Anja Holwerda

Predictors for Work Participation in Individuals with an Autism Spectrum Disorder: A Systematic Review

Introduction Research shows that only about 25% of people with autism are employed. Method We conducted a systematic review on factors facilitating or hindering work participation of people with autism in longitudinal studies. An extensive search in biomedical and psychological databases yielded 204 articles and 18 satisfied all inclusion criteria. We assessed the methodological quality of included studies using an established criteria list. Results Seventeen factors were identified and categorized as disease-related factors, personal factors or external factors. Limited cognitive ability was the only significant predictor consistently found for work outcome. Functional independence and institutionalization were both reported by one study to be significantly related to work outcome. Inconsistent findings or non significant findings were reported for the other fourteen factors. Conclusion These findings emphasize the need for more high quality cohort studies focussing on work participation as the main outcome among people with Autism.

Predictors of work participation of young adults with mild intellectual disabilities

Individuals with intellectual disabilities (ID) are three to four times less often employed compared to their non-disabled peers. Evidence for factors associated with work participation of young adults with ID is limited. Furthermore, studies on predictors for sustainable work participation among young adults with ID is lacking altogether. Therefore, the aim of this study was to investigate which factors predict finding as well as maintaining employment of young adults with mild ID. We obtained data on 735 young adults with mild ID, aged 15-27 years, applying for a disability benefit. The follow-up period ranged from 1.25 to 2.75 years. Motivation, expectations regarding future work level and living situation predicted finding work as well as maintaining employment for at least 6 months. In this study, especially personal factors were influential in predicting work outcome and may be suitable factors to include in interventions.

Predictors of sustainable work participation of young adults with developmental disorders

For individuals with autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) work participation is a challenge, as shown by their low employment rates. The aim of this study was to investigate which factors predict work participation, finding work as well as maintaining employment, of young adults with ASD as well as ADD. We obtained data on 563 individuals with ASD and/or ADD, aged 15-27 years. The follow-up period ranged from 1.25 to 2.75 years. Being male (for ADD), living independently (for ASD), expecting to be able to work fulltime (for ASD and ADD), high perceived support from parents and perceived positive attitude of parents regarding work (for ASD and ADD) and perceived positive attitude of social environment (for ADD) predicted finding work by the young adult, while being male (for ADD) and higher age (for ASD and ADD) and positive attitude of social environment regarding work (for ASD) predicted maintaining employment. Both personal and social factors predict work outcome and should be taken into account when supporting individuals with DD in their transition to work.

Work-ability assessment in young adults with disabilities applying for disability benefits

Purpose: To investigate the impact of diagnosis, co-morbidity, secondary conditions (e.g. learning problems, subclinical mental and somatic complaints, addictions, and socio-emotional and behavioral problems) and problems in social context on work ability as assessed by Insurance Physicians (IPs) in young adults applying for a disability benefit. Method: IPs of the Social Security Institute assessed young adults with disabilities (aged 15–27) applying for a disability benefit (n = 1755). Data were analyzed with multilevel ordinal regression techniques. Results: Primary diagnosis, co-morbidity and subclinical mental complaints were associated with IP-assessed work ability. Persons with mental health conditions as primary diagnosis were less likely to reach a higher work ability than persons with somatic diseases. Young adults with two or more co-morbid conditions and those with psychiatric or developmental co-morbidity were less likely to reach a higher work ability level than persons without co-morbidity. Young adults with subclinical mental complaints were half as likely to reach a higher IP-assessed work ability than young adults without this condition. Conclusion: Primary diagnosis, type and number of co-morbid conditions and subclinical mental complaints are associated with IP-assessed work ability. Work-ability assessments among adolescents with disabilities applying for disability benefits still focus mainly on medical factors. Implications for Rehabilitation Work participation of young adults with disabilities is limited. Young adults with disabilities often need support to be able to function in social and economic life. Adequate work ability assessment of young adults with disabilities and subsequent support may help to improve their participation rates.

Collaboration between mental health and employment services to support employment of individuals with mental disorders

Abstract Purpose: The aim of this study was to investigate the extent of the interdisciplinary collaboration between mental health (MHS) professionals and social security professionals (SSI), their perceptions of this interdisciplinary collaboration and whether these perceptions differed between professionals of the two organizations. Method: We obtained data from mental health professionals and social security professionals in the context of a national agreement between MHS and SSI to improve the collaboration between MHS professionals and SSI professionals in the support of individuals with mental disorders to improve work outcome of these individuals. Results: Mental health professionals as well as SSI professionals reported a moderate level of interdisciplinary collaboration, which does not seem to be affected by demographic variables, such as age, gender, profession and region. When professionals collaborated in a structural way they were more positive regarding their interdisciplinary collaboration with professionals of the other organization than professionals that collaborated in an ad hoc manner. Conclusions: Interdisciplinary collaboration was perceived as moderate by collaborating mental health professionals and social security professionals. In order to improve the collaboration between MHS and SSI on a local microlevel, organizations need to facilitate more structural collaboration between the professionals. Implications for Rehabilitation Collaborating mental health professionals and social security professionals perceived their interdisciplinary collaboration as moderate. In order to improve the collaboration between mental health services (MHS) and vocational rehabilitation services on a local microlevel, organizations need to facilitate more structural collaboration between the professionals. Integrated services with the participation of MHS as well as vocational rehabilitation services, e.g. to share client information and to refer clients to each other, need to be developed. A national agreement between MHS and vocational rehabilitation services is a good starting point to improve collaboration between both the sectors.

312 Predictors of work participation of young adults with mild intellectual disabilities

Objectives Unemployment rates among individuals with Intellectual Disabilities (ID) are three to four times higher compared to their non-disabled peers. Evidence for factors associated with work participation of individuals with ID stems from a limited number of cross-sectional studies. Furthermore, studies on predictors for sustainable work participation among young adolescents with ID are lacking altogether. Therefore, the aim of this study was to investigate which factors predict work participation, finding work as well as sustainable employment, of young adults with mild intellectual disabilities. Methods We obtained data on 735 individuals with mild ID, aged 15–27 years, applying for a disability benefit at the Dutch Social Security Institute. Participants completed a questionnaire on personal and social factors at baseline, which were linked to registry-data regarding work outcome. The follow-up period ranged from one year and three months to two years and nine months. Cox regression (survival) analyses were conducted in order to examine which factors predicted work participation. Results Living situation, expectation regarding future work level and self-esteem all predicted finding work as well as sustainable employment for at least 6 months for individuals with mild intellectual disabilities. Motivation was only related to finding work. Conclusion Personal and social factors are valuable in predicting finding work as well as sustainable employment. As this study is the first prognostic study to our knowledge to assess the predictive value of personal and social factors related to work outcome in this group, further research is needed to establish the predictive value of the factors found.

Jongeren met beperkingen en arbeidsvermogen op de arbeidsmarkt

SamenvattingWerkloze jongeren met beperkingen en arbeidsvermogen vallen vanaf 2015 onder de Participatiewet en onder verantwoordelijkheid van gemeenten. Een deel van hen heeft in het verleden een aanvraag voor de Wajong gedaan. In dit onderzoek is een groep van 44 afgewezen Wajong-aanvragers tot twee jaar na afwijzing gevolgd. Tijdens hun aanvraag en ruim een jaar na de Wajong-aanvraag is hun arbeidsmarktpositie, ervaren gezondheid, werkmotivatie en zelfinzicht in kaart gebracht. Uit de resultaten blijkt dat de Wajong-aanvragers zich ruim een jaar na afwijzing gezonder voelen, gemotiveerder zijn om te werken en meer zelfinzicht hebben dan tijdens hun aanvraag. Het blijkt echter ook dat slechts 9% van hen erin slaagt om binnen twee jaar een vaste baan te bemachtigen en dat bijna de helft ofwel uit beeld van UWV en gemeente is verdwenen, ofwel niet of nauwelijks ondersteund wordt in het vinden van werk. De groep van afgewezen Wajong-aanvragers blijft een kwetsbare groep op de arbeidsmarkt, ondanks dat zij aangeven zich gezond te voelen, gemotiveerd te zijn en over voldoende zelfinzicht te beschikken. Ondersteuning voor deze groep is daarom van groot belang, ook in het kader van de Participatiewet.AbstractYoung adults with disabilities and capacity to work at the labor market. A study on work participation, perceived general health and psychological factors of young adults who unsuccessfully applied for a disability benefit. Due to the Participation Act, municipalities are responsible for jobless young adults with disabilities and capacity to work since 2015. In this longitudinal study 44 people were followed for two years after their unsuccessful application for the Invalidity Insurance Act for Young Disabled Persons. At baseline and more than one year later their labor market position, perceived general health, work motivation and self-knowledge was measured. Results show that they reported a better health status, more motivation to work and more self-knowledge one year after their application than at the time of their application. However, only 9% had a stable job after two years and almost half of them was completely out of sight of the Social Security Institute and the municipality and/or received no substantial support in trying to find a job. Hence, this group remains very vulnerable on the labor market, in spite of their relatively high levels of perceived general health, work motivation and self-knowledge. Support for this group to find and retain work is therefore of utmost importance, also under the Participation Act.

Samenwerking tussen GGZ en UWV gericht op re-integratie van mensen met een matige tot ernstige psychische stoornis

SamenvattingAlhoewel uit literatuur blijkt dat werk een therapeutisch effect kan hebben voor personen met psychische aandoeningen, is binnen deze groep sprake van hoge werkloosheid en stijgende arbeidsongeschiktheidsaanvragen. Ondersteuning door multidisciplinaire teams lijkt een positief effect te hebben op arbeidsparticipatie van deze groep. Deze studie heeft bestaande samenwerkingsinitiatieven tussen GGZ-instellingen en UWV-kantoren gericht op re-integratie van mensen met een matige tot ernstige psychische stoornis geïnventariseerd. Uit de studie bleek dat de meerderheid van zowel GGZ-respondenten als UWV-respondenten samenwerking belangrijk vindt. De samenwerking bleek echter veelal ad hoc plaats te vinden en nog niet structureel in de organisaties te zijn ingebed. Gebleken is dat structureel overleg, kennisuitwisseling en casuïstiekbespreking tussen professionals van GGZ en UWV een belangrijke factor is in het in stand houden van en inhoud geven aan de samenwerking. Het is van belang dat zowel GGZ- als UWV-professionals concrete handvatten aangereikt krijgen voor verdere samenwerking.SummaryAlthough the therapeutic effect of employment on mental health has been known for a long time, unemployment rates and disability benefit claims are high among individuals with mental disorders. Evidence suggests that multidisciplinary teams have a positive effect on employment outcomes of these individuals. Therefore, the aim of this study was to investigate the interdisciplinary collaboration between mental health professionals and social security professionals regarding the work integration of people with moderate to severe mental disorders. Most mental health professionals as well as social security professionals indicated that interdisciplinary collaboration was important to them. Nevertheless, most existing collaboration initiatives were found not to be structurally embedded in their organizations. However, structural meetings with knowledge exchange and case history discussions between both professionals is an important factor in maintaining the collaboration. Both professionals should receive practical suggestions for further collaboration.

Een systematisch literatuuronderzoek naar voorspellers voor arbeidsparticipatie van personen met een autismespectrumstoornis

TBV 20 / nr 9 / november 2012 kennis in de werkomgeving was belemmerend, wat soms leidde tot een negatieve houding ten opzichte van het functioneren van (ex)kankerpatiënten. Tot slot vertelden sommige deelnemers dat ze weinig steun hadden gekregen van hun bedrijfsarts of leidinggevende bij de werkhervatting. Haaks op deze bevindingen rapporteerden andere deelnemers weer veel steun van hun werkomgeving als bevorderend. Deze steun bestond onder andere uit begrip krijgen en goede afspraken maken over werkhervatting. Tot slot maakten sommige deelnemers melding van het feit dat na verloop van tijd het lastig was om een balans te vinden tussen ‘normaal’ gevonden willen worden en toch wat extra begrip en steun nodig te hebben, om hun werk goed te kunnen uitvoeren.