). However, there is less research on employers’ interests and the quality and opportunities of jobs or the work itself for sustainable working careers.

2 Methods

The protocol for this scoping review has been published previously where the methodology and its selection are described in more detail (Poutanen et al., 2022). This study adheres the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines (Tricco et al., 2018). The study is designed and conducted in accordance with scoping review methodological frameworks by Arksey and O’Malley (2005), Levac et al. (2010) and O’Brien et al. (2016) as well as the Joanna Briggs Institute Manual for Evidence Synthesis (Arksey & O’Malley, 2005; Levac et al., 2010; O’Brien et al., 2016; Peters et al., 2020). The methodology was chosen to examine the extent, range, and nature of research activity, to summarise and disseminate the research findings and to identify the research gaps in the existing literature of the study field (Levac et al., 2010). The study process consisted of the following stages: 1. Identifying the research question, 2. Identifying relevant studies, 3. Study selection, 4. Charting the data and 5. Collating, summarising and reporting the results (Levac et al., 2010).

The final database searches were carried out on 31 August 2021 and the search strategy yielded a total of 3,178 articles, from which 20 were eligible and included in the scoping review. The identification and screening process of the studies is presented in a flowchart (Fig. 1). The included studies were published between 1991 and 2020 and seven were conducted in the United States, three in each of Canada, Sweden and the United Kingdom, two in Australia, one in Spain and one in India. The intervention of focus was SE in fourteen studies, IPS in four studies and two studies covered both interventions. Target groups could be divided into three groups: First, in four studies which were published during 1991–2020 (Sandys 1999; Siporin & Lysack 2004; Beyer et al., 2016; Pellicena et al., 2020), the target group was people with learning or intellectual disabilities. Second, in seven studies, the target group was defined for example as people with other disabilities or as Gilbride et al. (2003) described their target group as “people with a wide range of disabilities” and listed different groups or Gustaffson et al. (2018) as “people with disabilities” without further specification of the disability or disorder (Sale et al., 1991; Rogan et al., 2000, Aksey 2003; Kaehne & Beyer 2013; Gustaffson et al., 2014). Finally, in nine more recent studies during 2004-2020 (Salyer et al., 2004; Becker et al., 2007; Crain et al., 2009; McDowell & Fossey 2015; Kirsch 2016; Lexen et al., 2016; Williams et al., 2016; Nicholson et al., 2017; Jagannathan et al., 2020) the target group was people with severe mental illness (SMI) or other psychiatric disorders.

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Fig. 1

Study flowchart based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

A total of thirteen articles were qualitative studies, four were mixed-method studies, two were literature reviews and one was a scoping review. The detailed information on research methods, designs, data and analysis of included studies are summarized in Appendix 2. From the included studies, nineteen were peer-reviewed and there was no certainty about the peer-review of one article. However, it was decided the article should be included because its content answered the research questions.

4 Discussion

The cooperation and interaction of many actors in work-related rehabilitation has in recent years promoted employers’ role and the collaboration between workplace, health care and rehabilitation actors has been shown to contribute to the length of job tenure and working career (Juvonen-Posti, 2018). Even though the core of the SE or IPS method is the implementation specifically for paid work and workplace contexts, according to our results, little research has been done from the point of view of employers and other workplace actors. Furthermore, with the focus of our more specified research questions, we discovered that this study’s interests have not been a focus of research recently. Although many studies on method and impact of the SE and IPS inteventions have been published (Christensen et al., 2020; Frederick & VanderWeele, 2019; Kinoshita et al., 2013), we discovered a less studied SE and IPS research area. While we have strong evidence that the subjects in IPS obtain competitive employment about 1.6 times more likely compared to standard care, and differences in job tenure are moderate based on the effect sizes (Frederick & VanderWeele, 2019), these quantitative results do not sufficiently describe the quality of employment.

In the studies of our review both individual factors and some work, work team or organisation concerned entities formed factors which influenced the outcome, job performance or job tenure of the intervention by enhancing or preventing. The most reported work-related adjustment was flexible scheduling or reduced working hours (Arksey 2003; Lexén et al. 2016, Gustafsson et al. 2014; 2018, McDowell& Fossey 2015; Kirsh 2016). The results of this study showed that in many cases the interventions led to precarious, part-time and low-paid jobs (Table 2). In these often-so-called entry-level jobs, part-time work also led to low wages, which were compensated by social security. According to Becker’s et al. (2007) long-term follow-up most participants (89%) received along with salary also social security benefits to support their livelihood. However, part-time work can be the right long-term solution, the needed job-person match (see Table 4) enabling sustainable employment for those working age people in a vulnerable labor market position. Our results suggest that more attention should be paid to the quality of work, under what conditions they work and whether their work is meaningful (Tengland, 2011), and that they have opportunities for learning on the job and for otherwise a sustainable career (van der Klink et al., 2016). MacEachen & Ekberg (2019) also argued that policies and services for individuals with disabilities or disadvantages should prioritize decently paid and sustainable employment, rather than simply driving them towards any job, regardless ofquality.

From the sustainable employability and job tenure point of view, we gathered data on job titles and tasks, and also a few descriptions of learning on the job (Beyer, Meek, & Davies, 2016; Crain et al., 2009 in Table 4), but the perspective of one’s purposeful advancement in the working career (see Van der Klink et al. 2016) did not come up, but was described in one case study (Crain et al., 2009). The data of interaction at work with co-workers or customers was discovered in fifteen studies and the description of actual interaction situations was found in one ethnographic observational case study (Siporin & Lysack 2004), but there was no interaction study. All the included studies contained some data on the employees’ and the supervisors’ descriptions and experiences of the fluency of work. However, only a little information was found on the meaningfulness of the work, as only the studies by Gilbride et al. (2003), Siporin and Lysack (2004), Gustaffson et al. (2014) and Gustaffson et al. (2018) included this data.

According to Tengland (2011), an important factor in working capacity is the relevance of average daily tasks in the job in question, i.e. meaningful tasks. In our review, our findings on jobs and work tasks are consistent with previous research, which showed that SE/IPS participants mainly reach the entry stage because of interventions in entry level, precarious employment (Kirsh, 2016). In studies by Sandys (1999) and Gustaffson et al. (2014), employers described the advantages of hiring people with disabilities in monotonous jobs, which were, for example, an opportunity to fill labour shortages and access to cheap labour in a convenient way without career development requirements, as employees were assumed to be happy to have a job at all (Gustafsson et al., 2014; Sandys, 1999). However, clear contradictions were identified in the experiences of employers and employees. Employees reported dissatisfaction with jobs that required little skills and for not having the opportunity to utilise their self-assessed, highly valued competence, personal knowledge or abilities at their place of employment (Gustafsson et al., 2014). The employed also wanted to increase the working hours (Rogan, Banks, & Howard, 2000). Only in one study conducted in India were participants also employed in jobs requiring higher education qualifications (Jagannathan et al., 2020). IPS has been applied also for people with high education level (de Winter et al. 2022), however according to our results, there is no data on what kind of positions they have been employed in.

The quality of work for which recruitments have been made with the help of SE or IPS services can be explained by our result (Table 4) where we show that when recruiting people with disabilities, employers do it by keeping productivity expectations in mind. This is naturally one of the prerequisites for sustainable employment, but according to the results, some employers use this cheaper workforce for short-term labour shortage tasks, for which it is otherwise difficult to find staff (Gustafsson et al., 2014). These might be the first steps to paid work for somebody, but one must also keep in mind that, as Gustaffson et al. (2014) pointed out, that matching people with disabilities to low-paid and low-value jobs is problematic because it may promote the detrimental and unfair view that people with disabilities are not capable of more challenging tasks. On the other hand, people with disabilities who take career breaks and continually apply for new jobs do so not because of bad job performance but because of the structure of the labour market. Challenges that were reflective of low wage service sector jobs were also prevalent (e.g. physical discomforts, fast-paced work, pressure to complete tasks more quickly, feeling that the work is not respected or valued, and unpredictable scheduling) (Gustafsson et al., 2018). Also, the principles of the International Labour Organization’s (ILO) Decent Work Agenda are important challenges for the implementation of supported employment methods in the future (see also Kirsh, 2016; Gustafsson et al., 2014; ILO 2023).

According to our results, making a job-person match (Table 4) was one of the essential factors enabling fluency of work. As one of the factors, competence was mentioned in three studies (Gilbride et al., 2003; Jagannathan et al., 2020; Lexén et al., 2016). However, the studies did not reveal the occupation, skills or other data of those employed, although the SE/IPS criteria emphasise it. As described in Gustafsson et al. (2014), employers mentioned formal education as an important but not decisive factor. The important thing is that the contribution of the job or tasks can be tailored to suit the employers’ need and productivity expectations (Table 4). In our results of the employee’s experience of doing the job (Table 4) the lack of possibilities for upward or lateral job mobility came up (Crain et al., 2009; Sale et al., 1991; Siporin & Lysack, 2004). Therefore, more attention should be paid to measures that can better consider the competencies of those entering employment and to create and support sustainable career opportunities also through new ways of competence development for persons entering employment through SE/IPS measures (see Gustafsson et al. 2014).

In the descriptions of the kind of interaction with co-workers or customers work required the discussion has moved from problematic interpersonal behaviour at work due to the limitations caused by one’s disability to the socio-cultural aspects of the workplace (Table 3). Employers felt frustrated and sad when they had to deal with reactions and conflicts among the other employees (Sale et al., 1991). For example, the lack of social skills of the IPS service user or differential treatment by the employer compared to other employees might cause issues (Lexén et al., 2016). Furthermore, employers in smaller companies became frustrated when they had to struggle to manage sickness absence (McDowell & Fossey, 2015).

Work accommodations and the various ways to implement them was one of the topics in the study literature on the theme fluency at work (Table 4). Under the theme “Natural support in the workplace”, Williams et al. (2016) discovered that the interaction at work can be either encouraging or discouraging. Also, in Table 4 under the theme “The impact of organisational and work culture issues on job performance”, Siporin & Lysack (2004) reported that the feeling of belonging to a work community and positive feedback on one’s job performance strengthened job satisfaction (Siporin & Lysack, 2004). This matter is important with regard to meaningfulness as Gustafsson et al. (2018) underlines: “A person becoming someone or something in relation to others is what creates a sense of belonging”. On the other hand, Williams et al. (2016) and Jagannathan et al. (2020) discovered that work environments could be stigmatising. Although there were few descriptions of an experience of meaningfulness at their work, people with disabilities bring up the same issues as other working age people, such as female entrepreneurs, respecting one’s self-knowledge, using one’s professional abilities and developing as a professional (Lindström, Ansio, & Steel, 2022).

In the SE and IPS interventions, the goal is rapid employment, and the support for employment is based on supporting the person with disabilities. Our results show both a promoting and inhibiting impact on the job performance of the supervisor, co-workers and work team (see Natural support in the workplace and more broadly the impact of organisational and work culture on job performance in Table 4). Some of the employers had recognised some of these issues, but according to our results it remained unclear how recognisable this is to the individual workplace actor, how much does each workplace actor know about the effects of these factors on the success and productivity at work of an employee with disabilities. Finding a paid job can be a big challenge for both the person with disabilities and for their job coach. However, according to our results, job coaches need competence and the practical means to recognise the amount of natural support existing and, if necessary, strengthen it through interaction methods.

The SE/IPS method still focuses mainly on the transition to employment, i.e. access to paid employment. However, in the context of sustainable employment, more attention should be paid to the choice of work that corresponds to the occupation, skills, and professional aspirations of workers, i.e. their needs and interests. Even after finding a job, attention should be paid to job permanence, i.e. sustainable employment, which means the ability and opportunity to get a job, keep a job and advance in one’s career, and the conditions in which an employee can participate fully in work while safeguarding their health and well-being (van der Klink et al., 2016). In SE/IPS interventions, when possible, the goal should be set to the most professionally demanding and meaningful tasks instead of staying in the professions of beginners.

According to our results, the goal of sustainable employment is also challenged by the weak social skills of the employed. However, we have some evidence that the social skills were strengthened during job tenure. Therefore, there is a need for multimodal interaction and ethnographic research in the workplace actions of SE and IPS interventions. We need this kind of information for the evidence-based guidelines both for job coaches and workplace actors to support sometimes the very delicate interaction at work of people with different kinds of disabilities.

5 Conclusion

In conclusion, we know about the receptivity of the labour market and the quality of the jobs obtained through SE and IPS interventions. The jobs people were employed in were often low-paying, unstable jobs that did not offer good career prospects. At the same time, we know that from the point of view of sustainable employment, work tasks should be meaningful and appropriately challenging. Most descriptions of interaction at work were about interaction problems, fear of conflict and conflicts caused by an employee’s disability or illness. Also, descriptions of the different practical ways of communicating that supports interaction at work and descriptions of the features of organisational and workplace culture that may enhance or inhibit the interaction needed at work took place. The most discussed issues of the fluency and meaningfulness of the work were the productivity in the job performance, making a job-person match and workplaces strategies for integrating work, recovery and wellness. Although the implementation environment of the SE/IPS intervention is work and workplace, research from the point of view of the employers and other workplace actors is scarce. Especially more research is needed about interactions at work and the meaningfulness of work for people with disabilities.