Work Inclusion through Supported Employment? Perspectives of Job Counsellors in Iceland

Supported employment (SE) programmes are generally considered an effective measure to support disabled people in the labour market. While research about SE has mostly focused on quantitative measures, such as successful placement, scholars have argued for scrutinising the meaning behind programme implementation. To understand how SE contributes to work inclusion of disabled people, we studied how job counsellors view their support and how they give meaning to their own roles and the roles of clients and employers. Qualitative interviews were conducted with 10 job counsellors within the SE programme of the Icelandic public employment service. Analysis of interview data shows that while participants attached general importance to inclusion, their day-to-day approach to client-centred support, relations with employers, and follow-up support reflected a social integration rather than an inclusion perspective. The policy context in which job counsellors implement the programme appeared to play an important role in shaping their approach to support.


Introduction
Increasing disabled people's participation in employment represents a key policy goal of government at regional, national, and supranational levels in industrialised states (European Commission 2017;OECD 2010). At the same time statistics have documented the enduring underrepresentation of disabled people in the labour market in terms of employment rates (OECD 2010;World Health Organization 2011). Even when they achieve to participate in work and employment, disabled people experience particular marginalisation connected to sustainability of employment and career development (Lindstrom, Doren & Miesch 2011).
This raises questions about the effectiveness of labour market measures directed at disabled people, which are mostly focused on services aimed at developing disabled people's skills and supporting them in obtaining jobs, but also providing financial incentives to employers and enforcing employment quotas (Greve 2009). While measures such as supported employment (SE) have been successful in supporting a proportion of disabled people into employment (Kinoshita et al. 2013), finding and maintaining employment remains difficult for disabled people in general and especially for people with mental health issues and people with intellectual disabilities (Lysaght, Ouellette-Kuntz & Lin 2012;OECD 2010). In addition, research shows that employment does not imply successful work inclusion. For example, E. Hall (2004) and Mik-Meyer (2016) have demonstrated how even in a corporate context that emphasises inclusion disabled employees risk being casted as 'the other'. Barriers to inclusion in work and employment remain, in part because of a misconception of inclusion as making disabled people fit within existing ways of organising working life . Disability studies scholars like Barnes (2000) have pointed out that progress in inclusion depends upon revisiting the meaning of work and how it is organised, an approach that receives increasing attention from scholars (Lysaght, Cobigo & Hamilton 2012;Shier, Graham & Jones 2009). Applied to support measures in the labour market, a work inclusion approach asks questions about qualitative aspects of support, which were also put forward in a recent review study by Bonfils and colleagues (2017) about the implementation of SE programmes. To understand the role of SE in creating opportunities for inclusion, research should address the way in which support is provided and given meaning (Lysaght, Cobigo & Hamilton 2012). Departing from an Icelandic SE programme, this qualitative study aims to shed light on job counsellors' views regarding their support practices in relation to key aspects of work inclusion.

Supported employment programmes
Traditional approaches to supporting disabled people in obtaining employment are characterised by an emphasis on preparing individuals for labour market participation through functional rehabilitation and improvement of skills in dedicated settings outside the labour market. Behind the 'train, then place' approach lies the assumption that better skills lead to better opportunities (Bond 1992). The approach however has yielded limited success in closing the disability gap in employment, particularly for people with certain types of impairments (e.g., persons with psychiatric disabilities) (Bond 1992). In response to empirical evidence supporting the importance of a comprehensive approach, SE programmes were developed based on a 'place-then-train' approach. SE prioritises a quick transition into work, with much of the training and skills development taking place in the workplace (Bond 1998).
The most formalised model of support was developed in the US under the name of Individual Placement and Support (IPS), and it derives directly from the basic concept of SE (Drake and Becker 1996). IPS features a set of basic principles that should underpin its implementation (Bond 2004;Drake & Becker 1996;Drake et al. 1999), stipulating that (1) SE is aimed at achieving competitive employment (i.e., employment in the open labour market); (2) job search is rapid (i.e., placement is pursued shortly after the client's entry into the programme); (3) support collaborates in an integrated manner with health services; (4) eligibility is based on self-selection; (5) assessment is continuous and comprehensive throughout the support trajectory; (6) attention is given to client preferences; (7) support is offered in a time-unlimited manner; and (8) clients receive counselling with regard to social security and other benefits.
IPS is a particularly interesting form of SE, because its formalised character forms the basis for research into success of implementation (Bond 1998). There is relatively strong international evidence that IPS programmes are more effective than traditional vocational approaches (Bond 2004;Kinoshita et al. 2013;Latimer et al. 2006) and that they have positive psychosocial effects (Cramm et al. 2009), although evidence appears to be weaker outside the US (e.g., Heffernan & Pilkington 2011). While randomised-control trials have demonstrated effectiveness of IPS, they have focused on defining success rather narrowly in terms of so-called 'placement' (i.e., whether participants have obtained a job and whether they are still in that job after some time). Corbière and colleagues (2010) have argued that the 'philosophy of the programme' as well as the competencies of job counsellors (Corbière & Lanctôt 2011) should receive more attention as these are likely to influence participants' opportunities in working life. Vandekinderen and colleagues (2012) demonstrate that a lack of attention to women's career expectations can lead to dissatisfaction among female participants and missed opportunities for successful participation in employment. Consequently, Bonfils and colleagues (2017) in their systematic review of IPS implementation call for research that addresses how core principles are given meaning in the implementation of SE.

Inclusion of disabled people in work
In research about disabled people's participation in work, two concepts have been used widely and sometimes interchangeably: work integration and work inclusion. These two concepts have been defined in diverse ways, and while they generally share an emphasis on belonging and social relations, integration implies more acceptance of views of the dominant groups in society regarding the preconditions for participation . Inclusion on the other hand-as the opposite of exclusion and marginalisation-refers to a process leading to opportunities for meaningful participation that enables recognition, involvement, belonging, and good relationships with others (A.C. Hall & Kramer 2009). Work inclusion implies strong emphasis on subjective dimensions of participation and requires rethinking of accepted norms to support disabled people's sense of belonging, social relations, trust, and valorisation of professional contribution (Lysaght, Cobigo & Hamilton 2012).
Over the past decades, disabled people's participation in society in general and in work in particular has increasingly been framed in terms of inclusion by scholars in disability studies and disabled activists (Oliver & Barnes 2010). They have pointed out that the marginalisation and oppression of disabled people can only be successfully challenged by focusing on inclusion (i.e., participation founded on a fundamental respect for human diversity, which does not aim to make disabled people fit into norms upheld by non-disabled people, but instead revisits commonly accepted norms and expectations) (Barnes 2000;Roulstone 2012).
This shift in thinking about disabled people's participation in work is also reflected in the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), which describes state actors' responsibility for promoting and protecting disabled people's right to work within the context of a 'work environment that is open, inclusive and accessible to persons with disabilities' (United Nations 2007). Inclusion appears as a fundamental principle that should underlie the measures taken by state actors to support disabled people in realising their right to work. The UNCRPD represents a shift away from a focus on increasing individuals' market value, requiring interventions aimed at eliminating discrimination, providing reasonable accommodations, and creating inclusive workplaces (Jammaers, Zanoni & Hardonk 2016).
In terms of scholarship, the concept of work inclusion provides a foundation for research that addresses barriers to belonging, socially valued roles, respect for personal expectations and preference, and meaningful social relations. A work inclusion approach has, for example, been used in studies about recognition of skills and competence (Shier, Graham & Jones 2009), provision of reasonable accommodations (Gold et al. 2012), job content (Ellenkamp et al. 2015), access to roles of leadership (E. Hall 2004), and more generally organisational culture (Stone & Colella 1996;Williams & Mavin 2015).

Work inclusion through supported employment programmes
A work inclusion-approach also raises questions about the implementation of SE programmes. SE programmes were first established in the USA in the 1980s as part of the movement towards deinstitutionalisation and normalisation Hardonk (Saloviita 2000). Over the past 20 years, normalisation has made way for a conceptual shift towards inclusion (Culham & Nind 2003), and it is generally assumed that when SE programmes achieve 'placement' of a disabled person, this will result in inclusion in the labor market, and consequently in society. However, as Lysaght, Cobigo, and Hamilton (2012) have demonstrated in their review of literature, little is known about whether this is actually the case, because inclusion is more than presence at the workplace, and research about the impact of SE has focused mostly on quantitative work integration measures, such as employment rates. A recent study by Gustafsson, Peralta, and Danermark (2018) however shows the potential of a work inclusion approach to provide insight into the perspective of clients of SE programmes. Their qualitative study demonstrates the importance of opportunities for belonging and being a valued worker in clients' experience of work.
In relation to SE, Lysaght, Cobigo, and Hamilton (2012) suggest that subjective components of inclusion be scrutinised from the perspective of different actors. Given their central role in the implementation of SE, it is relevant to consider job counsellors' perspectives on how to support work inclusion in the labour market. With regard to IPS in particular, Corbière and Lanctôt (2011) have indicated that researchers have mostly taken the meaning of IPS basic principles for granted. A scenario study by Donelly and Given (2010) points to a number of issues in implementation of support, such as negative and essentialising representations of the client and a lack of attention for the client as a knowledgeable key actor. By contrast, Gustafsson, Peralta, and Danermark (2018) point out that SE can contribute to work inclusion if job counsellors' support actively engages with inclusion in the workplace (e.g., by stimulating natural supports). Further research into the perspectives of job counsellors in relation to central features of work inclusion has the potential to contribute to this growing literature.
Consequently, this study aims to analyse how job counsellors employed in the SE programme organised by the Icelandic public employment service (Directorate of labour; Icelandic: 'Vinnumálastofnun') view their support in relation to work inclusion and how they give meaning to their own roles, the roles of clients, and the roles of employers in the programme. More specifically, we looked at how job counsellors related their support to opportunities for belonging, socially valued roles, respect for personal expectations and preference, and meaningful social relations in the workplace.
Insight into job counsellors' perspectives on their support in relation to work inclusion has the potential to advance our understanding of how support practices affect unequal power relations in the labour market. In line with critical disability studies (Meekosha & Shuttleworth 2009;Shildrick 2012;Vehmas & Watson 2014), this study sheds light on how job counsellors' views on their support practices may empower disabled clients, or on the contrary reproduce their marginalisation in the labour market or workplace.
This study is part of a research project that also considered the perspectives of people with intellectual disabilities themselves and of employers (publications underway).

Background information about supported employment in Iceland
This study focuses on the SE programme (Icelandic: 'Atvinna með stuðningi') run by the Icelandic public employment service (PES) since 2011, which started as a local experiment in the South-western peninsula around 1990 and was subsequently implemented by local offices around the country (Spjelkavik 2012;Vinnumálastofnun 2012). It is grounded in the law that governs the PES in general (Lög um vinnumarkaðsaðgerðir 2006) and further described in the 'law on services for people with longstanding support needs' (Lög um þjónustu við fatlað fólk með langvarandi stuðningsþarfir 2018). The legal framework describes the responsibility of the PES to provide support to disabled people for finding jobs without specifically mentioning SE or any of its methods. The SE programme manual has not been published; however, the PES website (Vinnumálastofnun 2020) describes the programme as offering 'broad support for people with reduced work capacity due to cognitive, intellectual or/and physical disabilities, support for finding the right job and support in the workplace'. A number of principles are also listed, including client-centredness, collaboration with employers, importance of social networks in the workplace, and access to follow-up support (Vinnumálastofnun 2020). Neither the legal framework nor the PES website mention work inclusion as a goal or guiding principle in the implementation of the programme.
Apart from general descriptions in its yearly report, the PES does not publish evaluations or statistics regarding number of clients, background variables, or success rates in terms of employment. In a report published by the Ministry of Welfare (Velferðarráðuneytið 2016), the PES estimated that at the time (November 2015) around 700 persons were in a job that they obtained through SE, with another 300 on a waiting list. Since 2016 the Icelandic PES is also responsible for implementation of the wage subsidies measure (Lög um vinnumarkaðsaðgerðir 2006), which has been in effect since 1995 and covers up to 75% of wage costs of persons who are entitled to disability pension (Heilbrigðis-og tryggingamálaráðuneyti 1995).

Participants, data collection, and data analysis
The study sample consisted of all job counsellors in the SE programme. The study was presented to the staff of the programme, and subsequently invitations for participation were distributed by e-mail. All 10 job counsellors agreed to participate and gave their informed consent. Participants had between 2 and 19 years of experience in SE and diverse backgrounds, including in social sciences, psychology, human resources management, and career counselling.
Data collection was aimed at acquiring rich information about participants' views with regard to the implementation of support. Semi-structured face-to-face interviews were conducted using an interview guide based on study of SE and work inclusion literature and containing as main components job counsellors' views on the goals of SE; how they supported opportunities for inclusion with emphasis on belonging, socially valued roles, respect for individual expectations and preference, and meaningful social relations; and how they viewed the roles of clients and employers in this regard. Specific questions were asked about support, reasonable accommodations, and wage subsidies. Interviews were concluded with an open question about participants' view on the future of the programme. Interviews were held during the period March-June 2019 and lasted between 37 minutes and 1 hour and 40 minutes, with an average duration of 1 hour. All interviews were recorded and transcribed verbatim.
Interview data were analysed using a grounded theory approach (Charmaz 2014). The first step consisted of lineby-line coding, followed by identification of text fragments that are reflective of job counsellors' assumptions and views related to the meaning of their support. Within these text fragments we identified themes for further analysis, which were used to organise the results. Within each theme we went through a process of focused coding, analytically connecting participants' views, assumptions, and expectations of SE to the aspects of inclusion mentioned before. The critical disability studies lens meant that we looked specifically for how support empowered clients to be active agents who experience inclusion or, on the other hand, reproduced barriers in the labour market (Meekosha and Shuttleworth 2009).

Results
In this section, we present our findings along four key themes present in the accounts of our study participants, describing common aspects of their perspectives as well as different emphases.

The role of SE in pursuing work inclusion
All participants shared a general ambition of promoting inclusion and diversity through SE. There was, furthermore, agreement between our participants that they should work to address employers' negative attitudes and prejudice regarding disabled people and work, emphasising that to realistically achieve inclusion employers lacked knowledge about disabled people and the possibilities of SE. All participants perceived employers to commonly approach employment of disabled people from stereotypical assumptions of disability and with a lack of willingness to fundamentally change the way in which they organise work.
When it came to their day-to-day support practices, our participants felt unable to realise their general ambitions because of how deeply rooted and widespread employers' lack of knowledge and prejudice is, combined with a lack of resources for the programme.
I wish I could say that we are working in this way [towards work inclusion]. We are very much willing to do that. We are ready for that, but I don't think the labour market is ready. (Svava) Confronted with a labour market they considered to be 'not ready for diversity' and limited resources, our participants in practice reduced their ambitions regarding the role of SE to a focus on placement of clients and making the SE programme better known among employers.
[To support work inclusion] that is just done by continuing our work. You know, presenting our support to as many as possible and looking for jobs in all places. (Sara) Differences appeared in participants' views regarding how work inclusion of disabled people can be achieved in the long term. Some participants were convinced that inclusion will inevitably result from placement in the long run, because when disabled people are employed employers will eventually recognise their contribution. A process that participants said could further be stimulated by legal requirements for employers such as binding disability quota: Is that [inclusion] our goal. No-o, well, yes, yes, certainly. Of course we want diversity, it should be in the law, I think, that each workplace should have at least one disabled person. (Þóra) The idea put forward here is that work inclusion will somehow naturally be achieved when disabled people are employed, as this will inspire businesses to engage with diversity. This line of thought did not mention specific support practices that encourage employers to rethink their work organisations in order to ensure opportunities for socially valued roles, meaningful relations, and belonging at the workplace.
However, other participants talked about inclusion as a goal that should be actively pursued in order to be achieved. These job counsellors mostly considered it part of their role to combat segregation and exclusion and to facilitate inclusion in the labour market for their clients. Nevertheless, as mentioned before, they did not mention aspects of work inclusion, such as access to socially valued professional roles, as an explicit goal in their support practices. Instead, they commonly pointed at the importance of employers' attitudes as well as other instruments besides SE to achieve inclusion, such as legislation concerning equal opportunities in hiring procedures.

Perspectives on supporting clients in job search
The job counsellors in our study talked extensively about how they implemented their support from a perspective of ' client-centredness', which is a basic principle of SE. To understand how this fits with the emphasis on individual preferences and expectations within an inclusive approach, we looked at what our participants meant by this. There appeared to be a consensus that SE is essentially an individually oriented service, which participants explained as letting job search be guided by clients' interests and preferences, even if they did not fit with their own expectations.
Because this is client-centred support, from beginning to end we depart from what the individual needs. And we have… we are basically working first of all for people [clients], so we have also had to do things we find strange.
Participants also talked about the importance of framing support within clients' preferences and competence to customise the type and intensity of support. They expected clients to have influence over the direction of support: We make it very clear in the first interview, people [clients] need to get control, we are here to provide advise and guidance, but they should always make the final decision about what they want to do. (Jóhann) At the same time, assessing clients' needs also appeared to serve a totally different purpose early in the support trajectory i.e., deciding whether the client is 'fit' for the SE programme or rather should be redirected to 'the right measure', by which a segregated setting was meant. While framing this as supporting clients into services that suit them best, job counsellors effectively made decisions on who receives support in SE. Moreover, assessing clients' 'fitness' was not done in relation to a specific job opportunity but based on job counsellors' general understanding of the skills that a person needs to possess to get opportunities in the labour market e.g., showing up at work at the right time and being able to communicate with others. The PES also collaborates with a segregated workplace to assess clients' skills (i.e., in a work environment that does not necessarily correspond with clients' preferences or provides them with socially valued roles). Our participants emphasised that after receiving the assessment, decisions about whether the client is fit for the SE programme were made at their discretion. Within this decision-making, certain behaviour such as ' clients being too much in their own world' was negatively perceived. This relates to our participants' views of employers as explained before (i.e., employers as actors who hold negative beliefs about disabled employees and are reluctant to reconsider their work organisation).
Participants explained that some clients were allowed to be in the programme for a long time before getting a job, which they justified by pointing at these clients' educational level and professional status. However, in relation to other, less educated or experienced clients who would not get a job after a while in the programme, participants emphasised the importance of training in a segregated setting as a preparation before re-entering SE. Segregated settings in Iceland generally have limited opportunities for transitioning to socially valued roles in the labour market, which effectively obstructs a continued work inclusion process through SE.
The decision to refer clients to segregated settings was in some cases also based on an individualised assessment of clients' job performance that focuses on clients' fitness more than on the role of the work environment: Sometimes we find out that a client does not function in the labour market. Then we need to look at sheltered workshops. Sometimes that is the solution. (Sigríður) Interestingly, participants talked about regularly accepting applications from others than disabled individuals themselves (e.g., parents, social workers, physicians, and psychologists). Such applications were in many cases inspired by lack of available daytime services, rather than individuals' preferences and expectations.
To create job opportunities participants talked about the importance of employers' willingness to 'reduce their requirements', while at the same time this flexibility was assumed to be limited by the notion of 'burden': We are all different, it's very important to have flexibility. But nevertheless the individual [client] should never be a burden on the organisation. If a person is a burden, then he will not last long [in the job]. (Finnur) Framing creation of job opportunities in a context of 'burden' reflects a risk-perspective rather than a long-term inclusion process. This led participants to make meaning of client-centredness in terms of assessing fitness of clients for jobs rather than respect for their preferences, competence, and contribution.
Participants commonly talked about their role in assisting clients to revisit their preferences aimed at broadening their job opportunities. The job counsellors also said that in some cases this meant actively discouraging clients from pursuing certain jobs because they perceived it as unrealistic. They considered it to be their role to help clients ' avoid disappointment' and 'keep their dignity' by convincing them of what are 'realistic' expectations.
But of course we are counsellors, so we often need to point out other possibilities, so clients realise that something is unrealistic, undoable. (Sigríður) Broadening opportunities often included traineeships in the labour market, although our participants emphasised that it was clients' right to deny an offer for traineeship and that a traineeship does not equal further commitment from the clients' part.
Some participants talked about the importance of supporting clients who prefer to push through with their career expectations and their ideas of future skill development, even if this proved challenging. However others described such clients as ' difficult', framing their preferences for certain jobs as a desire to get their ' dream job' right away. These participants balanced respecting clients' preferences against norms about career development: It doesn't matter if you have a disability or not, we all start somewhere. I have done so many jobs in my career. You start somewhere, and then you work your way up on the ladder. (Þóra) It should be noted that our participants did not mention supporting career development as part of a continuous inclusion process through SE.

Relations with employers in job search
The job counsellors in our study perceived their role vis-á-vis employers in different ways. The role that was mentioned throughout all interviews focused on dealing with employers and could be termed the 'salesman', who engages with employers who are uncertain about the potential contribution of disabled people to their organisation. As 'salesmen', our participants focused on making convincing arguments to hire their clients, which meant placing emphasis on their strengths, talents, and skills. Participants explained that they felt like they were 'selling clients to employers' because they experienced that they should focus on their experience and positive characteristics, while avoiding disclosing much about why the client is in the SE programme as that could confirm stereotypical expectations on the part of the employer.
We should just admit that this also comes down to salesmanship, even if you have a client that you do not think can do a job, you have to sell him. (Svava) Assuming that employers are reluctant to a commitment that they perceive as risky, in conversations with employers our participants would stress that there was an opportunity to 'try out the client' through traineeships. Also, wage subsidies were often introduced early on in the process. In fact, participants described wage subsidies as the most important instrument to get employers to start considering a disabled person as a potential employee. Even though our participants viewed wage subsidies mostly as a compensation for the risk and effort employers take on, some participants framed wage subsidies as empowering and a basis for creating opportunities for inclusion. However, apart from stimulating placement, they did not mention how wage subsidies could contribute to making workplaces inclusive or how this could benefit SE.
Our participants also talked about being 'match-makers', who support a process aimed at finding a fit between a client and a specific job in the labour market. All participants emphasised the importance of taking clients' disability into account when making a match, which meant departing from clients' limitations. This appears as a very different approach compared to the emphasis on skills in interactions with employers mentioned before. While this seems contradictory, in the accounts of our participants this made sense as they perceived their role to be mediating between clients' individual competence and disability and employers' stereotypical expectations of competent employees. Consequently, rather than framing inclusion as a process, job counsellors made much effort to assess strengths and limitations on both sides to present employers the 'perfect match'.
As a job counsellor, to get a match, you need to point out the clients' best qualities, and also those of the employer. (Svava) Our participants mentioned employers' prejudice and stereotypical expectations as a challenge in their support activities, particularly with regard to clients with certain types of disabilities, such as mental health issues and intellectual disability. They experienced that many employers were not welcoming towards diversity, resulting in difficult access to socially valued professional roles, not least for people who need more support or accommodations. Despite wage subsidies, job counsellors often would not even get a chance to present their clients and support a process of inclusion, leading to disappointment about their potential to create opportunities.
We quickly sense when an employer is prejudiced and has no interest in employing people with special needs, or who need extra support. And then they are quick to close on us, they often don't want to hear any more from us. (Sigríður) Stereotypical expectations also emerged in a different way. Job counsellors experienced prejudice of employers with regard to people with Down syndrome in the sense that they were stereotypically perceived as happy, cheerful, cute individuals who help the company portray itself as a champion of diversity.
[Talking as if she was an employer] OK, so we employ for example a person with Down syndrome, everyone can see how great we are because we employ a person with Down syndrome, and then we get a pat on the back.
It appears that employers considered these assumed characteristics as an opportunity to have diverse employees who easily build social relations with co-workers and customers and contribute to a positive reputation for the company. However, the job opportunities that resulted from this were not necessarily based on a concern for personal preference or access to socially valued professional roles.
These examples show how our participants had to navigate employers' stereotypical expectations, rather than being able to focus on clients' preferences and support access to socially valued roles as part of a process of inclusion.

Perspectives on support after placement
Participants emphasised the importance of proactive follow-up support, which they discussed not so much in relation to employers but first of all clients, departing from their needs and limitations. Follow-up support was focused mainly on the first period after initial hiring. Our participants also explained how they would ask clients how they preferred to be contacted sometime after they started in a new job, providing them a choice between a phone call or e-mail communication. Upon request, workplace visits were also conducted. When asked about the way in which follow-up support was subsequently implemented, our participants talked about relying on their knowledge and experience rather than on formalised instruments, such as questionnaires. They had limited expectations of employers' building up knowledge about accommodations or playing an active role in revisiting their organisation. Rather, they attached much importance to developing insight into how their clients felt in their new jobs and whether they needed any accommodations, with more emphasis on physical and environmental adaptations of the workplace than adaptations related to job descriptions or work organisation. Most follow-up support was aimed at assisting clients to fit into the workplace, and to a lesser degree at employers who received support at their request to address specific issues, such as communication difficulties.
We have open communication channels, the employer can call us and then we respond immediately. So the employer does not feel alone, but feels he gets support from us. (Friðrik) Notwithstanding that our participants generally described follow-up support for employers as reactive in nature, some participants emphasised that in principle support for employers is a key condition for achieving inclusion, because it indirectly provides disabled people with opportunities to develop valued professional roles and competence.
All participants placed importance on follow-up support in principle being unlimited in time, referring to examples of clients who had received support for several years, although they added that this was rather exceptional. They explained how they had to balance ambitions of supporting work inclusion through follow-up interventions with limitations in terms of work load. This balancing act was described as a reality that they had to accept but which did not fit with their expectations about how they would like to perform their jobs and implement support. Given the opportunity, our participants would provide more support to their clients and employers related to aspects of work inclusion e.g., social relations and socially valued roles in the workplace.
Given the perceived limitations of the programme, some participants suggested strategies to improve follow-up support without a need for additional job counsellors (e.g., by engaging natural supports from co-workers or supervisors who could provide guidance to the client in the workplace and be a liaison with SE). I try to discuss whether another employee could be made available, so that there is always someone, the client should not eat his lunch alone for example. So that there is always someone around, so that the client can get access to social relations. (Gréta) This strategy was in some cases already part of participants' approach and several participants mentioned specific subsidies for mentors as a necessary accompanying measure.
Other participants suggested additional training for clients outside the labour market in response to what they perceived as insufficient opportunities for follow-up support aimed at promoting work inclusion. Follow-up support takes place when clients are in the labour market and it has the potential to depart from clients' preferences and competence to create opportunities for belonging, social relations, and socially valued roles. However, these participants perceived the labour market as too difficult for some clients to achieve inclusion. Working temporarily in a segregated setting would then serve as a preparation for the toughness and high demands that are common in the labour market, while protecting clients from stressful experiences and exclusion. These participants however did not further explain how preparation and protection outside the labour market would support future work inclusion in the labour market.

Emphasis on social integration
Our participants attached importance to work inclusion, however their implementation of support was affected by widespread prejudice among employers, high case loads, and clients lacking certain skills required by employers. This resulted in limited ambitions in terms of supporting work inclusion through respect for clients' expectations and support for socially valued professional roles, meaningful social relations, and belonging. Our participants focused on their role as 'match-makers', identifying opportunities within a labour market that they perceived as an environment in which it is hard to find a place for disabled people. In their support they negotiated stereotypical work-related norms with the preference and competence of clients. This approach resulted in employment opportunities; however, aspects of clients' inclusion in work received limited attention, which is consistent with what Cobigo and colleagues (2012) describe as social integration in work.
A social integration approach was also reflected in our participants' views on client-centeredness of support. While work inclusion requires support to be firmly rooted in clients' preferences and competence (Gustafsson, Peralta & Danermark 2018), our study participants felt that they had to balance this with clients' fitness for jobs in a labour market that they perceived to be largely unchangeable. This led our participants to depart from existing demands in the labour market and even to guide applicants away from the programme and into segregated settings. While contrary to the basic principle of self-eligibility, our participants perceived this as a way to be effective in match-making and to 'protect' clients from difficult experiences. Paradoxically, this may result in disabled persons who need support more than others experiencing continued exclusion from the labour market.
Similarly, in job counsellors' relations with employers, the social integration perspective was also present. The term 'burden' was used to describe what can be reasonably expected from employers in terms of accommodations, the emphasis being on efforts made by employers. In their support job, counsellors experienced limited opportunities to support employers in making their organisations inclusive so that they can avoid or remove burden (e.g., through natural supports). Wage subsidies were described as an effective instrument that is often used as an incentive for employers to show interest in hiring a disabled person, and as a compensation for assumed additional costs related to disabled employees. Our participants did not frame wage subsidies as assistance for organisations in becoming inclusive, and they felt they needed additional labour market measures to be able to support employers towards inclusion.
Follow-up support was described as mostly reactive in nature, as a tool for solving problems and avoiding that a person would lose his/her employment. Pointing at high case loads, our participants did not consider their follow-up support to be occupied with clients' career development (e.g., taking up leadership positions or changing jobs within or outside the organization), nor as a way to support workplaces in becoming inclusive. This reflects a focus on obtaining jobs as the main goal of support, which is consistent with a social integration approach.

Support in context
This study shows how job counsellors in the Icelandic SE programme interpreted basic principles, such as selfeligibility, client centeredness, and follow-up support, pointing towards the need for developing their inclusion skills, as suggested previously by Spjelkavik (2012) in his description of SE in the Nordic countries. However, job counsellors' approach of these principles cannot be simply considered an issue of programme fidelity, to be dealt with by programme management. Our study complements traditional fidelity measurements (Lysaght, Cobigo & Hamilton 2012) by directing attention to the qualitative aspects of the context in which job counsellors provide support in order to further our understanding of how SE contributes to work inclusion. Confronted with high case load, shortage of labour market measures aimed explicitly at inclusion, and prejudice from employers, our participants consciously adapted their efforts and ambitions, doing what they perceived as realistically achievable within the circumstances in which they are expected to demonstrate 'success'. This encourages job counsellors to focus on social integration and even reproduce ableist understandings of what constitutes a person who is 'fit to work', instead of recognising diverse competence from a perspective of inclusion (Shier, Graham & Jones 2009). Foster and Wass (2012) developed the notion of 'ideal employee', who meets a number of standards in terms of performance within an environment designed and controlled by non-disabled people. While Foster and Wass (2012) described the 'ideal employee' within the context of work organisations, our study indicates that similar expectations may be found within implementation of SE. 'Ideal employees' fit for SE appear in the context of our study to be those disabled individuals who generally have a higher likelihood of obtaining employment in the labour market as it is and who need relatively limited support or accommodations that are unlikely to upset the expectations of the organisation. Clients who require a more radical rethinking of what a job based on individual preference and competence looks like, and how work can be organised so it enables belonging, socially valued roles, and meaningful social relationships, appeared to be systematically situated as non-ideal employees at intake and during support.
For SE to be a facilitator of work inclusion, its implementation should be guided by attention for the way in which work organisations may create barriers and opportunities in relation to the aspects of inclusion considered in this study. This attention is required not only at the level of programme management, but also within labour market policy. Job counsellors are responsive towards the context in which they provide their support, adapting their views and practices regarding aspects of work inclusion. This underlines the importance of quality assessment of SE not being limited to measures of social integration but taking into account opportunities for work inclusion.

Ethics and Consent
This study was conducted in line with the principles of the Declaration of Helsinki. Approval was granted by the University of Iceland Research Ethics Committee on 15 November 2018 (nr. 18-031).
Written informed consent was obtained from all individual participants included in the study.

Funding Information
This study was conducted as part of the research project 'Rethinking work inclusion for people with intellectual disabilities' funded by the Research Council of Norway ('HELSEVEL' 2018-2020 number 273259).