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Factors of importance in the world of work for young people with intellectual disabilities

Authors:

Veronica Lövgren ,

Department of Social Work, University of Umeå, Umeå, Sweden, SE
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Kerstin Hamreby

Department of Social Work, University of Umeå, Umeå, Sweden, SE
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Abstract

This paper presents a critical synthesis of a selection of national and international research concerning the working life of people with intellectual disabilities who have left special upper secondary school. The 30 studies selected were carried out between 1996 and 2006, and involved two different welfare state models. These studies have been scrutinized and associated with five themes that include factors of importance. The first result that the review indicates is that it is difficult for people with intellectual disabilities to get and keep a job, and the second is that to obtain and keep a job is part of a process in which they are able (and/or should be able) to participate, because the process leads to the normalization of a pattern of life. It seems that the pathway to a job goes via some form of special organized support, which is often found within what is called welfare services/care for the disabled. The review also shows that this topic is mainly studied from a gender-neutral standpoint, and that individual factors are emphasized to a much higher degree than factors related to the environment, such as organizations and attitudes.
How to Cite: Lövgren, V. and Hamreby, K., 2011. Factors of importance in the world of work for young people with intellectual disabilities. Scandinavian Journal of Disability Research, 13(2), pp.91–117. DOI: http://doi.org/10.1080/15017419.2010.490742
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  Published on 02 Dec 2011
 Accepted on 18 Apr 2010            Submitted on 20 Jun 2008

Introduction and aim

Getting a job has not been an easy matter for young people, but it is even more difficult for someone with some form of disability (Public Employment Service 2006; Inghammar 2007; Olsen 2009; SOU 2001:56; Winn and Hay 2009). An intellectual disability further complicates the process of becoming established on the labour market (e.g. Antonsson 2002; National Board of Health and Welfare 2008).

The political cornerstone of Swedish labour market policy for quite some time has been the so-called ‘work ethos’, and this is the same in other countries irrespective of the form of welfare state. Briefly, this ‘work ethos’ stands for the idea that work should be the first choice for people of working age, and that as many people as possible should be able to support themselves (Antonsson 2002; SOU 2003:92; Tideman 2000). ‘The right to work’ is likewise emphasized in the field of policy in relation to the disabled. It is gainful employment that is envisaged in the first instance, although this does not exclude work that is supported by the government in the form of subsidized wages (Public Employment Service 2006), or ‘daily activities’. Daily activity can be performed in special premises or at an ordinary workplace, and can include rehabilitation activities and more production-orientated tasks. A general aim of the strategy is to develop the individual's work capability. According to the National Board of Health and Welfare (2008), the number of young people (22 years and below) in Sweden who were engaged in daily activities increased between 1999 and 2006. The same tendency is shown in other countries, for example Norway (Olsen 2009).

The increasing number of people engaged in daily activities in Sweden, correlates with an increased number of pupils who spend their school years within the framework of the special school (Molin 2004; National Agency for Education 2006, 2008; Tideman 2006). The number of pupils who complete their education at special upper secondary schools in Sweden has doubled over a period of 12 years; an increase that is expected to continue over the next few years (National Agency for Education 2008). There are discussions about why the number of pupils in special schools has increased, with no consensus in the answers. One of the reasons that has contributed to an increase in pupils being transferred to special schools is that an increasing proportion of compulsory school pupils fails to reach the educational targets. One explanation that has been put forward is that the problem lies in the combination of high theoretical goals and fewer resources in the compulsory school system (National Agency for Education 2006). The increasing number of pupils in special schools results in a greater number of men and women seeking entry to the labour market with certificates from special upper secondary school.

People with disabilities have often had an ambiguous relationship to work and have found themselves at a crossroads ‘between two different logics; a logic of care and a labour market logic’ (Olsen 2009, 212). The latter logic assumes that people with disabilities are defined in relation to public employment policies, whereas the logic of care defines them in relation to the world of care. In the case of care they are granted disability benefits and are not dependent on employment to earn their living (Olsen 2009). Daily activities have become a sort of permanent intervention for young people who leave special upper secondary school, and results in exclusion from the labour market (National Board of Health and Welfare 2008). Therefore, the dominant definition is the logic of care (cf. Olsen 2009). Here, there seems to be some sort of paradox at work: the logic of the market is foregrounded, but the care provided by the welfare state is increasing. This leads to questions about the role and impact of the welfare states’ regimes regarding work for young people with intellectual disabilities.

The aim of this paper is to chart and summarize the content and focus of national and international research on the different factors that are of importance for young people who have completed their education at a special secondary school or similar place of education in relation to obtaining and keeping a job.

Method

This critical synthesis covers 26 articles, which have been published in peer reviewed research journals, three doctoral theses and one report. The total of 30 studies come from eight different nations, which have adopted two different welfare state models – the social democratic and the liberal models (Esping-Andersen 1990). Briefly, in the former model the state has an important role as a provider of economic and social welfare, whereas universal benefits are modest and based on services or insurance schemes in the latter. The liberal state generally encourages the market to act as a co-provider of benefits, partly by providing a low level of public services. If we use the typology of Esping-Andersen (1990) we can see that the liberal model is represented by the United Kingdom (UK), the United States (US), Australia and New Zealand, and the social democratic model can be found in Finland, Iceland, Norway and Sweden.

What is of great importance for the accuracy of searches are terms and definitions because they have historical, cultural and social meanings (cf. Hughes 2002; Priestley 2003; Ridell and Watson 2003). The search took place in the databases Academic Search Elite, Album, ERIC, Social Services Abstract, Sociological Abstracts and Web of Science, and used the terms employment, work, occupation, transition, labour market and special needs education in combination with intellectual disability, learning disability, and mental retardation.

Regardless of the actual terms used in the studies (or nations) to refer to the group under study, the term ‘people with intellectual disability’ (ID) is used in what follows. This term is used because of its universal consensus (Gates 2005), and there is a similar social content in belonging to the category with such a designation (cf. Grönvik 2007; Hughes 2002). Unless it is especially obvious that a part of the overview refers to daily activity or some other form of employment, the term ‘work’ refers primarily to work on the regular labour market.

The 30 selected studies came from a multi-disciplinary research field, which includes medicine, pedagogy, psychology, social work and sociology (see Appendix). The survey shows that research concerning work for people with intellectual disabilities is dominated by quantitative studies, the majority of which emanate from the caring or medical research fields.

Of the 30 studies, 21 are from nations that represent liberal welfare states. The studies usually refer to people with mild intellectual disabilities, but there are also studies that refer to people with moderate or severe intellectual disabilities. In some instances groups with other forms of disability are included and in one study the disability is not defined. This study examines wage discrimination and its relation to the levels of prejudice towards disability. The study was included despite the lack of defined disability because intellectual disabilities are often portrayed as a disability highly associated with prejudices.

The period for the search was limited to 1996–2006, and the number of studies was narrowed down by scrutinizing the abstracts and making a selection. After a preliminary naïve reading of the material, the contents were sorted into three broad categories which were intended to reflect the imaginary passage of time during the process: preparing for having a job; getting a job; and the effects of having a job and not having a job respectively. Through a narrative analysis (Bergmark 2008) of the material using the time passage method, five themes were generated which emerged as characteristic. These themes then came to form the foundation of the presentation. The themes are: (1) Work – desirable and important but elusive; (2) Getting established on the labour market; (3) Different forms of support; (4) Political conditions or individual attributes; (5) The significance of gender.

Results

Work – desirable and important but elusive

Having a job is a symbol of adulthood and independence for people with ID and it is the highest valued way of earning a living, regardless of welfare regime. Having a job is also a social badge of citizenship and participation in the community (Kiernan 2000; Stephens, Collins, and Dodder 2005; Tideman 2000). In about half of the studies (see Appendix) it is very clear that it is a good thing for an individual to have a job, and best of all, a job on the regular labour market. Work in itself is presented as something good (Pierce, McDermott, and Butkus 2003), as a route to a higher degree of personal (Luftig and Muthert 2005; Reid and Bray 1997) and financial independence (Båtevik and Myklebust 2006), or as a path to greater self-reliance (Dixon and Reddacliff 2001; Eisenman 2003; Luftig and Muthert 2005). Work has also been seen as a way to avoid ill health (Rose et al. 2005; Taanila et al. 2005) or as a route to increased participation, social inclusion and becoming ‘ordinary’ (Stephens, Collins, and Dodder 2005; Szönyi 2005; West, Wehman, and Wehman 2005).

It would appear that being in employment provides the individual with access to a desired set of circumstances that are expected to create positive individual effects; greater social skills (Fillary and Pernice 2005; Shearn, Beyer, and Felce 2000) and a more comprehensive social network (Forrester-Jones et al. 2004). Forrester-Jones et al. found that a broad social network that does not involve the individual's own family and paid carers can contribute with support and effort. This support, may, in turn, lead to a scenario where fewer personnel are needed (Kiernan 2000). Good relations at work, however, do not guarantee that the individual employee with ID meets her/his fellow workers at social events outside working hours (Dixon and Reddacliff 2001).

Employment on the labour market is not regarded solely as a device for improving social skills. Stephens, Collins and Dodder (2005) argue that physical and cognitive skills are developed in competitive situations. Adaptability and skills for dealing with the physical and social environment are enhanced when people with ID have employment on the open labour market and this is regardless of the initial skill levels of the individual concerned. In contrast, adaptive skills diminish if the person has sheltered work or employment in a segregated environment (Stephens, Collins, and Dodder 2005). Larsson (2006) argues that employees with ID find themselves in a contradictory situation: at the same time as their jobs give them some degree of access to a desired ‘normal pattern of life’ (2006, 172), which helps them to escape from what is felt to be ‘deviant and different’ (2006, 172), they are also dependent on help and support in order to accomplish their work tasks.

The positive view of employment, which is evident regardless of welfare regime, sometimes takes the form of a discourse of normality, in which having a job is seen as a means of living ‘a life like those of other people’ (Larsson 2006, 172). These results indicate that it is desirable and necessary for young people to be prepared to take up their roles as employees at an early stage (Kiernan 2000). In other words, the labour market logic can be seen as the dominating discourse (Olsen 2009). However, the pathway to a job, and primarily one on the regular labour market, appears problematic.

Getting established on the labour market

The theme of half of the studies scrutinized were the difficulties involved when joining the labour market (see Appendix). These difficulties include issues such as the high rate of unemployment (Eisenman 2003; Taanila et al. 2005), the difficulties of getting a job (Båtevik and Myklebust 2006; Forrester-Jones et al. 2004) and of keeping it (Antonsson 2002; Moran, McDermott, and Butkus 2001).

We also found a pattern that can be connected to differences in the welfare regimes. The first example comes from two nations that represent the social democratic model: Sweden and Finland. Both studies show large scale unemployment among people with ID. The study from Sweden (Umb-Carlsson and Sonnander 2006), which focuses on living conditions among people with ID, shows that only 2 out of 110 people with ID had some form of paid work, while the rest participated in daily activity. A longitudinal study from Finland (Taanila et al. 2005) found that a large proportion of the group with ID received disability pension by the age of 34. Even when people with ID were in employment, it tended to take the form of short-term work in low-paid jobs with long periods of unemployment. Structural changes in society, such as a deteriorating economy and high unemployment, affected the group to a greater extent than the ‘normal’ population (Taanila et al. 2005).

The highest degree of employment reported among the studies examined is from the US, where 68% of a pupil population with mild ID had a job. These pupils took part in the special job-training element of an inclusive education programme, which involved being trained alongside pupils without disabilities (Luftig and Muthert 2005). In other studies from the US the reported levels of employment vary widely: from about one fifth of people with ID being in employment (Moran, McDermott, and Butkus 2001; Pierce, McDermott, and Butkus 2003) to almost 40% having jobs five years after leaving special school (Eisenman 2003, reference to Blackbory and Wagner 1996). Moran, McDermott and Butkus (2001) (in the US) state that there is a crushing level of unemployment among people with ID, even though the statistics show higher degrees of employment in the US than in other countries. A study from the UK, another nation with a liberal system, shows a low degree of employment among people with ID: less than 10% of people with ID had jobs (Forrester-Jones et al. 2004).

Moran, McDermott and Butkus (2001) argue that it is a fairly common experience for people with ID to lose their jobs. The factors that determine the duration of employment for people with ID are not personal factors such as intelligence, age and so on, but factors such as the work environment, equal relations (Moran, McDermott, and Butkus 2001) and wage level (Pierce, McDermott, and Butkus 2003). The higher the wage level for people with ID, the greater their chances of long-term employment. Pierce et al. also found that there was little difference in the risk of being made unemployed between groups that had jobs that were exposed to competition and groups who worked in non-competitive jobs. The occupational fields where most individuals held their jobs for three years or more were in restaurant work, the manufacturing industry, handicapped services and the food industry (Pierce, McDermott, and Butkus 2003).

On the other hand, Holmes and Fillary (2000) argue that a personal attribute such as the inability to handle social small talk is often decisive when people with ID have to leave their jobs. Small talk, or social communication, is often used in order to ‘oil the social wheels’ (2000, 277), a function that Holmes and Fillary consider to be a challenge for people with ID.

According to Antonsson (2002), both individual and environmental factors influence the duration of employment. Examples of individual factors are the ability to quickly learn the code of the workplace and to develop feelings of reliability in relation to co-workers. Colleagues can also be seen as important environmental factors, who can provide adequate and long-term support.

Different forms of support

One common route to securing a job, and which half of the studies discuss, is through various forms of support (see Appendix). Support can take the form of instructional sessions, job training prior to leaving school (e.g. Bjarnason 2005; Luftig and Muthert 2005), organized support (Forrester-Jones et al. 2004; Rose et al. 2005; West, Wehman, and Wehman 2005), technical solutions, such as self-instructional tape recorders (Taber, Alberto, and Fredrick 1998), or support efforts from within the disabled person's own family (Dixon and Reddacliff 2001; Reid and Bray 1997).

Two studies from the US and two from the Nordic countries address the issue of different educational pathways for people with ID, and how that affects future adult lives. Kiernan (2000) and Luftig and Muthert (2005) show that integrated education increases the chances for people with ID to gain future employment and increased participation in working life. According to Kiernan (2000), preparatory vocational training and skills development for coping with an independent life should be put into practice as early as the age of 14. By providing young people who have ID with the opportunity to cooperate on questions of future working life and adulthood with other young people who are not similarly handicapped, the development of their identity is strengthened (Kiernan 2000). Luftig and Muthert (2005) state that inclusive education should also include skills training to reinforce and develop the pupils’ prospects of achieving progress in the workplace as well as in life in general. This skills training would include the skills needed for coping with everyday tasks, and not just work-related ones.

The articles from Iceland (Bjarnason 2005) and Sweden (Szönyi 2005) discuss the role of the special school in a different way. It is claimed in these articles that the special school can be seen as a pointer to a future place in society for young people with ID. Szönyi argues that attending special school can involve several different implications that can lead either to participation or to exclusion. Bjarnason (2005) discusses how inclusive and exclusive processes simultaneously influence the pupils’ learning, participation and self-image; processes which affect every disabled pupil's chances of having a choice. Bjarnason argues that the school, very powerfully and regardless of type of functional impairment, leads its young pupils into two different paths. One path leads to a mutually dependent adult life; that is, an ‘adult life with a difference’ and rooted in the ordinary community, while the other path leads to a ‘special world for eternal children’ (2005, 126).

These four examples from special schools include a difference that might reflect the underlying differences in the welfare systems. In the studies from the US, the labour market logic is the main focus, whereas in the studies from Iceland and Sweden there is an ambivalence between the labour market logic and the logic of care (Olsen 2009).

In the studies that deal with different forms of support after leaving school, supported employment (SE) stands out as the most common support device (e.g. Antonsson 2002; Forrester-Jones et al. 2004; Rose et al. 2005). The methodology of SE has its roots in the US (Antonsson 2002; Kiernan 2000) and its liberal welfare system. SE is built on a strict structure with initial assessment and analysis, the listing of interests, job searches, matching, the analysis of work-tasks, training and assistance in the workplace, and includes follow ups. According to Kiernan (2000), a combination of personal networks for finding the job and then natural support in the workplace is most successful. Kiernan also states that the idea that people with ID can only get jobs with large elements of repetitive routine duties and no opportunities for self-advancement is not only misleading, but also based on false premises.

Another form of support is the Best Buddies Jobs Programme (BBJP). BBJP has evolved from earlier traditions and is based partly on SE, and partly on voluntary work between college students and pupils with ID, so-called Best Buddies College Programmes, (BBCP) (West, Wehman, and Wehman 2005). West, Wehman, and Wehman show that the BBJP has led to very good results with respect to wage levels, benefits and the duration of employment when compared with other types of programmes. West, Wehman and Wehman believe that one of the success factors of the BBJP is that the participants in the programme are already established in inclusive social environments and therefore their chances of getting and keeping a job increase. The BBJP-model is highly dependent on voluntary work that is more common in a society with a lower level of public support.

Even though organized support is important, four studies show that the support that young people receive from their own families is also a significant factor (Antonsson 2002; Dixon and Reddacliff 2001; Luftig and Muthert 2005; Reid and Bray 1997). Family effort in the form of practical help and support can be a decisive factor in enabling young people with developmental disorders to get and keep a job (Dixon and Reddacliff 2001). Dixon and Reddacliff show that the parents of people with ID generally devoted a great deal of time and commitment to the support, motivation and encouragement of their children and to make it a top priority to help them to get a job and keep it. Much effort was also devoted to sheltering their adult children from discrimination and exploitation inside and outside the workplace. Although Antonsson's (2002) study was conducted in Sweden, discussions about family support dominate such studies from nations with a liberal system.

Political conditions or individual attributes

Several of the scrutinized studies contain arguments that suggest there is a balancing act between the difficulties faced by individuals and the conditions of society. While the difficulties and obstacles that hinder people from becoming established on the labour market are described as prejudices towards disability (Dixon and Reddacliff 2001) or contraindications in the social system (e.g. Kiernan 2000; Petrovski and Gleeson 1997; Rose et al. 2005), it is usually personal changes that are proposed as the solution (e.g. Taylor et al. 2004; Yanchak, Lease, and Strauser 2005). There is an explicit ambition to change and re-shape the individual to fit in with the patterns and structures that prevail in society and on the labour market (cf. Holmes and Fillary 2000; Stevens and Martin 1999; Stephens, Collins, and Dodder 2005). Such a pattern is the normative significance of having a job, which can, for example, be seen as a route towards making a living and the chance to identify oneself as an adult (e.g. Båtevik and Myklebust 2006; West, Wehman, and Wehman 2005). However, a significant way of seeing it is as one of the threads in an overarching ideology of integration in which participation in the labour market is an indication of participation in the community (e.g. Dixon and Reddacliff 2001; Kiernan 2000; Stephens, Collins, and Dodder 2005; West, Wehman, and Wehman 2005).

An emphasis in some of the studies (e.g. Forrester-Jones et al. 2004; Kiernan 2000) is that the authors’ home countries have adopted political goals that declare access to the labour market as a universal right, or that their governments have ratified the UN's standard rules that guarantee the participation and equality of people with disabilities. How the individual governments go about this varies. For example, it may take the form of (anti)discrimination legislation (Kiernan 2000; O'Hara 2004). However, several studies show that public policy is not the same as practice or results (e.g. Dixon and Reddacliff 2001; Moore, Fiest-Price, and Alston 2002; Pierce, McDermott, and Butkus 2003). Labour market policy and policies concerning the disabled may both stipulate that all citizens have the right to work, but competing regulations may have quite different implications and contradictions occur among different social codes within the society (e.g. Forrester-Jones et al. 2004; Kiernan 2000; Pierini et al. 2001).

The manifestations of these contradictions could involve the idea that it is financially advantageous to draw a pension or welfare benefit rather than take a job (Rose et al. 2005), because the jobs that are available are low-skilled (Moran, McDermott, and Butkus 2001), low-paid (Kiernan 2000; Pierce, McDermott, and Butkus 2003; Taanila et al. 2005), or because the pension or welfare allowance is withdrawn once the client becomes employed, even if it is only a part-time role (Reid and Bray 1997).

Beliefs about the ability to work are generated from the interplay between society and the individual. Yanchak, Lease and Strauser (2005) found a correlation between the individual's ideas about her/his own capability and identity as a member of a gainfully employed occupational group, and success in the world of work. The researchers found no correlation between different types of disabilities and occupational identity, but Yanchak, Lease and Strauser found that individuals with ID have significantly less positive beliefs concerning a career compared to individuals with physical disabilities. According to Yanchak, Lease and Strauser, this way of thinking may be the result of people with ID having more problems with making decisions, or it may have to do with their difficulty in explaining the way in which their disability affects their work (Yanchak, Lease, and Strauser 2005).

Some studies focus on individual qualities. One example from Eisenman (2003) refers to a number of studies that argue that people with disabilities and low self-confidence when leaving school have less likelihood of getting a job, and that this applies particularly to women. Another individual quality is motivation, by which Kiernan (2000) and Reid and Bray (1997) mean that among the group of people with ID there are many highly committed and well-motivated workers. Rose et al. (2005) found that self-motivation was the only significant factor that could predict the results of support in seeking work for people with ID. The more the staff of the support organization assessed the clients’ initial degree of motivation, the better was the likelihood that the client would get and keep a job. Rose et al. argue that a high degree of motivation can have several effects: it may mean that the client commits herself/himself more strongly during the job hunt and at job interviews, or that the support organization's staff are inspired to make greater efforts. Another result of the study was that the degree of motivation decreased as the support programme went on.

One way for individuals to deal with their experiences of the balancing act between inclusive and exclusive tendencies is to develop different forms of strategies (Ringsby Jansson, and Olsson 2006) or by becoming ‘ordinary’. According to Szönyi (2005), becoming ‘ordinary’ is the process whereby pupils in special upper secondary schools develop strategies for dealing with the experience of being regarded as deviant while simultaneously adopting an attitude of participation, normality and self-esteem. Szönyi argues that becoming ordinary includes a range of different attitudes to activities that are associated with welfare services for the disabled and special rights. These attitudes range from taking full advantage of public special care services for the disabled to a very determined rejection, and are combined with a goal of being able to live alongside those who are regarded as being ordinary. One group of special upper secondary school pupils described their deviance as temporary and expressed ideas about gradually becoming more like others and being ordinary. In another environment, for example a workplace, they would no longer be regarded as out of the ordinary because that was something that was temporarily associated with being placed in a special school (Szönyi 2005).

When the difficulty of keeping a job, which many people with ID have experienced, comes under discussion, the discussion is clearly focused on the individual personal characteristics. These characteristics may include, for example, gender, ethnicity, IQ, age and behavioural disorders (Moore, Fiest-Price, and Alston 2002; Moran, McDermott, and Butkus 2001; Stephens, Collins, and Dodder 2005), or difficulties with social interaction via social small talk (Holmes and Fillary 2000). Factors that are external to the individual, such as the workplace organization or the attitudes of colleagues, are seldom mentioned in cases where people with ID lose their jobs.

The significance of gender

The fifth and final theme identified was that of sex/gender (we will use the term sex when it is clear that the authors describe the biological sex and the term gender when the study uses this term or when the actual study does not consider the power relation in their analysis. We will use a combination of the terms when it is necessary to include both aspects). Two all-embracing aspects of sex/gender and people with ID have been identified in the studies. The first aspect includes a number of studies of the relationship between sex/gender and work for people with ID. These studies show that sex is either of no importance (Pierce, McDermott, and Butkus 2003; Rose et al. 2005) or that sex/gender is a factor of significance for getting a job (e.g. Båtevik and Myklebust 2006). The second and more common aspect is to have a gender-neutral approach, which means either that sex is not present as a category, or that it is present but treated as if it was of no importance (e.g. Caton and Kagan 2006; West, Wehman, and Wehman 2005). Examples of no significance being ascribed to gender come from Holmes and Fillary's (2000) study of small talk in the workplace. The study was carried out exclusively in workplaces with male employees, a fact that is not discussed or problematized. The researchers discuss their results concerning the difficulties that they identified with small talk as if they applied to all people with ID.

Other studies show that being a woman has a negative influence on the prospects of getting a job (Moran, McDermott, and Butkus 2001; Shearn, Beyer, and Felce 2000), and that more women with ID have jobs in the service sector than men (Reid and Bray 1997; Tideman 2000). Shearn, Beyer, and Felce explain that the reason that women experience difficulties in getting a job is that the available jobs with low threshold requirements are traditionally regarded as suitable for men, and that the staff and parents of people with ID regard it as more important to arrange jobs for men. In other words, the people involved in the situation have stereotyped ideas about sex/gender and work. This explanation is also supported by Umb-Carlsson and Sonnander (2006), who comment that it is not the people with ID who have chosen the occupational field for themselves, but those around them like staff and parents who have guided people with ID into traditional sex-typing.

In two of the reviewed studies there was an explicit aim of clarifying the gender perspective for people with disabilities (O'Hara 2004; Umb-Carlsson and Sonnander 2006). O'Hara found that women with disabilities suffer double wage discrimination and that the discrimination applies to both sex and disability. O'Hara found strong indications that women whose disabilities were regarded with a higher degree of prejudice (such as ID for example) received lower wages in a new job compared with women without disabilities and women whose physical disabilities aroused less prejudice. Wage discrimination took place regardless of the degree to which work performance was restricted. Umb-Carlsson and Sonnander (2006) found few differences in living conditions between men and women with ID and suggest that this finding indicates that people with ID are treated as gender-neutral people.

In an overview of special education school-to-work literature, Eisenman (2003) found no support for the idea that being female damages the individual's prospects of finding employment. She suggests instead (without a discussion about gender stereotypes) that the reason why men and women have different labour market participation is that women enter earlier into parenthood than men do. A similar explanation is proposed by Båtevik and Myklebust (2006). They found that women had less success than men in getting a job, and that many of the women had children early on in life. Båtevik and Myklebust also found that formal qualifications increased young men's chances of getting a job, whereas the women in the study were more favoured if their education included an element of work experience.

Discussion

The aim of this paper is to chart and describe the content and focus of research concerning the working life of young people with ID, and who have left special upper secondary school. The picture that emerges shows that gaining access to the labour market is not easy. It is also quite clear that a job is desirable and highly valued by both the individual and society, and this result can be found in different forms of welfare state regime. It would seem that obtaining a job and keeping it is difficult for people with ID. A job is also an avenue to a gender specific, normalizing pattern of life. Work and employment are not viewed as a problem but are ‘good in themselves’, and it seems that a broader social network, higher degrees of independence, participation in the community and a life that is more like those of ‘everyone else’ can be achieved through work (e.g. Forrester-Jones et al. 2004; Kiernan 2000). However, work in itself is no guarantee of participation in social life and working conditions have sometimes excluding tendencies (e.g. Larsson 2006; Petrovski and Gleeson 1997).

A number of the studies in the overview provide an account of ideological starting points such as de-institutionalization, normalization and the UN's standard rules for securing participation and equality for people with disabilities. Furthermore, the introductions to these studies focus on relations (e.g. Forrester-Jones et al. 2004; Luftig and Muthert 2003; Reid and Bray 1997; Rose et al. 2005; Stephens, Collins, and Dodder 2005; Yanchak, Lease, and Strauser 2005). There is an implicit sub-text to the effect that the environment is important and that people with ID often encounter obstructive and segratory attitudes, which can produce more negative consequences than the impairment itself. The environment in the form of current conceptions and social norms has been discussed as though it is non-permissive and inflexible. However, when analysing factors that obstruct or facilitate the labour market for people with ID, it is the individual factors that matter (e.g. Holmes and Fillary 2000; Stephens, Collins, and Dodder 2005; Yanchak, Lease, and Strauser 2005). It is in the individual that the ‘problem’ is located and thus it is the individual qualities that are operationalized and incorporated as variables in statistical analyses, or as Grönvik (2007) explains it, it is the bodies that are measured and estimated. The organization and structures, attitudes and treatment, are seldom operationalized and problematized irrespective of the welfare system in question.

The extent to which people with ID have jobs varies markedly in the studies presented (e.g. Luftig and Muthert 2005; Umb-Carlsson and Sonnander 2006). However, a common factor, regardless of welfare system, is that the employment level of people with ID is low and that it is sensitive to economic fluctuations. Therefore, in times of economic retrenchment and high general unemployment, people with ID occupy the most exposed positions (Kiernan 2000; Taanila et al. 2005).

It seems that the pathway to a job, insofar as one exists, goes via some form of special organized support, and often within welfare services/care for the disabled. Depending on the welfare system, care for the disabled differs in both form and quality (public welfare service or private voluntary efforts).

The highest employment levels are shown in studies from the US and the Supported Employment method is frequently used as a form of organized support effort. The US with its liberal system model relies to a great extent on the market as a co-provider of benefits and the provision of low levels of public services. There are differences between the two liberal nations because the US has higher levels of employment among people with ID than UK does. According to Palme, there are aspects that make Europe different from the US and one is the degree of inclusion of different groups into the programmes of social protection. This inclusive strategy could, according to Palme, be seen as the essence of the European strategy (Palme 2001, 36). Another difference is how healthcare is organized. Scholnick (2005) argues that the UK maintains a universal system, which is more like the social democrat model, whereas the US has adopted a ‘liberal’ means-tested programme (Scholnick 2005).

This study has also pointed out contradictions within nations’ own social systems. These contradictions can be viewed in two ways: firstly, as a paradox between a labour market logic and a logic of care (Olsen 2009), which can be seen in the social democratic model, and secondly as a result of the rules of the market, which infers that the market does not provide benefits to those who are not productive.

To use sex/gender as a category is one way of spotlighting similarities and differences in the conditions of life for women and men, but it is not particularly common in research that focuses on disabilities (Kristiansen and Traustadóttir 2004). Few studies in this review refer to sex/gender, and most studies deal with their topic from a gender-neutral standpoint as though sex/gender and differences in conditions because of sex did not exist. Sex/gender has a biological dimension, but to belong to a sexual category also means to adhere to a set of different normative social ideas about what is considered normal and what is considered deviant (Hamreby 2004; Priestley 2003). Ideas about what it means to be a man or woman with ID are influenced by cultural norms that vary over time and space, and these cultural norms have various effects on how life is lived and how we view ourselves and are viewed by others. It would therefore be of interest to study how the social theories about ID and gender interact with one another in order to deepen the understanding of how working life is experienced by young men and women with intellectual disabilities.

Light has been shed on several areas but it has also become clear that there are many research areas that have not been in focus yet. It would be interesting to broaden the research into cultures outside the Anglo-Saxon countries, and to include more analyses of how living conditions of people with ID differ according to different welfare state models. It is the individual's shortcomings that tend to be exposed in the studies, and less often the environments. It is likewise important to scrutinize the obstacles and opportunities that are created via the encounter with the environment, both in the direct encounter and the conditions of the organisation.

Appendix: Overview of the articles and reports included in the article

Authors and publishing year Nation and research institute Aim Method Population of study Value of work Individual and environmental difficulties Support Relation to gender/sex
Antonsson, Sivert, 2002 University of Uppsala, Sweden Describe decisive occurrences for youth with disabilities against the labour market Qualitative interviews 21 young persons with different disabilities Work highly valued, hard to get and maintain Discuss a mixture of both individual and environmental factors Supported employment Different gender/sexes in the population, not discussed
Bjarnarson, Dóra S. 2005 University of Education, Reykjavik, Iceland Describe and discuss the students perspectives of their experience of participation in school Qualitative in-depth semi-structured interviews, 36 young adults with, varied severe impairments, 27 still in school   Discuss how school environment leads pupils in to different ways Inclusive and exclusive schooling Different gender/sexes in the population, not discussed
Båtevik, Finn Ove and Myklebust, Jon Olav, 2006 Möre Research, Volda univ. College/Möre Research, Norway Discuss circumstances that affect how successful former students with special educational needs are in gaining a foothold in the job market Longitudinal study of information gathered from schools in six different counties 494 former students with special educational needs Work important, e.g. financial independence, creating identity Individual difficulties depended on functional level Cooperation between school and local business Gender not the main focus but became an important conclusion; different pathways for young men and women caused by different choices
Caton, Sue, Kagan, Carolyn, 2006 Dep. of Psych. and Speech Pathology, Manchester Univ. UK Assess of the transition towards adult life for school leavers with mild intellectual disabilities A combin. of longitudinal design and triangulation, interviews, observations All school leavers 1998 in three different schools, n=90. The group in the end n=23   Discuss the attrition from the final year at school as a potential loss from the label disability, discussed in terms of loss of service   Gender/sex differences; male school leavers harder to locate, not discussed in gender terms
Dixon, Roselyn, Reddacliff, Chaterine, 2001 Faculty of Nursing, University of Sydney, Australia Examine the contributions witch families made to success young adults competitive employments Qualitative semi-struct. interviews, modified life history, demographic data cross checked with parents and staff. Eight male and seven female participants with mild ID, age from 19–30 Competitive work to increase vocational skill and develop identities as workers   Family support, practical assistance, moral support and protection The sex is differentiated but not discussed
Eisenman, Laura T. 2003 School of Education, University of Delaware, Newark, USA Summarize current research, identify theories, make connections to school-to-work theories outside special education, suggest shape of future research Review and synthesis of transitions literature Special education and school-to-work transition literature Work highly valued, primary indicator of adult success, hard to get     Some gender differences in chances to get a job, explained by women make different choice about career, not discussed
Fillary, Rose, Pernice, Regina 2005 School of Health Sciences, Massey University, New Zealand Identify inclusive characteristics in eight work environments and to assess inclusion levels of people with and without intellectual disabilities Used Hagner′s Workplace Culture Survey, 31 questions relating in five areas against workplace Nine supported workers with intellectual disabilities and nine co-workers without disabilities   Work place culture important. Workers with higher support needs is less included on the workplaces   The sex is differentiated, not discussed
Forrester-Jones, Rachel Jones, Samantha, Heason, Sophie, Di′Terlizi, Michele 2004 Tizard Centre, Univ. of Kent at Canterbury, Dept. of Psych, Univ. of Sheffield, UK Map changes in social network size, membership and social support provided, following one year of supported employment The composition and quality of individuals' social networks mapped using a Social Network Guide. Quantified interviews 18 individuals who entered Bridge Employment, a supported employment agency in Sheffield Work to maintain network size and be a way to meet others then professionals and family   Supported employment agency The sex is differentiated, not discussed
Holmes, Janet, Fillary, Rose 2000 Univ. of Wellington, Eastern Instit. of Tchnology Hawke′s Bay, New Zealand Analyse tape- recorded workplace small talk. Points out where workers with intellectual disabilities could get trouble Collecting tape-recorded interactions from different workplaces, the collecting done by volunteers from each workplace. 84 interactions collected in workplaces there young male workers with intellectual disabilities had been placed Employment central of participation in community Individual difficulties with ‘social small talk’, no environmental issue discussed   Only studied male workplaces, not discussed gender bias
Kiernan, William 2000 Institute for Community Inclusion, Univ. of Massachusetts, Boston, USA Overview the status of employments for people with ID Review of literature about Supported Employment Adults with ID Employment gives economic independence, social identification and increased network Discuss changes in workplace, social systems and attitudes toward people with ID Supported employment  
Larsson, Per Olof, 2006 Dep. of Social work, Univ. of Gothenburg Sweden Study integration in work and daily activity amongst people with ID Combined quantitative observation and qualitative interviews (case studies) Six persons in daily activity and three persons in wage-supported employment Work highly valued, a way to ‘normal’ life patterns   Support in the workplaces The sex is differentiated, not discussed
Luftig, Richard, Muthert, Dorothy, 2005 Dep. of Educational Psych., Miami Univ., USA Investigate how special needs graduated have fared in their employment careers 16-item questionnaire to the participants 36 individuals with special needs studies behind them Work hard to get, work a way to independent life Individual difficulties Inclusionary school with vocational and technology training The sex is differentiated, not discussed
Moore, Corey L., Feist-Price, Sonja, Alston, Reginald 2002 Langston Univ., Univ. of Kentucky, Univ. of Illinois, USA Examine the relationship between race, vocational rehabilitation services and rehabilitations outcomes Quantitative analysis of statistic data from vocational services database 188 African Americans or European Americans with severe or profound ID   Individual difficulties, also discussed that then ID more severe the underrepresented culture have more negatively outcome Vocational rehabilitation The sex is differentiated, not discussed
Moran, Robert, McDermott, Suzanne, Butkus, Stanley 2001 Univ. of South Carolina, Dept. of Disabilities and Special Needs, Columbia, USA Report some findings about getting a job, sustaining a job and losing a job Statistical analysis of data from Local Board of job programme, training, register data from Dep. of Disabilities and Special Needs 7750 individuals with ID, aged 19–64 years Work hard to get, easy to lose, ‘over-whelming underemployment’ Individual difficulties, discuss that it is important for policy- makers to adopt a strategy for progress   The sex is differentiated, shows that men have easier to get a job but no further gender discussion
O′Hara, Brett 2004 Social Security Administration Baltimore, USA Examine wage discrimination against women with disabilities during the initial employment process Longitudinal data from Survey of Income and Programme Participation Women without disabilities, with disabilities that elicit little prejudice, and with disabilities that elicit more prejudice   Discussed social obstacles and barriers   Analyse in a gender perspective, women with disabilities is twice penalized
Petrovski, Pandora, Gleeson, G. 1997 Dept. of Psychology Univ. of Western Sydney, Australia Examine job satisfaction in association with physiological health in workers with an intellectual disability who had secured competitive employment position In-depth semi-structured interviews 31 workers with a mild ID, aged between 18–41 years Job satisfaction influences life satisfaction Discuss how negative attitudes to disability will make handicapped persons adjustment more difficult   Analyse of gender, no differences in job satisfaction, females greater loneliness at work
Pierce, Kristen, McDermott, Suzanne, Butkus, Stanley 2003 Univ. of South Carolina, Columbia, Dep. of Disabilities Columbia, USA Describe job tenure and wages for people with mental retardation and factors affecting movement from non-competitive jobs to competitive jobs Register data from Dep. of Disabilities an Special Needs New hire in 1997, age 19–64, IQ between 20–80, no autism, $50 or more earned per week, residential care Employment as a key goal for people with ID It is no big differences in several characteristics that predicts maintaining at work, level of initial wage a important predictor   Sex/gender as a variable, no differences in job tenure and wages between female and male
Reid, Patricia, Bray, Anne 1997 Nelson Polytechnic Donald Beasley Institute, New Zealand Sought the opinions of workers, supporters, employers, and offer strategies for greater employments rates Participant research, semi-structured interviews 17 successful workers with ID and 11 others key persons whom the seventeen had pointed out Work highly valued by the persons themselves and by the community   Support very important, both by work support agencies and by family Gender is not the main issue but the study involves and discuss gender differences in type of work, outdoors for men and indoor for women
Ringsby Jansson, Bibbi Olsson, Sören 2006 Univ. of Gothenburg Trollhättan/Uddevalla Univ., Sweden Show how different life patterns have been created among young people with ID Semi-structured interviews with professionals, and participating observations and interviews with 23 young with ID The interviews provides an overall picture amongst 60 young with ID, the observations amongst 23 of the 60 Structural changes in welfare system implies larger force to participate in the labour market Differentiated life patterns amongst young people with ID, depending on changes in society   Gender is not the main issue but the study involves and discuss gender effects
Rose, John, Katie Saunders, Hensel, Elisabeth, Kroese, Biza Stenfort 2005 School of psychology, University of Birmingham, UK Identify factors that may affect the likelihood that people with ID will find employment through a supported employment agency Retrospective analysis of files of individuals who has use an supported employment agency The files of 200 clients (men 83%) who had most recently left the supported employment agency Work implies a positive effect on the mental and physical health, work hard to get A brief description of environmental factors such as discrimination and ‘benefit traps’ but the main conclusion is about the individuals own motivation Supported employment agency Sex/gender is one variable, not discussed further although the dominance of male clients in the study
Shearn, Julia, Beyer, Stephen, Felce, David 2000 Welsh Centre for Learning Disabilities Applied Research Unit, UK Evaluate differences in outcomes and cost-effectiveness between SE and traditional day service activities for people with high support needs Comparing the costs and outcomes for service in workplaces and daycentre People with ID over 18 and at least one add. disability, seven with part-time employment and seven with day centre care     Supported employment and traditional special needs day centre Bias in gender representation in the two groups, discuss gender differences in general but not in the study
Stephens, Dawn, Collins, Michael, Dodder, Richard 2005 Division of Social and Behav. Sciences, William Penn Univ., Oklahoma Univ., USA Examine whether employment and inte-grative types of employment are instrumental factors of change in adaptive skills and presence of challenging behaviours Quantitative and longitudinal, following individual through move-ment across types of employment 2760 individuals with developmental disabilities in Oklahoma who were receiving services 1997–98 Employment valued, social integration, economic benefits and increased well-being Strong relationship between the level of integrative employment and adaptive skills   Differenced gender/sex, one remark that it is easier for white males to get a job, no further discussion
Stevens, P., Martin, Neil 1999 Dep. of Psychology, Lambeth Healthcare NHS Trust, London, UK Overview of supported employment and its historical context, discuss SE for individuals with both ID and challenging behaviour, briefly outline a work model Based on previous work in the field and discuss against theory about challenging behaviour Directed to staff who would work with people with ID an challenging behaviour and their way to employment Work highly valued for sense of identity and status in society   Supported employment  
Szönyi, Kristina, 2005 University of Stockholm, Sweden Increase the knowledge about the pupils experience from special school Qualitative interviews, in group and individually 24 pupils in special school, aged between 7–22 year   Discuss attitudes and prejudices from the environment, the individuals urge of being treated as ‘normal’   Differenced sex, not discussed
Taanila, Anja, Rantkalliio, P., Koiranen, M., von Wendt, L., Järvelin, M-R. 2005 Univ. of Oulu, Finland, Univ. of Helsinki, Finland, Dep. of Epidem. and Public Health, London, UK Study how many individuals with ID in an age cohort where not receiving a disability pension by the age of 34 and what their life situations was like in terms of employment, education an morbidity Collect obtained data on employment, education, pensions and morbidity from national registers Age cohort of 1966, 129 individuals with intellectual disabilities and 147 individuals with borderline IQ, all in the age of 34 years. Work highly valued, to avoid marginalization and ill-health. Work is hard to get for people with ID Only individual attributes are measured   Differenced sex, no further discussion
Taber, Teresa A., Alberto, Paul, A., Fredrick, Laura D. 1998 Dep. of Educational Psych. and Special Education, Univ. of Atlanta, USA Compare the effectiveness of single- and multiple-word auditory prompts, determine if useful to teach workers with ID Videotaped observations of how the pupils handles the prompts – time and success statistically analysed Five pupils, aged 16–18 with moderate ID, integrated in high school and participated in vocational training   Individual difficulties Technical support in terms of self-operated auditory prompts The sex is differentiated, not discussed
Tideman, Magnus 2000 Dep. of Social Work University of Gothenburg Sweden Study a community reform and their consequences for children, youth and adults with ID A combination of modified life level studies and qualitative interviews, collected as a collective case study 1991=516, 1995=429 adults with ID (at least 331 persons cooperate in both) and 1991=284 1995=356 parents to children with ID   Social categorization as disability=creating process, the increased number of pupils in special school is mainly explained with the comprehensive school cutbacks   Discuss briefly traditionally differences between the sexes, explained as individual circumstances
Umb-Carlsson, Öie, Sonnander, Karin 2006 Dep. of Neuroscienc, Uppsala Univ, Dep. of Public Health, Uppsala Univ., Sweden Compare living conditions of men and women with ID and relate the results among the general population in corresponding age group Questionnaire to relatives or staff of people with ID. Register information on living conditions of the general population 112 persons with ID gave their informed consent Work hard to get   Supported daily activities Discuss few differences in living conditions between men and women amongst people with ID compared to the general population
West, Michael, Wehman, Paul Brody, Wehman, Paul 2005 Rehab. research, Virginia Common-wealth Univ, Richmond, James Madison Univ., Harrison- burg, USA Describe two programmes designed to enhance social and employment opportunities for individuals with ID. Present implications for the field Comparing and describe two programme in two major cities Persons with ID who participate in programmes for integrate them in schools on all levels, in business and industries Work high valued and important – status, financial possibilities, decreases stigma, interaction with other, and independency Main focus on environmental factors and the importance to provide prejudices by creating opportunities to one-to-one friendships Supported employment and Best Buddies Jobs, a development from Best Buddies from college settings  
Yanchak, Kristen, Lease, Suzanne, Strauser, David 2005 Depart of Counselling, Psychology and Research, University of Memphis, USA Comparing dysfunctional career thoughts and perception of vocational identity for individuals with cognitive an physical disabilities An initial interview and two survey instruments, demographic information by register verified in the interview 90 individuals with disabilities, receiving vocational evaluating service (46 with cognitive and 44 with physical disability) Work hard to get for people with disability Discuss that people with disabilities have more difficulties with career decision-making in terms individual difficulties   The gender/sex is differenced, not discussed

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