School-to-work transition for youth with severe physical disabilities: Stakeholder perspectives

Abstract

BACKGROUND:

Multiple challenges await people with severe physical disability when they are preparing to enter the labour market at the end of the school period.

OBJECTIVE:

This study aims to better understand the multiple factors that influence the course of disabled youth transitioning into the workforce by gathering perceptions from stakeholders. Methods The study used a qualitative descriptive design with an interpretative description approach to analyze the experiences reported by six school staff, six parents, and three employers.

RESULTS:

Significant facilitators to the workforce transition were the active involvement of the school’s staff in multiplying outreach activities between the various external partners. Significant obstacles include the level of help required to complete day-to-day activities at work and student lack of work experience. Government cutbacks were unanimously identified as the prominent obstacle.

CONCLUSIONS:

The results presented in this study indicate that a successful school to work transition program is dependent on many factors. These factors include the characteristics of the targeted population, the level of involvement from key stakeholders, the willingness of employers to hire this population, as well as program objectives deviating from paid employment. Further development opportunities have proven to be helpful, such as the development of a solid partnership and collaboration between all stakeholders.

Keywords

Adolescents severe disability social participation pediatric transition to adult care workforce participation

1 Introduction

According to the Universal Declaration of Human Rights, all people have the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment [1]. Being an active participant in the workforce, thereby exercising this right, allows people to form a solid occupational identity. This in turn becomes a significant motivating force, a source of pride and satisfaction, thus allowing the person to become an empowered worker [2]. Workforce participation enables people to develop positive relationships, significant activities and a sense of self-sufficiency, in addition gaining social recognition and reducing social inequities [3]. However, for an individual living with a severe physical disability, entering the labour market after graduating high school involves multiple challenges that can potentially complicate the transition [4]. As stated in the Convention on the Rights of Persons with Disabilities, recognizing the valuable existing and potential contributions persons with disabilities make to the overall well-being and diversity of their communities will result in an enhanced sense of belonging, in significant advances in the human, social and economic development of society, and in the eradication of poverty [5].

1.1 The human right to work

As active members of today’s society, we all hold the right to work—this is no different for a person living with a disability. Article 16 of the Quebec Charter of Human Rights and Freedoms prohibits employers from discriminating against a person based on his or her disability or on the use of any means to palliate a disability [6]. It states:

No one may practise discrimination in respect of the hiring, apprenticeship, duration of the probationary period, vocational training, promotion, transfer, displacement, laying-off, suspension, dismissal or conditions of employment of a person or in the establishment of categories or classes of employment.

In 2009, the Quebec government released a policy rooted in this fundamental right to equality and aiming to increase the social participation of disabled people, thereby empowering them to exercise this right [7]. Now, it must be determined how to apply this policy realistically.

The policy identified three major challenges: to create an inclusive society, a unified and more equitable society, and a society that respects the choices and needs of persons with disabilities. To meet these challenges, the policy listed several priorities, such as acting against prejudice and discrimination, improving cohesion and coordination of programs and services and making structured support services accessible to persons with disabilities and their families. The publication of this policy led to the development of specific action plans implemented by each Quebec government department, including the Ministry of Labour, Employment and Social Solidarity (MLESS). The detailed plans will be used to apply the priority actions set out in the policy. For example, the MLESS action plan commits to extending support for school-to-work transition programs for students with disabilities. It goes on to describe its efforts to help employers hire persons with disabilities, such as increasing funding allocated to the Contrat d’intégration au travail measure (a government program that pays wage subsidies to companies that hire employees with disabilities), which aims to facilitate the employment of persons with disabilities in the regular workplace [8]. Yet, while the Quebec government has made various efforts to encourage professional integration for disabled people, very few employers actually take the steps to hire such an employee [9]. In France, the government has addressed this problem by enacting a special law, La loi handicap, requiring workforces comprise a certain percentage of employees with disabilities [10]. The main obstacle to successful implementation of this law is determining what qualifies a person as having a disability. Nonetheless, the fundamental principal of this law could be the missing link in terms of full workplace accessibility and integration for people with disabilities.

One of the first steps to promoting inclusion is to incorporate job readiness programs into school curricula. For people living with a disability, these programs are called school-to-work transition (SWT). In the province of Quebec, most SWT programs are high school initiatives. Throughout the rest of the world, however, there is a wide range of employability programs aiming to facilitate SWT for young adults with disabilities.

1.2 A vulnerable population

The term “handicap” is defined as the continuous variation of human development. According to the International Network on the Disability Creation Process 1 , a handicap is a barrier to accomplishing day-to-day activities due to both intrinsic and extrinsic factors. The term “disability”, while quite similar, also denotes external societal factors. Disability should therefore be interpreted as a society’s restriction of activity in response to an individual’s impairments [11].

Due to disability, students approaching high school graduation and the eventual transition into adulthood will have to face many hurdles. One significant obstacle to workforce integration is the need for assistance in completing Activities of Daily Living (ADLs) [12]. Employers must consider the applicant’s ADL needs in the hiring process. The fact that our society currently values productivity over social participation makes these students a vulnerable group whose rights must be protected and whose needs must be accommodated [13].

1.3 Successful programs and conditions

Currently, employability programs vary in terms of specific objectives, components, and means. They use a variety of approaches to attain their respective objectives. Some take a multidisciplinary approach involving all stakeholders. Others focus on vocational training and take an educational approach. Still others offer customized employment opportunities complete with a cooperative support system for employers. According to Söderback, [14] programs to offer young people the best chance at success as they transition out of school must be put into place and must include the following components: a) pre-vocational preparation, b) individual transition planning, c) supported in-service training/employment, and d) employment and transfer of support/follow-up. Most studies on this topic identify characteristics that are favourable to work integration, such as personal skills, work experience, life goals, internship opportunities, and a certain level of community involvement [15 –22].

Certain program evaluations have focused on establishing which factors are more likely to lead to a successful transition, [23 –25] often targeting one specific population profile (e.g., intellectual disability or autism spectrum disorder). This makes the studies difficult to directly apply to all people living with a disability, be it physical, intellectual or, in many cases, both. Overall, there is a considerably broad range of components to consider and, as Stewart [26] stated in a literature review, it is unclear which combination works best. It is worth noting that none of the research in the above articles specifically focused on severe physical disabilities.

1.4 Stakeholder roles

A common conclusion drawn in several articles on this topic is that students’ social networks are a very important environmental factor that can facilitate or hinder the transition process [11 , 27–30]. These social networks are composed of a few key stakeholders, such as parents, specialized school staff, and potential future employers. The views and aspirations of these stakeholders regarding SWT will presumably influence the students’ employment outcomes.

Holwerda [27] conducted a cohort study on the expectations of students, parents, and professors regarding the students’ transition to the workplace after high school graduation. The results reveal how closely teachers’ expectations resembled the actual outcome, as opposed to students’ less realistic expectations. The authors explain that students are often not sufficiently self-critical regarding their abilities, so it is crucial that parents and teachers help facilitate the transition. To further explore the importance of the parent role, Bianco [29] conducted a qualitative study aiming to better understand parents’ perceptions of their children’s transitional phase. The nine participating parents reported on their adoption of several roles, which they described as a liaison, instructor, trainer, educator, role model, mentor, career counsellor, decision maker, and change agent. In addition, Betz’s [31] controlled trial revealed the difficult challenges parents face navigating this transition because they have very little knowledge of the systems involved. Antle’s [28] qualitative study examining the nature of social support identified parental support as the most significant form of support. Last but not least, students’ future employers were considered a noteworthy stakeholder group. Lindsay [32] conducted a qualitative study aiming to further understand employers’ expectations of students’ abilities upon entering the job market. In a guided interview, employers stated, generally, new job seekers with disabilities lack work and interview experience, as well as networking skills and job references that could facilitate the job-hunting process. However, they expressed that these young adults showed great loyalty towards employers. Gewurtz’s [33] scoping review on hiring persons with disabilities found many interrelated factors must be considered, depending on the stakeholders involved in the hiring process. Future research should include employer points of view and recommendations that could enhance the program.

In conclusion, although students with disabilities may have to face many barriers throughout their lives, the term disabled should be defined as a societal matter that is not inherent to the individual’s personal misfortune and requires the active involvement of all influencing stakeholders [3, 11].

2 Objective

The present study focuses on the school-to-work transition process for students enrolled in a specialised high school for disabled adolescents (12–21 years old). These students mostly present a moderate to severe physical disability with possible combination of an intellectual disability. The study was initiated upon the request of the school’s educators. The students often express high expectations for future job placements, which are perceived as “unrealistic” by parents and professionals. Despite this, a few employers agreed to give students a chance, for example, by offering an internship placement. The school created an in-house SWT program, which consists of a range of tools and strategies adapted to each student to fit with his or her personal needs and characteristics. According to the school staff, the various initiatives seem insufficient to foster work integration and do not meet parent and employer needs. As the literature review demonstrated, stakeholder involvement is fundamental to sustain work integration for the student. The school’s specialists wanted to know why stakeholders did not value their initiatives or find them as useful as expected. They also wanted to know which strategies would better prepare their students for entering the work force. The aim of this study is to better understand which factors influence the school-to-work transition process in this specific context and from the perspectives of the various stakeholders. To answer this, our study focuses on the following sub-objectives:

Identify the prominent challenges each stakeholder faces with regard to work transition.

Identify the facilitating factors that influence a successful transition in the specific context of this school.

Determine which factors can improve the current SWT program for this specific population. Suggest ways to enhance the current SWT program for this specific population.

3 Methodology and theoretical lens

The aim of this study is to understand stakeholder perspectives on factors that can lead to successful employment. It seems appropriate to use a theoretical framework that accounts for experience. This study applies a critical realist lens to capture the complexity of work integration from different points of view [34 –36]. This implies individual achievements are necessarily shaped by external factors, such as communities, policies, and educational and rehabilitation services. Additionally, the study takes an interpretative descriptive approach, which is appropriate when little is known in a particular area of research or when the topic is highly complex, as is the case with this article [37].

The qualitative investigation method aims to identify emerging themes and patterns through the compilation of participant perspectives on the subject [38]. Reflective and critical examination techniques were used to extract information to improve public understanding of the SWT process.

3.1 Study design

This is a qualitative study based on individual interviews. Data was analyzed through a phenomenological approach, which utilizes individual perspectives to better understand social phenomena.

3.2 Participants

This study sought out three categories of participants corresponding to three different stakeholder categories, all connected to the specialized school involved in the study. The categories are: specialist school staff (n = 6), students’ parents (n = 6), and potential future employers (n = 3). The objective was to recruit six participants in each category. An email inviting them to participate was sent to all school staff and specialists. The six members of the SWT school team volunteered to participate in the study. We randomly listed the parents of all students ages 18 to 21 enrolled in the School-to-work program (n = 100). Parents of intellectually impaired adolescents were excluded. The first six parents were sent an email requesting participation. Out of the five employers partnered with the school at the time of the study, only three agreed to take part. Very few employers had taken on trainees from this school due to the severity of their disabilities. A total of fifteen (15) participants were selected from the three categories. The following table presents the participant socio-demographic information (Table 1).

Table 1
Participant demographics

School Staff and Specialists

Participant Profession Gender Experience (Years)

S1 Special Educator F 7

S2 Guidance Counsellor F 5 (20 as a teacher)

S3 Resource Teacher F 23

S4 Teacher – Workplace Readiness F 6

S5 Social Worker F 21

S6 Occupational Therapist F 13

Parents

Participant Gender Child’s Gender Child’s Grade

P1 F M grade 8

P2 F F grade 9

P3 M M grade 8

P4 F F grade 8

P5 F M grade 11

P6 F M grade 8

Employers

Participant Profession Gender

E1 Owner-Pharmacist F

E2 Staff member at Canadian Union of Public Employees M

E3 Administrative Assistant at “Starlight Foundation” M

School Staff and Specialists
S1	Special Educator	F	7
S2	Guidance Counsellor	F	5 (20 as a teacher)
S3	Resource Teacher	F	23
S4	Teacher – Workplace Readiness	F	6
S5	Social Worker	F	21
S6	Occupational Therapist	F	13
Parents
Participant	Gender	Child’s Gender	Child’s Grade
P1	F	M	grade 8
P2	F	F	grade 9
P3	M	M	grade 8
P4	F	F	grade 8
P5	F	M	grade 11
P6	F	M	grade 8
Employers
Participant	Profession		Gender
E1	Owner-Pharmacist		F
E2	Staff member at Canadian Union of Public Employees		M
E3	Administrative Assistant at “Starlight Foundation”		M

3.3 Data collection

Individual open-ended interviews were conducted by phone and face-to-face, according to participant preference. All interviews were conducted in accordance with a pre-prepared interview guide with a list of topics to address with each participant category (see Table 2). All six interviews with school staff and one interview with a parent were conducted face-to-face in a quiet room at the specialized high school and lasted approximately sixty minutes. Five of the six parent interviews were conducted over the phone and lasted approximately thirty minutes. The three employer interviews were conducted over the phone and lasted up to twenty minutes.

Table 2
Interview topics with different categories of participants

School and professional staff Parents Employers

•Satisfaction with the in-house SWT program •Fears about the school-to-work transition •Challenges associated with hiring people with physical disabilities

•Perspective on progress of the SWT program •Expectations of the transition •Factors that facilitate hiring people with disabilities

•Strategies or clinical/educational interventions that contribute to SWT •Personal investment in the process •Level of productivity expectations for people with disabilities

•Tools developed or used •Expectations of school services and involvement •Possible physical accommodations

•Challenges and obstacles in the transition •Satisfaction with school’s role •Possible strengths and benefits of hiring people with disabilities

•Facilitators in the transition •Expectations of social programs that encourage work integration •Strengths and benefits of the SWT program

•Opinion about parental involvement, future employers and SWT resources in the community •Perception about government assistance and services •Perception of the level of preparation needed for a person with a disability to enter the work force

•Knowledge of the government programs, e.g., internship placement, work contracts, housing and transportation services. •Recommendations to the school for the SWT program and student preparation

•Perception of their children’s expectations of paid activities and work

School and professional staff	Parents	Employers
•Satisfaction with the in-house SWT program	•Fears about the school-to-work transition	•Challenges associated with hiring people with physical disabilities
•Perspective on progress of the SWT program	•Expectations of the transition	•Factors that facilitate hiring people with disabilities
•Strategies or clinical/educational interventions that contribute to SWT	•Personal investment in the process	•Level of productivity expectations for people with disabilities
•Tools developed or used	•Expectations of school services and involvement	•Possible physical accommodations
•Challenges and obstacles in the transition	•Satisfaction with school’s role	•Possible strengths and benefits of hiring people with disabilities
•Facilitators in the transition	•Expectations of social programs that encourage work integration	•Strengths and benefits of the SWT program
•Opinion about parental involvement, future employers and SWT resources in the community	•Perception about government assistance and services	•Perception of the level of preparation needed for a person with a disability to enter the work force
	•Knowledge of the government programs, e.g., internship placement, work contracts, housing and transportation services.	•Recommendations to the school for the SWT program and student preparation
	•Perception of their children’s expectations of paid activities and work

3.4 Data analysis

The fifteen interviews were recorded and transcribed. The verbatim transcriptions were then analyzed using L’Écuyer’s method, [39] which guides the identification of themes and units of classification, comparative data analysis, and results interpretation and validation. The main author selected the units of classification after initial analysis of the verbatim transcription. Field notes were taken to gather relevant contextual information and emerging themes. N-Vivo qualitative data software was then used to code the data for the purpose of analyzing thematic content, such as the various challenges, needs, facilitators and obstacles, as well as the application of the various SWT program components and suggestions for its improvement. To ensure consistency, ongoing comparative methods [40, 41] were used to detect contradictions and similarities between participant interviews in order to achieve data saturation. Coding was validated using a dual-coding approach with the second author until a consensus was reached.

4 Results

Before presenting the key findings about the stakeholder perspectives on the school-to-work transition program, the components of the current in-house SWT program must be listed. Furthermore, the experience and viewpoint of key stakeholders will be illustrated through the themes of perceived challenges, facilitating factors and obstacles to the transition to work, and suggested improvements to the school-to-work transition process.

4.1 Current in-house SWT components

The in-house SWT program currently in place is based on a set of guidelines provided by the Quebec government to all specialized schools. The guidelines recommend steps to take and when to take them:

3 years prior to graduation: Define a life goal

2 years prior to graduation: Develop skills to achieve life goal

1 year prior to graduation: Begin working toward life goal

At graduation: Continue working toward life goal

Realistically, the in-house program consists of a wider range of tools used to attain multiple objectives. Table 3 categorizes said tools according to the components of supported employment proposed by Wehman [42].

Table 3
In-house program

Support element Objective Tools

Consumer assessment (function, skills, interest) Complete assessment of work-related abilities •Evaluation of work-related skills service run by a resource teacher

Job development (job analysis and job matching, environmental adaptation and job change) Identify possible job opportunities matching the person with the environment •A work-oriented training program

•A wide variety of workshops

•Internal work placements

•External work placements

Job placement Give support and supervision throughout work placement •Liaisons with organizations aiming to offer work opportunities or internships to graduating students, mostly in adapted or adaptable workplaces, within the school board or businesses

•First visit to work environment accompanied by teacher

Employer liaison and jobsite interventions (training, behavior management) with use of job retention strategies Build professional relationship with employers •Establishing contact with employers having previously hired a student with special needs

Individualized support Offer services catered to individual needs •SWT means and needs plan identifying which field to address

•Personalized resource directory for each graduating student

•“In Brief” newsletter informing parents about which steps to take to better prepare their child’s SWT

•Information kiosks

Support element	Objective	Tools
Consumer assessment (function, skills, interest)	Complete assessment of work-related abilities	•Evaluation of work-related skills service run by a resource teacher
Job development (job analysis and job matching, environmental adaptation and job change)	Identify possible job opportunities matching the person with the environment	•A work-oriented training program
		•A wide variety of workshops
		•Internal work placements
		•External work placements
Job placement	Give support and supervision throughout work placement	•Liaisons with organizations aiming to offer work opportunities or internships to graduating students, mostly in adapted or adaptable workplaces, within the school board or businesses
		•First visit to work environment accompanied by teacher
Employer liaison and jobsite interventions (training, behavior management) with use of job retention strategies	Build professional relationship with employers	•Establishing contact with employers having previously hired a student with special needs
Individualized support	Offer services catered to individual needs	•SWT means and needs plan identifying which field to address
		•Personalized resource directory for each graduating student
		•“In Brief” newsletter informing parents about which steps to take to better prepare their child’s SWT
		•Information kiosks

In all the participant interviews, it was possible to determine how each stakeholder experienced the SWT program.

The seven professionals on the SWT team were asked about their level of satisfaction with the in-house program. Most members of the school staff characterized the program as a work in progress. Despite being motivated and believing in the SWT process, the staff cited insufficient funding and time was needed to further improve the program.

With regard to parent involvement, school specialists shared the perception that parents did not retain most presented information. Although parents were contacted several years prior to the child’s graduation, the actions of most seemed to indicate denial of the approaching reality. The specialists mentioned a general lack of parental involvement in collaborative initiatives, partially due to the volume of information they have to process for a child with a disability. S1 mentioned this particular obstacle as having an effect on the outcome of the SWT process.

“[... ] no matter how much information we give, as long as they don’t need it in the moment, you know... they receive so much information [... ] they aren’t gonna say: yeah! I’ll keep all that information on hand for later when it might come in handy.” – S1

From the parent perspective, even if they recognize that they have access to several documents and information, they often felt overwhelmed with everything they have to do in order to successfully plan this transition. When questioned about level of satisfaction with the school’s involvement, four out of six parents felt satisfied. However, two parents explained that the help provided by the school was generic and did not match their child’s specific needs. In response to this perception, the school specialists mentioned the virtual impossibility of developing an individualised transition program for each of the students due to a lack of resources.

As for the students themselves, four out of six parents said their child did not talk about transition to work. Some mentioned their child had unrealistic expectations about the future while others said their child simply could not think of the transition due to intellectual ability.

Employers were asked to share opinions on the student level of preparedness upon entering the job market. Two employers simply answered that the students were sufficiently prepared without further explanation. Generally, employers referred to the employment of a student with special needs as a positive endeavour. However, employers admitted it was nearly impossible to hire such a student because it would require too many accommodations to overcome every related obstacle. They cited physical adaptations in the workplace such as an automatic door, among others.

4.2 Is transition-to-work considered realistic?

Through the interviews, each stakeholder described the many roadblocks encountered throughout the SWT process. School staff, parents, and employers expressed different concerns about this complex transition in a student’s life.

School specialists mentioned parents seemed unaware of what was going to happen once schooling ended. Therefore, the staff assumes parents would feel stressed or anxious about the coming transition. Some of the staff noticed that some parents seemed more concerned by post-graduation housing options than employment opportunities. In accordance with this information, most parents confirmed they do not consider a job placement as a feasible outcome once their child graduates. Instead, they mentioned seeking a general activity to fill their child’s occupational schedule. Some insisted they wanted to find something that responds to their child’s interests and meets their particular needs.

“As far as I’m concerned, for now, I barely consider the possibility. Although I’m open to it, I just hope he can find an activity to keep him busy ‘cause he can’t just stay here. He wants to be part of the gang. I can’t picture him spending all day here, day in day out. So, at this point, it’s mostly a question of basic survival. As far as job expectations, well, I have to say, I don’t even contemplate it for now.” – P1

School specialists and staff broached the idea that parents might feel abandoned by the school after graduation, as S2 explains:

“Well, parents’ perception is one of abandonment, they feel abandoned. I mean, they receive hyper-specialized services from, like, the age of 5. From the age of 4 or 5 at primary school for X number of years, and then at high school for X years until the age of 21. Ok, so maybe a few continue on to a specialized resource school for another few years. But afterwards, there’s nothing, so they feel abandoned.” – S2

School specialists and staff members were asked the same question about future employment. In response to this question, a few believed it took a very specific and rare type of employer to offer a job placement to a student living with a severe disability. This type of employer would have to be open, sensitive, and a humanitarian. One specialist mentioned the employers might speak about being open to hiring a person but not actually follow through.

“[... ] I’d say there’s like... ya know like... anyway it’s my perception ya know... it’s a beautiful thing, people think it’s great to help out disabled people... like wow amazing if this guy is able do this or that, but not in my backyard. You know, we can feel that there’s a ‘wow cool, this person works here or another person works there’. We talk about how great it is, but would you be ready to hire such a person? Not necessarily. But, you know, people won’t say that, because it looks, well it doesn’t look good. Ya know, we live in a society where you gotta be productive and people have to perform.” – S5

According to the interviews, school specialists and staff are not very optimistic about finding effective employment placements; and they would choose to invest more of their time and efforts into developing leisure opportunities to satisfy some occupational needs.

The interviewed parents mentioned a need for greater government involvement at this juncture in their child’s life. According to the school specialists and staff, and confirmed by parents, students benefit from a significant support system during their compulsory schooling that is nearly eradicated after graduation. Therefore, parents feel they are left alone to solve the ensuing problems. When asked if they had any concerns regarding their child’s SWT, most parents shared many fears and apprehensions. However, two parents able to benefit from a financially stable household did not express this concern.

4.3 Challenges and requirements associated with a successful transition

All three categories of participants were asked to elaborate on the topics of facilitating factors and obstacles. Their answers were subcategorized into the following role-based determinants: student traits and behaviours, high school behaviours and characteristics, parental characteristics and support, workplace setting realities, and the involvement of external resources. This led to identify some challenges related to a successful RTW, but also the key requirements to foster this transition.

Regarding student traits and behaviours, a significant obstacle repeatedly mentioned in the school specialist and employer interviews, was the level of help required to complete day-to-day activities at work. For example, depending on the student’s ability, some require a full-time beneficiary attendant to use the washroom and help with meals. Undeniably, physical disabilities vary considerably and require different types and levels of help. The employer is asked to integrate not only the student but also the attendant. In addition, the specialised staff pointed out the cost and implications of hiring this full-time aid.

Another major obstacle identified by staff and employers was the students’ lack of work experience. Students enrolled in the regular academic system often gain work experience through summer jobs and other opportunities. These experiences help them acquire all kinds of job-related skills. For a student with a physical disability, these opportunities are not as readily available. Thus, at graduation, these students had not had the chance to develop these skills.

Staff at the specialised high school qualified the environment as “hyper-protective.” Students enrolled at this school benefit from a wide variety of specialised services throughout their 9 years of education, such as, beneficiary aid, rehabilitation services and social work involvement. However, after graduation, all services are eradicated. While these services are recognized to be of great help to the student’s academic pathway, they are no longer available after graduation. Thus, children who have been accustomed to an impressive amount of services are suddenly cut off from the majority of their resources.

Government cutbacks were unanimously identified as the prominent obstacle to a successful transition. Integrating a worker who requires specific assistance, such as human help (i.e., an attendant) and environmental adaptations—would require a significant financial investment on the part of the government.

4.4 The essential cooperation between all stakeholders

Participants were asked to share ideas on improving the SWT program currently in use at the specialized school. Some staff highlighted the importance of personalizing the process to each specific student. Most staff members brought up the importance of allowing the students to gain as much work experience as possible prior to graduation.

“[... ] we have many students in internships, and that helps. And at outside locations, I find, it’s always a good thing because they’re really in a genuine environment that is more realistic than in school.” – S1

The same question was asked to the potential employers. Some mentioned the importance of specializing the training programs offered by the school to the job placement with an aim to better prepare the student. For example, the school could offer a training program focusing on social skills for jobs that include customer service. One employer raised the importance of working more collaboratively with the school throughout the job placement in order for everyone to be fully informed about the student and his or her needs.

“I think that a few meetings with a teacher who knows the student very well, it’s great. I think, in my case, I had 2 or 3 of those. I was very comfortable with the student’s coach... or instructor. And it’s also great to talk privately without the student present. You know, to really get down to things, in reality. Sometimes we’re embarrassed to talk or just to say the word handicap, so you know... ” – E2

Each stakeholder experiences the SWT process in varying ways. Developing a program that considers every participant’s needs can be a challenging process. However, certain opportunities to increase chances of employment do exist. The development of a solid partnership between potential employers and specialized resource agencies has proven to be helpful. The school coordinating pre-employment experiences such as internships, work placement, or community work is important. Cooperation and coordination between all stakeholders is crucial in increasing the student’s chance of success.

5 Discussion and implications

The present study described how stakeholders experience the SWT process, which challenges arise, and which factors could contribute to a successful or unsuccessful transition. The SWT process is cross-disciplinary and includes integration into a work activity. Although it is acknowledged that workforce participation provides a wealth of benefits to the individual, transition programs focusing on persons living with a severe physical disability rarely incorporate a competitive employment component. The programs bypass the international conventions on human rights by considering leisure activities as work activities. This means the programs neglect the benefits related to a real work activity, such as financial independence and a sense of contributing to collective productivity. The right to work not only leads to self-actualization, it reduces social inequalities related to health and poverty.

The province of Quebec is currently stepping up efforts to support the transition from school to work through the promotion of SWT initiatives [7]. However, work participation objectives for students at this school have yet to be set. The participating high school enrols a very specific type of student characterized by the severity of their physical disabilities, which are often combined with social and intellectual impairments. Although a wide variety of adulthood transition programs are in place today, they do not match these particular students’ needs. For instance, the programs are often built using an intensive approach requiring heavy manpower, time, and managerial resources [15, 18]. Other programs have only proven successful through a systematic application of program components, which is too restrictive for the studied population due to their varying and unpredictable needs [17]. For these reasons, the school sought to develop their own transition program with customizable tools in order to better guide each unique graduating class. Although the participating school has invested significant effort in development, transitions to work have been less effective than hoped. For this reason, the school has asked the research team to help understand how the right mechanisms and social environments could lead to better employment down the road.

This study has identified a number of challenges for which there is a need to find and develop resources and the means to foster better employment opportunities. Throughout the majority of interviews, participants seemed perplexed about the intended purpose of the transition. Should it lead to a job placement or simply a non-remunerated activity to provide a day-to-day occupation? In addition, when asked what type of transition should be targeted, most parents focused on finding an adequate housing plan or leisure activities and not paid employment. The purpose of SWT would be altered to become a transition period with aims at finding activity to fill in the time previously spent in school rather than an effective transition to work. This distortion of the SWT objective could explain why certain parents’ level of involvement was deemed insufficient according to school staff.

Potential employer perceptions on the SWT process differed depending on level of familiarity with severely disabled employees. Finding a paid work placement seems unattainable for plenty of young disabled students simply because few employers are willing to hire an employee living with a severe physical disability. Many factors must be considered when integrating an employee. For example, the physical care needs are complex and sometimes difficult to meet. Environmental adaptations could be perceived as surpassing reasonable accommodations and therefore excessive.

The considerable number of challenges for a young person with a disability transitioning to adult living raises questions about our society’s perspective on the issue. Boucher [43] broached the subject in a study on the sociological aspect of disability. He demystifies two different models of disability: individual and social. The individual model contends that the disabled person is responsible for his own misfortune. Conversely, the social model accounts for society’s impact on disability production. The analysis of these two models leads to the emergence of the emancipatory paradigm, within which disability is defined as a political problem. This begs the question, where do we stand as a modern society? As health professionals, we would like to think that our training is based on this emancipatory paradigm, accounting for society’s effect on disability and thus enlightening us to this end. However, our study demonstrates through the analysis of each stakeholder’s perspectives on the issue that our approach relates more to the individual model. All identified obstacles directly related to the student’s characteristics indicate that the school professionals consider that part of the problem lies within the individual. Likewise, the parents who were interviewed expressed their need to find a general occupational activity for their child, therefore disregarding the possibility of finding a paid employment. Considering these concerns and perceived challenges, school staff has modified the SWT objective to find a general activity as opposed to paid employment, thus ignoring certain student’s life goals and reinforcing the individualistic paradigm.

This particular way of perceiving disability as presented through the emancipatory paradigm is reflected in the capabilities approach described by Nussbaum [44]. The insight brought by both these approaches can help us create a social model of disability that respects the human right to work accessibility.

In sum, capabilities are defined as a person’s ability to produce valuable outcomes considering the personal and environmental factors. One solution following this approach could be the Contrat d’inté gration au travail measure implemented by the government. This measure provides wage subsidies to the employer of a person with a disability to compensate for the workplace accommodations made for the employee’s functional limitations [31]. However, the Quebec government recently made cuts to the program, which could mean fewer contract allocations. Although some efforts are based on the right approach, the actual effects are blocked by environmental factors, such as government financial priorities. To help increase financial aid, our results demonstrate the need to promote this issue at the social level which will influence society’s perspective and public opinion on the subject. Hopefully, employers will be motivated to take a more active role in developing capabilities, and then paid employment might be a more feasible outcome after graduation.

6 Limitations and future perspectives

In this study, the student perspectives were not directly investigated. The students being the most important stakeholders, this study could have greatly benefited from their input. However, due to the allotted timeframe for this particular project and the extensive ethical considerations for involving the students directly, interviewing them was virtually impossible. In order to obtain approval from the ethics committee to directly contact the students, countless steps had to be taken. This limitation is an example of a direct consequence of a society based on an individualistic approach to disability; it is often hard to integrate a “vulnerable” population into a study design, especially with tight deadlines. Therefore, future studies might target the societal implications related to ethical regulations in research and the inevitable repercussions on advancing knowledge about disability.

7 Conclusion

The transition from school to working life is described through this study as a challenging process for all individuals involved. Stakeholders and parents seem to find the transition-to-work almost impossible for these young people. The findings show the importance of targeting societal collective solutions. Further development opportunities that have proven to be helpful and effective do exist, such as the development of a solid partnership between potential employers and specialized resource agencies. For instance, a structured school program that values pre-employment experience such as internship opportunities or community involvement activities could be beneficial to foster the process. As a society, we must develop financial incentives to hire disabled people which will help promote a more active participation in the workforce. We all have the right to actively participate in our communities. It is our responsibility as a modern society to ensure that every human being has the necessary tools to reach their personal goals. In addition, this would be particularly timely regarding the need for a flexible labour force to face the critical changes in the western countries.

Conflict of interest

None declared.

Funding

This study received no funding support from any public, commercial or non-profit sector.

Research ethics

Prior to data collection, the research ethics committee of the Sainte-Justine Hospital approved this study.

Footnotes

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