Frameworks describing the transition to open labour employment for persons with mild and moderate intellectual disability: a scoping review protocol

Introduction

Persons with intellectual disability (ID) represent about 1%–2% of the global human population,1 which may be an underestimate considering ‘…there is no clear indication of the level of uniformity of the definition or the comprehensiveness of national data’.2 According to the World Health Organisation (WHO) and World Bank (2011), ID is the world’s most prevalent disability.3 The Diagnostic and Statistical Manual of Mental Disorders (fifth edition) characterises ID as deficits in intellectual functioning, for example, reasoning, problem solving, academic learning, planning and abstract thinking, resulting in impairment to the person’s adaptive functioning ability (the age-appropriate behaviours necessary for people to live independently and to function safely and appropriately in daily life), including communication, social participation, academic or occupational functioning and personal independence at home or in community settings.4 Persons who have ID and the resulting adaptive functioning impairments are disabled when their access to full participation in all aspects of life is denied and their rights and needs (including different kinds, levels and types of support) are not upheld by society.5

There are four levels of severity of ID, namely mild, moderate, severe and profound.4 These levels are differentiated on the basis of adaptive functioning that determines the level of support required. For the purpose of this study, the specific population that will be referred to will be those persons with mild and moderate ID (MMID) who attended special schools before the age of 18 years and are currently at home, in sheltered or protective workshops or working in open labour market employment. Persons with ID with moderate to high support needs in South Africa have not been assessed as suitable for employment.

Persons with ID have the right to participate in all aspects of society as equal citizens, be afforded equal opportunities to realise their full potential and make meaningful contributions within their communities and society.6 These rights include the right to gain and maintain employment in an accessible work environment that they have freely chosen, where they feel accepted and receive necessary reasonable accommodations and support.5 6 Not only is competitive employment a form of financial benefit for persons with ID, but it also lessens the economic demand on the government, is associated with personal development and provides opportunities for social development, self-esteem and identity development.7

The South African Commission for Employment Equity states in its Annual Report (2021/2022) that the representation of persons with disabilities in the unskilled occupational level as compared with the economically active population was around 1.2% with representation in the semiskilled occupational level being 1.3%.8 This is significantly lower than the 7% employment equity target for persons with disabilities that was aimed for in the White Paper on the Rights of Persons with Disabilities policy directive target for 2015–2019.5

It is a challenge for persons with ID to find and maintain employment due to barriers such as limited formal education and skills; lack of vocational training and work experience; underdeveloped infrastructure; discrimination; lack of reasonable accommodation and resources; misconceptions and prejudice about the capability to perform certain jobs; negative attitudes and organisational cultures that are dismissive and prejudicial; how ‘inclusion’ is defined; and a high unemployment rate of a poorly skilled workforce.2 5 9–12

Many different mechanisms have been used globally to address barriers to the open labour market for persons with disabilities, for example, “…laws and regulations, tailored interventions, vocational rehabilitation and training, self-employment and microfinance, social protection and working to change attitudes’.3 Evidence of the costs, benefits and outcomes of the various mechanisms is not useful and highlights the need to research cost-effective and sustainable strategies that will improve competitive employment for people with disabilities.3 There is currently no framework in South Africa that is contextually relevant and considers the unique employment support needs and accommodations of persons with MMID, which can guide and inform the transition to employment interventions, strategies and national policy directives.

A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews and the Joanna Briggs Institute (JBI) Evidence Synthesis was conducted to ascertain if there are any reviews currently underway exploring transition to work frameworks for persons with ID. Cheng et al reported on strategies that can be used to support people with ID to obtain and maintain employment.13 Engelbrecht et al
14 reported on work transitioning of youth with disabilities into competitive employment. However, this preliminary search found no published scoping or systematic reviews that are currently underway that explore existing local and international frameworks, including guidelines, models, strategies, programmes and interventions, for the transition of persons with MMID into open labour market employment.

Although the various vocational rehabilitation strategies employed in South Africa have varying levels of success in ensuring the inclusion of persons with ID in open labour market employment, there are no studies that have mapped and synthesised the different elements of these strategies, programmes and interventions to highlight the gaps to inform the development of future employment transition frameworks.

Therefore, a synthesis of the body of evidence that is currently available in the area of work transition practices is needed to inform the development of an evidence-based, transition to employment framework for persons with MMID. A scoping review of the available body of literature on frameworks, including guidelines, models, strategies, programmes and interventions, describing the transition to open labour employment for persons with MMID is proposed. The objective of this scoping review is to identify, describe, map and synthesise the available peer-reviewed literature on open labour market employment transition frameworks (including guidelines, models, strategies, programmes and interventions) that will result in open labour market employment for persons with MMID.

Methods and analysis

Of the various systematic approaches that can be used to review published literature describing the transition to open labour market employment transition frameworks, including guidelines, models, strategies, programmes and interventions, for persons with MMID, we chose to undertake a scoping review. Scoping reviews can be used to determine the scope or coverage of literature on a topic; to give a clear overview of the volume of literature and studies available; provide an overview of its focus; and identify research gaps.15 16 The proposed scoping review will be guided by the enhancements to the methodological framework by Arksey and O’Malley,15 and its advancements by Levac et al,17 as were developed by a working group from the JBI and the JBI Collaboration.18 The study commenced in April 2023 and is due to end in September 2024.

Scoping review question:

  1. What current peer-reviewed studies describe and evaluate open labour market employment transition frameworks, including guidelines, models, strategies, programmes and interventions, that aim to facilitate the transition of persons with MMID into employment in the open labour market?

Scoping review objectives:

  1. To explore the types of employment transition frameworks, including guidelines, models, strategies, programmes and interventions, that are being implemented and evaluated around the transition into open labour market employment for persons with MMID?

  2. To synthesise the key findings related to research evidence regarding transition into open labour market employment transition frameworks, including guidelines, models, strategies, programmes and interventions, for persons with MMID?

  3. To synthesise research evidence regarding the characteristics or factors that underpin the transition to open labour market employment transition frameworks, including guidelines, models, strategies, programmes and intervention, for persons with MMID?

Inclusion criteria

The inclusion criteria were categorised according to population (participants), concept and context, as recommended by the JBI for scoping reviews.

Participants

  • Studies that focused on the transition process of persons with a primary diagnosis of MMID.

  • Any gender.

  • Studies that focused on the primary diagnosis of the individuals being ID.

  • Studies focused on persons with MMID who were old enough to begin planning their transition into adulthood (ie, 16 years and older).

Concept

  • Studies that describe and evaluate employment transition frameworks, including guidelines, models, strategies, programmes and interventions, that facilitate the transition of persons with MMID into open labour market employment that were carried out between 2012 and 2023.

  • Persons with MMID who achieved employment or supported employment in the open labour market after their participation in the transition intervention process.

  • All types of employment transition frameworks, including guidelines, models, strategies, programmes and interventions, (eg, post-school education programmes, training programmes, work experience programmes, job coaching, building community partnerships) as well as their modes of delivery (eg, classroom-based training, one-on-one job coaching, support groups), setting in which they take place (community, school, protective workshop), leadership (government led, non-governmental organisation led, family led) and duration.

  • Full text.

  • Peer-reviewed journal articles.

  • Literature published in English.

Context

  • Clinical, community or virtual settings where transition into open labour market employment processes for persons with MMID are taking place.

  • All countries and economic settings will be included in the study.

  • Quantitative, qualitative and mixed-methods study approaches will be considered for inclusion.

Exclusion criteria

Excluded from the study will be all forms of review studies, studies published in any language other than English; studies that focused on persons with a specific learning disorder, or other neurodevelopmental disorder, as defined by the Diagnostics and Statistics Manual-5 (APA, 2013)4; studies that included people with other diagnoses, for example, autism spectrum disorder, that did not differentiate the findings specifically for persons with MMID; studies that need purchasing prior to viewing; as well as studies that do not describe the transition to open labour market employment process for persons with MMID.

Search strategy

This study followed the recommendation from the JBI to use a three-step search strategy in order to search for literature describing the open labour market employment transition process for persons with MMID.18 The first step will be an initial search of two relevant online databases, namely Academic Search Ultimate and CINAHL Plus using the title of this review. An analysis of the text words contained in the title, abstract and index terms of the sources retrieved was conducted and these words will be used in the second phase full search strategy for all relevant online databases and platforms. The databases or platforms that were searched include EBSCOhost search platform (where seven databases will be searched simultaneously—MEDLINE, Health Source: Nursing/Academic Edition, CINAHL Plus, Academic Search Ultimate, Health Source—Consumer Edition, ERIC and APA PsycArticles), ScienceDirect, SAGE, SCOPUS, Sabinet African Journals and Cochrane Library. The full search strategy is detailed for all databases in online supplemental appendix 1. In the third phase of the search, the reference lists of articles selected for inclusion in the study will be examined for possible inclusion (reference mining). Following the database search, all identified sources will be uploaded to Covidence (Veritas Health Innovation, Australia) and duplicates will be removed. Titles and abstracts will then be screened by one independent reviewer (TLdT) for assessments against the inclusion criteria for the review. The full text of the selected studies will go through a detailed assessment against the inclusion criteria by three independent reviewers (TLdT, MSS and LW). One of the full-text reviewers (TLdT) will assess all full-text articles selected and the included articles will also be assessed by reviewer LW. Those full-text articles excluded by reviewer TLdT will be assessed by reviewer MSS. Disagreements will be resolved by discussion and where no agreement can be reached, a third independent reviewer (MSS for included studies and LW for excluded studies) will be consulted for further discussion. Reasons for exclusion of full-text papers that do not meet the inclusion criteria will be recorded and reported on in the final scoping review. The results of the search will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram (figure 1).19 A quality appraisal of included studies will be conducted using the Mixed Methods Appraisal Tool 2018 version by Hong et al (2018).20

Supplemental material

Figure 1
Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.19

Data charting

Data will be charted from papers included in the scoping review by one independent reviewer (TLdT) and assessed by two independent reviewers (MSS and LW) using a data charting instrument developed by the reviewers. A draft data charting instrument has been developed to record the characteristics of the included studies and the key information relevant to the review question (please refer to online supplemental appendix 2). This instrument was adapted from the JBI scoping review data charting instrument template to answer the review question.18 The data chart will include specific details, inter alia: citation details; country; population; context (eg, clinical, community or virtual); study aim/s; participants; study design; data collection methods; employment transition type and outcome measure/s. If required, modifications to the data charting instrument will be made and revised during the data charting process of each included study. All modifications made will be detailed in the full scoping review. If any disagreements arise between reviewers (TLdT and MSS), these will be resolved through discussion with a third reviewer (LW). Authors of papers will be contacted to request missing or additional data, where required. If authors do not respond to the request, a decision to include or exclude the article will be made based on the information available.

Supplemental material

Data analysis and reporting of results

The data chart will be analysed descriptively and thematically. Descriptive summaries containing demographic characteristics of included studies will be presented using tables and charts. Thematic analysis will be used to integrate the different identified open labour market employment transition processes for persons with MMID. The results will be presented following the main categories used in the data charting instrument. A checklist for protocol submission guidelines, adapted for use in this scoping review from Peters et al,21 has been completed (online supplemental appendix 3).

Supplemental material

Public and patient involvement

Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

This post was originally published on https://bmjopen.bmj.com