Factors in Studying Employment for Persons with Disability: How the Picture can Change 1787146065, 9781787146068

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FACTORS IN STUDYING EMPLOYMENT FOR PERSONS WITH DISABILITY: HOW THE PICTURE CAN CHANGE

RESEARCH IN SOCIAL SCIENCE AND DISABILITY Series Editors: Barbara M. Altman and Sharon N. Barnartt Recent Volumes: Volume 1: Expanding the Scope of Social Science Research on Disability
Edited by Sharon N. Barnartt and Barbara M. Altman, 2000 Volume 2: Exploring Theories and Expanding Methodologies: Where We Are and Where We Need To Go
Edited by Sharon N. Barnartt and Barbara M. Altman, 2001 Volume 3: Using Survey Data to Study Disability: Results from the National Health Interview Survey on Disability
Edited by Barbara M. Altman, Sharon N. Barnartt, Gerry E. Hendershot and Sheryl A. Larson, 2003 Volume 4: International Views on Disability Measures: Moving Toward Comparative Measurement
Edited by Barbara M. Altman, Sharon N. Barnartt, Gerry E. Hendershot and Sheryl Larson, 2006 Volume 5: Disability as a Fluid State
Edited by Sharon N. Barnartt, 2010 Volume 6: Disability and Community
Edited by Allison C. Carey and Richard K. Scotch, 2011 Volume 7: Disability and Intersecting Statuses
Edited by Sharon N. Barnartt and Barbara M. Altman, 2013 Volume 8: Environmental Contexts and Disability
Edited by Sharon N. Barnartt and Barbara M. Altman, 2014 Volume 9: Sociology Looking at Disability: What Did We Know and When Did We Know It
Edited by Sara Green and Sharon N. Barnartt

RESEARCH IN SOCIAL SCIENCE AND DISABILITY VOLUME 10

FACTORS IN STUDYING EMPLOYMENT FOR PERSONS WITH DISABILITY: HOW THE PICTURE CAN CHANGE EDITED BY

BARBARA M. ALTMAN Disability Statistics consultant, Rockville, MD, USA

United Kingdom
North America
Japan India
Malaysia
China

Emerald Publishing Limited Howard House, Wagon Lane, Bingley BD16 1WA, UK First edition 2017 Copyright r 2017 Emerald Publishing Limited Reprints and permissions service Contact: [email protected] No part of this book may be reproduced, stored in a retrieval system, transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without either the prior written permission of the publisher or a licence permitting restricted copying issued in the UK by The Copyright Licensing Agency and in the USA by The Copyright Clearance Center. Any opinions expressed in the chapters are those of the authors. Whilst Emerald makes every effort to ensure the quality and accuracy of its content, Emerald makes no representation implied or otherwise, as to the chapters’ suitability and application and disclaims any warranties, express or implied, to their use. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN: 978-1-78714-606-8 (Print) ISBN: 978-1-78714-605-1 (Online) ISBN: 978-1-78714-992-2 (Epub) ISSN: 1479-3547 (Series)

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CONTENTS INTRODUCTION: EMPLOYMENT AND PERSONS WITH DISABILITIES

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PART 1 RELATIONSHIP OF GENDER AND OTHER SOCIODEMOGRAPHICS TO WORK ROLE CHAPTER 1 EMPLOYMENT OUTCOMES AMONG MEN AND WOMEN WITH DISABILITIES: HOW THE INTERSECTION OF GENDER AND DISABILITY STATUS SHAPES LABOR MARKET INEQUALITY David Pettinicchio and Michelle Maroto

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CHAPTER 2 WHO GOT EARNED INCOME? HEALTH AND OTHER BARRIERS TO EMPLOYMENT FOR YOUNG MILLENNIALS IN HUD-ASSISTED AND OTHER RENTAL HOUSING Barbara A. Haley and Aref N. Dajani

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CHAPTER 3 TO WHAT EXTENT DOES DISABILITY DISCOURAGE FROM GOING ON THE JOB MARKET? EVIDENCE FROM ITALY Tindara Addabbo, Jaya Krishnakumar and Elena Sarti

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PART 2 DISABILITY INCLUSION STRATEGIES AND INTERVENTIONS CHAPTER 4 THE COMPLEXITY OF DISABILITY INCLUSION IN THE WORKPLACE: A SOUTH AFRICAN STUDY Nceba Ndzwayiba and Lieketseng Ned

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CONTENTS

CHAPTER 5 MODEL OF SUCCESSFUL CORPORATE CULTURE CHANGE INTEGRATING EMPLOYEES WITH DISABILITIES Douglas Waxman CHAPTER 6 A SYSTEMATIC REVIEW OF VOCATIONAL INTERVENTIONS FOR YOUTH WITH PHYSICAL DISABILITIES Shakira Hanif, Halie Peters, Carolyn McDougall and Sally Lindsay

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PART 3 WORK ROLE AND WELL-BEING CHAPTER 7 PEOPLE WITH PHYSICAL DISABILITIES, WORK, AND WELL-BEING: THE IMPORTANCE OF AUTONOMOUS AND CREATIVE WORK Robyn Lewis Brown, Mairead Eastin Moloney and Gabriele Ciciurkaite CHAPTER 8 DISABILITY AND COMMUNITY LIFE: MEDIATING EFFECTS OF WORK, SOCIAL INCLUSION, AND ECONOMIC DISADVANTAGE IN THE RELATIONSHIP BETWEEN DISABILITY AND SUBJECTIVE WELL-BEING Sara E. Green and Brianna Vice

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PART 4 THE FUTURE OF WORK CHAPTER 9 DISABILITY AND THE FUTURE OF WORK: A SPECULATIVE ESSAY Richard K. Scotch and Charles E. McConnel

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ABOUT THE AUTHORS

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INDEX

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INTRODUCTION: EMPLOYMENT AND PERSONS WITH DISABILITIES In the literature about employment among persons with disabilities, research results depend on the purpose of the definitions of work disability, the discipline within which it takes place, the model or paradigm of disability in which it is framed and the cultural context in which the employment occurs (Lederer, Loisel, & Rivard, 2014). The definition and the measurement of the conceptual elements of the definition of disability incorporates a variety of approaches and provides different results to the employment question. For example, the use of a functional limitation measure to identify the group with disability creates a larger population and somewhat different one than the use of a measure of participation, be it social or employment related, or the use of a self-proclaimed disability identity. This volume seeks to address those factors which have made describing, and examining the work experience of a person with a disability difficult. We encouraged authors to examine how employment for persons with disabilities has been defined, conceptualized and measured in practice, in policy decision making, in various industries, and in various social science research disciplines. We had hoped to get a variety of approaches to the conceptualization of work for those with disability, how they evolved over time or how they differ across cultures, organizations, and types of disability. What you get in this volume is the beginning of the examination of the variety of contextual framing of employment for those with disability, the well-being factor that employment provides and the continued impact as well as the interaction of gender, poverty and education and other socioeconomic characteristics on the workplace participation. While we didn’t expect to get all that we asked for we did receive and present in this volume an interesting range of what are important factors in employment for persons with disabilities from a rather wide perspective as well as the classic examinations of opportunities and barriers. Also we received exploration of these issues from a wide range of cultural contexts from South Africa to Italy. We also got observations from a variety of disciplines including Occupational Therapy, Sociology, Economics, Human Resources, Law, and Health Care Science. We hope this volume will begin to broaden the social science perspective to examine some very important aspects of the work situation that do not get as much attention in the general social science literature. For example: vii

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1. How does the organizational culture, which includes norms, traditions, values, and beliefs, impact the disabled worker? Are organizational cultures different across size, type or purpose of the organization? Do these impact the employee with disabilities differently and how do they impact the nondisabled workers as well? 2. How does organizational structure influence the work experience of a disabled worker? Does size, type, or purpose of the organization contribute to the accessibility of the job, discrimination on the job, the ability of the worker to advance, or the ability to maintain tenure? 3. What impacts the social dimension of a person’s work experience when they have a disability? What kinds of relationships with colleagues, supervisors and clients are experienced and how do the types of work environments or social or cultural constraints influence those relationships? 4. How does the definition and measurement of the population with a disability influence the levels of employment? Does a functioning limitations definition and measure which identifies the person as “at risk” to experience discrimination or other barriers in the work place give a more realistic picture of employment or is being unable or limited in ability to work the better definition and measure? How does severity of the limitation or the duration of the problem factor in? 5. What and where are the physical barriers/physical supports to the inclusion of persons with disabilities in the work setting? Are the issues workload, tools, chemicals or other processes, table heights, computer programs, repetitive motion requirements, lifting or carrying, communication issues, etc.? How balanced are the barriers compared to the supports? 6. What are the mental/emotional/behavioral factors that can be barriers/ supports to the inclusion of persons with disabilities in the work setting? What kind of demands are made and what kinds of stress or pressure are created in the workplace related to time, performance or productivity and other factors that would measure a person’s success? What kind of autonomy and control of tasks or schedules are available to the person in the job? What help is available? 7. How do age, gender, race, education, or type of disability influence employment outcomes. Does it make a difference if one lives in a rural area, or urban. What impact does transportation have on the employment equation? Does the sector of the country or the type of cultural/religious norms embraced by the country, or whether the country is developing or undeveloped impact opportunities to be employed? (adapted from Lederer et al., 2014). There are also big picture influences on work disability that are influenced by the sociodemographics of the culture. For example, an aging society may mean that more jobs
but certain types of jobs
are available than people to

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fill them, or there may be residual effects from an economic recession. Finally, cultural attitudes and norms related to gender (“women should not be in the work force”), race, or the appropriateness of a particular type of work can also subtly influence the employment of persons with a disability. One volume can’t possibly raise all the issues but it raises some of them and is an important step in identifying and exploring the many gaps in our employment knowledge as well as encouraging continued research. We have made a start in addressing these gaps and encourage the fields of social science to continue to pursue these issues. This volume addresses four important areas of employment: (1) The impact of intersectionality on employment and income for persons with disabilities; (2) Disability inclusion strategies and interventions; (3) How employment contributes to well-being; and (4) The future of employment for the population with disabilities. Below, I explore several of the cross-cutting issues that this volume identifies as well which can also contribute to the elaboration of employment problems.

Definition and Measurement of Disability Although a more standardized definition and measurement of disability has been established in the United States in leading census, health, and employment surveys sponsored by the Federal Government once again we are faced with a variety of definitions and measures of the disability population in the submissions to this volume. Since this is such an international group of papers that is not unexpected. However, readers should keep in mind that the definitions and measures vary somewhat extensively although there is a strong minority that have used a functional limitation definition and measure. The definition and measurement of the population is an important element for the generalization and interpretation of these papers about work and should always be kept in mind. An examination of the measurement of disability as reflected by indications of limitations in physical, mental and emotional functioning referred to as Basic Actions in Altman and Bernstein (2008) differs considerably from measures of participation which is identified as Complex Activities in the same work. In the United States, the measures of Complex Activities (inclusion in social activities, work and other participation activities) identifies 14.3% of the population ages 18 and above while a measure based on Basic Actions identifies about twice as much of the population ages 18 and above, 29.5% (Altman & Bernstein, 2008). When we apply those two different definitions and measures to employment we find that only 23.3% of those measured by Complex Activities had a job in the last week while 41.9% of those who were measured by Basic Actions worked last week (Altman & Bernstein, 2008; p. 63). This demonstrates the key role that definition and measurement play in elaborating the employment issues addressed.

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So, for example, the Hanif, Peters, McDougall and Lindsey (Chapter 6) paper limits their scoping analysis to papers that address vocational interventions for young people with physical conditions defined by such conditions as spinal cord injuries, cerebral palsy, amputation, juvenile rheumatoid arthritis, neuromuscular disease, scoliosis, movement disorder, muscular dystrophy, spina bifida, or stroke. They do not seem to include vision or hearing disorders or cognitive or mental health problems. On the other hand the Addabbo, Krishnakumer, and Sarti (Chapter 3) paper uses a broader functional limitations measure that includes sensory limits, intellectual and emotional limitations and of course mobility problems. The Pettinicchio and Maroto paper (Chapter 1) uses both a participation measure (limitations in work) as well as a functional limitation measure reflecting the standardized measure now in place in federal surveys in the United States. The Haley and Dajani (Chapter 2) also use the standardized measure as it appears in the American Housing Survey along with an indicator of fair or poor health. Finally, Scotch and McConnel in their essay about the future of work for persons with disabilities (Chapter 9) use the umbrella term “disability” as defined in the International Classification of Functioning, Disability and Health (ICF) to represent the population with impairments, activity limitations or participation restriction as elaborated in the American’s with Disabilities Act (ADA). Small surveys are used in the well-being papers (Chapters 7 and 8) which both interestingly enough take place in Florida. The emphasis in those two studies is primarily on basic actions or limitations in physical functioning, although Chapter 7 has a strong ADL/IADL element. The case study from South Africa (Chapter 4) also approaches the definition and measurement more along ICF lines concerned with impairment, activity limitation and participation limitation.

Intersectionality of Gender and Disability At least two of the chapters take a very extensive interest in the interaction of gender and disability as it impacts employment (Chapters 1 and 3). Both studies identify the important interaction effects between gender and disability, especially how it effects income for those fortunate enough to be in the workforce. The universality of this gender/disability interaction is demonstrated by the fact that one of the studies took place in the United States and the other in Italy. By highlighting how different types of disabilities interact with gender to produce varying degrees of negative labor market outcomes, the authors of Chapter 1 documents a hierarchy of disadvantage where women with multiple and cognitive disabilities continually have the lowest employment rates and earnings levels. When “all covariates were held at their means, men without disabilities had an employment rate of 82% and average earnings of

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$59,000 per year, but men with multiple disabilities had an employment rate of 17% and average earnings of $37,000” (Pettinicchio and Maroto, Chapter 1). The analysis showed that women with multiple disabilities had a 16% employment rates and earnings of $29,000, putting them at the very bottom of the hierarchy. The case study (Chapter 4) has also approached intersectionality from a different perspective. In that chapter the organization studied realized that its diversity initiatives focused primarily on race and gender but failed to recognize how these identities intersect with (dis)ability amongst other identity categories and the impact those intersections may have on employment. So factors such as race, gender and class intersect to situate persons with disabilities in social positions of either privilege or oppression. In the South African context the effects of the apartheid stratification can render black women in townships of rural areas marginalized across the intersections of race, gender, class and disability. The authors of Chapter 4 indicate that the organization studied was mindful of the interactions and attempted to include those in the formulation of strategies in order to construct a comprehensive and coherent disability mainstreaming approach. Chapter 2 additionally addresses the intersection of poverty with disability as it affects earned income using variables associated with housing support, food stamps and receipt of public assistance to identify the poverty status. While the analysis is limited to heads of households who are millennials (aged 19
25) it captures important indications of the transition period when young adults with disabilities attempt to follow the expectations for all adults of employment and earning a wage.

Type of Employment An important finding by Presser and Altman (2002) about employment in the 24 hour economy indicated that more than one-fifth of employed persons with disabilities work late or rotating shifts, about the same percentage as nondisabled workers and receive wages similar to those of their nondisabled counterparts. So the types of work schedules as well as the types of actual work (manufacturing, desk jobs or service provision) of the employment that is available is important to take into consideration. However, it is not just holding a job that is considered important in the big picture but whether that job contributes to the well-being of the person. In Chapters 7 and 8 the well-being of the person with the disability is examined in relationship to either the autonomy or creativeness of the job (Chapter 7) or just having a job and/or social inclusion (Chapter 8). Access to autonomous and creative work has been found to be important for the whole population. The authors of Chapter 7 document that such types of work are sought after by the population in general indicating that engaging in interesting work and having autonomy in the job are ranked higher or equal

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to income among preferred job characteristics. Because persons with disabilities tend to have a higher incidence of depression the authors of Chapter 7 sought to explore whether or not having interesting work and job autonomy could also lift the well-being of those who have a disability and work. In Chapter 8, the authors only investigated the impact of any kind of job on well-being. They found that differences in subjective well-being were explained by social inclusion of any kind and economic factors. Adaptive equipment, companion and caregiver services while important to facilitate social participation are also costly and only partially covered by insurance or government programs. The findings indicate less well-being for the population with disability because of the social and economic limitations they face.

Reciprocal Impacts: Person on Organization, Organization on Person Some of the research in this volume examines the bigger picture of the organizational setting and the impact of the organizational values and strategies. Chapter 4 examines a case study of a health care organization’s approach to increasing employment of persons with disabilities. Chapter 5 examines literature about organizations to establish a model of useful interventions and practices and Chapter 6 is a scoping review of vocational interventions for young people transitioning to the work environment. In Chapter 4 it is important to have country legislation that encourages inclusion of persons with disabilities in employment, but that is really found to be insufficient to produce the desired changes alone. The anti-discrimination and fairness paradigm that results from legislation acknowledges that prejudice can keep marginalized groups out of employment but does not address the organizational cultural changes necessary to make the inclusion of “others” part of the organizational diversity. This ownership by the organization itself shifts the desire for mainstreaming disability internally rather than as an outward compliance with externally forced legislation. In some ways Chapter 4 becomes an actual case study of the model elaborated in Chapter 5 which emphasizes the internal organizational components essential to improving disability employment. In Chapter 5 the model that is generated to successfully employ persons with disabilities also indicates a need for a change in organizational beliefs and culture. The model indicates that the starting point for improved employment of persons with disabilities is for senior management to recognize the business advantage in hiring persons with disabilities for both social responsibility and productivity. Such a vision must be communicated throughout an organization for managers and common employees so that eventually there is a cultural change for the whole organization. Once senior management makes the commitment to diversity and inclusion other employees throughout the

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organization need to receive disability awareness training to sensitize them to the circumstances so they appreciate the need for accommodations and mentoring. At the same time the person with disability needs to be evaluated and held accountable like any other employee thus promoting job necessary expectations and improving relationships with co-workers. While Chapter 6 focuses more narrowly on youth with physical disabilities, this review of the literature also records the numerous barriers to inclusion for that group as for the larger groups discussed in Chapter’s 4 and 5. Similar issues of discrimination, lack of accommodations are also documented. While the review indicates that good research and evidence on interventions are limited, the pattern of intervention are not dissimilar from those found in the case study (Chapter 4) and the organizational intervention model (Chapter 5), but focus on the preparation and training of the youth rather than within the organization where the jobs take place. As such, the interaction of the vocational interventions for the youth with the organizations which supply the jobs appears to be a missing piece. While the model in Chapter 5 does include the use of vocational organizations to provide the persons with disability who can be employed none of the chapters seem to elaborate on how the vocational programs and organizations with jobs can effectively interact. That can be the subject of another volume.

Similarity of Cross Cultural Impact The papers included in this volume come from Canada, the United States, Italy and South Africa and yet they seem to emphasize the commonality of the problems associated with employment for people with disabilities regardless of country or continent. As mentioned above Chapter 4 seems to be a case study demonstrating the model developed in Chapter 5, yet the model was written by a Canadian and based on a review of international literature (including Scandinavian, Australian, European and American) and Chapter 4 is a case study of a health care organization in South Africa. In the same way Chapters 1 and 3 use data from the United States or Italy and yet the results while organized by different disciplines provide very similar findings. While Chapter 1 is more focused on the actual interactionality of gender and disability the findings are similar in Italy. Age, education and marital status effects are also very similar.

Future of Employment The last chapter of the volume looks to the future and the potential for employment as the transition to a more technological and service based economy

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continues. While work disparities related to employment for persons with disabilities have continued over recent years and even possibly declined the authors of Chapter 9 explore the changes in the context and types of work as we move forward into the future and examine how they feel the population with disabilities will or will not be included in that future workforce. Advances in assistive technology and telecommunications may make work for persons with disabilities more easily accessible. However the changing nature of the economy and the types of work that will be available in the future may also negatively impact employment for persons with disabilities. On the one hand global competition, deregulation and the growth of the service sector in the Uber or Airbnb directions have created sharp changes in where and how work is accomplished. However, automation, computers, telecommunications are demanding fewer physical skills but greater intellectual ones requiring greater education and more flexibility in a variety of tasks. Even the 24 hour provision of services makes work different and not tied to when the sun is up which can be another influence on what, when, where employment is available for the person with disability or all persons who want and need to work. This paper raises a lot of research questions and insights into how the world of work is changing and may or may not change the conception of work for everyone not just those with disability. Barbara M. Altman Editor

REFERENCES Altman, B., & Bernstein, A. (2008). Disability and health in the United States, 2001-2005. Hyattsville, MD: National Center for Health Statistics. Lederer, V., Loisel, P., & Rivard, M. (2014). Exploring the diversity of conceptualizations of work (dis)ability: A scoping review of published definitions. Journal of Occupational Rehabilitation, 24, 242
267. Presser, H., & Altman, B. (2002). Work shifts and disability: A national view in. Monthly Labor Review, 125(9), 11
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PART 1 RELATIONSHIP OF GENDER AND OTHER SOCIODEMOGRAPHICS TO WORK ROLE

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CHAPTER 1 EMPLOYMENT OUTCOMES AMONG MEN AND WOMEN WITH DISABILITIES: HOW THE INTERSECTION OF GENDER AND DISABILITY STATUS SHAPES LABOR MARKET INEQUALITY David Pettinicchio and Michelle Maroto ABSTRACT Purpose
This chapter assesses how gender and disability status intersect to shape employment and earnings outcomes for working-age adults in the United States. Methodology/approach
The research pools five years of data from the 2010
2015 Current Population Survey to compare employment and earnings outcomes for men and women with different types of physical and cognitive disabilities to those who specifically report work-limiting disabilities. Findings
The findings show that people with different types of limitations, including those not specific to work, experienced large disparities in employment and earnings and these outcomes also varied for men and women. The multiplicative effects of gender and disability on labor market outcomes led to a hierarchy of disadvantage where women with cognitive or multiple disabilities experienced the lowest employment rates and earnings levels.

Factors in Studying Employment for Persons with Disability: How the Picture can Change Research in Social Science and Disability, Volume 10, 3
33 Copyright r 2017 by Emerald Publishing Limited All rights of reproduction in any form reserved ISSN: 1479-3547/doi:10.1108/S1479-354720170000010003

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However, within groups, disability presented the strongest negative effects for men, which created a smaller gender wage gap among people with disabilities.

Originality/value
This chapter provides quantitative evidence for the multiplicative effects of gender and disability status on employment and earnings. It further extends an intersectional framework by highlighting the gendered aspects of the ways in which different disabilities shape labor market inequalities. Considering multiple intersecting statuses demonstrates how the interaction between disability type and gender produce distinct labor market outcomes. Keywords: Disability; gender; intersectionality; labor market inequality

INTRODUCTION Despite protections from equal rights and antidiscrimination legislation, women and people with disabilities are still disadvantaged in the labor market. Even though women have increased their participation in the labor force and made large gains in education since the 1970s, a gender wage gap exacerbated by childcare responsibilities remains (Blau & Kahn, 2006; DiPrete & Buchmann, 2013; England, 2010). Among people with disabilities, labor force participation has declined over the last 30 years, and there is considerable variation in employment rates by disability status. For instance, people with mental or cognitive disabilities have lower rates of employment than individuals with physical disabilities, regardless of occupation (Jones, 2008, 2011; Maroto & Pettinicchio, 2014b, 2015; Wilkins, 2003). Earnings gaps are also larger for people with work limitations, cognitive difficulties, and independent-living barriers, but people with hearing difficulties tend to experience the smallest earnings gaps (Baldwin & Johnson, 1994; Burkhauser, Daly, Houtenville, & Nargis, 2001; DeLeire, 1995; Lewis & Allee, 1992; Unger, 2002). Building on the evidence for continuing wage gaps by gender and disability type, we seek to address how these two statuses jointly influence labor market outcomes for workers. Previous research demonstrates large additive effects on employment and earnings. Using an intersectional approach as our foundation, we illustrate how these effects become multiplicative. Many have sought to answer why labor market barriers and economic inequalities among women and people with disabilities have not declined more precipitously since the passage of key pieces of legislation, such as the Civil Rights Act of 1964 and the Americans with Disabilities Act of 1990. For women, scholars initially pointed to problems of enforcement of antidiscrimination legislation placing much of the burden on victims of discrimination

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(Burstein, 1990; Reskin, 2001). They have also alluded to class-based inequality in accessing family policy intended to provide women with resources and opportunities to participate in the labor force (Korpi, Ferrarini, & Englund, 2013; Pettit, Hook, & Hagan, 2009). Beyond the policy focus, researchers have drawn from statistical discrimination, implicit bias, and status characteristics theories to show how employment discrimination can result from both employers’ intentional actions based on prejudice, as well as unconscious bias (Arrow, 1973; Reskin & Roos, 1990; Ridgeway, 1991, 1997). Thus, scholars agree that labor market discrimination, shifts in labor market supply-and-demand, and occupational segmentation also contribute to the gender wage gap in spite of antidiscrimination policy (Acker, 2006; Blau & Kahn, 2006; Ridgeway, 2011). Many of these explanations also pertain to the persistent labor market inequality among Americans with disabilities (Baldwin & Johnson, 1994; Kaye, Jans, & Jones, 2011; Kruse & Schur, 2003; Robert & Harlan, 2006; Schwochau & Blanck, 2000; Stein, 2003). In addition to broader claims about the lack of policy enforcement (Maroto & Pettinicchio, 2014a), scholars also point to differences in human capital, education, age, and job preferences (Blanck, Adya, Myhill, Samant, & Chen, 2007; Blanck, Schur, Kruse, Schwochau, & Song, 2003), workers’ dependence on public assistance (Acemoglu & Angrist, 2001; She & Livermore, 2007), the nature of work (Beegle & Stock, 2003; Jones & Sloane, 2010), occupational segregation (Maroto & Pettinicchio, 2014b), and employer attitudes (Domzal, Houtenville, & Sharma 2008; Hunt & Hunt, 2004; Unger, 2002). Disability may receive a lower status value through ascriptive processes that are especially prevalent when employers base their preferences about people with disabilities on limited information about average group differences (Arrow, 1998; Blanck et al., 2003; Ridgeway, 1991; Webster & Hysom, 1998). Importantly, stereotypes and employer attitudes not only vary by the nature of the disability, but also by how disability type interacts with other characteristics such as gender. Intersectional studies show that workers’ experiences are unique to their multiple intersecting identities. Employers often make decisions based on stereotypes that are about a combination of statuses (Browne & Misra, 2003), which results in multiplicative effects that extend disadvantages (Greenman & Xie, 2008; Snipp & Cheung, 2016). Only recently have studies begun to examine disability in relation to other characteristics in shaping economic inequality, and few disaggregate the effects of these interactions by the nature of disability. This has become all the more relevant given the way in which the intersectionality of multiple statuses defines “modern discrimination” (Marchiondo, Ran, & Cortina, 2015). Women with disabilities may be “twice penalized” (O’Hara, 2004) or in “double jeopardy” (Doren & Benz, 2001) as a result of structural and attitudinal factors associated with the intersection of both statuses. Drawing from Kimberle´ Crenshaw’s recent TedWomen Talk (Crenshaw, October 27, 2016), understanding how disability and gender intersect to shape employment and earnings can shed light as to why employers may hire women and, may hire people with disabilities, but not women with disabilities.

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In this chapter, we consider the intersection of gender and disability in shaping labor market outcomes among people with different disabilities. More specifically, we focus on variation in both employment rates and average earnings among men and women who report either a work-limiting disability or disability more generally. We address the following research questions: Are the effects of gender and disability on employment and earnings multiplicative? Do they compound disadvantage as theories of intersectionality would predict? And, how do employment rates and average earnings vary for men and women with different types of disabilities, including those disabilities identified as work limiting? Given that employer preferences, workplace accommodations, occupational segregation, and earnings vary considerably by the nature of a person’s disability, it is important to break apart disability to illustrate how “being disabled” interacts with gender in the labor market. We pool five years of data from the 2010
2015 Current Population Survey (CPS) to analyze how rates of employment and annual earnings vary by disability status and gender. For these years, the CPS included both work-limiting and broader definitions of disability, which allows us to compare gendered outcomes across a variety of measures. We specifically examine how worklimiting disabilities and how the presence of cognitive, physical, independent living, self-care, sensory, and multiple disabilities differentially influence earnings and employment for men and women. Our findings show that people with different types of limitations, including those not specific to work, experienced large disparities in employment and earnings and these outcomes also varied for men and women. By interacting the presence of different disabilities with gender, we demonstrate that even though women with disabilities still face a double disadvantage in the labor market, disability has stronger negative effects among men. We suspect that these effects are related to dominant notions of masculinity that can make disability more limiting for men who are less able to inhabit masculine roles in the labor market. In presenting a more intersectional quantitative analysis of disability and gender, we highlight the importance of considering multiple statuses, including those related to the presence of different types of disabilities and limitations, in perpetuating labor market inequalities.

GENDER, DISABILITY, AND WORK Status characteristics like gender and disability influence the ways in which supply and demand side factors contribute to labor market inequalities. Despite gains in education and increases in labor force participation, men still out-earn women even after accounting for individual characteristics, occupational segregation, and differences in work-effort (Blau & Kahn, 2006; Charles & Grusky, 2004; Ridgeway, 2011). These outcomes also vary by family

Employment Outcomes among Men and Women with Disabilities

7

status, where women experience disadvantages in conjunction with childbearing and the added career interruptions associated with parenthood (Budig & England, 2001; England, 2005). Although disability has received less attention within stratification research, disparities by disability status are also readily apparent, and several factors help to explain declining employment levels and stagnant wages within this group. For instance, the voluntary and involuntary transition of disabled individuals into occupations that allow flexibility in hours often leads to lower earning parttime and non-standard work arrangements (Blanck et al., 2003, 2007; Schur, 2002, 2003). Other income sources, including Supplemental Security Income, coupled with persistent obstacles in finding employment that provides sufficient wages, can limit the motivation to work (Haveman & Wolfe, 1990, 2000). At the same time, unfavorable and stereotypical attitudes among employers about employees with disabilities, including limited productivity, weakness, and the inability to maintain employment, persist (Kaye et al., 2011; Schwochau & Blanck, 2000; Schur, Kruse, Blasi, & Blanck, 2009; Stein, 2003; Unger, 2002). Thus, when people with disabilities do work, they tend to be clustered into lower skilled, lower paying occupations, contributing to wage inequality (Domzal et al., 2008; Kaye, 2009; Lewis & Allee, 1992; Maroto & Pettinicchio, 2014b). Importantly, labor market outcomes also vary by the nature of a person’s disability where a hierarchy of preferences for types of disabilities exists in the workplace (Shaw, Chan, & McMahon, 2012). People with mental or cognitive disabilities have lower rates of employment than individuals with physical disabilities, regardless of occupation (Baldwin & Johnson, 1994; Jones, 2008, 2011; Maroto & Pettinicchio, 2015; Wilkins, 2003). They also experience significantly greater levels of occupational segregation than people with other types of disabilities. Maroto and Pettinicchio (2014b) found that people with cognitive disabilities were overrepresented in the food preparation and service industries where the average annual earnings were less than half the national average. This parallels other findings showing larger earnings gaps for people with work limitations, cognitive difficulties, and independent-living barriers but smaller disparities among people with hearing difficulties (Baldwin & Johnson, 1994; Barnartt & Christiansen, 1985; Burkhauser et al., 2001; DeLeire, 1995; Lewis & Allee, 1992; Unger, 2002). Finally, employers may hold more favorable attitudes towards employees with physical impairments compared to those with psychological impairments, suggesting that the latter are more stigmatized and potentially experience more discrimination and harassment (Kavanagh et al., 2015). Most quantitative studies seeking to shed light on disability labor market outcomes typically control for a host of factors that include gender. However, results have been mixed as to whether outcomes vary significantly between men and women with disabilities. Certain early studies found few differences in disability employment and earnings by gender (see Bennefield & McNeil, 1989; Bowe, 1978). Other work emphasized gender differences in explaining earnings

8

DAVID PETTINICCHIO AND MICHELLE MAROTO

disparities among workers with disabilities but with mixed findings. For instance, Luft (1975) found that disability especially affected black women in the labor market, and Johnson and Lambrinos (1985) indicated that discrimination was a larger factor for women with disabilities. But, in their analyses of CPS data, Haveman and Wolfe (1990) found a convergence of disabled women’s earnings with that of disabled men’s suggesting that women’s gains were a result of political activism and an earnings increase among younger women with more than a high school education. More contemporary studies have been rather ambiguous about the gendered effect of disability on labor market outcomes. Acemoglu and Angrist (2001) found differences in employment trends between men and women with disabilities but no consistent effects on disabled women’s wages.1 Kavanagh and colleagues (2015) found few differences in socioeconomic disadvantage between men and women with the same disability in the Australian labor market but noted that women with disabilities were significantly underrepresented in paid work. Although they may not necessarily invoke an intersectional framework, several studies make a more explicit connection between gender and disability pointing to the compounding effects of multiple identities in perpetuating the disability gender wage gap (see Barnartt & Altman, 1997; Bradsher, 1996; BLS, 2015b; Emmett & Alant, 2006; Kessler Foundation/ NOD, 2010; Maroto & Pettinicchio, 2015; Randolph & Anderson, 2004; Schur, 2004; Woodhams, Lupton, & Cowling, 2015). Quantitative labor market research on gendered disability employment and earnings outcomes provides less than definitive answers about why men and women with similar disabilities experience different levels of inequality. Nonetheless, there is some consensus that categorical inequality based on both disability and gender is similarly explained by supply-and-demand side factors that include human capital, job choice and involuntary job placement, occupational ghettoization, and employer bias and discrimination. Because women and people with disabilities are more likely to experience occupational clustering, being placed in precarious and nonstandard work arrangements and in work that conventionally (and wrongfully) might be seen as “suitably matched” to their status, it suggests that women with disabilities are especially disadvantaged in the labor market.

INTERSECTIONALITY Existing work showing how employment and earnings vary for women and men with different types of disabilities demonstrates the need for more intersectional analyses of labor market inequalities (see Barnartt, 2013 and Barnartt & Altman’s, 2013 volume on disability and intersecting statuses). Labor market outcomes for people with disabilities are shaped by other relevant status

Employment Outcomes among Men and Women with Disabilities

9

characteristics like race, class, age, and gender (BLS, 2015a, 2015b; Bradsher, 1996; Kessler Foundation/NOD, 2010). Scholars interested in how the intersection of race and gender produce inequalities have alluded to disability as a social category that positions individuals within a “matrix of domination” (Browne & Misra, 2003; Collins, 1990, p. 489). However, their analyses do not provide a systematic account as to how disability might intersect with gender. And, although most if not all studies of disability labor market inequality control for the effects of gender, few have sought to delve deeper into gendered dimensions of disability inequality, let alone contextualize those findings in terms of intersectionality. Intersectionality provides a framework incorporating multiple dimensions of disadvantage by addressing the interaction and intersection of different bases of stratification, as well as broader systems of oppression (Choo & Ferree, 2010; Crenshaw, 1991; MacKinnon, 2013; McCall, 2005). In other words, “Intersectionality refers to the interaction between gender, race, and other categories of difference in individual lives, social practices, institutional arrangements, and cultural ideologies and the outcomes of these interactions in terms of power” (Davis, 2008, p. 68). Proponents of this perspective therefore argue that inequality, subordination, and oppression cannot be understood without considering multi-dimensional categorical group membership. As early as 1980, US courts recognized that discrimination faced by black women was distinct from other forms of discrimination (see Jefferies v. Harris County Community Action Association, No. 77-1848)
that there is an “inseparability” of race, gender, and national origin (Wei, 1996) shaping employment and earnings outcomes. Our study incorporates these perspectives by highlighting the intercategorical complexity related to different disability statuses and gender. By addressing the role of gender and disability type in regards to economic inequality, we present a disaggregated or intersectional approach to disability research that expands the focus beyond gender, race, and class (McCall, 2001).2 We investigate two components at the intersection of disability and gender. First, we study the combined effects of these statuses on employment and earnings in order to better understand the double disadvantage faced by women with various disabilities. We incorporate hierarchies of disadvantage with disability types with the expectation that women with cognitive or multiple disabilities, who most often face the greatest levels of prejudice and discrimination, will experience the largest employment and earnings disparities across groups. Second, we examine within-group disparities, which allows us to discuss how disability leads to different labor market effects for men and women. We expect that within groups of men and women, a disability will have a stronger negative effect among men due to its association with weakness, which is often incompatible with norms of masculinity. Although there may be distinct labor market outcomes for people with disabilities and for women, the intersection of disability type and gender also represent specific obstacles and barriers contributing to lower employment levels and earnings.

10

DAVID PETTINICCHIO AND MICHELLE MAROTO

The Double Disadvantage of Gender and Disability Women with disabilities belong to “a specific category of bias” (Kotkin, 2008). They face a double disadvantage (Johnson & Lambrinos, 1985) or a “double handicap” due to the intersection of multiple disadvantaged statuses (Herna´ndez, 2006; Randolph & Anderson, 2004; Schur, 2004; Shaw et al., 2012). This leads to lower employment levels and higher poverty rates for women with disabilities than both women without disabilities and men with disabilities. Understanding gendered disability inequality requires explanations that take into account the intersection of both statuses. For example, because women with disabilities are more likely to have parenting responsibilities at home, they have fewer opportunities to develop network ties and social capital that lead to job opportunities. Additionally, they are less likely to develop job experience while in school, entering the labor market already at a disadvantage (Doren & Benz, 2001). In their meta-analysis of findings about disability and work, Pompeii and colleagues (2005) found that women with disabilities cited numerous reasons, including marriage and pregnancy, in addition to their disability, for leaving work. Family roles that continue to limit labor market activity and education, as well as employer perceptions of skill and performance, negatively affect the economic wellbeing of women with disabilities (Hale, Hayghe, & McNeil, 1998; Jones & Sloane, 2010; Leicht, 2008). When at work, women with disabilities are especially influenced by “gendered employment relations” (Jenson, 1996, p. 5). The so-called “feminization of employment norms” involves the growing association of women (especially immigrant women and women of color) with precarious employment (Cranford, Vosko, & Zukewich, 2003; Morris, Bernhardt, & Handcock, 1994; Vosko, 2003). A similar pattern has emerged among workers with disabilities, making certain workers with both characteristics more vulnerable in the labor market (see Schur, 2004; Shuey & Jovic, 2013). Women with disabilities face greater odds of being clustered or “ghettoized” into set-aside (often low paying) occupations (Maroto & Pettinicchio, 2014b), where according to Robert and Harlan’s (2006) work on public sector employment, they feel unchallenged and stuck. Similarly, research points to discrete negative perceptions held by employers based on the intersectionality of statuses and identities. O’Hara (2004) found that women with more prejudiced disabilities had lower average wages than women whose disability elicited less prejudice. Mereish (2012) found that Asian American and Pacific Islander women with disabilities were more likely to report experiencing discrimination in the workplace than those who did not report any disability. In addition to ethnicity and gender, work by Pilling (2012) on the intersection of disability, gender identity, and LGBQT status in the workplace found that employees identifying with either female or male were

Employment Outcomes among Men and Women with Disabilities

11

less likely to disclose mental illness fearing it would undermine their authenticity as LGBQT disabled by employers. Overall, men and women with the same types of disabilities have significantly different wages with variation extending to disability type as well. This relates to factors like the use of different mobility aids by women in the workplace (Pompeii, Moon, & McCrory, 2005), the interplay between psychiatric disorders and gendered occupational clustering (Ettner, Frank, & Kessler, 1997), and occupational norms around women with episodic disabilities (Vick & Lightman, 2010). Additionally, women with the same disability as men “may require different accommodations because the nature of their work differs” (Baldwin, Zeager, & Flacco, 1994). This conclusion supports Leicht’s (2008) finding that “the labor market that traditionally dominant groups occupy is a moving target.” That is, being pigeonholed in a low earning occupation may be very difficult or impossible to break out of
something women with disabilities are especially likely to experience.

The Gendered Effects of Disability Gender presents an added layer in understanding disability labor market outcomes. This not only points to an interaction between gender and disability, but it also highlights the gendered aspects of different disability statuses shaping labor market inequalities. When combined with common conceptions of masculinity and femininity, this can result in differing outcomes and experiences for women and men. Although women with disabilities face a double disadvantage within the labor market, disability can be especially limiting for men due to the ways in which it conflicts with traditional norms of masculinity. Gender is an interactional process where membership in certain gender categories must be continually enacted and performed (West & Zimmerman, 1987). When gendered performances break down, as they often do with the onset of a disability, masculinity becomes vulnerable (Connell, 1995). One reason for this is what Kavanagh and colleagues (2015) refer to as “the enactment of hegemonic forms of masculinity,” which denies people with disabilities access to certain “masculine” jobs associated with male physical strength (see also Sorensen, 2013; Verdier-Taillefer, Roullet, Cesaro, & Alperovitch, 1994). Numerous qualitative studies have demonstrated how disability erodes many of the privileges associated with masculinity because of its connection to weakness (Gerschick, 2000; Shakespeare, 1999; Shuttleworth, Wedgwood, & Wilson, 2012). People with disabilities are especially susceptible to widespread beliefs that they are too weak and too costly to employ, incapable of performing certain tasks, and underproductive when being considered for a job. These associations are troubling for men with disabilities because they conflict with norms of masculinity that emphasize power and autonomy (Shuttleworth et al., 2012).

12

DAVID PETTINICCHIO AND MICHELLE MAROTO

As a result, we expect disability to have stronger effects on employment and earnings among men. If the presence of a disability is more limiting for men, this will also likely lead to a smaller gender gap among persons with disabilities as men’s wages are suppressed, converging with the already lower wages among disabled women.

DATA, METHODS, AND MEASURES Due to its large sample size, inclusion of multiple disability questions, and detailed employment and earnings information, we analyze pooled Current Population Survey Annual Social and Economic Supplement (CPS) data from 2010 through 2015. The CPS includes more detailed measures of disability status, as well as information on whether a disability is work limiting or not. Traditionally, most labor market surveys have measured disability status with a question regarding the presence of a “work limiting” disability. In 2008, however, key work surveys including the CPS incorporated a broader set of questions that consider whether the respondent reports a vision, hearing, cognitive, ambulatory, self-care, and independent-living difficulties. Although other surveys, such as the American Community Survey (ACS) and the National Health Interview Survey (NHIS), contain information on work-limiting disabilities, the CPS is one of the few surveys to include, in addition to specific limitations and disability as a work-limiting status, detailed information on employment, earnings, and worker class (Livermore et al., 2011). It also comprises large yearly samples, which helps in studying smaller groups like people with specific disabilities. We limit our sample to working-age adults between 25 and 61 years of age in order to account for continued schooling and early retirement. Our full sample consists of 596,199 individuals and our sample for employed respondents with earnings comprises 413,007 individuals. We analyze the relationship between disability, gender, and labor market outcomes in two steps. First, we apply logistic regression models to estimate whether the respondent was employed with earnings in the previous year. In our tables and results, we report average marginal effects (AME), which provide the rate of change in employment (i.e., the predicted probability) relative to a unit change in an independent variable with covariate values averaged across the population (Long, 1997; Wooldridge, 2009). We then use ordinary least squares (OLS) regression to estimate a respondent’s logged annual earnings from wages and salary in the previous year. We log this variable in order to account for the skewed earnings distribution and to satisfy model assumptions. All monetary amounts also appear in 2015 US dollars. As shown in Table 1, 73% of male respondents and 64% of female respondents were employed between 2010 and 2015. Average wage and salary income over this time period amounted to $63,000 for men and $43,000 for women.

13

Employment Outcomes among Men and Women with Disabilities

Table 1. Descriptive Statistics by Gender, CSP ASEC 2010
2015. Men Estimate

Women SE

Estimate

SE

For all respondents Employed with earnings

73.33

0.11

63.55

Any disability, difficulty, or limitation

11.82

0.08

12.23

0.11 0.08

Any work limiting disability

8.57

0.07

9.03

0.07

Any difficulty or limitation

7.82

0.07

7.98

0.06

Cognitive limitation

1.02

0.03

0.97

0.02

Physical limitation

1.74

0.03

2.03

0.03

Independent living (IDL) limitation

0.26

0.01

0.35

0.01

Sensory limitation

1.54

0.03

1.08

0.02

Mutually exclusive disability type

Multiple limitations

3.25

0.05

3.55

0.04

42.89

0.03

43.14

0.03

High school diploma

30.86

0.11

26.51

0.10

Less than a high school diploma

11.56

0.08

9.69

0.07

Some college

26.05

0.11

29.11

0.11

BA or beyond

20.60

0.10

22.72

0.10

Currently married

59.64

0.12

60.41

0.12

Never married

26.49

0.12

20.52

0.10

Formerly married

13.88

0.09

19.07

0.09

Any children present

27.36

0.10

33.11

0.11

Non-Hispanic black

11.01

0.08

12.79

0.08

Hispanic

16.76

0.09

15.69

0.08

Mean age (years) Education level

Marital status

285,902

N

310,297

For employed respondents Mean wage and salary income (2015 dollars)

63,235.34

213.15

42,930.93

131.91

Weeks worked last year (weeks)

49.81

0.02

49.12

0.02

Usual hours worked per week (hours)

39.36

0.04

35.91

0.04

Government employee

14.32

0.10

20.25

0.12

Firm size

N

500þ employees

46.78

0.14

51.78

0.15

ChiSq

DF

Estimate

Intercept

1


3.5747

1.6064

4.9520

0.0261

Number of adultsþ

1

2.1643

0.4164

27.0141

ChiSq

Intercept

1

0.4753

0.9592

0.2455

0.6202

Number of adultsþ

1

0.8566

0.1481

33.4449

> > < p1i × ð1
p2i Þ if yi ¼ unemployed ðextended definitionÞ Li ¼ > p1i × p2i × ð1
p3i Þ if yi ¼ employed part-time > > > : p1i × p2i × p3i if yi ¼ employed full-time where p1i ¼ probability of being in labour force Λðx01i β1 Þ; p2i ¼ probability of being employed given in labour force Λðx02i β2 Þ; p3i ¼ probability of being full-time employed given employed Λðx03i β3 Þ; 1-p

1

No Labour Force 1-p

Labour Participation

2

Unemployed 1-p

p1

Labour Force p2

Fig. 1.

3

Part-Time

p3

Full-Time

Employed

Sequential Logit Tree.

To What Extent does Disability Discourage?

89

and Λðx0ji βj Þ ¼ expðx0ji βj Þ=[1 þ exp ðx0ji βj Þ] We see at least two reasons for using a sequential logit model rather than a nested model for modelling the different working situations. First, disability is a potentially strong discouraging factor for any activity, and hence the willingness to work for disabled people is above all the result of a conscious decisionmaking process that goes beyond economic considerations to the development of an appropriate mind-set that overcomes the challenge of disability. Thus the decision to go on the job market is likely to be taken in a first step before seeking a job. Secondly, a nested model assumes that there is no correlation between alternatives in different nests or groups (i.e., the property of IIA, Independence of Irrelevant Alternatives),15 but only correlation among alternatives within each nest (or group). However we do not want to exclude possible correlations between different choices in all nests due to the role played by (unobservable) attitudes at all levels of decision-making. In addition, the sequential model framework allows us to test interesting hypotheses across transitions from one state to another. Finally, for comparison purposes, we also estimate a multinomial logit model for the different states of labour force participation (or not), using the same variables included in the sequential logit. The multinomial setting avoids sequencing but has the limitation due to the IIA property, in the same way as a nested model. We find that the sequential model results provide better interpretations. The dependent variable (y) takes value j if the jth alternative is taken, with j ¼ 1, 2, …, m (Cameron & Trivedi, 2005): ( 1 if yi ¼ j yij ¼ 0 if yi ≠ j The multinomial logit model specifies the probability that an alternative j is chosen in a set of m alternatives as follows. Xm expðx0i βj Þ pðyij ¼ 1Þ ¼ expðx0i βj Þ= k¼1 with β1 ¼ 0 for identification.

DESCRIPTIVE EVIDENCE Our sample is composed of 1,632 individuals from 4 to 67 years old, with an equal proportion of men and women (817 and 815 respectively).16 However, all

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TINDARA ADDABBO ET AL.

Table 1. N. Dis.

Number of Disabilities by Sex, 25
64 Years Old. Men

Women

Tot

0

26.8

36.8

31.7

1

55.6

49.5

52.6

2

13.9

10.0

12.0

3

2.9

3.5

3.2

4

0.5

0.1

0.3

5

0.3

0.1

0.2

100.0

100.0

100.0

Tot

our descriptive statistics are computed for the group 25
64 which is the focus of our study as we expect that people would have normally completed their education by the age of 25. Within this, the most frequent age group is 55
64, followed by the 45
54 one and 65 þ . The majority (60.6%) of people interviewed (with no difference by gender) are married and live with the partner, while 30.1% are single or have never been married, this share being higher among men (35.2%). As for the geographical location, 44.6% live in the South of Italy or in Sicily and Sardinia, 37.3% in the North and 18.1% in the Centre. In the sample, 52.6% have only one disability (with a majority of men, 55.6%), 31.7% do not report any specific disability (especially among women, 36.8%), and 12% have two types of disability, with a prevalence among men, 13.9% (Table 1). However, within the group of people not reporting any disability (“nondisabled” in short), interviewees do present limitations in daily activity and/or chronic diseases. 71.2% of nondisabled people present limitations in daily activity (limits that last at least six months), serious and constrictive in 15.9% of the cases, and 74.4% have chronic diseases. Those who present one or more types of disability state serious limits in daily activities in 67.6% of cases, while 75.5% have a chronic disease (with similar percentages for men and women) (Tables 2 and 3). As shown in Table 4, the most common type of disability among those who have just one disability is mobility impairments (53% of cases), with a prevalence of women. The second type of disability stated is hearing impairments and men are more represented in this group than women, with a gender gap of 10.1%. Other disabilities present lower percentages and the language one is never present alone.17 Descriptive evidence on the education levels (with 1,220 observations, given by people from 25 to 64 years old) shows that men have on average higher qualifications than women. In particular, in most cases (34.4%) males have a leaving certificate awarded by a secondary school, while females have a primary

91

To What Extent does Disability Discourage?

Table 2. Health Problems that Limit the Daily Activities and Last at Least 6 Months by Number of Disabilities, 25
64 Years Old. N. Dis.

Yes, Serious

Yes, Not Serious

No

Tot

0

15.9

55.3

28.8

100.0

1

29.8

40.6

29.6

100.0

2

49.3

32.1

18.6

100.0

3

59.0

37.5

3.5

100.0

4

100.0

0.0

0.0

100.0

5

100.0

0.0

0.0

100.0

29.0

43.9

27.0

100.0

Tot

Table 3. Presence of Chronic Diseases by Number of Disabilities, 25
64 Years Old. N. Dis.

No

Yes

Tot

0

25.6

74.4

100.0

1

35.6

64.4

100.0

2

29.1

70.9

100.0

3

23.7

76.3

100.0

4

34.0

66.0

100.0

5

0.0

100.0

100.0

31.2

68.8

100.0

Tot

Table 4.

Type of Disability by Sex, 25
64 Years Old
People with One Type of Disability.

Disability

Men

Women

Tot

Vision

13.0

11.7

12.4

Hearing

21.7

11.6

17.0

Intellectual

8.1

5.1

6.7

Mental health

8.4

13.8

10.9

48.8

57.8

53.0

100.0

100.0

100.0

Mobility Tot

school qualification (36%). Only 3.7% of the population have a master or bachelor degree, while 7.4% do not have any qualification. The increase in the number of disabilities leads to a reduction in the level of education obtained and, if we compare disabled people and nondisabled ones, we can notice that women are less likely to achieve high education levels than

92

TINDARA ADDABBO ET AL.

Table 5. Education Level for Disabled (At Least One Disability) and Nondisabled People in a Strict Sense, 25
64 Years Old
Men. Education Level University

No Disability

Disability

Tot

5.8

3.6

4.2

High school

34.8

28.7

30.3

Secondary school

36.9

33.5

34.4

Primary school

21.3

25.5

24.4

No qualification Tot

1.1

8.7

6.7

100.0

100.0

100.0

Table 6. Education Level for Disabled (At Least One Disability) and Nondisabled “stricto sensu” People, 25
64 Years Old
Women. Education Level University

No Disability

Disability

Tot

2.2

3.7

3.2

High school

24.5

25.4

25.1

Secondary school

30.5

26.2

27.7

Primary school

39.4

34.0

36.0

No qualification

3.4

10.7

8.0

100.0

100.0

100.0

Tot

men. Surprisingly, the gender gap is higher especially among nondisabled, with 40.6% of men and 26.7% of women with at least a high school diploma. Furthermore, nondisabled women do not have any qualification or have only a primary school certificate in 42.8% of cases, while for men this percentage is equal to 22.4%. The difference between men and women with at least one type of disability is slight for well educated people (29.1% of women and 32.3% of men have at least a high school diploma), while for lower education levels women are those with higher percentages (Tables 5 and 6). Comparing these results with those of the whole Italian population, obtained from IT-SILC 2004 (the Italian component of EU-SILC, European Union Statistics on Income and Living conditions, ISTAT, 2004b), we notice that a university degree is achieved by 10.7% of IT-SILC interviewees aged 25
64, with really close percentages between men and women. The majority obtains a high school diploma (31.7%, similarly between men and women) or a secondary school certificate (33.1%, with a prevalence among men, 35.6%). Thus differences are notable between the general population and the disabled group and tend to be more pronounced in the case of women (Table 7). As could be expected, intellectual disability is correlated with a wide disadvantage in education. The overall majority (69.1%) of interviewees with this condition obtained, at most, a primary school qualification, none of them

93

To What Extent does Disability Discourage?

Table 7. Education Level

Education Level, 25
64 Years Old
IT-SILC 2004. Men

Women

Tot

University

10.7

10.8

10.7

High school

37.2

37.0

37.1

Secondary school

35.6

30.7

33.1

Primary school

13.7

18.0

15.9

No qualification

2.8

3.5

3.1

100.0

100.0

100.0

Tot

Source: Our elaboration of IT-SILC 2004.

received a university degree and only 9.8% have a high school qualification, which is the lowest percentage among types of disability for this level of education. The group affected by emotional problems presents the highest number of graduates (13.7%), even though it presents high heterogeneity, and mobility or sensory disabilities are the most represented health conditions in secondary and high school diploma holders. The greatest percentage of people without any qualification is in the South of Italy (11.9% of females and 9.9% of males), while the highest percentage of graduates is in the North, without any difference by gender (5.1%). Finally, if we consider the cause of disability, we find that the association of congenital cause with education is stronger for women, while men do not seem to have been influenced. Surprisingly, having a congenital condition does not affect the level of education, at least for men. Indeed, 10.9% of men in this group obtained a university degree and 32.5% possess a high school diploma.18 On the contrary, when an illness represents the cause of limits, the majority of men attains a secondary school certificate (37.4%), while for those who had an accident the two education levels more frequently achieved are high school diploma (35.7%) and secondary school certificate (35.1%). For women, the picture is more nuanced. When the cause is congenital, only 1.7% of women hold a university degree and the majority (72.3%) reports having a primary school or a secondary school certificate. When the cause is correlated with an illness, women are more likely to obtain a primary school certificate (37.6%), while for those who had an accident high school diploma is the most represented level of education (63.9%) (Tables 8 and 9).

DISABILITY AND EMPLOYMENT Considering the population between 25 and 64 years old, we briefly compare the employment rate of those with at least one disability in ISTAT 2004 to the

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TINDARA ADDABBO ET AL.

Table 8. Correlation between Education Level and Cause of Daily Limits, 25
64 Years Old
Men. Education Level

Congenital

Illness

Accident

Tot

University

10.9

2.6

1.4

4.4

High school

32.5

28.7

35.7

31.2

Secondary school

28.4

37.4

35.1

34.6

Primary school

12.5

25.8

26.9

22.7

No qualification Tot

15.8

5.6

0.9

7.1

100.0

100.0

100.0

100.0

Table 9. Correlation between Education Level and Cause of Daily Limits, 25
64 Years Old
Women. Education Level

Congenital

Illness

Accident

Tot

University

1.7

3.2

7.6

3.2

High school

9.7

26.0

63.9

25.3

Secondary school

37.7

26.0

14.6

27.4

Primary school

34.6

37.6

13.9

35.7

No qualification

16.3

7.2

0.0

8.4

100.0

100.0

100.0

100.0

Tot

Table 10.

Employment Rate, 25
64 Years Old
2004. Men

Women

IT-SILC 2004

73.4

46.1

At least one disability

40.9

20.6

Disability gap

32.5

25.5

Source: Our elaboration of IT-SILC 2004 and ISTAT 2004.

one obtained from IT-SILC 2004. Results show that the employment rate is much lower among disabled people, with a larger disability gap for men than for women. 40.9% of men are employed, a fraction that decreases sharply (20.6%) for women. For the whole Italian population in IT-SILC statistics, 59.8% are employed, with a prevalence among men (73.4%). As the number of disabilities increases, the percentage of employed people decreases and nobody with more than three types of disability has a job (people with four or five disabilities state that they are all unable to work) (Table 10).

95

To What Extent does Disability Discourage?

Table 11.

Hours of Work by Sex, 25
64 Years Old
IT-SILC 2004 and ISTAT 2004.

Working Hours

Men

Women

Tot

IT-SILC full-time

96.0

78.7

89.3

IT-SILC part-time

4.0

21.3

10.7

At least one disability full-time (ISTAT)

84.1

69.5

79.7

At least one disability part-time (ISTAT)

15.9

30.5

20.3

100.0

100.0

100.0

Tot

Source: Our elaboration of IT-SILC 2004 and ISTAT 2004.

A good proportion of women are housewives (34.6%), while men work at home only in 0.2% of cases. In IT-SILC 2004, instead, we find that 16.4% of the population fulfil domestic tasks and have care responsibility, in particular among women (30.7%). In our sample, among those who are employed, 83.3% has a permanent contract and 79.7% has a full-time job, especially among men (84.1%). In the ITSILC population, instead, 89.3% are employed full-time, especially for men (96%). Part-time jobs are consequently mainly covered by women in both samples (Table 11). People with a part-time job in ISTAT 2004 justify their working hours in different ways on the basis of gender. For the majority of women, having a parttime job is dictated by family reasons in 30.4% of cases, especially in the group with 45
54 years old women. This could happen because they have to look after elder members of the family or children. For men, instead, family reasons are the cause of half-time work only in 1% of cases. Health reasons seem to be the major cause (for 52.7%) for part-time work for men, with higher percentages in the age ranges of 35
44 and 45
54. Among those persons with a parttime job, 22.5% would like to have a full-time one. This happens for 27.5% of women, especially between 55 and 64 years old, and among young men (15
24 years old). To sum up, women seem to provide care work within the household in most cases and this task influences their working hour decisions (but only among those who are more than 25 years old), while for men it is the health condition that determines the number of hours worked. Turning to the type of job, those with mobility disability can also be found in higher job positions, whereas the intellectual one creates the biggest disadvantage (all people with intellectual disability are blue-collar workers). Among white-collar workers, women are more represented than men (35.4% and 27.2% respectively), while the opposite happens for managerial positions, which are nevertheless seldom held by disabled people (Tables 12 and 13).

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TINDARA ADDABBO ET AL.

Table 12.

Job Position for People with One Disability, 25
64 Years Old
Men.

Job Position

Vision

Hearing

Intellectual

Mental Health

Mobility

Tot

Executive

0.0

0.0

0.0

0.0

1.8

Manager

0.8

7.3

0.0

0.0

4.3

1.0 4.0

White-collar

25.5

13.1

0.0

16.5

36.9

27.2

Blue-collar

55.6

56.4

100.0

64.4

48.5

53.8

Apprentice

0.0

0.0

0.0

5.5

0.3

0.7

Entrepreneur

0.0

3.3

0.0

0.0

0.5

1.0

Freelance

4.6

7.8

0.0

0.0

1.3

3.1

12.4

12.1

0.0

13.6

5.8

8.7

Mutual comp. emp.

1.1

0.0

0.0

0.0

0.0

0.2

Carer

0.0

0.0

0.0

0.0

0.5

0.3

100.0

100.0

100.0

100.0

100.0

100.0

Self-employed

Tot

Table 13.

Job Position for People with One Disability, 25
64 Years Old
Women.

Job Position Manager

Vision

Hearing

Intellectual

Mental Health

Mobility

Tot

0.0

0.0

0.0

0.0

5.0

2.9

White-collar

35.8

34.4

0.0

35.0

36.9

35.4

Blue-collar

46.5

54.9

100.0

54.5

37.3

44.4

Apprentice

0.0

0.0

0.0

0.0

1.4

0.8

Home working-emp.

0.0

0.0

0.0

4.3

1.3

1.3

Entrepreneur

0.0

0.0

0.0

0.0

4.0

2.4 4.0

Freelance

10.5

0.0

0.0

0.0

4.3

Self-employed

6.7

9.6

0.0

0.0

6.6

6.0

Carer

0.5

1.1

0.0

6.3

3.1

2.8

100.0

100.0

100.0

100.0

100.0

100.0

Tot

Having a congenital impairment does not seem to be a disadvantage in obtaining higher job positions with regards to people with other sources of disability. Quite surprisingly, 10.8% of men with this characteristic are executives or managers (especially in industry) and the majority is white-collar (63.7%). This finding might be correlated with the fact that men with congenital disability also tend to achieve higher education levels, as also showed previously (Tables 8 and 9). Congenital conditions are a disadvantage especially for women, as they lead them to be more represented among the blue-collar group, .

To What Extent does Disability Discourage?

97

while men state a lower level in their job position when the limits are a consequence of accidents.

ESTIMATION RESULTS In this section, we go beyond simple descriptive evidence to draw model-based inference from the data. Let us recall that we use an extended definition of labour force participation in our study based on being employed or currently seeking work irrespective of the declared status of the person (as a student, housewife, retired or any other condition). First, a probit model is specified to identify the personal characteristics and environmental factors that influence the probability of being in the labour force, with a focus on the differences between men and women. To deepen our analysis, we formulate a sequential logit model to understand the factors affecting the transitions among different working situations. Finally, the sequential logit model is compared with the results obtained by estimating a different version as well as a multinomial logit model. All these models are estimated for those people in the sample who are 25
64 years old.

The Probit Regression Model The dependent variable of our probit model is a binary variable taking the value 1 for all individuals who say they are employed or seeking a job (independently of the fact that they sought actively or not in the last four weeks). So our labour force includes all people who are either working or wanting to work irrespective of whether they are housewives, students, retired or people in other conditions.19 This “broad” definition is proposed to include in the labour force all people who feel they are able to work and are willing to go on the job market. One should therefore keep in mind this extended meaning of labour force participation in the interpretation of our results. Potential determinants of labour force participation include the classical ones given by human capital characteristics, as well as health and disability characteristics (e.g., chronic diseases, disability status/type of disability) and some controls. Even if our sample is only concerned with disabled persons, a substantial proportion of the respondents do not report any specific disability as seen in the descriptive section. Thus we can in fact include a disability dummy (equal to 1 for people who report a specific type of disability) among the explanatory factors. However, the magnitude of the disability coefficient can be lower than for the general population since our sample is not representative of the whole population.

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TINDARA ADDABBO ET AL.

Tables 14 and 15 respectively provide a complete list and key descriptive statistics of the explanatory variables used in our empirical models. We report the average marginal effects in Table 16. We first estimate the model for the full sample, pooling men and women together. While Column (1) of Table 16 reports a negative and significant average marginal effect of age, the probit coefficients show a significant inverted-U shape relationship between the likelihood of participating in the labour force and age. Therefore, being older decreases the chances of entering the labour force and this effect occurs relatively early in the life of disabled people. Table 14.

Explanatory Variables.

Variable Age

Definition Person’s age

Age Sq

Interaction term: Age × Age

Female

Dummy variable ¼ 1 if female and ¼ 0 if male

Married

Dummy variable ¼ 1 if married and ¼ 0 otherwise

Wife

Interaction term: Female × Married

Disability

Dummy variable ¼ 1 if disabled person and ¼ 0 if nondisabled person

Chronic

Dummy variable ¼ 1 if the person has chronic diseases and ¼ 0 otherwise

Education

¼ 1 No Qualification, 2 ¼ Primary School, 3 ¼ Secondary School, 4 ¼ High School, 5 ¼ University

South/ Islands

Dummy variable ¼ 1 if the person lives in the South/Islands and ¼ 0 otherwise

Disabilities

¼ 1 Vision, ¼ 2 Language, ¼ 3 Hearing, ¼ 4 Intellectual, ¼ 5 Emotional/Mental, ¼ 6 Mobility

Table 15.

Variables Description.

Variable

Obs

Mean

Std. Dev.

Min

Max

Age

1,220

50.63

10.64

25

64

Age Sq

1,220

2676.19

1003.83

625

4,096

Female

1,220

.49

.50

0

1

Married

1,220

.62

.48

0

1

Wife

1,220

.31

.46

0

1

Disability

1,220

.70

.46

0

1

Chronic

1,219

.69

.46

0

1

Disab X Chronic

1,219

.47

.50

0

1

Education

1,220

2.82

1.03

1

5

South/Islands

1,220

.43

.50

0

1

(1) Whole S. Age Female

(2) Men

(3) Women

(4) Disabled

(5) Dis.Men

(6) Dis.Women


0.0151∗∗∗


0.0177∗∗∗


0.0125∗∗∗


0.0166∗∗∗


0.0162∗∗∗


0.0172∗∗∗

(
10.17)

(
7.88)

(
6.67)

(
7.89)

(
4.85)

(
6.09)


0.142∗∗∗


0.143∗∗∗

(
4.80)

(
3.80)

0.0181

0.125∗∗


0.0811∗


0.0237

0.0388


0.0405

(0.49)

(2.22)

(
1.80)

(
0.48)

(0.57)

(
0.68)

Disability


0.0548


0.00877


0.0805∗

(
1.64)

(
0.18)

(
1.86)

Chronic


0.0954∗∗∗


0.0736


0.111∗∗

(
2.87)

(
1.64)

(
2.47)


0.138∗∗


0.239∗∗∗


0.0584


0.0534


0.267∗∗∗

0.0393

(
2.00)

(
3.42)

(
0.63)

(
0.46)

(
3.64)

(0.33)

0.120∗∗∗

0.176∗∗∗

0.0580

0.0909

0.194∗∗


0.0268

Married

Education No Qualif. Sec. Sch. High School University

(2.87)

(2.83)

(1.07)

(1.60)

(2.38)

(
0.35)

0.276∗∗∗

0.308∗∗∗

0.241∗∗∗

0.315∗∗∗

0.435∗∗∗

0.208∗∗

(5.90)

(4.52)

(3.88)

(4.96)

(5.06)

(2.16)

0.265∗∗∗

0.266∗∗

0.255∗∗

0.299∗∗∗

0.403∗∗∗

0.190

(2.94)

(1.97)

(2.15)

(2.98)

(3.16)

(1.46)

0.0498

0.108


0.00575

(0.95)

(1.60)

(
0.08)

To What Extent does Disability Discourage?

Table 16. Probit Models (25
64 Years Old)
Marginal Effects.

Disabilities Vision

99

(1) Whole S.

(2) Men

(Continued )

(3) Women

Hearing Intellectual Emotional South/Islands

100

Table 16.

(4) Disabled

(5) Dis.Men

(6) Dis.Women

0.149∗∗

0.130∗

0.213∗∗∗

(2.51)

(1.83)

(2.63)


0.247∗∗∗


0.190


0.195∗∗

(
3.30)

(
1.51)

(
2.21)


0.116


0.0377


0.134∗

(
1.63)

(
0.32)

(
1.91)


0.0716∗∗


0.112∗∗∗


0.0420


0.0733∗


0.0841∗


0.0703

(
2.36)

(
2.67)

(
1.03)

(
1.89)

(
1.67)

(
1.37)

N

1219

624

595

645

345

300

pseudo R2

0.2695

0.2702

0.2698

0.3403

0.3438

0.3417

Dif High-Sec

0.156

0.131

0.183

0.224

0.241

0.235

DifSE High-Sec

(0.0429)

(0.0589)

(0.0598)

(0.0559)

(0.0741)

(0.0733)

Dif Un-High


0.0107


0.0419

0.0142


0.0151


0.0318


0.0181

DifSE Un-High

(0.0902)

(0.134)

(0.119)

(0.0998)

(0.128)

(0.123)

Education

TINDARA ADDABBO ET AL.

t statistics in parentheses in the upper part of the table. Standard errors in parentheses in the lower part. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01.

To What Extent does Disability Discourage?

101

Interestingly, the marital status does not have a significant effect on the likelihood of participation in the labour force, while being a woman decreases significantly the probability of being in the labour force by 14.2%. The negative coefficient for the “female” dummy after controlling for disability implies that a woman is less likely to be in the labour force compared to a man even if they are both disabled (in the sense defined earlier). This result is in line with the findings of other studies that mention the double discrimination faced in the labour market (but not only in this sphere) by disabled women: being female and being disabled (Abu Habib, 1995 and Sen, 2005). On average, people with chronic diseases have a 9.5% lower probability to enter the labour force, while being disabled does not have a statistically significant impact. However, the coefficient of the interaction term between the dummy variable for the disability status and the dummy variable for the chronic disease (not reported20) is insignificant. Thus chronic disease seems to be a stronger cause for not being in the labour force than disability, all other characteristics being equal. Education levels higher than the primary school certificate, which is the reference group, increase the possibility of entering the labour force by 12%, 27.6% and 26.5% if the education level corresponds to secondary school certificate, high school diploma or university degree, respectively. Conversely, not having attended any school significantly lowers the likelihood of entering the labour force by 13.8%. Furthermore, if we compare the marginal effects associated with different education levels, it is found that having a high school diploma or a university degree does not make a big difference, while jumping from no qualification to primary school, from secondary to high school or from primary to secondary school leads to a significant increase in the probability of entering the labour force. The importance of obtaining qualifications for disabled people also emerges in the analysis of Jones et al. (2003) and Jones et al. (2006) for United Kingdom. It may be argued that education itself is potentially affected by disability and disabled people may not invest as much in education in anticipation of their lower chances of being employed.21 In this case the (negative) impact of disability on employment may be underestimated in absolute terms.22 We note that in our sample (considering all age groups), 322 people experienced the onset of a disability before 25 years old, 935 people between 25 and 64 years old and only 7 after the age of 64. If we restrict the sample considering only those between 25 and 64 years old, 271 people experienced the onset of a disability before 25 years old and 698 people between 25 and 64 years old. Therefore, it can be concluded that the majority of people with disability experienced the onset of a disability after they have completed their education. Finally, people living in the South/Islands (i.e., the area with a slacker labour market and with more difficulties in implementing laws addressed to people with disability) are less likely to participate in the labour force than those living elsewhere in Italy, with a marginal effect of 7.2%. This may be an

102

TINDARA ADDABBO ET AL.

outcome of worse education and labour market situations, a lower degree of implementation of laws in favour of the job placement of people with disability and of poorer active labour market policies. As a further analysis, we split the sample into men and women. Columns (2) and (3) of Table 16 report the average marginal effects estimated from the Probit model for labour market participation. Like in the pooled sample, the likelihood of participating in the labour force is increasing with age, but the effect fades out and turns negative for old people. Being married and living with the partner is a significant predictor of the participation in the labour force, with a positive effect for men and a negative one for women, confirming the existing evidence (Gannon & Nolan, 2003; Jones et al., 2003 and Mitra & Sambamoorthi, 2006). Women with chronic diseases are less likely to participate in the labour force than those without such type of diseases, on average by 11.1%, while disabled women are 8% less likely to participate in the labour force than nondisabled ones. This reinforces our earlier finding of chronic illness having a bigger impact than disability, here for women. Moreover, the coefficient of the interaction term between being disabled and having a chronic disease (not reported, see footnote 20) is significant and negative for men and not significant for women. Furthermore, the descriptive analysis on employment suggests that health conditions are the main reason for having a part-time job, particularly true for men. The econometric evidence in Table 16, columns (2) and (3), shows in fact that health conditions are also a significant factor in determining the decision to participate in the labour force, both in general and especially for women. Any education level higher than the primary school certificate (the reference group) has a positive and significant impact on the probability of entering the labour force for men. Women, instead, are more likely to participate in the labour market only if they have achieved the two highest levels of education (university degree or high school diploma). As for the differential impacts across education levels, there is a positive and significant difference between labour force participation for men with a secondary school certificate and for those with primary school. Also, the effect of having a high school diploma is significantly higher than the one of having a secondary school certificate. For women, instead, there is a significant jump in the probability of entering the labour force only when going from secondary school to high school. Finally, the probability of being in the labour force is 11.2% lower for men living in the South than for those living elsewhere in Italy. Conversely, women in the South do not have a statistically different probability of participating in the labour force from that of women living elsewhere in Italy and this is probably due to the fact that they can be equally disadvantaged as disabled women in the North/Centre of Italy.

To What Extent does Disability Discourage?

103

RESULTS FOR THE SUB-SAMPLE OF DISABLED PEOPLE Until now the econometric analysis was focused on the whole sample of disabled and “nondisabled” people. We now exclude those who did not report a disability. The probit regression model has the same dependent variable (equal to 1 if the person is in the labour force in its extended definition, and 0 otherwise) and explanatory variables, except that we distinguish disabilities by type, and these types substitute the dummy variables indicating the presence of chronic diseases and disability. The average marginal effects estimated from the modified probit model are reported in Column (4) in Table 16. Again, we estimate an inverted-U shaped effect of age on labour force participation, with the marginal effect being negative on average. Being female has a negative and significant impact of 14.3% on the probability of participating in the labour force for disabled people (reconfirming the double discrimination phenomenon mentioned earlier), while the marital status does not affect it. The marginal effects of the education indicators are measured with respect to those people having a primary school education. In general, obtaining a high education level (high school diploma or university degree) has a positive and significant effect on the likelihood of participating in the labour force, with average marginal effects of 31.5% and 29.9% respectively, even if the difference between obtaining a university degree and a high school diploma is not statistically significant.23 People living in the South or in the Islands are, on average, 7.3% less likely to participate in the labour force than people living elsewhere, confirming the territorial duality of the Italian economy. Finally, the marginal effects of the type of disability indicators are estimated taking the mobility disability as reference group. Having a hearing disability rather than a mobility one increases the probability of being in the labour force by 14.9%, while people with intellectual disability are 24.7% less likely to enter the labour force. This result is in line with the descriptive evidence on employment, the empirical findings in Jones et al. (2006) and in Jones et al. (2003) on the probability of being employed in the British labour market and with the study on India by Mitra and Sambamoorthi (2006). We then proceed by estimating the same probit model for men and women separately. Columns (5) and (6) of Table 16 report the marginal effects. Like in the pooled sample, being one year older decreases the likelihood of participating in the labour force by about 1.6% for men and 1.7% for women. Married women and men do not display different patterns of labour force participation with respect to their unmarried counterparts. Compared to people with a mobility disability (the reference group), women with a hearing disability are 21.3% more likely to participate in the labour force, while the effect of a hearing disability for men is much smaller (13%).

104

TINDARA ADDABBO ET AL.

Furthermore, women with an intellectual or emotional disability are less likely to enter the labour force than those with a mobility disability (with marginal effects of 19.5% and 13.4%, respectively), while these types of disability do not make significant difference on labour force participation of disabled men compared to mobility disability. Jones et al. (2003), instead, find that having mental health forms of disability influences significantly and negatively the probability of being in employment for both men and women in United Kingdom. Obtaining a higher education level than primary school has a positive and significant effect on the likelihood of participation in the labour force for men. More specifically, having a secondary school certificate has a statistically different effect from a primary school one, while there is no difference between a university degree and a high school diploma. For women, instead, only a high school diploma has a significant effect of 20.8% on average and, if we compare the effects of achieving different education levels, we obtain a statistically significant difference only between high school and secondary school. Finally, disabled women in the South/Islands do not have a statistically different probability of participating in the labour force from those living elsewhere in Italy, while for men there is a negative and significant effect of 8.4% on average. Overall, the type of disability seems to be an important factor in determining the labour force participation of women, with emotional and intellectual disabilities having a negative effect. Conversely, the level of education plays an important role mainly for men. Furthermore, health conditions seem to affect men within the labour market as we saw in the decision of not working fulltime (see the descriptive statistics on employment), while for women the health condition plays a role in the probability of participation in the labour force, that is, “before” the employment choice is taken.

A Sequential Logit Model for the Working Conditions Before discussing the results of the sequential logit model, we would like to mention a methodological extension that was incorporated in our model. Starting from the specification of the (transition) probabilities given under the Methodology section, we introduce unobserved individual heterogeneity following the approach by Buis (2011). In this approach, an additional unobserved standardised variable z is introduced24 with a coefficient γ in each transition probability and different values are assumed for γ leading to different variances of the variable zγ. This is done in order to perform a sensitivity analysis of the impact of unobserved heterogeneity on the estimation of the coefficients of observed variables. Formally, we write: pji ¼ Λðx0ji pj þ zγÞ; i ¼ 1; 2; 3 with z ∼ N (0, 1) and different possible values for γ.

ð1Þ

105

To What Extent does Disability Discourage?

The explanatory variables of our models are given in Table 14. Table 17 shows our results, considering different amounts of unobserved heterogeneity, starting from the case of no omitted unobserved variables, i.e., fixing the values of γ from 0 to 2. We assume γ to be constant over transitions. Results show that being older is beneficial at the first and third transitions, but the effect fades out and turns negative for old people. For one more year of education, the log-odds of being in the labour force, in employment and a fullTable 17. Transitions

Sequential Logit Model (25
64 Years Old).

(γ ¼ 0)

(γ ¼ 0.5)

(γ ¼ 1)

(γ ¼ 1.5)

(γ ¼ 2)

LF v NoLF Age

0.399∗∗∗ (6.39)

Age Sq Female Education


0.00516∗∗∗

(
7.54)

(
7.51)

0.157

0.183

0.204

(0.55)

(0.56)

(0.58)

(0.59)

(0.57)

0.739∗∗∗
0.420∗∗
0.661∗∗∗
0.353∗∗ 1.233∗∗∗ (5.39)

Wife


1.867∗∗∗ (
6.00)

cons


0.00786∗∗∗

0.135

(
2.38) Married


0.00684∗∗∗

0.606∗∗∗ (6.23)

(
7.57)

(
4.24) South/Islands


0.00598∗∗∗

0.528∗∗∗ (6.27)

0.126

(
2.51) Chronic


0.00538∗∗∗

0.462∗∗∗ (6.32)

(
7.58)

(9.38) Disability

0.416∗∗∗ (6.37)


8.704∗∗∗ (
6.12)

0.774∗∗∗ (9.42)
0.436∗∗ (
2.50)
0.691∗∗∗ (
4.24)
0.370∗∗ (
2.39) 1.295∗∗∗ (5.41)
1.957∗∗∗ (
6.01)
9.083∗∗∗ (
6.10)

0.866∗∗∗ (9.48)
0.479∗∗ (
2.46)
0.771∗∗∗ (
4.24)
0.415∗∗ (
2.40) 1.462∗∗∗ (5.46)
2.198∗∗∗

0.996∗∗∗ (9.53)
0.539∗∗ (
2.41)
0.885∗∗∗ (
4.23)
0.481∗∗ (
2.41) 1.697∗∗∗ (5.50)
2.532∗∗∗

(
7.47)

1.150∗∗∗ (9.55)
0.610∗∗ (
2.37)
1.021∗∗∗ (
4.22)
0.560∗∗ (
2.42) 1.972∗∗∗ (5.53)
2.921∗∗∗

(
6.04)

(
6.06)

(
6.06)


10.10∗∗∗


11.56∗∗∗


13.29∗∗∗

(
6.05)

(
6.00)

(
5.96)

Emp v Un Age Age Sq

0.149

0.171

0.231

(1.12)

(1.24)

(1.55)


0.000611 (
0.39)

Female


0.0906 (
0.22)

Education

0.579∗∗∗ (3.06)


0.000858 (
0.54)
0.0869 (
0.20) 0.635∗∗∗ (3.23)


0.00154 (
0.89)
0.0772 (
0.17) 0.776∗∗∗ (3.64)

0.319∗ (1.94)
0.00256 (
1.34)
0.0616 (
0.12) 0.965∗∗∗ (4.13)

0.423∗∗ (2.34)
0.00379∗ (
1.82)
0.0403 (
0.07) 1.180∗∗∗ (4.63)

106

TINDARA ADDABBO ET AL.

Table 17. Transitions Disability

(γ ¼ 0)
0.868∗∗ (
2.35)

Chronic South/Islands


0.999∗∗ (
2.45)

(γ ¼ 1.5)
1.141∗∗∗ (
2.58)

(γ ¼ 2)
1.302∗∗∗ (
2.71)


0.280


0.346


0.452


0.582

(
0.89)

(
1.02)

(
1.22)

(
1.43)


1.205∗∗∗ 0.721
0.917 (
1.54)

cons


0.902∗∗ (
2.37)

(γ ¼ 1)


0.259

(1.63) Wife

(γ ¼ 0.5)

(
0.85) (
3.92) Married

(Continued )


4.307 (
1.50)


1.262∗∗∗ (
3.95)


1.405∗∗∗ (
4.04)

0.811∗

1.043∗∗

(1.77)
1.014∗ (
1.65)
4.961∗ (
1.67)

(2.11)
1.277∗ (
1.91)
6.685∗∗ (
2.07)


1.588∗∗∗ (
4.14) 1.355∗∗ (2.49)
1.659∗∗ (
2.25)
9.091∗∗ (
2.56)


1.782∗∗∗ (
4.23) 1.707∗∗∗ (2.86)
2.112∗∗∗ (
2.61)
11.89∗∗∗ (
3.05)

Full v Part Age

0.238∗ (1.77)

Age Sq Female Education


0.00243

Chronic

(
2.78)


0.383


0.410


0.431

(
0.83)

(
0.82)

(
0.80)

(
0.77)

(
0.74)

0.264

0.325∗

0.482∗∗

(1.74)

(2.38)

0.688∗∗∗ (3.12)


0.314


0.362


0.485


0.641

(
0.92)

(
1.02)

(
1.26)

(
1.53)


0.552∗ 0.123 1.761∗∗∗
2.071∗∗∗
4.580 (
1.55)

N

(3.39)
0.00670∗∗∗

(
2.23)

(
3.22) cons

(2.88)
0.00515∗∗∗


0.359

(3.42) Wife

(2.37)
0.00379∗∗

0.611∗∗∗

(
1.80)

(0.34) Married

(1.95)
0.00281∗

0.478∗∗∗


0.349

(
1.70) South/Islands

0.360∗∗

(
1.62)

(1.47) Disability

0.272∗

1216


0.605∗ (
1.80) 0.0722 (0.19)


0.734∗∗ (
2.02)
0.0552 (
0.14)

1.876∗∗∗

2.176∗∗∗

(3.56)
2.227∗∗∗ (
3.36)
5.529∗ (
1.80) 1216

(3.89)
2.626∗∗∗ (
3.69)
7.951∗∗ (
2.38) 1216

t statistics in parentheses. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01. (γ ¼ 0): LRchi2(27) ¼ 573.18, P rob > chi2 ¼ 0.0000.


0.899∗∗ (
2.27)

(
3.34)

0.913∗∗∗ (3.84)
0.805∗ (
1.77)
1.073∗∗ (
2.51)


0.215


0.380

(
0.49)

(
0.81)

2.569∗∗∗ (4.28)
3.147∗∗∗

2.993∗∗∗ (4.64)
3.710∗∗∗

(
4.07)

(
4.43)


11.17∗∗∗


14.75∗∗∗

(
3.06) 1216

(
3.71) 1216

To What Extent does Disability Discourage?

107

time worker increase, with stronger effects when the amount of unobserved heterogeneity increases, and this is coherent with expectations and what has been found in the probit estimations. Having a disability and living in the South/ Islands do not help passing the first two transitions, i.e., to enter the labour force and to be employed, and the size of the effects increases as the amount of unobserved heterogeneity increases. Furthermore, having a chronic disease contributes negatively to labour force participation and full-time employment, and this is in line with the results found in the descriptive evidence on employment, where health conditions are recognised as one of the major causes of part-time employment. Moreover, being a married man is an advantage for passing all the transitions, but being a married woman turns the effect negatively. These results have been in part anticipated by our findings in the probit models, where being married turned out to have a negative impact on the probability of being in the labour force only for women, and in the descriptive statistics on employment, where family responsibilities are found to be the main reason for working part-time for women. Given that the choices specified in the tree structure of the sequential logit procedure could also take place in two stages rather than three, i.e., a first decision of whether to participate in the labour force or not and a second stage with three possible outcomes
unemployed, part-time, full-time. In this case, the new tree structure has only two transitions: the first one for entering or not in the labour force and the second one for the three options, as shown in Fig. 2. Note that we still maintain the sequential nature of the decision-making process in line with our above-mentioned arguments. Table 18 shows the results of our estimations which are similar to the earlier ones. Again, having a disability does not help the access to the labour market and also affects significantly and negatively the probability of being employed (full-time or part-time). Furthermore, having a chronic disease contributes negatively to labour force participation, and people living in the South/Islands of Italy are more likely not to enter the labour force or to be unemployed. Being married man contributes positively to enter the labour force and to be a full-

Fig. 2.

Alternative Sequential Logit Tree with Three Branches.

108

TINDARA ADDABBO ET AL.

Table 18. Transitions

Alternative Sequential Logit Model (25
64 Years Old). (γ ¼ 0)

(γ ¼ 0.5)

(γ ¼ 1)

(γ ¼ 1.5)

(γ ¼ 2)

LF v NoLF Age

0.399∗∗∗ (6.39)

Age Sq


0.00516∗∗∗ (
7.58)

Female Education

0.155

0.183

0.215

(0.57)

(0.59)

(0.59)

0.739∗∗∗
0.420∗∗
0.661∗∗∗
0.353∗∗ 1.233∗∗∗ (5.39)

Wife


1.867∗∗∗ (
6.00)

cons


0.00789∗∗∗ (
7.49)

0.133

(
2.38) Married


0.00685∗∗∗ (
7.52)

0.609∗∗∗ (6.25)

(0.56)

(
4.24) South/Islands


0.00599∗∗∗ (
7.55)

0.530∗∗∗ (6.29)

0.126

(
2.51) Chronic


0.00538∗∗∗ (
7.57)

0.463∗∗∗ (6.33)

(0.55) (9.38) Disability

0.416∗∗∗ (6.37)


8.704∗∗∗ (
6.12)

0.773∗∗∗ (9.41)
0.438∗∗ (
2.51)
0.692∗∗∗ (
4.25)
0.370∗∗ (
2.39) 1.293∗∗∗ (5.41)
1.955∗∗∗ (
6.01)
9.086∗∗∗ (
6.10)

0.865∗∗∗ (9.47)
0.484∗∗ (
2.49)
0.775∗∗∗ (
4.26)
0.414∗∗ (
2.39) 1.457∗∗∗ (5.45)
2.191∗∗∗

0.995∗∗∗ (9.51)
0.549∗∗ (
2.46)
0.889∗∗∗ (
4.25)
0.476∗∗ (
2.38) 1.687∗∗∗ (5.49)
2.520∗∗∗

1.149∗∗∗ (9.52)
0.624∗∗ (
2.42)
1.023∗∗∗ (
4.23)
0.549∗∗ (
2.38) 1.961∗∗∗ (5.52)
2.906∗∗∗

(
6.02)

(
6.03)

(
6.03)


10.12∗∗∗


11.59∗∗∗


13.36∗∗∗

(
6.05)

(
6.01)

(
5.98)

Part v Un Age


0.00600 (
0.04)

Age Sq

0.000962 (0.51)

Female

0.0151 (0.09) 0.000733 (0.38)

0.0740 (0.41) 0.0000766 (0.04)

0.161

0.266

(0.84)

(1.29)


0.000921 (
0.42)

0.104

0.111

0.127

0.146

0.165

(0.21)

(0.22)

(0.23)

(0.25)

(0.26)

Education

0.354 (1.51)

(1.72)

(2.19)

(2.75)

Disability


0.741∗


0.773∗


0.862∗


0.989∗

(
1.67) Chronic

0.115 (0.29)

South/Islands


1.312∗∗∗ (
3.20)

Married


0.00215 (
0.90)

0.412∗

(
1.70) 0.0858 (0.21)
1.373∗∗∗ (
3.27)

0.559∗∗

(
1.80) 0.00520 (0.01)
1.521∗∗∗ (
3.44)

0.754∗∗∗

(
1.94)

0.973∗∗∗ (3.32)
1.134∗∗ (
2.08)


0.114


0.256

(
0.25)

(
0.53)


1.707∗∗∗ (
3.62)


0.903


0.820


0.601


0.303

(
1.43)

(
1.27)

(
0.90)

(
0.43)


1.903∗∗∗ (
3.78) 0.0340 (0.05)

109

To What Extent does Disability Discourage?

Table 18. Transitions Wife cons

(γ ¼ 0)

(Continued )

(γ ¼ 0.5)

(γ ¼ 1)

(γ ¼ 1.5)

(γ ¼ 2)

0.910

0.803

0.519

0.120


0.344

(1.16)

(1.00)

(0.61)

(0.13)

(
0.36)


1.745


2.391


4.117


6.542

(
0.50)

(
0.66)

(
1.07)

(
1.58)


9.367∗∗ (
2.10)

Full v Un Age Age Sq

0.211

0.233

(1.52)

(1.63)


0.00124 (
0.78)

Female Education

Chronic South/Islands


0.180


0.169


0.156


0.141

(
0.35)

(
0.29)

(
0.24)

0.653∗∗∗
0.906∗∗


0.941∗∗

(3.90)
1.038∗∗

1.046∗∗∗ (4.36)
1.174∗∗∗

(
2.41)

(
2.49)

(
2.60)


0.378


0.408


0.491


0.613

(
1.21)

(
1.26)

(
1.41)

(
1.61)


1.176∗∗∗ 0.903∗∗
1.154∗
6.171∗∗ (
2.05)

N

0.854∗∗∗

0.710∗∗∗ (3.51)

(
2.38)

(
1.88) cons


0.00442∗∗ (
2.07)

(
0.41)

(2.00) Wife


0.00318 (
1.62)

0.489∗∗∗ (2.62)


0.185

(
3.71) Married


0.00216 (
1.21)

0.383∗∗ (2.25)

(
0.43) (3.35) Disability


0.00148 (
0.90)

0.294∗ (1.89)

1216


1.236∗∗∗ (
3.77)


1.385∗∗∗ (
3.89)

0.986∗∗

1.201∗∗

(2.12)
1.262∗∗ (
1.98)
6.828∗∗ (
2.20) 1216

(2.39)
1.545∗∗ (
2.25)
8.575∗∗ (
2.54) 1216


1.571∗∗∗ (
4.02) 1.495∗∗∗ (2.72)
1.944∗∗∗

1.263∗∗∗ (4.82)
1.327∗∗∗ (
2.72)
0.758∗ (
1.82)
1.768∗∗∗ (
4.13) 1.827∗∗∗ (3.04)
2.406∗∗∗

(
2.58)

(
2.91)


11.02∗∗∗


13.85∗∗∗

(
2.98) 1216

(
3.41) 1216

t statistics in parentheses. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01. (γ ¼ 0): LRchi2(27) ¼ 572.63, P rob > chi2 ¼ 0.0000.

time worker, while being married woman has a negative effect on both statuses. Finally, a good education level is always profitable in terms of labour force participation and employment. On the whole, people with health problems, as well as married women and people living in areas of Italy characterised by a worse situation as far as the labour market and the implementation of disability laws and active policies are concerned, encounter higher obstacles in entering the labour market, especially when these characteristics occur together. Furthermore, chronic illness is found

110

TINDARA ADDABBO ET AL.

to be a stronger deterrent for labour force participation than disability, confirming that though disability discourages from work, it does not do as much as chronic diseases. Once in the labour force, all these categories of people usually remain unemployed or, at best, work part-time.

Comparison Between Multinomial and Sequential Logit Models In this section, we see how the results change if we specify a nonsequenced multiple outcome setting namely a multinomial logit model, using the same variables included in the sequential logit depicted in Fig. 1. As shown in Fig. 3, we estimate the model for the nonlabour force status, part-time employment and full-time employment, all in relation to unemployment, calculating log-odds for all other categories relative to the baseline. As can be seen from Table 19, our two key variables
disability and chronic illness
do not have any significant impact and this is a major difference with respect to the sequential logit model. The other variables turn out to be significant. For a 1 unit increase in education level, the log-odds of being outside the labour force instead of being unemployed are expected to decrease by 0.6 unit, while holding all other variables in the model constant. People living in the South/Islands are found to be statistically less likely to work (part-time or full-time) than people living elsewhere in Italy. Married men are significantly more likely to work full-time than their nonmarried counterpart, while married women are less likely to work full-time and more likely to be unemployed relative to their nonmarried counterpart. As a “robustness” check of the above results, we use the same variables of the benchmark model in a different multinomial tree. More specifically, as shown in Fig. 4, we first branch out the “out of labour force” and “in labour force” separately, and nest the unemployment, part-time and full-time within the “in labour force” branch.

Fig. 3.

Multinomial Logit Tree.

111

To What Extent does Disability Discourage?

Table 19.

Multinomial Logit Model (25
64 Years Old).

No Labour Force Age


0.266∗∗ (
2.28)

Age Sq

0.00430∗∗∗ (3.15)

Female


0.0104 (
0.03)

Education


0.567∗∗∗ (
3.82)

Disability


0.0423 (
0.12)

Chronic

0.442 (1.55)

South/Islands


0.238 (
0.88)

Married


0.708 (
1.61)

Wife

0.947∗ (1.67)

cons

6.603∗∗∗ (2.66)

Part-time Age

0.0325 (0.21)

Age Sq

0.000343 (0.19)

Female

0.260 (0.54)

Education

0.0455 (0.23)

Disability


0.517 (
1.20)

Chronic

0.134 (0.35)

South/Islands


0.969∗∗ (
2.56)

Married


1.071∗ (
1.70)

112

TINDARA ADDABBO ET AL.

Table 19. Wife

(Continued ) 0.825 (1.06)

cons


1.489 (
0.45)

Full-time Age

0.275∗∗ (2.17)

Age Sq


0.00221 (
1.51)

Female

0.0762 (0.19)

Education

0.257 (1.64)

Disability


0.550 (
1.55)

Chronic


0.360 (
1.24)

South/Islands


0.676∗∗ (
2.39)

Married

0.803∗ (1.84)

Wife


1.327∗∗ (
2.25)

cons


6.198∗∗ (
2.26)

N

1216

t statistics in parentheses. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01. LRchi2(27) ¼ 557.66, P rob > chi2 ¼ 0.0000.

The results, as shown in Table 20, are very similar to the previous multinomial variant with disability and chronic illness remaining largely insignificant. For a 1 unit increase in education level, the log-odds of working full-time (compared to the unemployment status) are expected to increase by 0.7 unit, holding all other variables in the model constant. The estimates show also that married men are significantly more likely to work full-time than their nonmarried counterpart. Conversely, the log-odds of working full-time is lower for married women relative to their nonmarried counterpart. Results suggest that disabled people and people living in the South/Islands are significantly less likely to

113

To What Extent does Disability Discourage?

Fig. 4.

Table 20.

Alternative Multinomial Logit Tree for Only Three Branches.

Alternative Multinomial Logit Model (25
64 Years Old).

Part-time Age


0.00600 (
0.04)

Age Sq

0.000962 (0.51)

Female

0.104 (0.21)

Education

0.354 (1.51)

Disability


0.741∗ (
1.67)

Chronic

0.115 (0.29)

South/Islands


1.312∗∗∗ (
3.20)

Married


0.903 (
1.43)

Wife

0.910 (1.16)

cons


1.745 (
0.50)

Full-time Age

0.211 (1.52)

Age Sq


0.00124 (
0.78)

Female


0.185 (
0.43)

114

TINDARA ADDABBO ET AL.

Table 20.

(Continued )

Education

0.653∗∗∗ (3.35)
0.906∗∗

Disability

(
2.38)
0.378

Chronic

(
1.21)
1.176∗∗∗

South/Islands

(
3.71) Married

0.903∗∗ (2.00)
1.154∗

Wife

(
1.88)
6.171∗∗

cons

(
2.05) 444

N t statistics in parentheses. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01. LRchi2(27) ¼ 123.01, P rob > chi2 ¼ 0.0000.

work (part-time or full-time) than people without any disability and people living elsewhere in Italy respectively. Given that the variables indicating health condition (i.e., presence of disability and chronic diseases) are insignificant in the multinomial variants, whereas they both have a significant and meaningful economic interpretation along with the other variables in the sequential logit model, we are inclined to favour the latter for our data. Moreover, the sequential estimation results on the relationship between disability and work are in line with the expectations based on the descriptive evidence and consistent with the literature.

CONCLUSIONS AND AVENUES FOR FUTURE RESEARCH This chapter investigates the extent to which disability discourages an individual to go on the job market in Italy, after controlling for education and other relevant individual characteristics. It considers an extended definition of labour force participation and makes use of a unique data set constructed from a national survey carried out specifically targeting disabled people and their labour market status.

To What Extent does Disability Discourage?

115

The descriptive evidence already shows some interesting trends. First, an important gender gap seems to exist. Disabled men have, on average, higher qualifications than disabled women, and mobility and sensory disability lead to a longer tenure in school, compared to intellectual disability. Furthermore, as expected, with the increase in the number of disabilities there is a reduction in the level of education obtained. Looking at the work situation of disabled people, among those who are employed, people with a mobility disability achieve higher job positions, while those with an intellectual disability face the biggest disadvantage, even more than the “emotionally challenged.” We apply several probit and logit models to analyse the impact of classical human capital variables as well as health and disability factors on work, using the extended definition of labour force participation. The usual evidence of a positive effect of education on work is repeated in our case too. Chronic illness has a significant negative effect whereas disability does not seem to be significant when men and women are pooled together. Separating men and women leads to significant effects of disability and chronic illness for women, but not for men. Focusing on disabled people, we find intellectual and hearing disabilities to be the most affecting types, and emotional disability to a lower extent for women. In all variants, living in the South/Islands of Italy has a negative influence. Finally, high education levels seem to be necessary to access the labour market and to obtain a good job position for both men and women. Going further to look at the type of labour status using a sequential logit model, we find that having a disability and/or a chronic disease fails to pass the labour force transition and the employment transition, with chronic diseases having a greater impact than disability. Being married acts against labour force participation and employment for women. These results are robust across different sequential and multinomial specifications. A direct multinomial logit model seems to be the least satisfactory specification as it fails to offer adequate explanations for the employment status. From a policy perspective, our results suggest that satisfactory outcomes in terms of placement of disabled people can be attained through coherent and tailored programmes that involve educational institutions and health authorities, as education and chronic diseases consistently have the most significant influence in all settings. Our estimations, in fact, show that any education level higher than the primary school certificate has a positive and significant impact on the probability of entering the labour force for men, while this is true for women only if a university degree or a high school diploma is obtained. In addition, it is important that interventions distinguish between specific types of disability and provide the necessary support to disabled people to be able to acquire an appropriate education level and skills suited to their characteristics, addressing also the gender inequalities observed in the levels of education. To end the chapter, we would like to point out some limitations of our study and possible future research. Firstly, our sample is not representative of the “disabled” population in Italy as only people who reported a disability before

116

TINDARA ADDABBO ET AL.

1999
2000 are included and even among them attrition is observed. It would be interesting to contrast our findings with those obtained using a more representative data set. Second, we assumed that attrition was random in our sample for lack of data on people who did not answer. Thirdly, we only have one cross-section data and hence are not able to perform a deeper analysis following the same individuals over time, which would provide additional insights. Finally, given that education and employment decisions could be simultaneously taken, it would be useful to specify a system of equations for studying both educational and employment opportunities of disabled people. A useful future research is to analyse the impact of disability on other aspects of life, in particular education, as mentioned above, and social participation. Finally, our analysis could be repeated for data on other countries and definitions of disability, in order to draw more general conclusions on labour force participation of disabled people.

NOTES 1. Italian data from ISTAT 2004
2005, which can be consulted on the web-site http://www.handicapincifre.it, show that people with disability have serious chronic diseases (58.4%) or multi-chronic diseases (60.8%) more than the rest of population (respectively 11.6% and 11.8%). 2. We thank two anonymous referees for pointing out the need for an explanation on the distinction made between disability and chronic illness in our study. 3. We will discuss this point in more detail later, see under Data source section. 4. It is found that Italian firms employing a number of workers near the threshold are more likely to be inactive and move backward. Furthermore, in Austria employment quotas accompanied by financial sanctions as well as an increase in noncompliance tax are found to rise the employment of disabled people. 5. Published in the Official Journal, n. 109, April 30, 1968. 6. Supplement to the Official Journal, n. 39, February 17, 1992. 7. Supplement to the Official Journal, n. 57, March 23, 1999. 8. There are some exceptions from the obligation for political parties, unions and organisations of social solidarity, nevertheless they are obliged in case of new hirings. 9. People with disability must be registered in a specific unemployment list to benefit from this law and employers can hire by nominative calls (introduced by Law 68/1999) or numerical calls (through a specific ranking). Furthermore, Article 11 introduces the possibility of hiring through special Agreements stipulated with authorised offices, which concern the possibility of apprenticeships and vocational training, longer trial period, reduced working time and part-time contracts, temporary work in social cooperatives, etc. 10. For further information on the implementation of Law 68/1999, see Ministero del Lavoro (2006, 2008, 2011). Every two years the Italian Ministry of Labour presents to the Parliament a report about the implementation of Law 68/1999. 11. The interviewees could state different types of disability. Mobility disability, vision disability, hearing disability, intellectual disability and emotional/mental disability. The first one refers to impairments which limit the physical function of limbs or fine or gross motor ability. Vision disability is a significant limitation of visual capability, while hearing disability refers to those situations in which individuals are fully or partially unable to detect or perceive at least some frequencies of sound which can typically be heard by

To What Extent does Disability Discourage?

117

most people. Intellectual disability is characterised by impaired cognitive functionings and a lack of the skills necessary for daily living, while emotional disability influences person’s ability to recognise and express fundamental emotions, but it is not caused by organic abnormalities of the brain. 12. For more information about the model, see e.g., Cameron and Trivedi (2005) and Buis (2007). 13. The choices specified in the sequential logit tree don’t have to be necessarily binary (i.e., pass or fail). 14. The probability of observing someone who is not in the labour force equals the probability of failing the first transition. The probability of observing someone unemployed equals the probability of passing the first transition and failing the second one. The probability of observing someone employed part-time is equal to the probability of passing the fist and the second transition, but failing the third one. Finally, the probability of observing someone employed full-time is equal to the probability of passing all the transitions (Buis, 2011). 15. The Independence of Irrelevant Alternatives means that an individual’s choice between two alternatives is unaffected by other choices available. If A is preferred to B out of the choice set A,B, introducing a third alternative X, which expands the choice set to A,B,X, do not change the preference for A or B. In other words, X is irrelevant to the choice between A and B (Weiler, 1986). 16. The main questions and answer categories of the ISTAT questionnaire are reported in the appendix. 17. If the interaction between two disabilities is considered, the most common situation is mental health and intellectual disability at the same time or cognitive and mobility disabilities together. 18. The number of observations is 1,166 (592 men and 574 women). 19. The definition of labour force includes employed people and those seeking work. The ILO defines the labour force as the number of working-age people engaged actively in the labour market, either by working or looking for work. As such, the labour force is obtained summing the number of employed and unemployed. In our setting, however, some people state to be housewives, students, retired or in other conditions and, at the same time, they admit they are looking for a job (this group is very small) and thus are included in the labour force. Others state to be in the category of those who are looking for the first or a new job, even if in practice they did not take any active step to find a job in the previous four weeks. For this last category, a broader definition of unemployment is applied, thus relaxing the criterion of being an active job seeker suggested by ILO. 20. As we do not report the beta coefficients but only the marginal effects, the interaction term cannot be added in the tables. As such, there is no marginal effect of the interaction term as it can go with either of the two variables. We decided not to attach the interaction effect with one or the other of the two variables as there is no strong reason to do one way or the other. Thus we only limit ourselves to commenting on its sign. 21. We thank two anonymous referees for pointing this out. 22. Let us note that the possible negative influence of disability on education may not render education endogenous as we are talking of a possible common cause of both education and employment which is disability and hence a strong correlation between two explanatory variables of our regression. In a linear setting it can be shown that it underestimates the coefficient of ”disabled” while leaving that of education unaffected. If there are other common causes of education and employment apart from disability that have been omitted from the regression, then endogeneity could be suspected. Unfortunately we do not have any valid instrument in our data set. 23. Only jumping from secondary school to high school is statistically significant. 24. For practical purposes, we do not consider a single unobserved variable, but a weighted sum of all the unobserved variables and our model assumes that the

118

TINDARA ADDABBO ET AL.

unobserved component is normally distributed and its value and effect remain constant over the transitions (Buis, 2011).

REFERENCES Abu Habib, L. (1995). Women and disability don’t mix!: Double discrimination and disabled women’s rights. Gender & Development, 3(2), 49
53. Ameri, M., Schur, L., Adya, M., Bentley, S., McKay, P., & Kruse, D. (2015). The disability employment puzzle: A field experiment on employer hiring behavior. Working Paper No. 21560. National Bureau of Economic Research, Cambridge, MA. Brandolini, A., Cipollone, P., & Viviano, E. (2006). Does the ILO definition capture all unemployment? Journal Of The European Economic Association, 4(1), 153
179. Buis, M. L. (2007). SEQLOGIT: Stata module to fit a sequential logit model. EconPapers available at http://econpapers.repec.org/software/bocbocode/s456843.htm. Buis, M. L. (2011). The consequences of unobserved heterogeneity in a Sequential Logit Model. Research in Social Stratification and Mobility, 29(3), 247
262. Cameron, C. A., & Trivedi, P. K. (2005). Microeconometrics. Cambridge: Cambridge University Press. Cullinan, J., Gannon, B., & Lyons, S. (2011). Estimating the extra cost of living for people with disabilities. Health Economics, 20(5), 582
599. Gannon, B., & Nolan, B. (2003). Disability and Labour Market Participation. Papers HRBWP04, Economic and Social Research Institute (ESRI), November. Garibaldi, P., Pacelli, L., & Borgarello, A. (2003). Employment Protection Legislation and the Size of Firms. IZA Discussion Papers 787. Institute for the Study of Labor (IZA), Bonn. May. ISTAT. (2004a). Indagine di ritorno sui disabili. http://www.istat.it/it/archivio/5500 ISTAT. (2004b). Reddito e condizioni di vita. http://www.istat.it/it/archivio/4152 Jones, M. K., Latreille, P. L., & Sloane, P. J. (2003). Disability, Gender and the Labour Market. IZA Discussion Papers 936. Institute for the Study of Labor (IZA), Bonn. November. Jones, M. K., Latreille, P. L., & Sloane, P. J. (2006). Disability, gender, and the British labour market. Oxford Economic Papers, 58(3), 407
449. Kidd, M. P., Ferko, I., & Sloane, P. J. (2000). Disability and the labour market: An analysis of British males. Journal of Health Economics, 19(6), 961
981. Krishnakumar, J. (2007). Going beyond functionings to capabilities: An econometric model to explain and estimate capabilities. Journal of Human Development and Capabilities, 8(1), 39
63. Lalive, R., Wuellrich, J.-P., & Zweimu¨ller, J. (2013). Do financial incentives affect firms’ demand for disabled workers? Journal of the European Economic Association, 11(1), 25
58. Ministero del Lavoro. (2006). Terza relazione al Parlamento sullo stato di attuazione della legge 12 marzo 1999, n. 6 Norme per il diritto al lavoro dei disabili. Anni 2004-2005. Technical Report, Ministero del Lavoro e della Previdenza Sociale. Ministero del Lavoro. (2008). Quarta relazione al Parlamento sullo stato di attuazione della legge 12 marzo 1999, n. 6 Norme per il diritto al lavoro dei disabili. Anni 2006-2007. Technical Report, Ministero del Lavoro, della Salute e delle Politiche Sociali. Ministero del Lavoro. (2011). Quinta relazione al Parlamento sullo stato di attuazione della legge 12 marzo 1999, n. 6 Norme per il diritto al lavoro dei disabili. Anni 2008-2009. Technical Report, Ministero del Lavoro, della Salute e delle Politiche Sociali. Mitra, S. (2006). The capability approach and disability. Journal of Disability Policy Studies, 16(4), 236
247. Mitra, S., & Sambamoorthi, U. (2006). Employment of persons with disabilities: Evidence from the National Sample Survey. Economic and Political Weekly, 41(3), 199
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Mont, D. (2004). Disability Employment Policy. Social Protection Discussion Paper, No. 0413. World Bank, Washington. Mori, Y., & Norihito, S. (2017). Economic Consequences of Employment Quota System for Disabled People: Evidence from a Regression Discontinuity Design in Japan. Journal of the Japanese and International Economies, Available online 7 February 2017. Nazarov, Z., Kang, D., & von Schrader, S. (2015). Employment Quota System and labour market outcomes of individuals with disabilities: Empirical evidence from South Korea. Fiscal Studies, 36(1), 99
126. OECD. (2003). Transforming Disability into Ability. Policies to promote work and income security for disabled people. Technical Report, OECD, Paris. Parodi, G., & Sciulli, D. (2012). Disability and low income persistence in Italian households. International Journal of Manpower, 33(1), 9
26. Sen, A. (1985). Commodities and capabilities. Amsterdam: North Holland. Sen, A. (1992). Inequality re-examined. Oxford: Clarendon Press. Sen, A. (1999). Development as freedom. Oxford: Oxford University Press. Sen, A. (2005). Essere disabili due volte. Il Sole-24 Ore. Stapleton, D. C., & Burkhauser, V. (2003). The decline in employment of people with disabilities: A policy puzzle. Kalamazoo, MI: WE Upjohn Institute. Weiler, W. C. (1986). A Sequential Logit Model of the access effects of higher education institutions. Economics of Education Review, 5(1), 49
55. WHO. (2001). International Classification of Functioning, Disability and Health. Geneva: World Health Organization. Wuellrich, J.-P. (2010). The effects of increasing financial incentives for firms to promote employment of disabled workers. Economics Letters, 107(2), 173
176. Zaidi, A., & Burchardt, T. (2005). Comparing incomes when needs differ: Equalization for the extra costs of disability in the U.K. Review of Income and Wealth, 51(1), 89
114.

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APPENDIX. IMPORTANT QUESTIONS AND ANSWER CATEGORIES OF THE ISTAT SURVEY Some categories have been pooled together in the empirical models employed.
Gender: 1. Male 2. Female
Year of birth: XXXX
Place of residence: 1. North-West 2. North-East 3. Centre 4. South 5. Islands
Marital status: 1. Single/Never been married 2. Married/Living with the partner 3. Not married/Living with the partner 4. Legally separated 5. Divorced 6. Widow
Highest education level achieved: 1. Ph.D. 2. Master degree 3. Bachelor degree 4. High school (4
5 years) 5. High school (2
3 years) 6. Secondary school 7. Primary school 8. No education
able to read and write 9. No education
not able to read and/or write

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Presence of chronic diseases: 1. Yes 2. No 99. No answer
Presence of limitations (lasting at least 6 months) in daily activities: 1. Yes, serious 2. Yes, not serious 3. No
Presence of one of these types of disability (more than one answer is allowed): 1. Vision disability 2. Language disability 3. Hearing disability 4. Intellectual disability 5. Mental disability 6. Mobility disability
Cause of the disability: 1. Congenital disability 2. Illness 3. Accident 4. Other cause 5. Professional disease 6. Vaccination/medicines 7. Operation 98. Don’t know 99. No answer
Age when experienced the onset of the disability: 1. At birth 2. X X years old 3. Less than 1 year old 98. Don’t know 99. No answer

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Work condition: 1. Employed 2. Looking for a new job 3. Looking for a first job 4. Military service 5. Housewife 6. Student 7. Unable to work 8. Retired from work 9. Other condition
Job position in the last job: 1. Executive 2. Manager 3. White-collar worker 4. Blue-collar worker 5. Apprentice 6. Home working employee 7. Entrepreneur 8. Freelance 9. Self-employed 10. Member in a mutual company 11. Carer
Type of contract: 1. Permanent 2. Temporary 98. Don’t know 99. No answer
Working hours: 1. Part-time (see also the question below) 2. Full-Time 99. No answer

TINDARA ADDABBO ET AL.

To What Extent does Disability Discourage?


What is the main reason for working part-time? 1. Not found a full-time job 2. Family reasons 3. Other commitments (study, hobby, etc.) 4. Health condition 98. Don’t know 99. No answer

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PART 2 DISABILITY INCLUSION STRATEGIES AND INTERVENTIONS

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CHAPTER 4 THE COMPLEXITY OF DISABILITY INCLUSION IN THE WORKPLACE: A SOUTH AFRICAN STUDY$ Nceba Ndzwayiba and Lieketseng Ned ABSTRACT Purpose
The purpose of this research is to investigate the process of development and implementation of strategies to promote diversity and inclusion of persons with disabilities in the workplace within Netcare (the largest private hospital group) in South Africa. Methodology/approach
A single case study methodology is used to document best practices developed at Netcare for the integration of persons with disabilities in the workplace. Findings
The case study demonstrates that integrating people with disabilities in the workplace is a complex process that requires bringing together disability theory/model and organizational change models. Disability integration within Netcare is an ongoing process with positive gains and gaps that can be leveraged to improve the process. Nonetheless, significant improvements in the number of persons with disability integrated at work as well as a good retention rate in the skills development program have been realized.

$

Author’s Contributions: The authors of this chapter have made equal contributions in the writing thereof. Thus the sequence of authors does not represent first author and second author status.

Factors in Studying Employment for Persons with Disability: How the Picture can Change Research in Social Science and Disability, Volume 10, 127
154 Copyright r 2017 by Emerald Publishing Limited All rights of reproduction in any form reserved ISSN: 1479-3547/doi:10.1108/S1479-354720170000010006

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Practical implications
The documentation of practice based initiatives such as those developed by Netcare is useful for future cross-organizational and cross-context comparative studies. This will ultimately redirect policy and research agendas from the deficit analysis approach towards a more positive inquiry based upon practical and workable solutions. Social implications
The treatment of disability as a silo identity does not provide full appreciation of the multiple intersecting identities that interlock to position some persons with disabilities in positions of privilege and marginalization simultaneously. Originality/value
This chapter reveals the importance of situating disability mainstreaming within a broader organizational transformation strategy. Legislating social and organizational transformation issues is necessary but insufficient to produce the desired social change. This research highlights the value of inculcating transformative leadership culture and building leadership accountability to realize the desired social and organizational change. Keywords: Disability; employment; organizational change; complex embodiment; transformation; Netcare

INTRODUCTION Disability and employment are interconnected phenomena that need to be viewed as social justice issues, globally. These issues bring together several epistemic and praxis fields that remain largely autonomous of each other namely; organizational theory and practice, social development, identity politics of ability
disability binaries and disability mainstreaming. Though contemporary organizations embrace the idea of organizational citizenship or corporate social responsibility and the vast projects this brings for emancipation of marginalized social groups, organizations tend to miss the interconnectivities involved in this transformation, diversity and inclusion work by leaning more towards adopting a singular perspective. The most commonly selected perspective always attempts to harmonize organizational citizenship with organizational performance and profitability. This research indicates that this harmony is not always possible. In fact, this chapter shows that processes of disability inclusion in the workplace demand an ability to hold together complex, contradictory, and fluid models and practices in order to achieve the goals of challenging and changing systematized obstructions that inhibit employment prospects of persons with disabilities without totally disregarding the medical condition that causes the disability and without essentializing these medical conditions either.

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Globally, it is estimated that disability affects 10% to 15% of adults of which 470 million are predicted to be of working age (ILO, 2007; WHO, 1981; WHO & World Bank, 2011). As a social group, persons with disabilities experience high levels of unemployment; this economic exclusion deprives societies of an estimated $US 1.37 to 1.94 trillion in annual loss to GDP (ILO, 2007). The diminutive numbers of persons with disabilities that manage to secure employment generally occupy entry level jobs with low pay (ILO, 2007). The high unemployment has produced a social world in which persons with disabilities have little choice but to endure the burden of perpetual inequality and poverty, particularly in developing economies. Almost 80% of all persons with disabilities in the world live in the rural areas of developing countries with limited or no access to opportunities and services (ILO, 2007; WHO & World Bank, 2011). Developing countries, including South Africa, have begun to address this pervasive socio-economic exclusion of persons with disabilities through enactment of empowerment programs that promote the creation of decent work for persons with disabilities. However, the realization of these goals remains very slow (Yeo & Moore, 2003). Empirical literature, mainly from developed (OECD, 2003, 2009) and transitioning countries (Mete, 2008; OECD, 2003), has generated valuable knowledge on barriers that prohibit the successful employment of persons with disabilities. However, there is a paucity of empirical literature that focuses on practical solutions implemented by employer organizations and other social partners within developing countries to overcome barriers to disability mainstreaming. This gap also exists in South Africa. Postcolonial-post-apartheid South Africa’s democratically elected government has been hailed for placing disability mainstreaming at the epicenter of socio-economic reform strategies and policies. The Constitution of RSA, Act No (108) of 1996 is quite unique internationally in its explicit mentioning of disability as a key equity issue. South Africa was also an early signatory of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). In the sphere of employment, disability diversity in the workplace is legislated for in the Broad Based Black Economic Empowerment Act (BBBEE), the Employment Equity Act (EEA) and the Skills Development Act (SDA) of 1998, with the intention of improving socio-economic empowerment of persons with disabilities amongst other designated social groups. These laws mandate public and private sector organizations to implement skills development initiatives and to create employment opportunities for persons with disabilities; with a 2% of total workforce target being set. Despite these progressive developments, disability in South Africa is nearly synonymous with skills deficits, high unemployment, poverty and marginality. South African organizations are struggling to meet the prescribed 2% workforce representation of persons with a disability target. In fact, workforce representation of persons with disabilities is declining. According to the 2014 Commission on Employment Equity (CEE) report, employees with disabilities

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accounted for 1.3% of the country’s workforce in 2003; and this plunged to a meager 0.9% out of 5.6 million employees in 2013 (CEE, 2014). Virtually 99% of potentially employable South Africans with disabilities remain unemployed. Almost 1.2 million of the estimated 4 million South Africans with disabilities receive government social grants of R 1,200 per month for a period of 12 months. According to South Africa’s Integrated National Disability Strategy (1997) almost 70% of schooling age learners with disabilities remained outside of the general education and training system. In 2009, Minister of Higher Education, Dr Blade Nzimande, reported that students with disabilities accounted for a mere 0.6% (4,666) of total students enrolled at South Africa’s tertiary institutions. It is on these grounds that the South African government conceptually interlinked the priorities of human resource development, workplace transformation and employment creation for persons with disabilities through the enactment and enforcement of the Skills Development Act and Employment Equity Act. South African literature, however, suggests that there is a gap between macro policy intent and the local implementation of this intent. The policy-practice gaps pertaining to disability mainstreaming are quite common in developing economies. This challenge has been identified in countries such as Uganda (Hoogeveen, 2005), South Africa (Mitra, 2008), India (Mitra & Sambamoorthi, 2008), Mexico (OECD, 2003), Vietnam (Palmer et al., 2010), Rwanda (Rischewski et al., 2008), Afghanistan and Zambia (Trani & Loeb, 2010), Namibia (Eide & Kamaleri, 2009; Eide, van Rooy, & Loeb, 2003), Lesotho (Kamaleri & Eide, 2011), Malawi (Loeb & Eide, 2004) and Peru (Zambrano, 2006). The World Health Organization’s (WHO) study on employment rates between persons with and without disabilities in 69 worldwide countries affirmed that developing countries are also reporting low employment rates of persons with disabilities compared to their able-bodied counterparts (Mizunoya & Mitra, 2013). Thus there is a need for empirical studies that seek to identify and examine disability mainstreaming initiatives to determine best practices. The lessons learned from these practices could assist in the development of prototype models and program evaluation benchmarks. In this chapter, we present a single case study of one of the largest private hospital groups in South Africa, Netcare Ltd, (Netcare), as a contribution towards the closure of this epistemic gap. Netcare improved their disability representation in the workforce from 0.31% (60) in 2008 to 2.63% (563) by 2015.

Methodology This research adopts a case study design to study the processes of strategy development, implementation and evaluation employed within Netcare to promote diversity and inclusion of persons with disabilities in the workplace.

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Yin (2014) asserts that a case study methodology is very useful when seeking to explain the how and the why of social phenomena. Case study design arises out of the desire to understand complex social issues by allowing investigators to focus on a “case” and retain a holistic and real-world view perspective. Yin and Davis (2007) also posit that a case study is appropriate when the behaviors of those involved in the study cannot be manipulated by the researcher; and when the phenomenon is studied in-depth in its real-world context, assuming that such understanding will likely involve essential contextual conditions pertinent to the case. An organizational development (OD) model, more specially, Lewin’s (1947) three step model of change, is adopted for the purposes of guiding our assessment of the Netcare’s processes of developing, implementing and evaluating the strategy of disability inclusion. Generally, organizational development entails systematic steps for transformative change within an organization (Armstrong, 2009). As Jex and Britt (2008) posited, organizational development interventions need to be situated within systems theory so as to ensure that intra organizational change responds to dynamics that exist in the organization’s external environment. This view is important as the phenomenon of disability is largely viewed as a social development and a medical issue rather than an organizational diversity and inclusion issue. Nonetheless, the OD field has developed innumerable models aimed at guiding organizational transformational change. Chief amongst these is Kotter’s eight step model, Larry Greiner’s Model, and Kurth Lewin’s three step model. While these models are sound and enjoy popularity, they focus mainly on the process of change rather than evaluating the impact of change. Butler, Scott and Edwards (2003) correctly observed that evaluating organizational development
change interventions “is a thorny issue.” This is due to the emergent nature of OD evaluation models, their multiplicity and their tendency to sharply focus on evaluating one dimension of organizational change. In the main, these evaluation models tend to assess the effects of organizational change interventions on organizational strategy and performance (Cummings & Worley, 2005; French & Bell, 1990; Loitaruk, 2013), process reengineering (Armstrong, 2009), and organizational learning and culture change (Khanka, 2003; Maxwell, Asumeng, Osae
Larbi, 2015). Considering these complexities, we intentionally focused our research primarily on exploring the change process followed by Netcare and the evaluation models they applied to measure the effects of their disability inclusion strategies and interventions. Thus, this chapter focuses on the change process analysis with key interest on understanding how Netcare navigated the complexities associated with disability inclusion at work. Accordingly, we intentionally selected Lewin’s 3-Stage Model of Change to guide our inquiry into the change process.

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Lewin’s Change Model The German
American Social Psychologist Kurt Lewin (1947) developed a change model consisting of three steps; Unfreezing
Transforming/Changing
Refreezing. According to Lewin, the unfreezing involves the creation of the desire for change within the organization. This involves conscientisation of organizational stakeholders about the limitations of the status quo in terms of thought processes, behaviors, structures and processes. Conscientisation is then followed by a careful analysis of the hindrance factors and the communication thereof with employees with the aim of creating buy in, explaining the logic for change, and creating a climate that anticipates the change. Lewin believed that the more organizational role players are aware of and have a shared vision for change, the more they will be motivated to support change. At this stage, the organization as Lewin suggests, can begin the transition process by designing and implementing carefully planned and well executed change interventions. Lewin warned that this transformation phase is generally marked by uncertainty, fear, unlearning of old behaviors and learning to adopt new behaviors. Fisher (2012) refers to this stage as the transitional curve. Lewin advised proses that organizations must implement educational programs, strengthen communication and show greater support to employees in this phase. The transition phase, according to Lewin, needs to also be accompanied by continuous monitoring, evaluation and review. The gains and benefits of the change need to be communicated to employees as part of behavior change reinforcement. Lewin proposes that as the organizations become familiar with the new ways of doing things, they can begin to refreeze, stabilize and solidify the new stage of change. Thus, the new state becomes normalized. While Lewin’s model is useful in many ways, its limitations lie in assuming change as a linear process that has an end point. In this research, we are cognizant of this limitation. Hence, we resolved to use it alongside Siebers theory of complex embodiment which we discuss in our definition of disability below.

Defining Disability Various debates on the subject of disability offer varying viewpoints on what is understood as disability. Thus, it is critical to clarify how we describe disability in this chapter. The concept of disability is best understood from a biopsychosocial model, which Goodley (2011) and Magasi et al. (2015) report as incorporating not only a biological perspective, but also the first person’s account of disability experience and social accounts. This is reflected in the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001), which integrates two competing perspectives (medical and social models) for describing disability. The biopsychological model has also been credited for identifying

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environmental factors that influence participation across all aspects of life and the experience of disability. Thus, two individuals may have the same impairment, medically speaking, but the level of disability they experience may be significantly different, dependent on environmental factors. This interaction of factors is most important in understanding its influence on participation of persons with disabilities while also being cognisant that disability does not exist in isolation. The ICF does not provide a comprehensive conceptualization of these relationships (Magasi et al., 2015). In this regard, the intersectionality lens assists to better understand the multidimensionality of disability. Intersectionality refers to “interaction between different social locations” (Larson, George, Morgan, & Poteat, 2016, p. 965), which may include race/ ethnicity, gender, religion, sexuality, language and age, to name a few. Each of these social locations may be associated with privileges or discriminatory barriers which also influence the experience of disability. This has been overlooked in the literature on disability and employment. In this research, we elect Siebers’ (2013) theory of complex embodiment. Siebers (2013) idea of complex embodiment theory attempts to position disability as a social justice. Siebers proposes this approach with intent of holding together the identity politics, social constructionism, empowerment and the medical condition. So Siebers sees disability as complex and none fixated to a singular definition or lens. Siebers (2013) contends that embodiment is caught between competing models of disability. We derive our idea of disability inclusion as entailing complexities
contradictions and fluidity from Siebers’ theory of complex embodiment. The theory of complex embodiment welcomes and challenges the medical and social models of disability but goes a step further to appreciate disability as a form of human variation. This theory also considers interacting factors that influence the very experience of disability as pointed by the ICF. Theory of complex embodiment views this interaction as reciprocal. This implies that, as awareness is raised about the impact of disabling environmental factors on the experience of their bodies, attention is also given to the view that some of these factors (such as secondary health effects, pain, poor endurance, etc.) actually derive from the body. The latter is neither less significant than the environmental factors nor viewed as weaknesses because of their resistance to change. Siebers (2013) adds that all these dynamics should rather be seen as belonging to the human difference spectrum, comprehended as such, both between individuals and within individuals’ life cycles and also in tandem with social forces affecting disability. Therefore, these multiple factors can be construed as not unidirectional as the social model proposes nor can they be construed as nonexistent as the medical model propositions. They are rather reciprocal, mutually transformative and therefore critical in researching issues of disability and employment. In what follows, an introduction to Netcare is provided with an eye to this conglomerate’s organization, mission and culture. The development of their integrative program and its implementation in the workplace are described. We then draw upon the theory of complex

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embodiment which encompasses social justice, intersectionality and transformational leadership theories to discuss key issues, lessons and critics that emerge from this case. We conclude with a brief discussion of the implications for policy, practice and scholarly research. Having mapped our operating definition of disability and methodology for this research, we now present the Netcare case study and provide a discussion thereafter.

THE NETCARE CASE Netcare is the largest private hospital group in South Africa and in the United Kingdom. At the time of conducting this inquiry, Netcare group owned 55 private hospitals with some 9,052 registered beds, 88 Netcare pharmacies, a network of Medicross and Primecure facilities and the emergency services division famously known as Netcare 911. At the end of the 2015 financial year, Netcare
SA employed nearly 22,000 employees of which 82% were women, 73% were Black (African, Colored, and Indian), 27% were White, and 2.63% had a disability (Netcare Annual Report, 2015). Netcare has six strategic pillars of which one is “Accelerating transformation.” This sixth strategic pillar was introduced post 1994 to align with South Africa’s agenda of deepening democracy. This strategic decision placed the imperative of engendering socio-economic reforms at the center of Netcare’s boardroom agenda. Pursuant to this, governance structures were enacted to ensure leadership accountability for transformation objectives and to ensure that these objectives translate into actions and outcomes. Netcare’s strategic pillars are underpinned by as set of approved values of care, dignity, participation, passion and truth. All employees within Netcare contract to living by and practicing these values in their daily endeavors. Additionally, Netcare ratified a leadership pledge that encapsulates the ethos with which Netcare leadership (commit to) drive reforms. Amongst other salient points, the leadership pledge states that: We the leadership of Netcare recognize the injustices of our past; honour those who suffered for justice and freedom in our land; and believe that South Africa belongs to all who live in it, united in our diversity. As the leadership of Netcare, we commit to participate in the greater transformation of South Africa by pledging to take individual responsibility for enabling transformation in Netcare, through our own personal transformation. We commit to create an environment where cultural and individual diversity is understood and respected; and to actively work towards the correcting of past injustices by committing to equity in our workforce and the upliftment of the greater communities we serve.

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Unfreezing In 2008, Netcare observed that its diversity promotion efforts had yielded some positive gains in promoting greater racial and gender diversity within the workforce relative to the national economically active population. However, people with disabilities, particularly from the black population, were still invisible in the workforce profile as they only accounted for a mere 0.31% (60 persons out of the workforce of 19,908). Netcare Chief Executive, Dr Richard Friedland, regarded this underrepresentation as misaligned with the soul of the group’s transformation strategy. Dr Friedland postulated that a truly diverse workforce is inclusive of persons with disabilities across all levels of occupancy, thus challenging the leadership team to improve the 0.31% representation to at least 4% by 2015. This 4% target was nonnegotiable and the aim was to include it in the leaders’ balanced scorecards. The balanced scorecard (BSC) comprises group priorities for a determined period and links these priority objectives to financial incentives and nonfinancial recognition. 1st step: Attempt to Understand the Challenges Limiting Employment of Persons with Disabilities at Netcare Firstly, a task team comprising some human resource practitioners, disability consultants and some business leads was constituted. The task team conducted a desktop analysis of internal and external barriers resulting in the crafting of a document titled “Netcare draft disability strategy.” The document outlined the challenges in the national education system stemming from a non-integrated education system for pupils with disabilities and those without. Consequently, pupils in special needs schools barely completed grade 12. This in turn resulted in a handful of students with disabilities proceeding to tertiary institutions. A high dropout rate amongst those that manage to make it to tertiary institutions was identified coupled with low employment prospects for those that manage to complete tertiary education due to lack of work experience. The strategy document recommended implementation of learnerships and internships to close these gaps. However, this proposed solution focused on external barriers and the proposed solution was going to create disability inclusion in administrative roles of the Netcare business. The task team recommended a formal study to be conducted in the core areas of the business, more specifically nursing, to determine barriers and possibilities. Indeed, an internal investigative study was conducted to identify internal barriers to employment with greater focus on the nursing profession. The greater focus on nursing was prompted by the fact that these professionals make up almost 60% of the workforce. The other areas of the business, specifically administration and pharmacy had already indicated some commitment

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to create employment opportunities should suitably qualified individuals be available. The outcome of the investigation showed, firstly, that social stereotypes within a predominantly able-bodied workforce were the biggest barrier that stymied the employment of persons with disabilities, particularly in the nursing profession. This was based on perceived limitations and abilities of persons with disabilities. These disruptive stereotypes were persistently produced, reproduced and entrenched through many of the able-bodied persons’ daily culture at work. This had the unintended consequence of causing employees with disabilities to shy away from disclosing their disability for fear of being judged and “othered.” Interestingly, interviews conducted with various nursing professionals as part of the study led to some of the participants revealing to the researcher that they had some form of a disability. Apart from one nurse who used a wheelchair, nurses that advised the researcher of their disability status had mild to invisible disabilities. When asked reasons for not disclosing the disabilities to their managers so that they could be reasonably accommodated, these nurses alluded to fear of being marginalized. The study recommended that the disability awareness intervention needs to carefully deal with these seemingly contradictory messages. Rather than providing answers on which disabilities could fit better in what environments, the study rather focused reasonable accommodation requirements for different broad categories of disabilities and emphasized the need for case by case evaluation as different persons with the same impairment may develop different coping strategies and abilities depending on a variety of factors. The study recommended the adoption of targeted selection criteria for recruitment purposes. During interviews, it was recommended that each applicant must be asked targeted questions about their disability in relation to the job requirements. It was recommended that applicants could be asked to share how they have performed in previous jobs or how they would perform the job role given the limitations they have specified and to stipulate any reasonable accommodation they would require from the organization. It was recommended that all recruiting personnel and managers were to undergo targeted selection training so that they could be equipped with the interview techniques for candidates with disabilities. Lastly, the study also revealed that although human resource practitioners had encouraged employees to disclose disability, the rational for disclosures was largely framed within the Employment Equity Act compliance paradigm. Lastly, Netcare realized that its diversity initiatives focused primarily on race and gender but failed to recognize how these identities intersect with (dis)ability amongst other identity categories.

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Transforming Strategies Employed to Bridge Identified Gaps: Netcare’s Integrated Approach In response to the national skills deficit challenge, Netcare designed and launched the Sinako (which means “We Can”) Project. Sinako offered learnership opportunities to unemployed youth with disabilities who had completed grade 11 or grade 12 but who did not have a tertiary qualification; and internships for youth with disabilities who had successfully completed a tertiary qualification but lacked the work experience “required” to be gainfully employed. A learnership is a structured learning program with 30% theoretical content and 70% experiential learning which culminates in a qualification that is registered on the South African Qualification Authority’s (SAQA) National Qualifications Framework (NQF). Learnerships were offered in Business Administration (NQF 4), Basic Pharmacist Assistant (year 1) and Post Basic Pharmacist Assistant (year 2). Young people with disabilities who had a tertiary qualification were placed on various internships aligned to their qualifications and this covered areas such as human resources, information technology and finance. Netcare took a strategic decision to limit student intakes into the programs so that the number of enrolled students corresponded to potential employment opportunities that were anticipated to arise during the course of the learning intervention. This decision was informed by the realization that learnership and internship programs offered by most corporates for persons with disabilities failed to manifest as tangible employment opportunities. Accordingly, Netcare aimed for a target of 85% retention rate of those who successfully complete the program. In 2015, Netcare achieved an 82% retention rate thereby narrowly missing the 85% target (Table 1). Additionally, the industrial psychologist specializing in the area of disability mainstreaming that had been hired to conduct the internal study on the barriers Retention Rates per Program.

Table 1.

2012/2013

2013/2014

2014/2015

Enrolled Completed Enrolled Completed Enrolled Completed Business administration (NQF Level 4)

39

33

27

12

49

National certificate for pharmacist assistants (NQF Level 3)

4

3

4

3

3

46 In progress

Sinako internships







4

4

21

7

National youth chefs program

6

4













Total participants

49

40

35

19

73

53

Source: Netcare Annual Report, 2015.

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and possibilities in the nursing environment was requested to disseminate the research findings and use the same platform for educating and creating awareness amongst managers and teams. All line managers in nursing and nonnursing departments were invited to attend the whole day sessions. Sessions were conducted in each of the six provinces of South Africa with Netcare. The first two hours of the sessions focused on dissemination of research findings. The remaining six hours were used for education and dialogue sessions on issues of barriers, recruitment and disability inclusion. The program challenged stereotypes emanating from normalization of abledbodiedness as the epitome of wellbeing. Thus placing greater emphasis on how most of the barriers stem from these normalized ideas over and above the actual limiting medical condition an individual classified as disabled may have. The sessions generated positive energy resulting in the inclusion of disability targets as one of the priorities in the departmental performance management scorecards. Partnerships were also formed with community based disability organizations and special interest groups who were called upon from time to time to present to the various leadership and employee teams on specific disability categories. Netcare also leveraged this relationship when confronted with complex issues of reasonable accommodation and team integration. Lastly, a strategy, “One Hospital
One Employee with a disability per small site per annum
Two per medium site and Three per large site” was adopted. An external recruitment drive was also initiated and a referral system which incentivized employees who refer a person with a disability who is subsequently successfully placed within Netcare. Relationships with disability organizations were also established to access their expertise and receive guidance. Disability awareness was then mainstreamed in all Netcare learning programs.

Monitoring and Evaluation Internal human resource systems were reconfigured to be able to produce monthly reports on the number of persons with disabilities per business area. These reports were monitored by the head of transformation, regional human resource managers and regional directors to engage teams on progress and to understand challenges in areas where progress was not evident. The reports were also presented to the Operational Transformation Committee and the Board Social and Ethics Committee
Transformation sub-committee for accountability and reporting. These committees played a vital role in providing leadership and mobilizing resources where required. An external consultant, ICAS, was also brought in 2013 to survey the experiences of persons with disabilities employed by the organization and to determine how these employees were integrating into the organization. The scope of the study also includes managers and colleagues of employees with

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disabilities. The outcomes of these monitoring and evaluation systems are presented in the section below.

Refreezing The Outcome of the Integrated Strategy Netcare’s workforce has since become more inclusive of persons with disabilities. Representation of persons with disabilities increased from a meager 60 (0.31%) employees to 563 (2.63%) in 2015. While the 4% target was missed in 2015, Netcare continues to drive disability integration and most importantly to learn from the daily experiences of their diverse workforce for the purpose of improving the quality of employee stay. Minding the race, gender and (dis)ability intersections, Netcare has closely monitored progress in improving economic participation of these marginalized social groups. Accordingly, representation of Black employees with disabilities improved from 16 (0.08%) in 2008 to 310 (1.33%) in 2015. Likewise, representation of Black women with disabilities improved from 11 (0.06%) in 2008 to 170 (0.82%) in 2015, as illustrated in Table 2. Netcare has also monitored employment trends of persons with disabilities on different occupational levels. Fig. 1, below, illustrates that the group has indeed made some positive progress in ensuring inclusion across all aspects of its business: In 2014, 57% of employees with disabilities were employed in the administration and support areas while 31% were employed as professional nurses and 11% in pharmacy related occupations. Netcare also closely monitors representation of persons with disabilities across all levels of occupation, as illustrated in Fig. 2. Fig. 2, below, illustrates that persons with disabilities made up 3.70% of senior managers, 2.38% of middle managers, 1.80% of junior managers, 2.66% at semiskilled and 3.96% at unskilled level respectively. This profile confirms the efficacy of Netcare’s pipeline development strategy and that the education and awareness sessions were effective in shifting perception stereotypes on disability.

Types of Disabilities Netcare adopted a stance that aligns with the requirements of Employment Equity Act no. 55 of 1998. This Act prescribes that an employee may disclose the disability and type if they wish to do so. While this stance respects the dignity of the person concerned, it poses some challenges when the employee requires reasonable accommodation. So, Netcare developed broad categories of

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Table 2.

Head Count

2008

2009

2010

2011

2012

2013

2014

2015

19,908

20,769

21,110

20,944

21,857

22,382

22,355

20,831

Total

60 (0.31%)

111 (0.53%)

137 (0.65%)

245 (1.14%)

410 (1.88%)

505 (2.30%)

540 (2.42%)

563 (2.70%)

White

44 (0.22%)

74 (0.36%)

88 (0.42%)

157 (0.75%)

191 (0.87%)

233 (1.04%)

245 (1.09%)

237 (1.14%)

Black

16 (0.08%)

37 (0.18%)

49 (0.23%)

98 (0.48%)

203 (0.93%)

269 (1.20%)

295 (1.32%)

310 (1.33%)

Black Females

11 (0.06%)

23 (0.11%)

26 (0.12%)

62 (0.30%)

124 (0.57%)

152 (0.68%)

169 (0.76%)

170 (0.82%)

Source: Netcare Annual Report, 2015.

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Category

Representation of Persons with Disabilities by Race and Gender.

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2012/2013

Enrolled Business

2013/2014

2014/2015

Completed Enrolled Completed Enrolled Completed

administration 39

33

27

12

49

46

Level 3)

4

3

4

3

3

In progress

Sinako internships

-

-

4

4

21

7

programme

6

4

-

-

-

-

Total participants

49

40

35

19

73

53

(NQF Level 4) National

certificate

for

pharmacist assistants (NQF

National

Fig. 1.

youth

chefs

Employment Trends of Persons with Disabilities in Different Occupation Levels. Source: Netcare Annual Report (2015).

Category

2008

2009

2010

2011

2012

2013

2014

2015

Head Count

19908

20769

21110

20944

21 857

22382

22355

20831

Total

60

111

137

245

410

505

540

563

(0.31%)

(0.53%)

(0.65%)

(1.14%)

(1.88%)

(2.30%)

(2.42%)

(2.70%)

44

74

88

157

191

233

245

237

(0.22%)

(0.36%)

(0.42%)

(0.75%)

(0.87%)

(1.04%)

(1.09%)

(1.14%

16

37

49

98 (0.48%) 203

269

295

310

(0.08%)

(0.18%)

(0.23%)

(1.20%)

(1.32%)

(1.33%)

Black

11

23

26

152

169

170

Females

(0.06%)

(0.11%)

(0.12%)

(0.68%)

(0.76%)

(0.82%)

White

Black

(0.93%) 62 (0.30%) 124 (0.57%)

Fig. 2. Inclusion of Persons with Disabilities on All Occupational levels. Source: Netcare Annual Report (2015).

disability for statistical reporting and justifying expenditure on reasonable accommodation as seen in Fig. 3. The above graph shows that majority of employees had physical impairments (248), followed by unspecified impairments (150) and hearing impairments.

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Fig. 3. Types of Disabilities Included. Source: Netcare Annual Report (2015).

Cognitive, mental and visual impairments constituted the least disability types. The outcome of the integration and quality of stay survey conducted by an independent firm revealed that 98% of the 398 participants had disclosed their disabilities within the company. Almost 83% of these employees cited positive experience from colleagues and managers regarding the disclosure, 7% stated that they had a very poor experience while 10% did not respond to this question. Forty-two percent signaled indifference and or bad experience. Positive responses cited support from line manager and team and being approached by team members to determine what type of support they can offer. Employees who reported a poor response a couple of reasons ranging from feeling supported only by manager or human resources department but unsupported by the team, being unattended to well, no reasonable accommodation being offered, and some felt stereotyped by the team. On the dimension of reasonable accommodation, 60% of the participants indicated that they required reasonable accommodation, 34% didn’t while 6% did not respond. Reasonable accommodation requirements included flexible hours, specialized equipment, alternative duties, and colleagues taking up some tasks. Experiences of reasonable accommodation varied with 81% indicating a positive experience, 11% citing a poor experience, 2% a very poor experience and 6% not responding to the survey question (see Fig. 4). Poor and very poor experiences mainly related to unsatisfactory time it took for the incumbent to receive reasonable accommodation, devices being not so helpful, colleagues being unwilling to assist, and sometimes reasonable accommodation being denied because the company considers it unreasonable. Nearly 35% of employees with positive responses indicated that they received reasonable accommodation within one week, 31% received it within one week to two months, and 12% received it within three months.

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Fig. 4.

Experiences of Reasonable Accommodation. Source: Netcare Annual Report (2015).

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Participants were asked to rate their managers’ and colleagues’ understanding of disability and attitudes towards persons with disabilities. Nearly 80% of the respondents cited positive experiences while 6% cited negative experiences and 14% did not respond to the survey question. Moreover, 67% of participants indicated that the buildings and general environment was accessible and disability friendly, 25% did not respond to this question as they felt they did not need accessibility adjustments and 8% cited accessibility as poor. Most of the negative responses related to parking bays that were either far from reception area or often taken up by nondisabled persons, and some floors of the building that have no lifts and therefore restricting freedom of movement of persons with disabilities within the entire establishment. Managers and colleagues cited that they were not necessarily experiencing challenges per se by 72% stated that they need further training on disability issues. Netcare has utilized the feedback from stakeholder engagements and the survey to refine the strategy as part of continuous improvement. The Sinako project is ongoing and implemented on an annual basis as part of institutionalization of disability mainstreaming.

Discussion of Issues Arising from the Case The Netcare case study presents the contradictions of successes, failures and possibilities in the area of disability mainstreaming. The evident transformative gains in this case study are juxtaposed with challenging gaps which need to be viewed as opening room for improvement. This contradiction is also indicative of the fact that Netcare’s disability integration program has not come of age; it is rather work in progress. The contradictions also bear testimony to the complexity related to disability as a construct and to disability mainstreaming as a practice. Firstly, the development and publication of the Netcare leadership pledge, the analysis of external and internal barriers and the subsequent development and implementation of contextualized solutions that lead to employment creation, further illustrate the importance of transcending the compliance driven organizational justice approach to situate disability mainstreaming within the social justice framework. This speaks to the intention of Siebers’ (2013) theory of complex embodiment which is to situate disability as a social justice issue. In this analysis, we purposely draw a distinction between organizational justice and social justice. Organizational justice focuses on the identification and correction of systematic disparities between participants in relation to equal employment opportunities, equal income for equal work, assignment of resources, and participation in decision making authority (Acker, 2006). Organizational justice thus focuses more on distributive justice (Young, 2011). Young (2011) argues that distributive justice lacks the ability to deal with other

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forms of injustices that are embedded in labor market processes and in the segmentation of labor. It also complicates the institutional context within which the distributions occur. Organizational justice paradigm tends to promote a compliance oriented approach to reforms akin to what Liswood (2009) termed the Noah’s ark approach. Liswood (2009) explains the Noah’s ark approach as the bringing on board of a pair of each kind with no (thorough) account of what happens thereafter. Thus, the consideration of social justice is critical as Young (2011) puts it as encompassing three aspects: decision making structures and procedures; division of labor; and organizational culture. Young (2011) states that effecting social justice requires organizations to interrogate structures and practices, organizational guiding rules and norms, the language and symbols that mediate social interactions within civil society and the workplace. Robinson (2008) concludes that social justice includes both the distributive and nondistributive facets. The Netcare case study shows that the distributive aspects were addressed through the Sinako initiative which created a pipeline at entry levels of occupation, and through the referral program in the recruitment processes together with internal disability disclosures which served to ensure that the organizational structure is inclusive of persons with disabilities through all occupation levels. Secondly, the complexity of disability and organizational processes which are largely designed by able-bodied people is a practical challenge that transcends the philosophical (post-structuralist
social constructionist) contestations highlighted by Siebers. This case study demonstrates the importance of situating disability mainstreaming within the broader organizational transformation strategy. The value of inculcating the transformative leadership culture as well as leadership accountability for social and organizational change is highlighted. In order to create a compelling vision for social change, this strategic alignment requires that leaders understand social inequalities and injustices that antagonize marginalized social groups, whether they be internal or external to the organization. This dimension brings the importance of considering transformational leadership theory within the complexity of disability mainstreaming (Burns, 1978; Daszko & Sheinberg, 2005; Demming, 1993; Heifetz & Linsky, 2002; Rodin, 1999). Transformational leadership requires a dedicated leadership style with an inspiring and compelling vision for the future that leads the organization into unknown ventures, with passion for learning and for taking actions based on lessons learned (Daszko & Sheinberg, 2005; Demming, 1993; Drucker, 1994). Thus, transformational leadership relentlessly questions the status quo of systems, paradigms, assumptions, patterns and habits, with a view to developing and applying new strategies, initiatives and management theories to realize change (Daszko & Sheinberg, 2005). Bass (1998) argues that transformational leadership is a people-centered approach and comprises four dimensions which can be stated as, “idealized influence, inspirational motivation, intellectual stimulation and individualized consideration” (p. 506). In our view, the Netcare CEO demonstrated transformational leadership

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characteristics when he challenged and inspired the team to create a diverse and inclusive workforce with 4% thereof being persons with a disability. Notwithstanding the above, Netcare attempted to develop an operating definition of disability. Their definition of disability seems to straddle between the medical model, the social model and some recognition of intersectionality. The organization made efforts to shift recruiting officer’s focus on the medical condition of the incumbent to the person’s ability to perform the job role and to request the incumbent to stipulate reasonable accommodation they require. The organization also makes mention of the race and gender intersection, a phenomenon that is critical for the South African context given the fact that race is a salient issue that remains interlinked with poverty, inequality and exclusion in meaningful work. The case highlights the need to challenge and change the organizational culture towards viewing disability as part of being human rather than a phenomenon to be frowned upon. However, balancing between this messaging of disability as part of humanity and being realistic around how certain disabilities (continuously or at some point in time) pose limitations in one’s ability to perform certain job functions optimally remained very tricky for the organization. Thus, while Netcare’s efforts of focusing on the social model and the identity intersection politics, the company ran a risk as Siebers (2013) explains of dismissing the body “as a kind of empty code of signifiers.” This, according to Davidson (2008), offers minor ease for a person undergoing chronic pain or “receiving dirty looks when boarding a bus or being denied access to a job.” Thus, Netcare can benefit from considering Seiber’s theory of complex embodiment as this could allow them to navigate and hold together the complexities of defining and working persons with disabilities. Linked to the above, the organization encourages disability disclosures. While this practice is permitted by legislation in South Africa and sometimes grounded in the interest of ensuring that persons with disabilities receive reasonable accommodation, there are nuances worth considering. Siebers likens disclosures with the process of coming out in queer theory. Coming out is likened to a process of becoming visible to skeptical able-bodied persons in the public sphere failing which one must close the door to avoid offending others (Davidson, 2008). Persons with invisible disabilities are able to pass unnoticed while persons with visible disabilities cannot. Failure to come out in this instance can lead to denial of resources one needs to function optimally or have the same access as able-bodied colleagues. This process affirms the complexity involved in the very process of reasonable accommodation and how one size fits all approach cannot be assumed and applied without leaving room for other options. We note in this case study that the very process of disclosures needs to be underpinned by social justice agenda and must go alongside organizational culture change efforts. In the Netcare case, some employees who needed reasonable accommodation initially did not disclose such needs out of fear of being marginalized. Netcare seems to have managed to resolve this issue through education and awareness initiatives and through promotion of

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dialogue while promoting disclosures for reasonable accommodation purposes. This issue also validates why linear approaches to disability and employment reproduce so much damage. The implemented multi-pronged strategy enabled for the complexities to be addressed from different angles. Thus shifting from being merely compliance driven to mainstreaming (implying building disability into existing agendas, not adding separate disability activities) (Jones & Webster, 2006). The commitment to build skills through learnerships, and ensuring that these translated into tangible internal employment opportunities, is also indicative of the group’s commitment to the betterment of marginalized groups. It is especially given that South African organizations have a record of implementing learnerships that do not necessarily translate into employment (Seirlis & Swartz, 2006). Netcare also addressed, to an extent, the nondistributive justice factors that are embedded in organizational culture, practices, rules and norms by designing a contextualized education and awareness training program for hiring decision makers in various areas of the business. The awareness program sought to address the oppressive stereotypes found to be hindering employment prospects of persons with disabilities and silencing those that were already employed within the group. The realization that these stereotypes were indicative of dominant social constructions of (dis)ability was another facilitator recognized from this case. The medical model of disability is preoccupied with the bio-psycho-physio-pathology of disability and the cataloguing of disabilities into specific job clusters based on functional assessments of which disabilities would fit well in what job-environments. Seibers (2008, p. 45) refers to this as the “hyper-individualization” of disability. This finding confirms the literature which states that, despite the shifts in the understandings of disability in South Africa, the individual or deficit understanding still prevails (Fotim Report, 2011). This understanding, together with negative attitudes, is well documented as a barrier to the participation of persons with disabilities in both skills development and employment opportunities (Howell, 2006; Ndlovu & Walton, 2016; Ned, 2013). When these barriers prevail, Seibers (2008) notes that society embodies ability as a universal human trait and a signifier of humanity. By so doing, disability becomes represented as an individual trait that belongs to an unfortunate person and not inevitably representative of humanity as a whole (Seibers, 2008). This accords persons with a disability a “quasi-human” status and places human beings with disabilities outside of the collective human category. This paradigm is preoccupied with individual human bodies, the shape, form, and function of the archetypal body for whom our culture is constructed
the body that is welcome in public spaces, the body that has the right to consensual sexual activity, the body that signifies human worth (Seibers, 2008). As is well explained by Potheir and Devlin (2006), disability is not primarily a medical or health issue nor a matter of sensitivity and compassion, but an issue of politics and power. Linton adds that disability is “a social, political, and cultural

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phenomenon” (Linton, 1998, p. 133). In essence, consideration on both the impairment, the environment and the reciprocal relationship of these factors remains imperative. This understanding is evident in Netcare’s approach and it validates the understanding that no one model can address issues of disability. Netcare’s education and awareness program challenged these normalized hegemonic able-bodied notions that (unintentionally) operated as an instrument of exclusion, prejudicial treatment and unfair discrimination towards persons with a disability. The program also challenged predominant conceptions of work, worker and work processes that are crafted primarily through the prism of the medical model of disability and benchmarked against abled-bodied workers. Netcare refocused attention on the human ability to perform the job. This refocusing on the human ability does not necessarily ignore the existence of the impairment but explores human capability with the intent of unleashing human talent alongside the impairment. Ned (2013) and Ramphele (2008) postulate that unleashing the talent potential of people with disabilities is crucial for enabling this social group to participate in the growth of society and economy. The Question of Intersectionality Davidson (2008) argues that through the theory of complex embodiment, Siebers intended to bring back the idea of minority discourse as a necessary stance on any rights-based claims of empowerment and as inclusive of all individuals with their differences. This idea aligns with Crenshaw’s (1991) notion of intersectionality. What we found interesting in this case study is that persons with disabilities recognized by Netcare are not a homogenous group. In a sense, disability does not become a stand-alone issue. Factors such as race, gender and class intersect and constitute each other to simultaneously situate persons with disabilities in social positions of privilege and domination. The effects of the apartheid stratification for instance render Black women in townships or rural areas marginalized across the intersections of race, gender, disability and class. As demonstrated in the case, Netcare was mindful of these intersections and ensured that the skills development and recruitment opportunities were proportionally allocated in an inclusive manner using the economically active population statistics as the guide. Kimberly Crenshaw’s (1991) Intersectionality Theory is useful for theorizing Netcare’s formulation of strategies and initiatives that respond to these multiple layers and dimensions of marginality. Intersectionality theory emerged within Black feminism and articulated the relationships amongst compound dimensions and modalities of subject formations and their consequent social relations. Thus, intersectionality recognizes that human identity and subjectivity is complex, multi-layered and fluid and that these (shifting) identities shape human experiences of the social world (Crenshaw, 1991; McCall, 2005). McCall (2005) explicates that the identities humans embody, including race, gender, sexuality and (dis)ability, situate

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human subjects in social positions of power, privilege and oppression. Patricia Hill Collins’s (2000) matrix of domination model explains that intersecting systems of domination and oppression come together in historically and socially specific contexts to privilege dominant social groups and oppress the subjugated “others.” Thus, organizations interested in effecting social justice need to be mindful of these intersections in order to construct a comprehensive and coherent disability mainstreaming strategy that weaves together these multiple strands of subjectivity and marginality. This is evident from the presented case and has thus far worked well in integrating persons with disabilities within the workplace.

CONCLUSION AND IMPLICATIONS FOR PRACTICE Morgan and Ziglio (2007) remind us that the historic approaches which have been based on a deficit model, focusing on identifying needs and problems, has for many years disregarded what works well in different contexts, especially in developing countries. This deficit approach led to the formulation of policies that focus on the failure of employers to meet the equity percentages for persons with disabilities. Mizunoya and Mitra (2013) postulate that there is a need for empirical research to explore and evaluate interventions that attempt to improve the employment prospects of persons with disabilities in developing countries. Such studies are crucial for generating knowledge aimed at addressing the triple burden of unemployment, poverty and inequality that still confronts the majority of persons with disabilities in developing countries despite the ratification of the Convention on the Rights of Persons with Disabilities (CRPD) by these countries. We acknowledge that causal factors of high unemployment, poverty and inequality within the disability sector are multiple, intersecting, complex and contextual. Consequently, there is no single strategy or intervention, particularly from a single case study that can resolve all these problems. However, we believe that the creation of a repository of knowledge on practice based initiatives such as Netcare’s is useful for future crossorganizational and cross-context comparative studies that can consolidate these best practices to extrapolate some key lessons that would be useful in informing the development of prototype strategies. This would ultimately redirect policy and research agendas from the deficit analysis approach towards positive inquiry. One of the pertinent implications of this study is the importance of transcending a legislative compliance approach to disability mainstreaming towards an organizationally driven approach. South Africa, like other developed and developing economies, has relied mainly on legislative instruments such as the Employment Equity Act to drive disability mainstreaming without preparing our society for a modern understanding of the nature of disability oppression. This could contribute to the failure of these policies. This is because even when

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persons with disabilities are integrated, they may still be faced with the same marginalization if the environment is not conducive to accepting them and enabling their future development and success. Instead, they may be seen or labeled merely as “equity employees” due to the negative attitudes and misinformed understanding of disability from colleagues. This is particularly relevant in the South African environment where employers in both the private and the public sector are continuously struggling to include persons with disabilities despite the existence of the various employment policies and legislation such as the EEA. Hence Seirlis and Swartz (2006) assert that persons with disability (and many other vulnerable groups) cannot merely be tolerated in the workplace as part of the requirement of meeting equity. The Netcare case study presented in this chapter shows that legislating social and organizational transformation issues is necessary but insufficient to produce the desired social change. In fact, legislation has potentially unintended consequences of producing a compliance driven approach to social change. Kelly, Wale, Soudien, and Styen (2007) refer to the legislative driven change as the anti-discrimination and fairness paradigm. These authors explain that, while the anti-discrimination and fairness paradigm acknowledges that prejudice has kept marginalized groups (persons with disabilities) out of employment and presents affirmative action as a fair means of realizing organizational diversity, this paradigm promotes compliance over social justice and engenders an assimilationist discourse that fails to challenge dominant preconceptions of difference and otherness (Kelly et al., 2007). This discourse misses the opportunity of learning from differences in order to inform organizational cultural change and to improve (diverse) individual relations and organizational practices of social change, allocation of resources and creation of leadership accountability for change. This ownership shifts the desire for mainstreaming disability inwardly rather than an outward compliance with externally forced legislation. This case study articulates the significance of some practical internal solutions that, once implemented, appeared to create leadership ownership for disability mainstreaming, for the allocation of resources, for the analysis of barriers, for the design of solutions and for program evaluation. It is important for future empirical inquiries to document clear step by step actions and decisions taken by organizations to mainstream disability and to report on tools or mechanisms applied by organizations to measure the impact. This will ultimately enable comparative studies and lead to better understandings of what could potentially work in what context and under what conditions. This could also lead to the development of models of best practice that can be adapted and used as templates by employers to assist in the process of transforming their workforce profile. The above recommendation leads us to a methodological recommendation, which we call practice based theorization. It is common practice amongst scholars to initially explore theories pertinent to disability and to then select a theoretical lens to be used for the study of disability mainstreaming related

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challenges. In our view, using theory to investigate practice clouds the data collection and limits the researcher’s analysis to a predetermined single disciplinary theoretical lens. We also recommend that future studies use literature as an introductory mapping of the nature and the scope of the problem and then give prominence to the examination of organizational approaches and practices geared towards disability mainstreaming in their “purest form” so as to unearth the contextual dynamics and nuances of the case, and then return to theory to make sense of the key emerging themes. This practice based theorization opens space for the identification of deficiencies within current theories and allows space for the utilization of interdisciplinary theories in order to find new ways of thinking about disability mainstreaming that are solution focused. Theoretically, disability studies tend to focus on disability as a phenomenon that does not occur to racialized, gendered, classed and sexualized bodies. This treatment of disability as a silo identity does not provide a full appreciation of the multiple intersecting identities that interlock to position some persons with disabilities in positions of privilege and marginalization simultaneously. Consequently, the examination of disability mainstreaming solutions is also likely to treat disability as a homogenous group thereby failing to develop solutions that instigate equality across these multiple intersections.

ACKNOWLEDGMENTS We would like to thank the executive leadership of Netcare Limited for granting us permission to study their disability strategies and initiatives for the purpose of writing this chapter. We would also like to acknowledge Prof Leslie Swartz, Stellenbosch University for mentoring, facilitating our thinking towards conceptualizing this chapter and providing that objective readership. Conflict of interest The authors declare that they have no financial interest which may have inappropriately influenced them in writing this chapter. Disclosure Although the co-author holds a PHD from the University of the Witwatersrand’s Centre for Diversity Studies, he is currently working for Netcare on a full time basis. He has been directly involved in the development and execution of the case presented in this chapter. The initiatives and statistics discussed in this chapter can also be found in Netcare’s annual reports for further reference and authentication.

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CHAPTER 5 MODEL OF SUCCESSFUL CORPORATE CULTURE CHANGE INTEGRATING EMPLOYEES WITH DISABILITIES Douglas Waxman$ ABSTRACT Purpose
The purpose of this chapter is to survey and synthesis the literature on: (1) myths and misinformation about persons with disabilities that create attitudinal barriers to employment, (2) best practices in employing persons with disabilities, (3) the business case for hiring persons with disabilities and (4) corporate social responsibility and disability, in order to distill a model for changing corporate culture for successfully integrating employees with disabilities into an organizations workforce. Methodology/approach
An extensive review of the above mentioned literature is synthesized and distilled into a model. Findings
The review indicates a number of best practices to be implemented in order to successfully integrate employees with disabilities into the

$

Douglas Waxman is a Ph.D. candidate in the Critical Disability Studies program at York University. He has a Juris Doctor from Osgoode Hall Law School, and Masters in Public Administration from the Wagner School of Public Service at New York University.

Factors in Studying Employment for Persons with Disability: How the Picture can Change Research in Social Science and Disability, Volume 10, 155
180 Copyright r 2017 by Emerald Publishing Limited All rights of reproduction in any form reserved ISSN: 1479-3547/doi:10.1108/S1479-354720170000010007

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workforce. These factors have been synthesized into a model to guide employers in affecting corporate cultural change to address the integration of person with disabilities into the organization.

Practical implications
A systematic approach to integration of employees with disabilities, informed by the significant business logic for doing so. Originality/value
The chapter provides an extensive survey of the literature on disability employment and highlights attitudinal barriers to employing persons with disabilities, the business case and social responsibility case for employing persons with disabilities, the best practices for success and synthesizes these factors into an original model to guide business in cultural change making. Keywords: Disability; employment; corporate culture; best practices

INTRODUCTION Disability continues to be an underrepresented category of persons within the workforce. A World Health Survey shows employment rates range from a low of 20.8% to a high of 62% (World Health Organization, 2011). We know that the persons with disabilties experience much higher levels of unemployment in the West. Employment rates for persons with disabilities in the European Union in 2011 were 47.3% or 38.1% depending on the definition of disability used (Eurostat, 2014). This places the employment rate 20
30% lower than for nondisabled persons (Eurostat, 2014). Similarly, Canada’s employment rate in 2011 was 49% relative to 79% for nondisabled persons (Turcotte, 2014, p. 1) and the United States reports 17.5% of persons with disabilities were employed relative to 65% for nondisabled persons (Bureau of Labour Statistics, 2016). Most organization behavior in respect to avoiding hiring persons with disabilities remains unchanged due to various beliefs. One concern is that persons with disabilities lack the capacity to do the job and have low productivity (Bengsiu & Balta, 2011; Donnelly & Joseph, 2012; Frazer et al., 2009; Fredeen, Martin, Birch, & Wafer, 2013; Gro¨schl, 2007; Houtenville & Kalargyrou, 2012; Jasper & Waldhart, 2012). Another behavior, relates to coworkers and management reluctance to work with persons with disabilities (Donnelly & Joseph, 2012; Gro¨schl, 2007; Houtenville & Kalargyrou, 2012; Schur, Kruse, & Blanck, 2005). Similarly, corporations are reluctant to hire persons with disabilities due to concerns about customer acceptance (Houtenville & Kalargyrou, 2015). Misperceptions about the cost of accommodations for workers with disabilities is an another significant behavior that poses a barrier (Donnelly & Joseph, 2012; Frazer et al., 2009; Fredeen et al., 2013; Gro¨schl, 2007; Houtenville & Kalargyrou, 2012; Kalargyrou & Volis, 2014). Concern over legal liability and

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the cost of litigation, for terminating or disciplining an employee with disabilities, poses another barrier to employment (Frazer et al., 2009). Concerns over whether persons with disabilities pose a greater safety concerns to themselves and coworkers than nondisabled workers, is another brake on employing persons with disabilities (Frazer et al., 2009; Fredeen et al., 2013). Some employers also have a negative perception that employees with disabilities will have a poor attendance record (Bengsiu & Balta, 2011; Frazer et al., 2009). Lastly, employers have concerns over these employees lacking mobility (Bengsiu & Balta, 2011; Fredeen et al., 2013; Gro¨schl, 2007). Clearly, certain stereotypes and myths about employees with disabilities still permeate the business environment and effects corporate behavior in respect to persons with disabilities. Yet, there has been some success in integrating persons with disabilities into certain business organizations. Some recent disability specific scholarship shows examples of success, in integrating person with disability into the workforce. In the ensuing discussion, a review of the current literature is undertaken, looking at various myths stemming from organizational values and beliefs, supervisor and coworker attitudes, issues around recruitment capacity and employee capacity and the suggested best practices to overcome these barriers. However, despite these myths some best practices emerge from the literature. These best practices, as we will discuss, have a business logic in hiring persons with disabilities. There is evidence that hiring persons with disabilities taps accesses to an unused resource, creating a competitive advantage that can lead to enhanced profitability (Houtenville & Kalargyrou, 2012; Kalargyrou, 2014). Secondly, hiring persons with disabilities can enhance the perception of the corporation’s social responsibility, and in turn benefit from accessing untapped talent and markets (Disability in Sustainability Reporting, 2015; The European Network, 2013). Organizations can however learn. Management practices are behaviors that can be changed resulting in organizational cultural change. The culture of an organization is determinative of the organization intentions and values and, in turn, how supervisors and coworkers treat each other. An organization that recognizes the value of persons with disabilities, can create a psychologically safe, accepting, flexible, inclusive environment, that benefits all employees and is appreciated by customers.

METHODOLOGY A review of the literature on myths and misinformation about persons with disabilities that create attitudinal barriers to employment of persons with disabilities is undertaken, as well as an examination of best practices in employing persons with disabilities. Further the literature on the business case for hiring persons with disabilities is considered and an exploration of corporate social responsibility (CSR) that results from employing persons with disability is

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undertaken. These literatures are synthesized to distill a model for successfully changing corporate culture and successfully integrating employees with disabilities into an organizations workforce.

ORGANIZATIONAL VALUES, BELIEFS AND CULTURE Some scholars have suggested that the theory of planned behavior can be used to understand employer perceptions with respect to employing persons with disabilities (Jasper & Waldhart, 2012). Planned behavior theory is premised on predicting behavior based on assessing three categories of beliefs, in that behavior can be gauged by one’s beliefs relevant to the action taken. Behavioral intention can be accounted for through examining: (1) one’s own beliefs
behavior beliefs, (2) significant others beliefs and social pressure
normative beliefs, and (3) beliefs about resources and skills necessary to perform the behavior
control beliefs. To the extent these beliefs are perceived to be favorable, significant others support the initiative and there is perceived resources available for the initiative, there is more likelihood for the intention to engage in the behavior (Frazer et al., 2009). To the extent hiring persons with disabilities is seen as having detrimental effects in respect to the three categories of beliefs, the more likely employers’ attitudes will be negative and they will avoid the behavior (Frazer et al., 2009). The most supportive behavior beliefs practices identified in promoting disability employment are tax credits to incentivize hiring and flexible work schedules which are seen as a strategy to remove disability employment barriers (Houtenville & Kalargyrou, 2012; Jasper & Waldhart, 2012). The most detrimental behavioral concerns include fear of potential litigation, loss of revenue and fear of the cost of physical accommodation (Frazer et al., 2009). In the United States literature the threat of discrimination and wrongful termination litigation is a persistent factor in workplace integration, arising out of experience with the American with Disabilities Act (Wooten & James, 2005). Similar concerns over human rights code litigation persist in Canada as well (Fredeen et al., 2013). Wooten and James (2005) point out that organizations often attempt to decouple themselves from situations of negative or embarrassing information about corporate practices through defensive postures and therefore fail to reflect and learn from the situation, such as litigation, and therefore the discriminatory practice is likely to persist, as likely will the behavioral belief. Normatively, the most salient behaviors in favor of successful employment of persons with disabilities are disability awareness and top management commitment (Frazer et al., 2009; Jasper & Waldhart, 2012). For example, Kalargyrou and Volis (2014) outline a number of companies that have disability awareness programs and have been successful at integrating persons with disabilities, such as Embrace Hotels Association and Accor Hotels. With

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respect to top management commitment, Fredeen et al., state, “Tone from the top plays a crucial role in putting people with disabilities to work. As gatekeepers of profitability and their company’s social responsibility profile, Canadian business leaders and their boards have a huge influence on the agenda” (20). Other top concerns identified are concern for customer attitudes and aesthetics (Gro¨schl, 2007; Jasper & Waldhart, 2012). This later concern, over aesthetic skills was seen in the hospitality industry, where employers were concerned that employing persons with disabilities would make their business seem less attractive to customers (Gro¨schl, 2007; Jasper & Waldhart, 2012). Control beliefs, as mentioned above, are beliefs around the availability of resources or skills to undertake an action. Mentoring, which can be understood as a resource, was found to be the most supported control belief in successfully employing persons with disabilities (Jasper & Waldhart, 2012). Whereas, control belief barriers remain around effectiveness and efficiency of contact with vocational rehabilitation (Frazer et al., 2009) and the ability of persons with disabilities to do the job, were the most striking perceived challenges (Frazer et al., 2009; Houtenville & Kalargyrou, 2012; Jasper & Waldhart, 2012). Behavioral concerns were more salient to small companies, with normative concerns or significant others concerns/peer pressure concerns are more relevant to midsize companies. All companies, independent of size, were concerned with the control issue (Frazer et al., 2009). Other studies have come to similar conclusions, with fear of ability to perform and the cost or perceived cost of accommodations as the top concerns (Collin, Lafontaine-E´mond, & Pang, 2013; Fredeen et al., 2013; Houtenville & Kalargyrou, 2012; Jasper & Waldhart, 2012; Shaw, 2013). As Collin et al., state, “these challenges can be as much about misconceptions as about the feasibility of addressing [accommodations]” (Collin et al., 2013, p. 4). Studies have shown that 71% of accommodations cost $500 or less (Houtenville & Kalargyrou, 2012, citing Gro¨schl, 2007; Lengnick-Hall, 2007; citing Hammett, 2003, Houtenville & Kalargyrou, 2012, citing Meinhert, 2012; Schur et al., 2014). These concerns were more significant for smaller firms (Jasper & Waldhart, 2012). Other studies found beliefs that there is a high cost of training and accommodation and that there would be low productivity (Gro¨schl, 2007). Larger companies were less concerned with cost and more concerned with supervisor discomfort in managing workers with disabilities (around discipline and lack of information about persons with disabilities) and the larger firms were more concerned with the uncertainty of accommodation cost than the actual cost (Houtenville & Kalargyrou, 2012). Other misperceptions are that disabled employees have greater health and safety risk and the requirement for extra supervision (Fredeen et al., 2013). In general, “Employer lack of awareness of disability and the management of disability related issues in hiring and retention, and lack of integration of services and policies to promote hiring and retention” is a systemic barrier (Shaw, 2013, p. 6). Obviously, the extent to which corporations and their managers hold these negative attitudes is detrimental to

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employing persons with disabilities and what any model of best practices would need to dispel. The data however, reveals that the most appealing practices for leisure and hospitality firms to hire persons with disabilities are employee and manager attitudes, job mentoring and financial incentives (Jasper & Waldhart, 2012). Therefore, top management commitment is vital as a starting point and disability awareness training can be helpful to obtain manager and employee buy-in, as can providing greater awareness of the true costs of accommodation to employers, particularly where financial incentives are not available. Houtenville and Kalargyrou (2012) conclude, “Overall our results suggest that providing employers and managers with information about the capabilities and performance of workers with disabilities…would increase the employers’ confidence in hiring them” (50). There are, however, still biases to overcome about capabilities and accommodations. The failure to incorporate employees with a disability is impacted by corporate behavior. Fit with organizational values impacts job satisfaction and turnover of employees generally (Schur, Kruse, Blasi, & Blanck, 2009). A climate of justice is an important aspect of the corporate culture that impacts the employment of persons who traditionally have marginalized participation. Such a climate reflects “collective beliefs” imbedded in organizational structures. These beliefs reflect the organizations’ culture about distributive justice (pay and accommodations), procedural justice (policies and procedures), and interpersonal justice (being treated with respect, dignity and sensitivity) and is shaped by corporate structures (Schur et al., 2009). Obviously, structures that are premised on ableist assumptions create barriers to hiring and retaining persons with disabilities (Schur et al., 2009). The justice climate has been connected to performance, job attitudes and “organizational citizenship behaviors” (Schur et al., 2009, p. 384). Research further suggests that corporate culture that treats people with disabilities with dignity and respect; that are being fair and responsive to employee needs generate higher levels of employee loyalty (Schur et al., 2009). Persons with disabilities do better in flexible organizations that value diversity and in organizations that work on customized needs as compared to those with strict equity (Schur et al., 2009). Job characteristics that focus on required characteristics of the job (i.e., breaking the job down into essential tasks) rather than ideal characteristics, such as rugged individualism, competiveness and self-reliance are more likely to foster employment of people with disabilities (Schur et al., 2005). The key is the flexibility of the work environment. Persons with disabilities do less well in bureaucratic and competitive environments (Schur et al., 2005; Schur et al., 2009; Stone & Coella, 1996). Schur et al. (2009) show that disparities in pay, job security, higher levels of supervision, lower levels of participation in decision making, and less opportunities for training and promotion contribute to negative disability employment experiences. Corporations that are successful in integrating persons with

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disabilities are found to have positive attitudes to diversity and an inclusive organizational culture (Samant et al., 2009). Fortunately, management practices are behaviors (Wooten & James, 2005) which can be adapted through learning. Behaviors in organizations are derived from routines. “Organizations learn by encoding inferences from history experiences into routines that guide behavior” (Levitt & March, 1988, p. 32). Routines include the organizations beliefs, frameworks, paradigms, codes and cultures, as well as forms, rules, procedures, conventions, strategies and technologies upon which the organization operates. Organizational learning involves knowledge acquisition, information distribution, information interpretation and development of an organizational memory (Huber, 1991). Learning occurs for an organization if its behaviors change as a result of processing information. Corporate culture is developed through this accumulated learning and effects how coworkers and supervisors interact and the employer’s intentions, attitudes and behaviors in various situations (Samant et al., 2009). So existing corporate behaviors that are ableist impact persons with disabilities. Ableist attitudes of employers affects hiring of persons with disabilities and willingness to accommodate. Ableist attitudes of employees may influence hiring decisions and if hired the extent of their social acceptance and engagement with the person with disabilities (Bulk, 2015). As Spataro (2005) reminds us that, “a more subtle (and thus potentially more insidious) resistance to increasing minority presence in the workforce may manifest indirectly, out of a reluctance to share power and resources that have been traditionally controlled by the white, male, nondisabled minority” (23). Even where blatant forms of discrimination may be waning, Deal (2007) argues that subtle forms of prejudice still exist in the form of lower pay, poorer career prospects, less support and less job security. So, more than ever we need organizations to embrace a concept of diversity that includes disability. Diversity management inclusive of disability is one of the areas around which corporations are still struggling to learn. The composition of the modern workforce means that managing corporate culture includes managing diversity (Samant et al., 2009). Diversity management, however, has been dominated, to date, by ethnicity and race “because the adoption of human resource management policies is driven by workforce competition and pressure from dominant coalitions” (Wooten & James, 2005 citing Macy, 1996; Stone & Coella, 1996). So organizations may lack knowledge and routines that incorporate disabled persons (Wooten & James, 2005 citing Blanck, Schur, Kruse, Schwochau, & Song, 2003). Furthermore, research has not shown a clear path for managers to follow to manage diversity (Spataro, 2005). In most organizations corporate culture is characterized as a culture of differentiation, as opposed to a culture of unity or a culture of integration. It places emphasis on personal characteristics (Spataro, 2005) and those employees who posses these characteristics, valued by the organization, possess more influence with their peers. Organizational values shape this preference. In a corporation where

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disabled workers are less valued then nondisabled workers the culture is generally unmanaged. Diversity in a climate of differentiation requires management. Implications are if the disabled worker is not as valued as the nondisabled worker, integration of the disabled worker will be unlikely (Spataro, 2005). A culture of integration fosters the recognition of diversity to enable creativity and provides the greatest opportunity to integrate diversity. Having a diverse pool of applicants has been shown to provide competitive advantage (Houtenville & Kalargyrou, 2012 citing Government Accountability Office, 2002; Chi & Qu, 2003; EarnWorks, 2009). It is, however, a challenge for managers to establish such a culture and to manage diverse opinions, however it also may provide the greatest opportunity to tap an ever more diverse workforce. This failure to yet incorporate disability diversity management is reflected in that only 40% of corporate diversity plans include disability in the United States (Donnelly & Joseph, 2012). Including disability in a corporation’s diversity plan will demonstrate the management’s commitment to disability inclusiveness. Only 42% of Fortune 100 companies (the 100 largest as ranked by Fortune Magazine top 500 companies by annual revenue in the United States) include disability in their diversity statement and only 15% have supplier diversity policies (policies which promote diversity by require purchasing from entities owned by persons from a diversity group) (Ball, Monaco, Schmeling, Schartz, & Blanck, 2005). As Ball et al. (2005) say it is possible that persons with disabilities are not benefiting from the rise of diversity management and that companies are not benefiting from a truly diverse workforce. Employing persons with disabilities signals a more caring corporation about “sensitive groups,” which improves overall employee trust and productivity (Kalargyrou & Volis, 2014, p. 448). In creating an inclusive environment, through changes in the culture and support from the company, all employees benefit from improved psychological safety (Kalargyrou, 2014). Psychological safety “is the sense of being able to show and employ one’s self without fear of negative consequences to self-image, status, or career” (Kalargyrou, 2014). Psychological safety is increased through basic values of courtesy and respect set by top leadership and their commitment to the initiative and through employees feeling more engaged when they can provide their disabled colleagues informal training. Corporate values and beliefs translate into behaviors and become cultures. It is important for persons with disabilities that these beliefs not be premised on myths and misinformation about accommodations, litigation, management requirements etc. One important practice that is evident in avoiding these biases is disability awareness training, which will be considered further, below, in respect to management practices and coworker attitudes. As is also evident, companies can learn and create routines that guide new behaviors about managing diversity and specifically employees with disabilities. In doing so they can

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create cultures of integration and climates of justice which provide psychologically safe environments. This in and of itself benefits the overall workforce, as well as employees with disabilities but altruism need not be the reason to effect cultural change. There is a business rational to do so as we will see in examining the business case and Corporate social responsibility.

THE BUSINESS CASE A business case exists for hiring persons with disabilities that contributes to corporate success. Kalargyrou argues based on the findings of Barney (1991) and Grant (1991) that tapping into unused resources can lead to a competitive advantage. In summary the argument is that by tapping into an untapped resource, in this case employees with disabilities, the corporation can gain a competitive advantage and increase profitability (Kalargyrou, 2014 adapted from Grant 1991). Kalargyrou argues that by identifying this resource, then creating a culture of disability inclusion leads to a sustained competitive advantage of a bigger pool of applicants. Secondly, creating this culture benefits the corporation’s sense of corporate responsibility. The strategy is proactive recruitment of persons with disabilities, which results in lower turnover, higher attendance, improved corporate reputation and therefore decreased cost and higher profits, which is evident from studies of various firm’s disability inclusion initiatives in the hospitality sector (Bengsiu & Balta, 2011; Hernandez et al., 2008; Houtenville & Kalargyrou, 2012; Kalargyrou, 2014; Kalargyrou & Volis, 2014). Other significant benefits of employing persons with disabilities have been shown to be that persons with disabilities have below average absentee rates in general, persons with disabilities are average or above average in terms of safety, and persons with disabilities have a positive effect on coworkers. Perceived barriers to hiring disabled persons can be overcome with skills and awareness training for supervisors and employees where myths about persons with disabilities can be dispelled (Kalargyrou, 2014). In fact, in studying Walgreens and Mohegan, Kalargyrou (2014) found productivity and safety were higher, as long as there was the right job placement (i.e., match of ability to skills required) and training. These organizations experienced higher attendance rates, mostly resulting from pride in their workplace (Kalargyrou, 2014, p. 132). Bengsiu and Balta (2011) in a study of the Turkish hospitality industry came up with similar principles as the Walgreens and Mohegan examples. They conclude that hiring considerations should be based on merit not disability. They also recommend training and orientation for new hires, adopting the work environment and placing the right worker in the right position (Bengsiu & Balta, 2011).

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Recognizing the business case is the first step in the process of best practices, as it leads to those beliefs and behaviors that result in the type of organizational cultural change discussed in the previous section on organizational values, beliefs and culture.

CORPORATE SOCIAL RESPONSIBILITY In addition, to operational benefits of hiring persons with disabilities outlined above, there are additional benefits in being seen as a socially responsible corporation, exhibiting diversity and inclusivity in hiring employees with disabilities. Surveys show that that 92% of consumers felt more favorable towards companies that employed persons with disabilities (Siperstein, Romano, Amanda Mohler, & Parker, 2006) and 87% would prefer to give their business to such an organization. Kuo and Kalargyrou (2014) found that consumers had a “moderate positive purchase intention” for restaurants employing a significant amount of persons with disabilities, for certain occasions (with family and friends vs. business and romantic occasions (175). Mandal and Ose, looking at disability and social responsibility in Norway found “that the behavior and actions of enterprises might be more important for their efforts vis-a`-vis people with disabilities, than factors that are more or less given in advance, such as sector, industry and company size” (Mandal & Ose, 2015, p. 185). There are findings that consumers demonstrate a moderately positive purchase intention and prefer to give their business to hospitality companies that employ workers with disabilities (Kuo & Kalargyrou, 2014). In other words, it may make the company more attractive to a substantial customer market, the globe’s largest minority group
persons with disabilities, if these customers identify with the company. Persons with disabilities have been a largely unrecognized market with significant purchasing power (Buck, Espinach, te Roller, Tussy, & Bonino, 2015). “The innovations and insights derived from taking disability into account are applicable to goods and services, and if implemented effectively drive ROI [return on investment] benefits” (The European Network, 2013, p. 3). To be successful at marketing to disability market they need to “recognize and truly understand their needs,” through an inclusive workforce (Fredeen et al., 2013, p. 19). This may make the service more responsive to a more diverse population. Employing persons with disabilities also contributes to a positive company image, improves marketing initiatives, creates positive brand imaging, and contributes to the appearance of social sustainability and a reputation for corporate citizenship (Jasper & Waldhart, 2012; Kalargyrou & Volis, 2014, p. 448). Hiring persons with disabilities accesses an untapped pool of talent. “Disability is seen as part of diversity, which is increasingly seen as a source of

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talent, creativity and innovation” (The European Network, 2013). As a result of their challenges, persons with disabilities often have developed resilience, determination, creativity and become innovative problem solvers (Dart, Francuz, & Graziosi, 2013, p. 7; Buck et al., 2015, p. 11; Fredeen et al., 2013, p. 18). In addition to the business reasons for corporate social responsibility (CSR), there is also a moral imperative for corporations to be socially responsible in respect to disability. CSR recognizes persons with disabilities, “participation in society and the workplace is a matter of rights at the individual level, of diversity, talent and business opportunities and benefits at the company level, of social economic development at the country level and of global social cohesion and social inclusion” (European Network, 2013, p. 1). More specifically, Article 27 of the Convention on the Rights of Persons with Disabilities (CRPD) (Assembly, U. N. G., n.d.), requires state parties to prohibit discrimination on the basis of disability in respect to all aspects of employment. It is argued that this Article protects infringements from business operations to private sector employees (Buck et al., 2015; Fasciglione, 2015). In addition, Article 4 of the CRPD requires state parties to eliminate disability discrimination by any person, organization or private entity and Section 5 requires state parties to provide equal and effective legal protection against disability discrimination. These rights create, “an obligation on state parties to create an enabling and conductive environment for employment in both the public and private sectors” and to promote employment opportunities for persons with disabilities including in the private sector (Fasciglione, 2015, p. 176). This moral imperative towards disability CSR, is also undergirded by the United Nations Principles on Business and Human Rights (Special Representative of the Secretary-General on the Issue of Human Rights & Transnational Corporations and Other Business Enterprises, 2011 “Principle(s)”), which sets out principles that should govern a business relationship to respect its impact on human rights and address any adverse effects (Principle 13). The principles require businesses to respect human rights. To do this they are required to have a policy statement which expresses their commitment to human rights, approved by senior management and is encompassed in the organizations policies and procedures (Principles 15
16). The principles set out that to accomplish the duty of respect the corporation is to undertake human rights due diligence (Principles 17
21). Section 12 of the Principles requires corporations to respect internationally recognized human rights, which would include persons with disabilities. And while the principles are nonbinding and therefore only suggestive, they do add to the importance of CSR and add to a growing culture of disability inclusion. There is significant convergence around the importance CSR with the European Commission (A renewed EU strategy 2011
2014 for Corporate Social Responsibility) (Commission to the European Parliament, 2011), European Union Parliament and Council (Directive on Disclosure of

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non-financial and diversity information by certain large enterprises and groups) and the Organization for Economic Development and Cooperation (Guidelines for Multinational Enterprises) (OECD, 2011), issuing CSR standards or updating existing standards (Codero, Zu´n˜iga, & Rueda, 2014). As well, The Global Reporting Initiative (GRI) and Fundacio´n ONCE published a guide to applying GRI criteria, a widely applied sustainability reporting standard, to disability (Buck et al., 2015). Furthermore, there are organizations whose aim is to promote the incorporation of disability as part of CSR, such as the European Network for Corporate Social Responsibility and Disability (CSRþD) (Codero et al., 2014). CSR connected with voluntarism is seen as an outdated vision with increasing recognition that CSR is a responsibility (Codero et al., 2014) with CRS reporting being valued as a way of being held accountable, reaching various stakeholders, establishing best practices benchmarking and “fostering leadership in the field” (the European Network, 2012, p. 4). Rather, the more current approach is to see CSR as a way to “integrate the human rights impactapproach fostered by the EU and UN” (Codero et al., 2014, p. 43). Reporting demonstrates their commitment to respecting and promoting the rights of persons with disabilities (Buck et al., 2015). Despite the known benefits of employing persons with disabilities as a form of CSR, the literature indicates that disability is just being recognized as a significant form of diversity which “returns value to the organization” (Samant et al., 2009, p. 172). One study identifies, “the lack of a strong commitment to include disability as a cultural group in their companies’ diversity plan,” as a barrier to hiring and retaining employees with disabilities (Chan et al., 2010, p. 419). A 2005 study of Fortune 100 companies found that only a minority of these 100 companies specifically enumerate disability in their workplace diversity policies (Ball et al., 2005). Many of those companies do not, however, support this with further elaboration of what the obligation means. While these numbers may be dated, The American Association of People with Disabilities and the US Business Leadership Network’s Disability Equality Index only list 42 companies who score high enough to be considered a Disability Equality Index Best Places to Work (Disability Equality Index Results, 2016). A recent study (Codero et al., 2014) of 40 multinational enterprises CSR reporting reveals that even where the enterprise is addressing disability specifically, it is not necessarily reported. Secondly, few corporations “report on inclusion of disability in their policies on promotion, health and safety, job retention or having specific grievance procedures in place” (9). Third, less than half of the companies reported data on employees with disabilities and when they did they are not linked to targets and are not usefully disaggregated. Another report looked at 16 companies all of whom were both members of CSR þ D Network and CSR Europe. Given that these companies recognize the significance of CSR, it is surprising that only 31% of companies reported on 70 % of the six CSRþD indicators (strategy and leadership, employment, accessibility, customers and employees, suppliers and social action) (The European Network,

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2012). These results do indicate that there is a considerable way to go, to achieve the benefit of disability inclusivity.

LEADERSHIP FROM THE TOP Once the business logic of hiring persons with disabilities is recognized, it takes management from the top of the organization to drive the disability inclusion initiative that will effect corporate cultural change. Researchers indicate that companies told them, “the lack of a diversity champion for people with disabilities
someone who can raise the profile and break down barriers, creating paths to employment” was a barrier (Fredeen et al., 2013, p. 8; see also Hernandez et al., 2008). Senior management that is visibly committed to supporting employment of persons with disabilities improves outcomes (Schur et al., 2005). Several authors argue that to successfully accomplish employment of persons with disabilities, leadership from the top of organizations is key in setting the tone (Frazer et al., 2009; Fredeen et al., 2013; Hernandez et al., 2008). Gro¨schl (2007) states that “Proactive approaches need the involvement and support of key decision makers such as General Managers and/or corporate headquarters, and appropriate HR policies and guidelines” (681). Management needs to be trained and educated about persons with disabilities to overcome barriers and myths perceived by organizations (Fredeen et al., 2013; Kaye, Jans, & Jones, 2011). Research has shown that manager bias against employees with disabilities is extant due to concerns about impact on operations from perceived lack of productivity, increased absences and costs of accommodations and increased liability from litigation but that these concerns were often the result of their lack of experience with managing employees with disabilities and unfamiliarity of disability issues. (Hernandez et al., 2008; Lengnick-Hall, Gaunt, & Brooks, 2001; Shaw, 2013). Businesses which have actually employed persons with disabilities had a more positive view of persons with disabilities and likely a more realistic understanding of their capabilities and less concern in respect to operational and liability issues, then employers who lack this contact (Hernandez, Keys, & Balcazar, 2000; Hemenway, King, Rohani, Word, & Brennan, 2003; McFarlin, Song, & Sonntag, 1991; Unger, 2002). Attitudinal barriers effect managers from undertaking the planning necessary to hire persons with disabilities and when they are confronted with an applicant who is disabled they do not feel qualified to assess their capability (Shaw, 2013). In fact, management also benefits from working with diverse levels of ability: The initiative also improved the workforce, and more specifically management, since watching the daily satisfaction and zeal of people with disabilities was a changing force in their lives. Furthermore, management improved because working with people with disabilities

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provided them with the opportunity to work with many different ability levels, making them more involved and empathetic with their team members (Kalargyrou, 2014, p. 133).

So it is a win-win situation for employees and managers.

SUPERVISOR AND COWORKER ATTITUDES Once senior management is on board, the rest of the team needs to be brought along. Disabled workers do better in less stressful work environments where they fit in better (Schur et al., 2005) and supervisor and coworker attitudes play an important part in their employment experience (Schur et al., 2005, 2009). Corporate commitment in and of itself is not sufficient, if supervisors and fellow employees do not accept the disabled worker disability initiatives will fail (Schur et al., 2005). Coworker’s and supervisor’s attitudes are affected by stereotypes, discomfort in being around persons with disabilities, strain caused by communication difficulties, and prior experience with disabled persons (Schur et al., 2005). Limited awareness, understanding and communication between persons with disabilities and nondisabled persons limits integration (Gro¨schl, 2007); as does employees generally lacking understanding of disability legal rights (Markel & Barclay, 2009). Choice of supervisors is a key to success. Assuring supportive managers are in key positions is a best practice. Stereotyping diminishes with prolonged contact to persons with disabilities, the right leadership in supervisory positions and by holding persons with disabilities to the same standards as other employees (Kalargyrou, 2014). Some of the organizations surveyed used formal and informal performance appraisals for feedback to hold employees accountable (Kalargyrou & Volis, 2014). Assuring supportive managers, who recognize abilities rather than constraints, are in key positions, is considered a best practice, in employing persons with disabilities (Kalargyrou, 2014). One of the factors supervisors and coworkers need is sensitivity to the importance of workplace accommodations for persons with disabilities. Schur et al. (2014) show that corporate culture impacts accommodation in two ways. There is a correlation between granting accommodations and the employees’ positive attitude and the likelihood of retention of the employee but furthermore the effects of accommodation are moderated by coworker inclusion, which is more likely in a supportive environment (Schur et al., 2014). Middle managers also influence the inclusive environment of the workplace and have significant influence over the granting of accommodations to workers with disabilities (Schur et al., 2014; Unger, 2002). Accommodations can cause animosity among coworkers, particularly in workplaces that are equity ruled as opposed to need ruled and where the workplace is highly regimented and uniform (Markel & Barclay, 2009; Schur et al., 2005). However, this effect is related to workplace culture as studies show that

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accommodations can have a multiplier beneficial effect on other employees through improving productivity, retention and moral and all employees benefit from a more flexible and supportive environment (Schur et al., 2014). Employing persons with disabilities is found to have a positive impact on the corporate environment: As it is stated that persons with disabilities have positive effects on the workforce and workplace. In terms of the workforce, it is noted that recruiting persons with disabilities helps to maximize work - force talent and retaining workers with disabilities improves management skills and the psychological safety of staff collectively. Lastly, it is reported that employees with disabilities help to positively alter the workplace by creating a barrier-free environment (Kalargyrou & Volis, 2014, p. 445).

Kalargyrou states, “Management’s role is crucial in building a positive relationship amongst team members and demonstrating to the employees that are not disabled that management does not treat favorably workers with disabilities but mainly provides them with necessary and reasonable accommodations” (Kalargyrou, 2014, p. 132). It is noteworthy that studies have found that a substantial number of nondisabled employees also receive accommodations in the workplace (Schartz, Hendricks, & Blanck, 2006; Schur et al., 2014). This may serve to normalize the idea of accommodations “within a broader culture of flexibility” and to diminish the sense of disability accommodation being expensive (Schur et al., 2014). A best practice seen in the literature, for which there is a great deal of consensus, is disability awareness training for all employees in respect to legal obligations and how to create and maintain an effective working relationship with the hiree (Bengsiu & Balta, 2011; Chan et al., 2010; Fredeen et al., 2013; Gro¨schl, 2007; Houtenville & Kalargyrou, 2012; Kalargyrou, 2014, p. 48; Kalargyrou & Volis, 2014; Markel & Barclay, 2009; Schur et al., 2014). All employees should receive some level of disability awareness education, but those working closest with the individual should receive targeted training relative to the coworker’s impairment (Markel & Barclay, 2009). Establishing a diversity inclusion council, team, foundation or task force is valuable for raising awareness and integration practices. They can be important in recruiting, hiring and supporting employees with disabilities (Kalargyrou & Volis, 2014). Education and disability awareness promotional events produce increased acceptance. They develop employment strategies, establish inclusion goals and implement metrics. Kalargyrou (2014) also identifies “using champions and ambassadors by leveraging the passion of the workforce” as an important practice (136). Coworkers can play an important role in integrating employees with disabilities into the workplace. Work is often a significant source of development and maintenance of social relationships for persons with disabilities (Ward & Baker, 2005). Social relationships are associated with happiness, less

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stress and a higher quality of life and work is often the second most important social context after immediate family to develop social relationships (Chadsey & Beyer, 2001). Butterworth et al., tells us that, “[t]here appeared to be a clear relationship between inclusion and support outcomes and the culture of the workplace” for adults with developmental disabilities, but likely for all employees with disabilities (Butterworth, Hagner, Helm, & Whelley, 2000). Failure to integrate persons with disabilities in the workforce leads to diminishment of social capital and can affect the health of the employee (Ward & Baker, 2005). Gay (2004) found that “[d]isability status affects the level of social support in general through the effect of perceived stigma” (n.p.). Hanley and Maxwell (1986) tell us that the majority of workers with disabilities in a supported context were terminated for social reasons. Mentors have been shown to have a beneficial impact on career advancement by providing sponsorship, coaching, protection, visibility, acceptance and confirmation, role modeling and advising about corporate politics (Jones, 1997). Jones (1997) points out that, is however “less likely that persons with disabilities will develop a relationship with a mentor” in the normal course (2). This is unfortunate as Schur et al., indicate that workers with disabilities are less likely to receive informal training from coworkers and this is detrimental because this constitutes a great deal of the on the job learning, which translates in their findings, to lower levels of promotions (Schur et al., 2009). So practices that improve integration are essential for success of the employee and for their quality of work experience and its concomitant effects on the rest of the person’s life. However, mentoring may be assistive in integrating employees with disabilities into the workplace community (Snyder, Carmichael, Blackwell, Clevland, & Thorton, 2010; Storey, 2003). We know that mentors have been important for the advancement of other minority groups in the workplace, namely woman and African-Americans (Jones, 1997). What literature there is on workplace mentoring of persons with disabilities suggests that natural support is preferable to job coaching in terms of providing support and increasing integration in the workplace (Storey, 2003). Workers with severe disabilities in supported employment settings who had mentors had more reciprocal interactions with nondisabled coworkers than those who were trained by job coaches (Lee, Storey, Anderson, Goetz, & Zivolich, 1997). Social interaction for individuals with psychological disabilities had improved employment outcomes (Banks, Charleston, Grossi, & Mank, 2001). Integration results were also seen to increase even where high levels of direct support were provided, if the employee with a disability receive coworker training (Mank, Cioffi, & Yovanoff, 2000). There have been a few studies to note, where coworker interventions have been less conclusive than other interventions, leading Chadsey and Beyer (2001) to suggest the need for further study of the use of coworker support. Also, the effectiveness of the mentoring may be dependent on the needs of the mentee vs. the skills of the mentor (West, Kregel, Hernandez, & Hock, 1997). The later

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may need training on how to be an effective mentor. One might suggest that, given the limited positive results in supported situations, that mentoring should be useful in less supported employment situations as well. We know that in companies where there has been successful integration of employees with disabilities, mentoring support has been provided. Ninety-seven percent of large companies in one study of the leisure industry used mentoring as a barrier reducing strategy (Houtenville & Kalargyrou, 2012). Another study found that 70.9% of leisure and hospitality companies surveyed saw mentoring as one of the five most widely supported practices in being helpful in employing persons with disabilities (Jasper & Waldhart, 2012). So we can see what a vital role coworkers play in the successful integration of employees with disabilities.

RECRUITMENT A lack of an inclusive recruiting policy is detrimental in reaching qualified candidates with disabilities (Fredeen et al., 2013). Another barrier to workplace accommodation is that human resource personnel and employment agencies are not sufficiently trained in the benefits of hiring persons with disabilities and in accommodation strategies (Donnelly & Joseph, 2012; Shaw, 2013) or lack knowledge and understanding of the businesses needs, resulting in mismatches (Fredeen et al., 2013). Gro¨schl (2007) found “[o]ne of the central issues that emerged from the findings is the limited communication between the participating hotel organizations and employment agencies provided the basis for many of the challenges … and nurturing stereotypes by both parties” (Gro¨schl, 2007, p. 681). On the other hand, human resource staff in organizations with insufficient human resource personnel may not have the time to deal with accommodations. Some corporations have had success hiring through community partners, if the right partner can be identified, for the nature of the employer (Fredeen et al., 2013). Kalargyrou (2014) identifies partnering with local agencies and disability groups as an important practice. Kalagryrou and Volis’s (2014) study, of disability inclusion initiatives in the American hospitality industry, also identifies partnering with social service and vocational rehabilitation services and other disability awareness raising organizations as important contributors to hiring employees with disabilities. Employment agencies can play an important role in matching the right employee to the job and assisting employers with accommodations (Hernandez et al., 2008). In addition, these agencies provide job ready candidates due to providing assessment, work skills training and work experience for the applicants (Blanck, 1998). Blanck’s analysis, of an employment agency working with persons with disabilities, demonstrates that these agencies have capabilities to assist persons

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with disabilities to transition to work and help employers meet their staffing requirements (Blanck, 1998a, 1998b). Community partners should treat the employer as a customer, provide a continuous pipeline of talent ready for the workplace, assist in on-boarding new hires to integrate them in the workplace, training and post-placement support if necessary (Fredeen et al., 2013; Hernandez et al., 2008). Chan et al. (2010) point out the importance of training applicants to satisfy employers’ requirements. In other words, using demand-side models to focus on jobs employers actually need to fill. Demand-side models focus on the employer and the work environment (Chan et al., 2010) as opposed to training the employee for some notional job that may not exist. As Burke et al. (2013) say given the context of the current economy and the situation of workers with disabilities: the traditional supply-side approach (i.e., providing medical, psychological, educational, and vocational services to improve functioning, physical stamina and job skills) without taking into account organizational behaviors, employer needs and the changing labour economy is no longer adequate for achieving meaningful employment outcomes for people with disabilities. (p. 22)

Doing so will reduce managers and coworkers’ negative perceptions of workers with disabilities (Chan et al., 2010).

EMPLOYEES Finally, once all these best practices are in place, we can successfully integrate the employees with disabilities. The literature suggests, that to have a successful hire, one needs to put the right person in the right job (Bengsiu & Balta, 2011; Kalargyrou, 2014), in that the employee’s abilities need to be matched with the position’s requirements (Kalargyrou, 2014). The employee should be hired on account of “merit, suitability and capability” and “the type and degree of disability should not be of any concern for the employer; rather the criteria for selection should be professional knowledge, abilities, experience and capabilities of a candidate” (Bengsiu & Balta, 2011, p. 48). Pre-work training is a key best practice, which also incidentally leads to enhanced loyalty to the company (Bengsiu & Balta, 2011; Kalargyrou, 2014; Kalargyrou & Volis, 2014). “In sum, as long as employers provide persons with disabilities with sufficient training prior to job placement, limited challenges will present” (Kalargyrou & Volis, 2014, p. 450). Extensive training has been shown to be one factor leading to lower turnover (Kalargyrou, 2014). As one would expect, providing accommodations, is a best practice along with “open-mindedness and acceptance of people without being consumed by their disability must be present for successful inclusive initiative to succeed” (Kalargyrou, 2014, p. 135). Employers have been reluctant to hire employees with disabilities over concern of the “actual and unknown costs of accommodation” (Jasper &

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Waldhart, 2012, p. 589) but as discussed above the cost accommodations generally are quite modest.

THE MODEL The starting point for improved disability employment is when senior management recognize the business advantage in hiring persons with disabilities, both in terms productivity and in terms of corporate social responsibility and the talent and markets that being disability diverse attract. In other words, hiring persons with disabilities can derive a competitive advantage. Changing organizational behavior and particularly initiating disability inclusiveness must be driven by senior management’s commitment to the initiative. That vision needs to be communicated throughout the organization, to supervisors and employees. Once managerial commitment is established the middle managers, who are sensitive to inclusion, need to be put in key positions to facilitate the commitment; supervisors who will manage for ability, not disability. Relationships with key partners, such as vocational agencies need to be established, to facilitate recruitment of qualified candidates. Vocational agencies need to communicate with management or human resources to understand their needs, in terms of skills and training required. Once a candidate is determined it is key to assure the right fit between the employee’s skills and the job requirements. Appropriate accommodations need to be put in place. The satisfaction and likelihood of retention improve with receipt of appropriate accommodations. All new hires should receive pre-employment training for safety and productivity. It is important that supervisors and coworkers know they can depend on the new employee. Lastly, the employee needs to be evaluated and held accountable like any other employee. This promotes job necessary expectations and improves relationships with coworkers. It is essential that other employees throughout the organization receive disability awareness training, to educate them about the significance of diversity, to sensitize them to the circumstances of their fellow employee(s) and to appreciate the need for accommodations, so nondisabled employees do not perceive accommodations as special treatment and so they can understand the legal requirements for accommodations. The success of accommodations in part is moderated by coworkers. Secondly, awareness for hiring managers removes the mistaken biases in respect to accommodating an employee. Some organizations institute diversity inclusion councils to involve nondisabled employees, so they can become disability awareness advocates and so they can hold events to promote disability awareness. Lastly, mentoring has been shown to be beneficial for both the person with the disability and the mentor.

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Mentoring has shown promise in providing natural support in supported situations and this should translate to less supported circumstances, as well being one of the resources firm see as being useful in overcoming barriers to integration.

Business Case/ Social Responsibility

Top Management Demonstrates Visible Commitment

Communicate the vision Assure supportive managers are in key positions

Relationship with social services, Vocational Agencies, Disability Advocacy Groups

Diversity committee Pre-employment training

Assure right fit between ability and required skills

Disability Awareness Training

Hold employee accountable

Mentoring

Accommodations

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Implications for Further Research Given the nescient nature of many of these employment initiatives it will be interesting to to have longitudinal studies on how successful these companies are in integrating employees with disabilities over time, how the employees continue to perform and if any competitive advantage continues to endure. It would also be interesting to map the corporate culture change in these corporations over time, that occurs to facilitate employees with disabilities and the likely benefits to other employees in the firms. Further, it will also be interesting to monitor the change in attitudes of coworkers, managers and customers over time and to try and gage what impact this has on the acceptance of persons with disabilities in the wider society. As well, given the recentness of disability as a form of corporate social responsibility, to what extent longitudinally do these concepts actually become imbedded in the companies professing them and to what extent the concept spreads throughout the corporate world. A great deal of the literature on the effect of mentorship of employees with disabilities is circa l990s. It would be helpful to have updated data on the impact of mentorship on the integration of employees with disabilities.

CONCLUSION Successfully employing persons with disabilities will require corporations to appreciate the need and benefit of diversity and the need to change their corporate beliefs and cultures. It will require corporations to learn to overcome preconceived ideas about employing persons with disabilities and appreciate that in doing so they derive a competitive advantage in terms of less turnover, greater loyalty, less absenteeism and increased workplace safety and therefore, less recruiting and retraining costs and the organization therefore, achieves greater productivity, as well as an improved psychologically safe environment, in which all voices are valued and improved corporate reputation. A model of success starts with management understanding there is a business case for hiring individuals with disabilities and to be aware that the negative factors perceived about hiring persons with disabilities are due to misinformation and stereotypes. Success requires creating an accepting culture of routines that incorporate disability. A number of practices have been identified that have led to success in incorporating persons with disabilities into a workforce. It is important that senior management set the tone and be visibly supportive of hiring persons with disabilities. Secondly, it is important to assure the right persons with the appropriate commitment and sensitivity are in supervisory roles. Matching the employee’s skills with the job and providing appropriate accommodations assures a proper

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fit and chance of success. Providing pre-employment training enhances job readiness. Similarly, disability awareness training for other employees helps eliminate misunderstandings about accommodations and reduces stereotypes. Mentoring from coworkers benefits both parties. Associating with disability vocational services and disability awareness groups provides a source to recruit a more diverse workforce and a source of useful information. Holding all employees equally accountable fosters trust amongst coworkers and useful feedback for the employee. Disability awareness committees and disability champions help create the appropriate environment to successfully integrate employees with disabilities. Creating this environment creates a psychologically safe environment, which all workers benefit from. The literature demonstrates that where these initiatives are undertaken everyone wins: The disabled worker, the corporation and coworkers. There are societal implications in actualizing previously marginalized persons into a productive, satisfied employees, increasing the employment participation rate of persons with disabilities, so that less human capital is left to waist and there by reducing the burden on social assistance. Disability work inclusive practices will be an important step in reducing not only discrimination in obtaining work but also in reducing disability discrimination at work. Disability training should reduce the incidence of stereotyping and exclusion by coworkers. Organizations whose culture becomes inclusive likely will have a greater justice climate and more distributive justice, reducing the incidence of harmful discriminatory experiences for employees with disabilities around unfair treatment in respect to pay, promotions and training. But there is much to do before this is realized on a systemic scale.

ACKNOWLEDGEMENT Funding from DRPI AWARE. DRPI Aware Project, undertaken with financial support of the Government of Canada provided through Global Affairs Canada and York University. I would like to thank with gratitude Professor Marcia Rioux for her on going support and encouragement.

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CHAPTER 6 A SYSTEMATIC REVIEW OF VOCATIONAL INTERVENTIONS FOR YOUTH WITH PHYSICAL DISABILITIES Shakira Hanif, Halie Peters, Carolyn McDougall and Sally Lindsay ABSTRACT Purpose
Many youth with a disability would like to work but encounter challenges finding employment. Vocational interventions can help youth with disabilities gain employment skills and jobs. In this chapter, we assess: (1) how vocational programs for youth with physical disabilities influence employment-related skills and outcomes; and (2) the common components of vocational programs for these youth. Design/methodology
Our research team conducted a systematic review of peer-reviewed literature with six major databases: Medline, PsychInfo, Scopus, Web of Science, CINAHL, and Embase. Publications selected for inclusion met the following criteria: (1) peer-reviewed journal article, dissertation, or conference paper, published between 1990 and January 2014; (2) addresses vocational program or intervention for youth with physical disabilities; and (3) sample includes at least 50% youth (aged 15
25) with an acquired or congenital physical disability.

Factors in Studying Employment for Persons with Disability: How the Picture can Change Research in Social Science and Disability, Volume 10, 181
202 Copyright r 2017 by Emerald Publishing Limited All rights of reproduction in any form reserved ISSN: 1479-3547/doi:10.1108/S1479-354720170000010008

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Findings
Of the 4,588 studies identified in our search, 8 met the inclusion criteria. In six of the studies, the majority of participants gained paid or unpaid employment after participating in a vocational program. Five studies showed improved knowledge and perceptions of employment. Most studies showed improvements in at least one vocational outcome such as knowledge about job searching, job interviews, advocating for workplace adaptations, and how to access services and supports. Common intervention components included: experiential learning, mentorship, and family involvement. Most programs took place in the community or rehabilitation centers that varied in length and were delivered by a variety of professionals. Most programs had a combination of group and individual components. Implications
There is some evidence to suggest that vocational programs can influence employment outcomes for youth with physical disabilities. However, further research is needed with more rigorous and longitudinal designs. Keywords: Vocational rehabilitation; youth; adolescent; employment; training; occupational therapy

INTRODUCTION Youth with disabilities face a variety of challenges as they age and transition throughout their lifespan. Employment is an important indicator of successful transition among youth, and it provides benefits at individual, social, and economic levels (Stewart, Law, Rosenbaum, & Williams, 2001). By participating in employment, both able-bodied youth and those with disabilities establish a sense of independence and self-worth as they begin to view themselves as citizens who contribute to the well-being of their community (Shandra & Hogan, 2008; Taylor et al., 2012). For youth with physical disabilities (e.g., cerebral palsy, spina bifida), employment in meaningful occupations can lead to increases in self-esteem, creativity, and responsibility as they transition into adulthood (Anderson & Vogel, 2000). The benefits of employment at a social and economic level are well documented (Anderson & Vogel, 2000; Koch, 2000; Phelps & Hanley-Maxwell, 1997). Socially, employment is an accepted activity that provides an opportunity for youth to interact with other individuals of varying ages and backgrounds (Anderson & Vogel, 2000). Social relationships allow youth to develop emotional intelligence and social skills (Shandra & Hogan, 2008; White & Weiner, 2004). Economically, employment provides the opportunity for youth to earn an income for independent living, social activities, and education

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(Phelps & Hanley-Maxwell, 1997; White & Weiner, 2004). Research shows that youth with physical disabilities who are employed experience fewer hospitalizations and increased physical and psychological wellness, which can help to reduce financial burdens on the healthcare system (Yuen, Burik, & Krause, 2004). Research shows that most youth with physical disabilities are willing and able to work
but encounter many barriers in finding work (Lindsay, McDougall, Menna-Dack, Sanford, & Adams, 2015). The exclusion of people with disabilities from the workforce is costly; it is estimated to result in a significant annual global loss of gross domestic product (GDP) (Canadian Association for Community Living, 2010). Such individuals often face obstacles that limit their opportunities to find a job and maintain employment. Those obstacles include discrimination, lack of accommodations, and lack of experience and support enabling them to develop professional skills (Lindsay, 2010). Research also highlights that some individuals with disabilities may be reluctant to participate in employment out of fear of losing their disability benefits (Lindsay et al., 2015). Faced with a plethora of barriers, at both the individual and societal level, youth with disabilities may not be receiving adequate training to develop employable skills. They arguably have the most to gain from early employment experiences (Lindsay, Adams, McDougall, & Sanford, 2012); thus, it is critical they begin to receive support at an early age to help them develop employable skills and bridge their transition into adulthood. Vocational interventions can provide an essential foundation for career development by allowing youth to explore their individual interests and abilities, providing them with skill development opportunities, and enabling their participation in society (Lindsay et al., 2012). To inform best practice for vocational programs, it is important to gain a clear understanding of the available programs, skills, and experiences that youth with physical disabilities currently receive. Past research has focused on synthesizing the available literature on vocational interventions for people with mental health issues and youth with intellectual or developmental disabilities (i.e., ASD). Such studies indicate that these programs can help combat barriers to employment and provide employable skills (Bond, 2004; Taylor, McGilloway, & Donnelly, 2004). Vocational interventions also exist for youth with physical disabilities; however, little is known about their effectiveness and common elements
and there are currently no systematic reviews that synthesize and critically appraise research on vocational interventions for youth with physical disabilities. Focusing on youth with physical disabilities is salient because they have different needs than able-bodied youth and those with developmental or intellectual disabilities; they also face challenges in transitioning to adulthood related to developmental tasks, social developmental, and role functioning (Lindsay et al., 2012, 2015). The transitional period of adolescence

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provides a critical window of opportunity to prevent impaired work productivity throughout the lifespan (Fraas & Bellerose, 2010). In conducting this systemic review, our objectives are two-fold: (1) to understand how vocational interventions for youth (15
25 years old) with physical disabilities can influence employment-related skills and job outcomes; and (2) to learn about the common components of vocational interventions for youth with physical disabilities.

METHOD Our research team undertook a systematic review to synthesize and critically appraise available research on vocational interventions for youth with physical disabilities, including the common components and efficacy of those programs. We followed the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA), a method of transparent reporting, which consists of a 27item checklist (Moher, Liberati, Tetzlaff, & Altman, 2009).

SEARCH AND DATA SOURCES Each publication reviewed met the following inclusion criteria: (1) peerreviewed journal article, dissertation, or conference paper, published between 1990 and January 2014; (2) addresses an intentional vocational program or intervention (i.e., purposively designed to help youth with physical disabilities obtain employment or vocational training); and (3) the sample includes at least 50% youth (aged 15
25) with an acquired or congenital physical disability (defined as a physical functional limitation, such as spinal cord injuries, cerebral palsy, congenital disorder, amputation, juvenile rheumatoid arthritis, neuromuscular disease, scoliosis, movement disorder, muscular dystrophy, spina bifida, or stroke). We excluded publications that did not meet the above criteria. We also excluded editorials, opinion pieces, and program descriptions that did not evaluate or report on outcomes. Our research team used the following databases to conduct our systematic search: Medline, CINAHL, Embase, Web of Science, PsychInfo, and Scopus. We developed our search strategy (see Fig. 1) in consultation with an experienced hospital librarian. It was based on three categories: (1) employmentrelated terms; (2) age-related terms; and (3) disability-related terms (see Table 1). Throughout our systematic review, we aimed to: (1) understand how vocational interventions for youth with physical disabilities influence employment-related skills and job outcomes; and (2) learn about the common components of these programs. Here we refer to vocational interventions as

1 publication identified through screening of reference lists of articles selected for inclusion

4,588 publications identified through baseline database search

Screening by Title

125 articles selected for potential inclusion, based on title

Screening by Abstract

18 full text articles selected for potential inclusion, basedon abstract

Full Review

8 articles selected for quantitative synthesis, based on full text review

4,464 articles excluded, based on title

107 articles excluded, based on abstract: • Focuses on intellectual disability or mental illness; • Does not assess employment readiness program; • Does not engage majority sample of youth between 15-25 years old; • Theory rather than program based; and/or • Publication inaccessible

A Systematic Review of Vocational Interventions

Baseline Search

1,795 MEDLINE 294 PSYCHINFO 303 CINAHL 912 EMBASE 981 SCOPUS 303 WEB OF SCIENCE

2 pre-post design 3 pre-post-post design 2 mixed methods 1 control group

Fig. 1.

Flow of Studies Through the Systematic Review Process. 185

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Table 1. Overview of Search Terms. Employment-related terms:

Employment readiness, vocation readiness, work readiness, vocational rehabilitation, occupational rehabilitation, vocation, occupations, vocation service, rehabilitation, vocational training, employment, employment training, work participation, work experience, supported employment, volunteer, life skills, work skill, employment skill, career skill, profession skill, office skill, customized employment

Age-related terms:

Youth, adolescent, teen, juvenile, young adult, student

Disability-related terms:

Disabled persons, physical disability, disabled, handicap, spinal cord injuries, cerebral palsy, congenital disorder, spina bifida, amputation, juvenile rheumatoid arthritis, neuromuscular disease, scoliosis, movement disorder, muscular dystrophy, stroke

intentional programs designed specifically to help prepare youth with disabilities for employment. Our baseline search produced 4,588 results. Of those 4,588 publications, we identified 8 publications meeting our inclusion criteria (see Fig. 1). Following the principles of narrative synthesis outlined by Petticrew and Roberts (2005), we identified eligible studies through a six-stage process. In this first stage, two authors conducted a baseline search using the search engines and terms described above. Second, we screened the baseline search results, and read each publication title/abstract and assessed its relevance to the study objectives. Third, to further screen the publications identified in stage two, the authors read each abstract, resolving disagreement and uncertainty through discussion. Fourth, all authors read the full texts of publications selected for inclusion in stage three. Using the Guidelines for Critical Review Form
Quantitative Studies, we extracted initial data for each publication, including: country of study, recruitment setting, study design, sample (size, disability, age, sex), research objectives, measures, scales, statistical analysis, cost of intervention (total and per participant), theory, delivery setting, intervention format, delivery format (homework assignments), skills learned, experiential session (e.g., role play or work experience), family involvement, connection to business, mentorship, on-the-job support, number of sessions, estimated total intervention time, duration, outcomes, clinical implications, and limitations. Fifth, to identify any additional relevant publications, we searched the reference list of all publications selected for inclusion in stage three. We extracted initial data for any additional publications identified. In the final sixth step we compiled common elements of vocational interventions, while extracting the relevant data. Research team members extracted data independently using a structured abstract form. To analyze findings, we followed the guidelines for narrative synthesis outlined by Petticrew and Roberts (2005). All authors reviewed the common elements of vocational interventions until we reached a consensus.

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RESULTS Study Characteristics We provide an overview of key study characteristics in Table 2. Two of the studies were conducted in the Netherlands and six in the United States. The sample size of studies ranged from 10 to 108 participants. Five of the studies entailed pre-post designs (without control groups) (Kolakowsky-Hayner, Wright, Shem, Medel, & Duong, 2012; Shem, Medel, Wright, KolakowskyHayner, & Duong, 2011; Verhoef, Miedema, Van Meeteren, Stam, & Roebroeck, 2013; Verhoef, Roebroeck, van Schaardenburgh, Floothuis, & Miedema, 2014; Wolf-Branigin, Schuyler, & White, 2007); two entailed mixed method designs (involving a survey and interviews) (Francis, Gross, Turnball, & Turnball, 2013a; Francis, Gross, Turnbull, & Parent-Johnson, 2013b); and one entailed a quasi-experimental design (random assignment with a control group, post-test only) (Carter, Trainor, Ditchman, & Swedeen, 2009). The quality of evidence reported was poor, at a level IV for most studies (Edlund, Gronseth, So, & Franklin, 2004).

Participant Characteristics Only one study included participants with a single type of physical disability (spinal cord injury). The remaining seven studies included participants with varying types of disabilities. Across the studies, specific physical disability types included: cerebral palsy (n ¼ 5), spina bifida (n ¼ 2), spinal cord injury (n ¼ 4), muscular disease (n ¼ 2), and orthopedic impairment (n ¼ 1). Both male (n ¼ 145) and female (n ¼ 107) participants were represented. The mean age of participants ranged from 14.8 years old to 22.9 years old. Of the eight studies, four included Caucasian participants, five included Hispanic participants, five included Asian participants, six included African-American participants, one included European-American participants, one included Native American participants, three included Mixed/Other participants, and two did not report the ethnicities of their participants.

Vocational Intervention Characteristics Across the publications, six different vocational programs were represented (note that two programs had two publications each about them). Those programs varied in content, length, and delivery, from 2 sessions over two days to 36 sessions over two years. One program consisted of six sessions over eight weeks, while two did not specify the length (see Table 3). Two vocational

Characteristics and Overview of Studies.

Table 2. First Author, Year

Country

Recruitment Setting

Study Design

Sample Size

Sex

Disability

Age (Mean)

Ethnicity

Verhoef et al. (2013)

Netherlands Rehab Centre

Pre-post

n ¼ 12

M ¼ 6; F¼6

N/A

CP, muscular disease, TBI, spina bifida, SCI, MS, COPD

21.5 years old

Verhoef et al. (2014)

Netherlands Rehab Centre

Pre-post

n ¼ 11

M ¼ 6; F¼5

N/A

CP, muscular disease, TBI, spina bifida, SCI, MS, COPD

22 years old

n ¼ 108

N/A

Caucasian; Hispanic/Latino; Asian/ Asian-American; Black/ African-American; Multiple races/ ethnicities

Autism, developmental disabilities, multiple disabilities, down syndrome, CP, ADHD, hearing impairment/ deafness

22.9 years old

Francis et al. United (2013a, States 2013b)

N/A

Mixed methods

Kolakowsky- United Hayner et al. States (2012)

N/A

Pre-post-post; n ¼ 89 prospective (n ¼ 77 successfully matched)

M ¼ 61; F ¼ 28

Caucasian, Hispanic, Asian, African-American, Other

SCI, TBI, & other neurological conditions

20.5 years old

Shem et al. (2011)

United States

N/A

Pre-post-post; n ¼ 10 prospective

M ¼ 6; F¼4

Caucasian, Hispanic, Asian, African-American, Other

SCI

19.8 years old

WolfBranigin et al. (2007)

United States

Community (receiving Supplemental Security Income)

Pre-post-post

n ¼ 64

M ¼ 38; F ¼ 26

African American; Mixed

Cognitive impairment, medical disability 14.8 years (asthma, arthritis, obesity, diabetes, and old seizure disorders), ADHD, learning disability, and CP

Carter et al. (2009)

United States

High schools

Randomized experimental design; posttest only

n ¼ 67 (I ¼38; C ¼29)

M ¼ 17 I, 12C; F ¼ I
21, C
17

African American, Asian/ Pacific-Islander, European American, Latino, Native American

Autism, cognitive disability, orthopedic impairment, speech & language disabilities, visual impairment, other impairment

I ¼ 18.4 years; C ¼ 17.6 years

I ¼ Intervention, C ¼ Control; CP ¼ cerebral palsy; TBI ¼ traumatic brain injury; SCI ¼ spinal cord injury; MS ¼ multiple sclerosis; ADHD ¼ attention deficit hyperactivity disorder; COPD ¼ chronic obstructive pulmonary disease.

First Author, Year

Vocational Rehabilitation Program Description.

Employment Readiness Program

Delivered By

Delivery Setting

• Multidisciplinary vocational rehabilitation intervention for youth with physical disabilities, aiming to increase self-efficacyGroup sessions: ○ Increasing insight into personal disabilities ○ Work-related coping strategies ○ Occupational balance ○ Job hunting ○ Job interviews ○ Employment regulations ○ Social security ○ Communication and interaction skills ○ Shared experiences • One-to-one sessions: ○ Personal capacities and goals ○ Work placement opportunities ○ Work placement modifications

• Occupational therapist • Job coach • Psychologist • Social worker • Job interview trainer • Mentors (employed young adults with a physical disability)

• Rehabilitation center

Verhoef et al. (2014)

• Program for youth with physical disabilities, aiming to improve skills to help achieve work participation • [FORMAT OF ACTIVITIES]: ○ Motivation for employment ○ Productive roles and routines ○ Vocational skills

• Occupational therapist • Job coach • Psychologist • Social worker • Job interview trainer • Mentors (employed young adults with a physical disability)

• Rehabilitation center

Francis et al. (2013a, 2013b)

• Family Employment Awareness Training (FEAT) program for youth with physical disabilities and their families, aiming to enhance employmentrelated knowledge • Group lectures: ○ Supported and customized employment options ○ Family role in supporting employment ○ Transition to adulthood

• University of Kansas researchers • State Parent Training and Information Center leaders

• Community

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Table 3.

First Author, Year

Employment Readiness Program

190

Table 3. (Continued ) Delivered By

Delivery Setting

Support resources Systems navigation ○ Employment services and supports ○ Funding information ○ Anti-discrimination policy ○ ○

• One-to-one mentorship program for youth with spina cord injury and other neurological conditions, aiming to connect participants to mentors who had successfully gained employment • Mentor training: ○ Training curriculum with refresher sessions throughout the program • Mentee-mentor sessions: ○ A minimum of three meetings per month (person, telephone, email)

• Mentors with or without a disability (efforts made for mentors to have a SCI as well) • Physician • Program coordinator • Program assistant • Vocational counselor • Rehabilitation psychologist

• Community

Shem et al. (2011)

• One-to-one mentorship program for youth with spina cord injury, aiming to connect participants to mentors who had successfully gained employment • Mentor training: ○ Training curriculum with refresher sessions throughout the program • Mentee-mentor sessions: ○ A minimum of three meetings per month (person, telephone, email)

• Mentors with or without a disability (efforts made for mentors to have a SCI as well) • Physician • Program coordinator • Program assistant • Vocational counselor • Rehabilitation psychologist

• Community

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KolakowskyHayner et al. (2012)

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programs took place in a rehabilitation center, while the remaining four were held in the community. Two programs entailed an estimated intervention time of 12 hours; two were not time-limited; and four entailed total intervention times that could not be calculated based on the study descriptions. The majority of programs entailed a combination of both one-to-one and group intervention formats. A variety of professionals, including an occupational therapist (n ¼ 1), job coach (n ¼ 1), social worker (n ¼ 1), physicians (n ¼ 2), vocational counselors (n ¼ 2), and/or teachers (n ¼ 1) coordinated the programs. The At Work?! program (representing two studies) included a multidisciplinary vocational rehabilitation intervention developed for youth with physical disabilities. It aimed to improve the abilities of youth to achieve work participation (Verhoef et al., 2013, 2014). This program utilized both group and one-toone formats. During group sessions, participants received information about work-related topics, including insight into personal disabilities, coping strategies, and occupational balance. During one-to-one sessions, participants focused on personal goals, work placement opportunities, and workplace modifications and mentorship (Verhoef et al., 2013, 2014). Six sessions were implemented over eight weeks and were delivered in a rehabilitation setting by a variety of professionals. The program included homework assignments, job placements, indirect mentorship, on-the-job supports, and connections to business (Verhoef et al., 2013). The Family Employment Awareness Training (FEAT) program (also representing two studies in our review) was delivered by a multidisciplinary rehabilitation team in a community setting to youth with a variety of disabilities, including autism, down syndrome, and cerebral palsy (Francis et al., 2013a, 2013b). The group-based format (lectures) of the intervention sought to support and customize employment options for participants by providing knowledge about transition to adulthood, support resources, system navigation, employment services and supports, funding information, and anti-discrimination policy information. Two sessions were provided over two days. The program encouraged the involvement of family/caregivers throughout the intervention, reflecting the belief that family plays an important role in supporting employment for youth with disabilities. The program also involved indirect mentorship and connections to businesses. It demonstrated a small effect size (cohen’s d ¼ 0.10) for expectations for competitive employment and medium effect size (cohen’s d ¼ 0.68) for knowledge of employment and supports. The Back on Track program entailed a one-to-one mentorship program. On a one-to-one basis, it connected youth with physical disabilities with a mentor in their community who had successfully gained employment (KolakowskyHayner et al., 2012; Shem et al., 2011). The program coordinators attempted to match mentees with mentors with the same types of disability. The program aimed to provide youth with one-to-one support to help them navigate the employment assistance programs and services available to them in their community. The program entailed 36 sessions over two years. A multidisciplinary

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team of professionals and mentors based in the community delivered the program. Kolakowsky-Hayner et al. (2012) applied their program to youth with spinal cord injury and other neurological conditions, while Shem et al. (2011) focused on spinal cord injury only. The Adolescent Employment Readiness Center sought to support youth with disabilities during their early adolescence to improve their quality of life and employment readiness outcomes (2007). Its intervention entailed both group and one-to-one sessions. Group sessions included job boot camp, summer employment preparation, job placement, and parenting support class (family involvement). During one-to-one sessions, counselors provided youth and family/caregivers with support on individually determined needs and goals. Participants could choose which intervention activities they wanted to take part in over a period of two years. The intervention did not yield significant improvements in findings on emotional or social functioning. The program assessed by Carter et al. (2009) consisted of a multi-component intervention focused on connecting youth with severe disabilities (i.e., autism, orthopedic impairment, and visual impairment) with a summer work experience. Teachers and employment specialists delivered the intervention in high schools and the wider community. The intervention entailed both group and one-to-one activities, including five specific strategies: community conversations, resource mapping, summer focused planning, community connectors, and employer liaising. The number of sessions and their duration are unknown (Tables 4 and 5).

Common Components of Vocational Programs Across the vocational programs and studies reviewed, all programs offered multiple intervention components related to preparing youth for employment. Common components included: job placements (n ¼ 4), family involvement (n ¼ 4), combined group and one-to-one sessions (n ¼ 4), networking with potential employers (n ¼ 6), and mentorship (n ¼ 6). For job placements, program coordinators did not randomly assign participants to job opportunities; rather, they identified suitable and meaningful jobs that matched participants’ interests. In terms of family involvement, program coordinators encouraged parents and/or caregivers to participate in educational sessions and workshops to help them learn about available supports and services and learn how to better support their children in finding employment. Program coordinators’ provision of both group and one-to-one sessions enabled them to meet participants’ varied needs. For instance, group-based interventions allow youth to engage in social interactions and peer-to-peer learning; one-to-one support provides youth with more individualized experiences, addressing their particular interests and needs. In terms of networking, program coordinators invited potential

First Author, Year

Intervention Format

Delivery Format

Group

1-on-1

Verhoef et al. (2013)

Yes

Yes

Individual & group sessions

Verhoef et al. (2014)

Yes

Yes

Francis et al. (2013a, 2013b)

Yes

KolakowskyHayner et al. (2012)

Homework Assignments

Experiential Sessions

Family Involvement

Mentorship

On-the-Job Support

Connection to Businesses

Role Play

Job Placements

Yes

No

Yes

No

No

Yes

Yes

Yes

Individual & group sessions

Yes

No

Yes

No

No

Yes

Yes

Yes

No

Group lectures

No

No

No

Yes

No

Yes

No

Yes

No

Yes

Individual sessions

No

No

No

No

Yes

No

No

No

Shem et al. (2011)

No

Yes

Individual sessions

No

No

No

No

Yes

No

No

No

Wolf-Branigin et al. (2007)

Yes

Yes

Individual & group sessions

No

No

Yes

Yes

No

No

No

Yes

Carter et al. (2009)

Yes

Yes

Individual

No

No

Yes

Yes

No

No

Yes

Yes

First Author, Year

Number of Sessions

Direct Indirect

Estimated Total Intervention Time

Duration of Program 8 weeks

6

12 hours

Verhoef et al. (2014)

6

12 hours

8 weeks

Francis et al. (2013a, 2013b)

2

N/A

2 days

Kolakowsky-Hayner et al. (2012)

Minimum of 36

Minimum of 36 hours

2 years

Shem et al. (2011)

Minimum of 36

Minimum of 36 hours

2 years

Wolf-Branigin et al. (2007)

N/A (participants choose activities over 2-year period)

N/A

2 years

Carter et al. (2009)

N/A

N/A

N/A

193

Verhoef et al. (2013)

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Table 4. Vocational Rehabilitation Program Components.

First Author, Year

Skills Learned & Knowledge Gained

Results of Studies.

194

Table 5.

Outcomes

• From group sessions: • 8/12 participants were employed post-intervention (work was 12 þ ○ Personal coping style and strategies for coping with hours/week) ○ 4 paid, 4 unpaid health-related problems in work situations ○ Achieving occupational balance, in relation to personal ○ Average of 18 hours/week ○ Broad variety of jobs, mainly low-to-medium level (e.g., office clerk, interests, abilities, self-care, work, and leisure ○ Looking for job vacancies, assessing job demands, and kitchen aid, museum guard, help desk worker, graphic designer, shop assistant) finding a suitable job ○ Participating and presenting self in job interviews ○ 6/8 still employed at 2-year follow-up (4/6 paid, 2/6 unpaid) ○ Information market: (rules and regulations, ○ 5/8 still employed at 3-year follow-up (all paid) organizations, support evaluation, and continuation). • Participants displayed more positive values and interests, more positive • From individual sessions: image of future, and increased ability to demonstrate productive and ○ Coaching on the job satisfying occupational behavior ○ Workplace adaptations ○ Job placement

Verhoef et al. (2014)

• From group sessions: • 8/11 participants achieved employment ○ Personal coping style and strategies for coping with ○ 4/8 paid, 4/8 unpaid health problems in work situations • Overall, participants expressed satisfaction with performance in domains ○ Achieving occupational balance, in relation to personal of paid and unpaid work interests, abilities, self-care, work, and leisure ○ Looking for job vacancies, assessing job demands, and finding a suitable job ○ Participating in and presenting self in job interviews ○ Information market (rules and regulations, organizations, support evaluation, and continuation). • From individual sessions: ○ Coaching on the job ○ Workplace adaptations

SHAKIRA HANIF ET AL.

Verhoef et al. (2013)

• Increased expectations for competitive employment ○ Results not statistically significant, but clinically significant ○ There was a need for knowledge of employment services and supports ○ Medium effect (d ¼ 0.68) • Family perceptions of program: ○ Positive perceptions: feeling inspired by stories, enjoying learning new information, appreciating networking opportunities ○ Negative perceptions: failure of program to match needs of family member, gap between FEAT info and real-world opportunities

KolakowskyHayner et al. (2012)

• From one-to-one mentorship: ○ Knowledge of available employment support and resources

• 42 participants achieved employment and/or educational goals: ○ 29/42 attained further education ○ 13/42 attained employment • 53 participants set goal to attain post-secondary education ○ 23/53 achieved goal ○ 7/53 attained employment instead • 12 participants set goal to attain employment ○ 5/12 achieved goal ○ 1 attained further educational instead • 12 participants set combined goal to attain both education and employment ○ 5/12 attained further education ○ 1/12 attained employment

Shem et al. (2011)

• From one-to-one mentorship: ○ Knowledge of available employment support and resources

• 10 participants completed the program ○ 7/10 returned to school full-time ○ 1/10 returned to school part-time ○ 2/10 returned to work

Wolf-Branigin et al. (2007)

• From group sessions: ○ Healthy development and wellness ○ Interview skills ○ Resume development ○ Application writing ○ Professional self-presentation ○ College planning ○ Career development ○ Leadership skills

• Focusing on career readiness skills provided adolescents with transferable skills that improved their well-being (e.g., learning to use public transportation in order to participate in the program) • Adolescents and younger adolescents demonstrate improvements in physical and psychosocial functioning • Results varied across lifespan: ○ Interest in prevocational services peaked around 13
14 years old ○ 7th- and 8th-grade youth with a physical disability reported higher career readiness compared to age norms

195

• From group lectures: ○ Knowledge of employment services and supports

A Systematic Review of Vocational Interventions

Francis et al. (2013a, 2013b)

First Author, Year

(Continued )

Skills Learned & Knowledge Gained Independence Self-advocacy • From individual sessions: ○ Identifying own needs and goals ○ On-the-job work experience ○

Outcomes

○

196

Table 5.

As the youth aged, they had a harder time keeping up with their peers

○

Carter et al. (2009)

• From multiple components: ○ Individual skills related to gaining summer employment

SHAKIRA HANIF ET AL.

• Employment status varied across intervention and control groups: ○ Intervention group: ▪ 21 initially employed; 16/21 maintained job by end of summer ▪ 13 not initially employed; 11/13 still not working by the end of summer ○ Comparison group: ▪ 5 initially employed; 5/5 maintained job by end of summer ▪ 21 not initially employed; 19/21 still not working by the end of summer; 2/21 could not be reached for follow-up • Compared to the control group, a higher proportion of youth (65.8%) who took part in the intervention participated in paid/unpaid community-based work at some point during the summer ○ Youth in intervention group were 3.5x more likely to have any community-based work ○ Youth in intervention group worked 2x more hours/week on average 44.7% (compared to 11.1%) had paid competitive jobs at some point during the summer ○ 21.1% (compared to 7.4%) had unpaid jobs ○ 7.9% (compared to 11.1%) had exclusively sheltered jobs ○ 26.3% (compared to 70.4%) did not work at any point during the summer • The characteristics of summer jobs and search efforts among participants varied: ○ Wide range of job responsibilities, including cleaning, food service, and/or childcare ○ Sheltered jobs consisted of assembly work

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employers to attend and participate in workshops; built connections between their programs, businesses, and youth participants; and/or identified and advocated for employment opportunities for youth participants. Mentorship components included both direct mentoring (i.e., youth participants were paired with a mentor with a physical disability that had been successful in gaining employment) and indirect mentoring (i.e., individuals with a physical disability led workshops or were present during the programs to provide support and guidance for youth participants).

Skills and Knowledge Gained Across the vocational programs and studies reviewed, youth participants learned a variety of skills, including strategies to find a suitable job (Carter et al., 2009; Kolakowsky-Hayner et al., 2012; Shem et al., 2011; Verhoef et al., 2013, 2014) effectively participate in job interviews (Carter et al., 2009; Verhoef et al., 2013, 2014; Wolf-Branigin et al., 2007), and advocate for workplace adaptations (Carter et al., 2009; Verhoef et al., 2013, 2014). Participants also gained knowledge on work and health (Verhoef et al., 2013, 2014; WolfBranigin et al., 2007), occupational balance (Verhoef et al., 2013, 2014), and the availability of employment services and supports (Verhoef et al., 2013, 2014; White & Weiner, 2004; Wolf-Branigin et al., 2007). They also accessed experiential opportunities through job placements (Verhoef et al., 2013, 2014; White & Weiner, 2004; Wolf-Branigin et al., 2007) and on-the-job coaching (Carter et al., 2009; Verhoef et al., 2013, 2014; Wolf-Branigin et al., 2007), which allowed them to practice and develop employment-related skills and gain additional knowledge related to their specific area of employment. The program assessed by Francis et al. (2013a) found a medium effect for knowledge of employment services and supports (d ¼ 0.68).

Outcomes of Participation in Vocational Programs Employment achievement In six out of eight studies reviewed, the majority of participants gained unpaid or paid employment after participating in a vocational program. Unpaid employment consisted of volunteer work. In terms of paid work, the majority of participants found entry-level jobs
for example, as food service staff, office clerk, help desk worker, graphic designer, shop assistant, cleaning services staff, or childcare staff
which is common for this age group. The remaining two studies focused on the knowledge and perceptions of employment among the youth and family/caregiver participants assessed, rather than their achievement of employment (Francis et al., 2013a, 2013b).

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Knowledge and perceptions of employment In five out of eight studies, participation in vocational programs promoted positive perceptions of achieving and maintaining employment among youth participants. Youth also gained knowledge of the employment services and supports available to them in their communities. Some studies also included parents/ caregivers as participants. Results of those studies suggest that parents/caregivers can also develop a more positive perception of their child’s ability to gain and maintain employment after participating in a vocational program.

DISCUSSION Our review addresses an important gap in literature regarding vocational programs for youth (15
25 years old) with physical disabilities. To our knowledge, this is the first published review on vocational programs for youth with physical disabilities. While conducting this review, we aimed to understand how vocational programs could influence employment-related skills for youth with physical disabilities and learn about the common components of such programs. We found some evidence to suggest that vocational programs can be effective for youth with physical disabilities; however, the studies included in our review varied in study design and scales, sample size, and dosage (i.e., duration and extent of intervention). Further research entailing more rigorous design is needed to explore the longer-term implications of vocational programs for youth with physical disabilities. Common components of the vocational programs and studies that we reviewed included: job placements, family involvement, combined group and one-to-one support, networking with potential employers, and mentorship. The majority of youth who participated gained paid or unpaid (i.e., volunteer) employment. In all cases, their employment consisted of entry-level jobs, which is typical for the age group studied; this finding may reflect wider trends in job offers made to individuals aged 15
25 upon entry to the workforce, rather than the specific skills and abilities of participants engaged. Our present study demonstrates some consistency with previous reviews on vocational programs for individuals with mental health issues and also youth with autism spectrum disorder (ASD) (Bond, 2004; Taylor et al., 2004), which also highlight the importance of family involvement in vocational programs (Bond, 2004). In our review, we also found several programs and studies that entailed family involvement (Carter et al., 2009; Francis et al., 2013a, 2013b; Wolf-Branigin et al., 2007) which can provide a good source of social and informational support during their transition into employment. However, evidence on the efficacy of involving family members in vocational programs is lacking and future research should explore this further.

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Job placements in the labor market are another essential component for vocational programs where our findings show similarity to other disability types (Bond, 2004). Our results suggest that job placements provide participants with an opportunity to practice the skills they learn, while gaining hands-on experience with employment (Carter et al., 2009; Verhoef et al., 2013, 2014; WolfBranigin et al., 2007). Other research focusing on youth with ASD identified on-the-job-support as a common component of the interventions and studies they reviewed (Taylor et al., 2004). They found that on-the-job-support was more beneficial for youth with ASD than sheltered workshops; however, the authors noted the overall quality of the studies they review was poor (Taylor et al., 2004). In our review, we also found that on-the-job support was an important component in many programs for youth with physical disabilities. This suggests that on-the-job-support it may be used for a variety of populations beyond individuals with ASD (Carter et al., 2009; Verhoef et al., 2013, 2014). However, evidence is lacking on the efficacy of on-the-job support for individuals engaging in vocational programs. Despite the demonstrated potential of vocational programs, there are few available that are evidence-based. Of those that have been evaluated there are limited numbers of youth enrolled. There is a critical need for more vocational programs for youth with physical disabilities. Much work is needed to address this gap to help improve employment outcomes for those youth.

LIMITATIONS There are several limitations to our review that should be noted. First, rigorously designed studies on the subject with heterogeneous outcomes and samples are lacking. As such, it is challenging to draw definitive conclusions about effective components of vocational programs for youth with physical disabilities. Secondly, our search focused on intentional vocational programs in general
and our search did not focus on specific aspects related to job readiness (e.g., on-the-job support). Third, our search included only published articles and conference proceedings. Thus, we may have missed conference papers that were unpublished. Our rationale for excluding unpublished work was so that we could base our findings on the best available evidence, which is common practice in systematic reviews. Finally, although some vocational programs for youth with disabilities, most of them have not been evaluated. We came across many program descriptions that provided little insight on the efficacy of the programs. Clinicians and educators should be encouraged to evaluate their programs to assess whether or not
and how
they are making a difference for youth.

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DIRECTIONS FOR FUTURE RESEARCH This review provides a foundation of knowledge regarding vocational programs for youth with physical disabilities. Future research should assess the effectiveness of vocational programs using more rigorous study designs (i.e., RCTs). Further work is also needed to understand which components of the interventions are most effective in helping youth gain employment. That assessment that could help promote cost-effective employment interventions and support improved employment outcomes. Specifically, studies should examine the effectiveness of job placements, family involvement, combined group and one-to-one support, networking with potential employers, and mentorship as components of vocational interventions. Researchers should also explore whether it is more or less effective to offer a generic vocational program to youth with a variety of disability types or a specific/tailored program. Finally, studies should also compare different lengths, formats, and types of interventions.

CONCLUSION For youth with physical disabilities, employment in meaningful occupations can lead to increases in self-esteem, creativity, and responsibility (Anderson & Vogel, 2000). However, youth with physical disabilities face numerous barriers when seeking employment, including discrimination, lack of accommodations, and lack of experience and supportive opportunities to develop their professional skills (Lindsay, 2010; Lindsay et al., 2015). Vocational programs have the potential to aid youth with physical disabilities in overcoming many of those barriers, helping them improve their employment-related skills and employment outcomes. Our review indicates that high-quality research and evidence on interventions for this population is limited. The studies we reviewed suggested that common intervention components often included job placements, family involvement, combined group and one-to-one support, networking with potential employers, and mentorship; however, it is important to note that each study varied in dosage and duration. Clinicians and researchers should use caution when applying any of these particular interventions within their clinic.

ACKNOWLEDGMENTS We would like to thank the staff and volunteers in the TRAIL lab for their assistance in the preparation of this manuscript. Sally Lindsay is supported from a career award from the Ontario Ministry of Research and Innovation. Declarations of Interest: The authors report no conflicts of interest.

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REFERENCES Anderson, C., & Vogel, L. (2000). Preparation for employment in children and adolescents with spinal cord injuries. Topics in Spinal Cord Injury Rehabilitation, 6, 170
175. Bond, G. (2004). Supported employment: Evidence for an evidence-based practice. Psychiatric Rehabilitation Journal, 27(4), 345
359. Canadian Association for Community Living. (2010). Position statement on employment June 2010. Toronto, ON: CACL. Available from http://www.cacl.ca/sites/ Carter, E., Trainor, A., Ditchman, N., & Swedeen, B. (2009). Evaluation of a multicomponent intervention package to increase summer work experiences for transition-age youth with severe disabilities. Research in Practices and Personnel Services, 34(2), 1
12. Edlund, W., Gronseth, G., So, Y., & Franklin, G. (2004). Clinical practice guidelines process manual. St. Paul, MN: American Academy of Neurology. Fraas, M., & Bellerose, A. (2010). Mentoring programme for adolescent survivors of acquired brain injury. Brain Injury, 24(1), 50
61. Francis, G., Gross, J., Turnball, A., & Turnball, R. (2013a). The family employment awareness training (FEAT): A mixed method follow up. Journal of Vocational Rehabilitation, 29, 167
181. Francis, G., Gross, J., Turnbull, R., & Parent-Johnson, W. (2013b). Evaluating the effectiveness of the family employment awareness training in Kansas: A pilot study. Research in Practices in Personnel Services, 38(1), 44
57. Koch, L. (2000). Career development interventions for transition-age youths with disabilities. Work, 14(1), 3
11. Kolakowsky-Hayner, S., Wright, J., Shem, K., Medel, R., & Duong, T. (2012). An effective community-based mentoring program for return to work and school after brain and spinal cord injury. NeuroRehabilitation, 31, 63
73. Lindsay, S. (2010). Discrimination and other barriers to employment for teens and young adults with disabilities. Disability & Rehabilitation, 33(15
16), 1340
1350. Lindsay, S., Adams, T., McDougall, C., & Sanford, R. (2012). Skill development in an employmenttraining program for adolescents with disabilities. Disability & Rehabilitation, 34(3), 228
237. Lindsay, S., McDougall, C., Menna-Dack, D., Sanford, R., & Adams, T. (2015). An ecological approach to understanding barriers to employment for youth with disabilities compared to their typically developing peers: Views of youth, employers and job counselors. Disability & Rehabilitation, 37(18), 1651
1663. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264–269, W64. Epub July 20, 2009. Petticrew, M., & Roberts, H. (2005). Systematic reviews in social sciences: A practical guide. Victoria, AU: Wiley Blackwell. Phelps, L., & Hanley-Maxwell, C. (1997). School-to-work transitions for youth with disabilities: A review of outcomes and practices. Review of Educational Research, 67(2), 197
226. Shandra, C., & Hogan, D. (2008). School-to-work program participation and the post high school employment of young adults with disabilities. Journal of Vocational Rehabilitation, 29, 117
130. Shem, K., Medel, R., Wright, J., Kolakowsky-Hayner, S., & Duong, T. (2011). Return to work and school: A model mentoring program for youth and young adults with spinal cord injury. International Journal of Spinal Cord Society, 49, 544
548. Stewart, D., Law, M., Rosenbaum, P., & Williams, D. (2001). A qualitative study of the transition to adulthood for youth with physical disabilities. Physical & Occupational Therapy in Pediatrics, 21(4), 3
21.

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Taylor, B., McGilloway, S., & Donnelly, M. (2004). Preparing young adults with disability for employment. Health and Social Care in the Community, 12(2), 93
101. Taylor, J., McPheeters, M., Sathe, N., Dove, D., Veenstra-Vanderweele, J., & Warren, Z. (2012). A systematic review of vocational rehabilitations for young adults with autism spectrum disorder. Pediatrics, 30(3), 531
538. Verhoef, J., Miedema, H., Van Meeteren, J., Stam, H., & Roebroeck, M. (2013). A new intervention to improve work participation of young adults with physical disabilities: A feasibility study. Developmental Medicine & Child Neurology, 55, 722
728. Verhoef, J., Roebroeck, M., van Schaardenburgh, N., Floothuis, M., & Miedema, H. (2014). Improved occupational performance of young adults with a physical disability after a vocational rehabilitation intervention. Journal of Occupational Rehabilitation, 24, 42
54. White, J., & Weiner, J. (2004). Influence of least restrictive environment and community based training on integrated employment outcomes for transitioning students with severe disabilities. Journal of Vocational Rehabilitation, 21(3), 149
156. Wolf-Branigin, M., Schuyler, V., & White, P. (2007). Improving quality of life and career attitudes of youth with disabilities: Experiences from the adolescent employment readiness center. Research and Social Work Practice, 17(3), 324
333. Yuen, H., Burik, J., & Krause, J. (2004). Physical and psychosocial well-being among adults with spinal cord injury: The role of volunteer activities. Topics in Spinal Cord Injury Rehabilitation, 9(4), 19
25.

PART 3 WORK ROLE AND WELL-BEING

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CHAPTER 7 PEOPLE WITH PHYSICAL DISABILITIES, WORK, AND WELL-BEING: THE IMPORTANCE OF AUTONOMOUS AND CREATIVE WORK Robyn Lewis Brown, Mairead Eastin Moloney and Gabriele Ciciurkaite ABSTRACT Objective
Motivated by research linking job autonomy and job creativity with psychological well-being, this study examines how these work characteristics influence well-being among people with and without physical disabilities, utilizing both a categorical and continuous measure of disability. Method
Data were drawn from two waves of a community study in Miami-Dade County, Florida, of 1,473 respondents. Structural equation modeling was used to assess whether job autonomy and job creativity mediate the associations between the indicators of physical disability considered and depressive symptoms and whether these associations varied by gender. Results
Controlling for the effects of the sociodemographic control variables, both job autonomy and job creativity significantly influence the association

Factors in Studying Employment for Persons with Disability: How the Picture can Change Research in Social Science and Disability, Volume 10, 205
224 Copyright r 2017 by Emerald Publishing Limited All rights of reproduction in any form reserved ISSN: 1479-3547/doi:10.1108/S1479-354720170000010009

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between physical disability and depressive symptoms regardless of the measure of disability used. The effects of job autonomy were significantly greater for women than men in the context of greater functional limitation.

Conclusions
The findings highlight the need to further consider the work characteristics of employed people with disabilities. They also demonstrate that the conceptualization and measurement of physical disability has important research implications. Keywords: Working conditions; Mental health; Physical disability; Gender

INTRODUCTION A common saying often attributed to Confucius suggests that if you “choose a job you love…you will never have to work a day in your life.” This statement is supported by decades of research showing that having both control over one’s work activities and the ability to engage in work that is creatively satisfying are central for psychological functioning and well-being (Kohn & Schooler, 1982; Lennon, 1994; Link, Lennon, & Dohrenwend, 1993; Mirowsky & Ross, 2007; Ross & Wright, 1998). Indeed, one review of this literature concludes that having job autonomy (i.e., the ability to control one’s working conditions) as well as access to creative work (i.e., work that is nonrepetitive, pleasurable, and provides opportunities for learning) are associated with better psychological wellbeing both cross-sectionally and over time (Burgard & Lin, 2013; Mirowsky & Ross, 2007). However, access to autonomous work and creative work is not egalitarian and, thus, the benefits of such work represent important dimensions of social inequality. A social model of disability recognizes that the economic inequities of many people with disabilities are one such form of this inequality, as reflected in part in observations that people with physical disabilities are more likely to be unemployed and earn less than people who do not have physical disabilities (Charlton, 1998; Iezzoni, McCarthy, Davis, & Siebens, 2001; National Council on Disability, 2008; Weil et al., 2002). As an illustration, US Census estimates from 2010 indicate that the median monthly earnings for people with any kind of a disability was $1,961 compared with $2,724 for people with no disability (Brault, 2012). To be sure, there is some indication that differences in employment circumstances between people with physical disabilities and those without importantly drive findings linking job autonomy and creativity with health (e.g., Mirowsky & Ross, 2007). However, consideration of these trends has been relegated to ancillary discussions in the literature on work conditions and psychological

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well-being. In fact, it appears that in the few circumstances in which job autonomy or creativity among people with physical disabilities are the main focus of previously-published research, they are discussed only as factors that influence the likelihood of qualifying for disability benefits (for a review, see De Croon et al., 2004). Given the important effect attributed to working conditions in the mental health literature, further attention to the salience of working conditions for employed people with disabilities seems critical. To this end, the central goal of the present study is to further explore the associations between physical disability, job autonomy and creativity, and depressive symptoms among a community sample of working adults (N ¼ 1,473) in MiamiDade County, Florida. Because different working definitions of disability address different aspects of disability conceptually, and can yield varying findings empirically (Lederer, Loisel, Rivard, & Champagne, 2014), we separately assess the effects of two disability measures. The first, self-defined disability status, is described as reflecting an acceptance of physical impairment, as well as an understanding to varying degrees of certain social disadvantages shared by people with disabilities (Lawson, 2001). The second, functional limitation, is a broader category that concerns restrictions in the ability to perform activities of daily living (ADLs), instrumental activities (IADLs), or more complex work and social activities (Verbrugge & Jette, 1994). (The survey questions gauging functional limitation in this study are included as Appendix A.) Additionally, because women are consistently found to report higher levels of depressive symptoms than men (Brown & Richman, 2012; Horwitz & White, 1987), and because there is some indication that physical impairments are associated with greater depressive symptomatology among women (Brown, 2014; Coyle & Roberge, 1992; Hughes, Swedlund, Petersen, & Nosek, 2001), particular attention is paid to the question of whether, or the extent to which, any observed associations between the indicators of physical disability, job autonomy and creativity, and depressive symptoms vary by gender. Tests of the indirect and conditional effects of physical disability are integrated into parsimonious structural equation models.

BACKGROUND Physical disability, operationalized as a self-defined status or by an index of functional limitation, has been linked with greater depressive symptoms both cross-sectionally and over time (Brown & Turner, 2010; Hughes et al., 2001; Nosek & Hughes, 2003). There is some concern, however, that the potential confounding of somatic symptoms of depression and physical impairmentrelated symptoms, coupled with the tendency to compare people with physical disabilities to the general population in most research, equates disability with depression and overshadows the fact that most people with disabilities

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are not depressed (Brown, 2014; Diener & Diener, 1995). These observations highlight the need to further understand the ways in which linkages between physical disability and depressive symptoms are both situational and complex (Brown, 2014). Our focus on the salience of autonomous and creative work derives from an understanding that these characteristics
and, by extension, the psychological satisfaction they afford
is often absent in paid employment, which, to paraphrase Marx, more often strips workers of autonomy and the satisfaction of creative labor (Mirowsky & Ross, 2007). The ability to engage in independent, unsupervised work and opportunities for original, self-expressive labor are distinguished empirically as unique dimensions of one’s working conditions (Smith, Tisak, Hahn, & Schmieder, 1997). They are also each found to independently contribute to health (Mirowsky & Ross, 2007). Although there is a dearth of research on the significance of autonomous and creative work for psychological well-being among people with physical disabilities, grounds for anticipating this linkage derive from evidence that these aspects of work are highly desirable to both people with disabilities and the population at large. One analysis of data from the 2006 General Social Survey, for example, found that both people with and without disabilities rank a desire to engage in interesting work higher than income in terms of preferred work characteristics, and job autonomy was also identified in the most important category of preferred work characteristics among all respondents (Ali, Schur, & Blanck, 2011). No significant differences were found between people with and without disabilities in preferences for these work characteristics (Ali et al., 2011). However, these characteristics may be particularly elusive for people with disabilities because of lingering prejudice and stereotypical attitudes held by employers (Altman, 1981; Lengnick-Hall, Gaunt, & Kulkarni, 2008; Luecking, 2008). Lengnick-Hall et al. (2008) study of employer hiring preferences, for example, highlights widespread prejudice in that the most common issues raised by employers about people with disabilities are that they: “(a) may lack necessary knowledge, skills, and abilities; (b) may not be able to perform physically demanding tasks; (c) may increase health care costs; (d) will require costly accommodations; (e) may create safety problems; (f) may sue for discrimination; (g) may hurt coworker morale; and (h) may affect customers negatively” (p. 258). Certainly, many employers hold positive views of people with disabilities in general
but, as one review of this literature emphasizes, positive affirmations do not tend to correspond with actual hiring practices (Luecking, 2008). Moreover, it may be difficult to challenge prejudicial attitudes and stereotypes because people with disabilities, underrepresented in professional and managerial careers (Ali et al., 2011), tend to lack institutional authority (Luecking, 2008). Taken together, these observations provide some grounds for hypothesizing that differences between people with and without disabilities in

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psychological well-being partly derive from differences in access to autonomous work and creative work.

Gender As a Moderator Prior research also provides grounds for anticipating that the associations between physical disability, autonomous and creative work, and psychological well-being may vary by gender (Brown, 2014; Coyle & Roberge, 1992; O’Hara, 2004). A formal test of whether the mediating effects of one’s working conditions for the physical disability
psychological well-being association are conditional based upon gender
a circumstance referred to as moderated mediation (Preacher, Rucker, & Hayes, 2007)
can provide information on whether any observed mediating effects are contingent upon gender, and clarify why this is so. For example, moderated mediation may occur because the effect of disability on working conditions varies fundamentally by gender. This potential linkage is represented as the first potential moderating effect of gender in Fig. 1. In general, women with disabilities are less likely to be employed than women without disabilities or men with or without disabilities (Alston & McCowan, 1994; Foley, Schuster, & McInerney, 2002; LaPlante, Kennedy, & Trupin, 1997). Women with disabilities face a “double-bind” in terms of employment
not only do they need resources such as transportation or child care to find a job, but, once securing employment, they often need more resources like workplace accommodations and rehabilitation services (Timmons, Foley, Whitney-Thomas, & Green, 2001). Thus, employers may have fewer incentives to hire women with disabilities compared to their male or nondisabled female counterparts

Job Autonomy W1

Physical Disability

Depressive Symptoms W1

Depressive Symptoms W2

(i.e., Disability Status and Functional Limitation, W1)

Job Creativity W1

First Potential Moderating Effect of Gender

Second Potential Moderating Effect of Gender

Fig. 1. Potential Moderating Effects of Gender on the Associations between

Physical Disability, Job Characteristics and Depressive Symptoms.

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(Foley et al., 2002; Hanna & Rogovsky, 1991; Stapleton, Burkhauser, & Houtenville, 2004). Once employed, women with disabilities earn less than men with disabilities and both men and women without disabilities (Hanna & Rogovsky, 1991; O’Hara, 2004). For example, one analysis of the US Census Bureau’s special survey including questions on health and disability reported that, among people in their forties, the mean monthly income of women with disabilities was $578, compared to $843 for men with disabilities, $1,744 for nondisabled women, and $2,330 for nondisabled men (Hanna & Rogovsky, 1991). By extension, it seems plausible that working women with disabilities are least likely to have access to work that is autonomous and creative and, thus, less likely to reap the psychological benefits of these work characteristics. Alternately, or additionally, moderated mediation may occur as a function of gender differences in the effects of work characteristics on depressive symptoms, as represented in the second potential moderating effect of gender in Fig. 1. Women are thought to benefit psychologically from autonomous and creative work more than men because these conditions are a less normative aspect of the work many women do (Ross & Mirowsky, 2006). Evidence indicating that working conditions, including job autonomy and work creativity (Mausner-Dorsch & Eaton, 2000; Ross & Mirowsky, 2006), do have a greater influence on depressive symptomatology for women compared to men supports this consideration. Research also suggests that work creativity is particularly salient for explaining gender differences in depressive symptoms (Ross & Mirowsky, 2006). In summary, previous research provides grounds for anticipating that both job autonomy and job creativity substantially account for any apparent association between physical disability and depressive symptoms, supporting Hypothesis 1 (H1): job autonomy and job creativity mediate the associations between the two indicators of physical disability and depressive symptoms. Additionally, given evidence suggesting that any mediating effects observed may be conditioned by gender, we test two hypotheses: Hypothesis 2 (H2): the effect of physical disability on work conditions is moderated by gender; and Hypothesis 3 (H3): the effect of work conditions on depressive symptoms is moderated by gender. We test these hypotheses controlling for the socio-demographic characteristics of age, socioeconomic status, race/ethnicity and employment status.

METHODS Study Procedures and Sample Data are derived from a two-wave panel study of Miami-Dade County, Florida, residents that was undertaken in order to examine the social determinants of mental health problems among individuals with and without chronic

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211

physical health conditions. Based on national age, gender, and race/ethnicityspecific rates of disability, and on the Miami-Dade County demographic structure, approximately 10,000 households were randomly screened to develop a sampling frame that would allow a sample within which people with chronic physical health conditions were significantly overrepresented. The identification of people with physical health conditions was established in response to the question, “Do any adults in the household have a physical health condition or physical handicap that has resulted in a change in their daily routine or that limits the kind of or amount of activity they can carry out?” Comparison participants without physical health conditions (N ¼ 1,000) were matched on age, sex, area of residence, and race/ethnicity. The study sample was drawn so that there was equal representation of the four major race/ethnic groups comprising approximately 95% of all Miami-Dade County residents (non-Hispanic Whites, Cubans, non-Cuban Hispanics and African Americans). Additional details regarding this sampling procedure are described by Turner and colleagues (2006). A total of 1,986 first-wave interviews were completed in 2000
2001, with a success rate of 82%. W1 study participants included 1,086 adults screened as having no physical health conditions and 900 adults who self-reported or were reported by a family member as having a health condition that limited the kinds of activities they could engage in. Of the 900 respondents who were screened as having such a health condition, 559 confirmed this status within the actual interview. The distribution of health conditions represented within this subsample is reported in Table 1. Additional tests indicate that the 341 respondents who were screened as having a physical health condition but did not report one within the interviewing process appear to represent an intermediary group that experiences significantly greater functional limitation than those screened as not having a health condition and significantly less limitation than those who confirmed the presence of a health condition during the interviews. No additional differences are observed on the variables included in this analysis between those screened as having a physical health condition that did or did not confirm its presence during the interviews. We acknowledge these differences by presenting analyses considering the effects of both self-defined disability and functional limitation. It should be noted that the over-sampling of individuals with physical health conditions and the fact that participants without health conditions were group matched on age resulted in a greater proportion of older respondents than in the general population. Ages in the sample ranged from 18 to 93 at W1 with a median of 59 (the median age of the general population of Miami-Dade County in 2000 was 35.6 according to the US Census Bureau). Given this discrepancy in ages and the dramatic over-sampling of people with physical health conditions, it is inaccurate to suggest that this sample is representative of the Miami-Dade County population. However, the sample can be taken as

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Table 1. Distribution of Chronic Physical Health Conditions Represented in Sample. Condition Heart diseases including rheumatic fever, acute myocardial infarction, subacute and chronic ischemic heart disease, pulmonary heart disease, others

Frequency

%

89

15.9

Arthritis (non-rheumatoid)

75

13.4

Diabetes Mellitus

66

11.8

Back pain, including back problems and whiplash

46

8.2

Spinal cord, multiple sclerosis, peripheral nerve disorders, polio, primary muscle disease

39

7.0

Amputation, other musculoskeletal injury

30

5.4

Osteoarthritis of spine, degenerative disk disease

27

4.8

Osteoarthritis (other than spine)

25

4.5

Brain substance including Parkinsonism, cerebral palsy, posthead injury

23

4.1

Cerebrovascular diseases including stroke, brain aneurysm, brain hemorrhage

20

3.6

Metabolic disease, organ disease (other than heart)

20

3.6

Rheumatoid arthritis

19

3.4

Emphysema and chronic obstructive pulmonary disease

16

2.9

Cancer

16

2.9

HIV, hepatitis, other infectious disease

12

2.1

Asthma

11

2.0

Blindness
complete and partial

11

2.0

Acquired deformities of the spine
scoliosis, fusion of the spine

5

.9

Congenital deformity (not otherwise classified)

3

.5

Other

6

1.1

Total

559

100

representative of people with physical health conditions in Miami-Dade County and of their nondisabled age, gender, race/ethnic counterparts. Respondents were re-interviewed three years later. Excluding the 100 W1 participants who died in the interim and 59 W1 participants who were too ill to be interviewed, the second wave of interviews achieved a success rate of 82.5%. The working sample for this study includes the 1,473 respondents who are currently or previously employed and provided complete responses to study questions during both the first and second wave of interviews. It should be noted that, because this analysis considers the long-term effects of physical disability, as indexed at W1, it does not assess changes in disability status between the study waves, it provides a conservative estimate of the influence of disabilitybased differences in working conditions for psychological well-being.

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Measures Summary statistics for all study variables are found in Table 2. The outcome variable is depressive symptoms, as indexed at W2. Predictor variables are self-defined disability status, functional limitation, job autonomy, job creativity, and gender, measured at W1. The sociodemographic characteristics of age, socioeconomic status, and race/ethnicity (measured at W1), as well as employment status, are included as covariates in all analyses. Depressive symptoms. The occurrence of depressive symptoms is estimated using a modified version of the 20-item Center for Epidemiological Studies Depression Scale (CES-D) (Radloff, 1977), for which there is ample evidence of reliability and validity. This abbreviated 14-item measure excludes somatic complaints in order to avoid potential confounding of mental and physical health status. The omitted items include problems with eating, keeping your mind on what you are doing, effort, restlessness, talking, and getting going. The summated measure has high reliability (α ¼ .83) and produces results similar to the full scale (Brown & Turner, 2010). Disability status. We assess self-defined disability status with a dummy variable based on responses to the question, “Do you have a physical or health condition that limits or interferes with the amount or kind of day-to-day work or recreational activities you can engage in?” Respondents who answered affirmatively are coded 1 and respondents who answered no are coded 0. Functional limitation. The measure of level of functional limitation is an adaptation of the models of disability proposed by the World Health Organization Table 2. Means and Standard Deviations of Variables (N ¼ 1,473). Characteristics

Range

Mean

Standard Deviation

Depressive Symptoms

3
48

13.954

7.761

0,1

37.9

—

Functional Limitation

5
80

36.503

14.568

Job Autonomy

0
12

4.22

4.94

Job Creativity

0
12

3.38

3.99

Sex (% female)

0,1

56.5

—

Disability Status

20
93

59.787

15.191


2.359
2.702


.287

.946

Non-Hispanic White

0,1

23.50

—

African American

0,1

39.33

—

Latino

0,1

37.17

—

0,1

44.4

—

Age Socioeconomic Status Race/ethnicity (%)

Employment Status

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ROBYN LEWIS BROWN ET AL.

(2001). Degree of limitation is assessed by considering activities or abilities that are compromised, and the extent to which they are compromised. Pooling from several previously-employed measures (Fries, Spitz, Kraines, & Holman, 1980; Jette, 1980; Jette & Deniston, 1978; Katz, Downs, Cash, & Grotz, 1970; Lawton & Brody, 1969; Nagi, 1976; Rosow & Breslau, 1966), this 19-item index assesses difficulties related to the performance of activities of daily living (ADLs) (e.g., personal hygiene, eating), instrumental activities (IADLs) (e.g., housework, shopping) and physical mobility (e.g., walking without aid, ability to stand from sitting) (full list of items available upon request). This standardized measure yields an alpha coefficient of .91. Job autonomy is measured with a four-item scale articulated by Lennon (1994). The measure is a summed index (α ¼ .79) assessing the extent to which respondents feel they make decisions on their own; control the speed at which they work; have freedom to decide how to work; and have a supervisor that decides what they do and how they do it at work. Responses to each item range from never (0) to almost always (4). Job creativity is assessed with a three-item abbreviated version of the measure introduced by Mirowsky and Ross (2007), which considers the extent to which work is nonrepetitive, enjoyable, and provides learning opportunities. Responses to this summed index (α ¼ .64) range from never (0) to almost always (4). Gender. Gender is coded 1 for females and 0 for males. Covariates. Age is employed as a continuous measure in years. Socioeconomic status is estimated in terms of three components
income, education and occupational prestige level (Hollingshead, 1957). Such an approach provides a general assessment of SES while reducing sample loss associated with missing data. This approach was selected because information on household income could not be obtained for 15% of the sample. Scores on these three dimensions are standardized, summed, and divided by the number of measures on which each respondent provided data. Race/ethnicity is a set of dummy variables including non-Hispanic Whites, African Americans, and Latinos. The “Latino” designation primarily represents individuals from Cuba and Central America. In all regression analyses, non-Hispanic Whites represent the reference category. Employment status is a dummy variable coded 1 for respondents working parttime or full-time and 0 for respondents who are unemployed, retired or homemakers.

Analytic Strategy Structural equation modeling using Mplus software (version 6.11; Muthe´n & Muthe´n, 1998
2010) was utilized to examine the predictive significance of

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disability status and functional limitation for job autonomy and creativity at W1 and depressive symptoms at W2, net of gender and the sociodemographic control variables. The first stage in the analysis considers the potential for job autonomy and creativity to mediate the associations between the indicators of physical disability and depressive symptoms (Hypothesis 1). Formal mediation tests using the procedures described by Muthe´n and Muthe´n (1998
2010) for Mplus software were utilized. The next step in the analysis examined whether any significant indirect paths from W1 disability status and functional limitation, respectively, to depressive symptoms at W2 are conditional based upon gender. The moderated mediation procedures for Mplus software described by Preacher et al. (2007) were utilized for these tests. These procedures determine whether any indirect effects observed are conditional because: The effect of disability status or functional limitation on job autonomy or creativity is moderated by gender (Hypothesis 2); or the effect of job autonomy or creativity on depressive symptoms is moderated by gender (Hypothesis 3).

RESULTS Table 3 presents the inter-correlations of major study variables. It is noteworthy that depressive symptoms at W2 are associated with each of the predictor variables measured at W1 as predicted: Disability status, functional limitation and gender are associated with greater depressive symptoms, whereas job autonomy and creativity are associated with fewer depressive symptoms. It is Table 3. Partial Correlation Matrix of Depressive Symptoms, Disability Indicators, Job Autonomy, Job Creativity, Gender and Select Covariates (N ¼ 1,473). 1 1. Depressive symptoms 2. Disability status

2

3

4

1.000 .186***

1.000

3. Functional limitation

.191***

.619***

4. Gender (1 ¼ Female)

.091**

.050*

1.000 .117**

5. Job autonomy


.192***


.270***


.325***


.128***

6. Job creativity


.122***


.205***


.303***


.102***

7. Socioeconomic status


.223***


.200***


.214***


.094**

8. Employment status


.112***


.298***


.350***


.122***

1.000

Notes: * significant at .05; ** significant at .01; *** significant at .001. The biserial correlation coefficients are presented for disability status and gender; for all other variables, the Pearson correlation coefficients are reported.

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ROBYN LEWIS BROWN ET AL.

also noteworthy that similar patterns are found whether disability is assessed with a self-report measure or based on indications of functional limitation: The significant correlations between these disability measures and job autonomy and creativity provide some preliminary support for the hypothesis that the association between disability and depressive symptoms may partly derive from the tendency of people with disabilities or limitations to experience less autonomous and creative work. Further, disability is associated with lower socioeconomic status and a lesser tendency to be employed, regardless of the measure used. In addition, the possibility that the effects of disability on work characteristics and/or depressive symptoms may vary by gender is supported by the observation that women reported greater disability and limitation and less autonomy and creativity at work than men. The strong correlation between disability status and functional limitation also supports separate analysis of their effects in SEM analysis. The hypothesized associations between gender, disability, work characteristics and depressive symptoms were further elaborated upon in the SEM analysis in three steps. As a precursor to the full models, Preacher and colleagues (2007) emphasize the importance of first establishing a connection between that which is to be mediated and the outcome of interest. Estimation of these preliminary models (not shown), including only disability status or functional limitation, depressive symptoms, and the sociodemographic covariates, produces justidentified models and, as such, meaningful fit statistics are not provided. The standardized path coefficient from disability status to depressive symptoms demonstrates that disability is associated with greater depressive symptoms over time (β ¼ .176, p < .001), net of the sociodemographic covariates. Functional limitation is also predictive of an increase in depressive symptoms (β ¼ .204, p < .001) over time in the preliminary model. In the baseline models, it should additionally be noted that significant differences by gender are observed, such that women reported a greater increase in depressive symptoms between the study waves, controlling for disability status or functional limitation and the sociodemographic covariates (β ¼ .059, p < .01 and β ¼ .047, p < .05, respectively). Full models separately assessing the effects of disability indicators with the addition of work characteristics are included as Figs. 2 and 3. When the combined effects of disability status, work characteristics and the covariates are considered, in Fig. 2, the coefficient for the path from disability status is reduced slightly (β ¼ .156, p < .001). Formal mediation tests reveal that job autonomy and creativity
both negatively associated with depressive symptoms
both significantly mediate the effects of disability status. The total effect of functional limitation on depressive symptoms in this model is .228, of which .023 (or about 11%) is explained by its indirect effect via job autonomy and .049 (or about 21%) is explained by the indirect effect of job creativity. A similar pattern of findings is observed in the model assessing the effects of functional limitation rather than disability status, which is presented as Fig. 3.

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People with Physical Disabilities, Work, and Well-being

Depressive Symptoms W1

Job Autonomy W1 —.085**

—.273***

Disability Status W1

.156***

—.259***

.273*** Depressive Symptoms W2

—.188***

R2 =.18

Job Creativity W1

Fig. 2. Structural Equation Model Relating Disability Status to Job Characteristics and Depressive Symptoms (N ¼ 1,473). Notes: Model controls for age, gender, socioeconomic status, race/ethnicity, and employment status. Standardized regression coefficient reported.*** significant at .001; ** significant at .01; * significant at .05.

Gender (Functional Limitation W1 * Female)

.063*

Job Autonomy W1 —.129***

—.344***

Functional Limitation W1

Depressive Symptoms W1

Depressive Symptoms W2

.171***

—.389***

Job Creativity W1

.279***

—.067**

R2 =.16

Fig. 3. Structural Equation Model Relating Functional Limitation to Job Characteristics and Depressive Symptoms (N ¼ 1,473). Notes: Model controls for age, gender, socioeconomic status, race/ethnicity, and employment status. Standardized regression coefficient reported. *** significant at .001; ** significant at .01; * significant at .05.

With the inclusion of work characteristics
both of which are again negatively associated with depressive symptoms
the standardized coefficient for the path from disability status is reduced by slightly more than one-quarter, from β ¼ .204 (p < .001) to β ¼ .171 (p < .001). Formal mediation tests reveal that job autonomy and creativity near equally account for this effect. The total effect of functional limitation on depressive symptoms in this model is .251, of which .044 (or about 17%) is explained by its indirect effect via job autonomy and .036 (or about 14%) is explained by the indirect effect of job creativity. Moderation tests next assessed whether the mediating effects of job autonomy and creativity vary by gender (Hypotheses 2 and 3). The first stage in this

218

ROBYN LEWIS BROWN ET AL.

test examined whether the pattern of findings may vary for men and women because of gender differences in the associations of disability status and functional limitation with job autonomy and job creativity (Hypothesis 2). Partial support for this hypothesis is found for the model assessing the effects of functional limitation only. Specifically, the significant interaction of functional limitation and gender in the prediction of job autonomy reveals that the pattern of findings reported are greater for women with more functional limitations because they experience lower job autonomy. The next stage in this test considered whether the pattern of findings vary for women and men because of gender differences in the effects of work characteristics (Hypothesis 3). Contrary to expectations, no significant effects are observed for this pathway.

DISCUSSION The present study provides compelling evidence that the growing body of research on work characteristics and psychological well-being (Burgard & Lin, 2013; Kohn & Schooler, 1982; Lennon, 1994; Mirowsky & Ross, 2007; Ross & Wright, 1998) needs to further consider the experiences of working people with physical disabilities. This broader point for the field is highlighted here in addressing two questions: The first is the question of whether, or to what extent, job autonomy and job creativity mediate the associations between the two indicators of physical disability and depressive symptoms (Hypothesis 1). The second question concerns whether any mediating effects observed are conditional based on gender (Hypotheses 2 and 3). Further, the findings of this study underscore that the conceptualization and measurement of physical disability impacts the findings of investigations on employment and other topics of critical importance. As we show, categorically classifying people as having a physical disability or not can produce less subtle differences in results in some cases, whereas utilizing a continuous measure of functional limitation in other cases captures more subtle variation not observed with categorical measurement. With respect to the first question (Hypothesis 1), this examination clearly demonstrates that the lower levels of job autonomy and job creativity experienced among working people with disabilities compared to those without disabilities partly accounts for the association between physical disability and depressive symptoms over the three-year study period. These findings were observed regardless of the indicator of physical disability utilized. That is, both self-defined disability status and greater functional limitation are associated with lower job autonomy and job creativity, as well as increases in depressive symptoms. Job autonomy and job creativity also both partly account for the associations of disability status and greater functional limitation with increases in depressive symptoms. The similarity in this general pattern of findings across both indicators of physical disability (i.e., disability status and functional

People with Physical Disabilities, Work, and Well-being

219

limitation), though consistent with Hypothesis 1, does raise questions concerning whether or how other aspects of disability might impact job autonomy and job creativity. For example, the effects observed may vary depending upon the type of health condition involved, its duration and severity, and whether one’s limitations are visible to others (Crocker & Quinn, 2000; Nosek & Hughes, 2003; Rohmer & Louvet, 2009). Because this sample was heterogeneous with respect to health conditions included, individual categories included too few cases to examine these issues. Further study may help resolve these issues. Moreover, in considering the impact of the work characteristics investigated in the present study, it is notable that job creativity plays a more important role in accounting for the effects of disability status on depressive symptoms than job autonomy (in contrast, job autonomy and job creativity have a near equivalent role in explaining the functional limitation
depressive symptoms association). At face value, it may seem surprising that the novelty and pleasure of one’s work experiences has a somewhat greater psychological impact than the ability to control work within the context of physical disability. We are reminded, though, of the work of numerous disability scholars and activists that has emphasized that reclaiming one’s sense of agency and autonomy across various spheres of life is often a catalyst for activism precisely because this allows us more authentic and engaging experiences (Charlton, 1998; Davis, 1999; Pfeiffer, 2002; Zola, 1967). It seems plausible, thus, that the analytic strategy that we have employed, while appropriate for addressing our research questions, only hints at the more complex social psychological processes linking the work characteristics we investigate with psychological well-being among people with disabilities. One possibility is that at least part of the impact of job autonomy on psychological well-being derives from its association with job creativity
that is, that autonomous working conditions bolster the sense that one’s work is pleasurable and engaging, thereby enhancing psychological functioning. This is a possibility we also recommend for future research. This investigation additionally demonstrates gender differences in the mediating framework assessed. Although no support was found for the hypothesis of gender differences in the associations of work characteristics with depressive symptoms (Hypothesis 3), gender differences were found in the linkage between functional limitation and job autonomy, partly supporting Hypothesis 2. These findings are consistent with other work indicating that women with disabilities experience the dual burden of sexism and ableism (e.g., Brown, 2014; Foley et al., 2002; Hanna & Rogovsky, 1991), and expand our understanding of how this burden undermines women’s opportunities and ability to achieve desired social roles. Extending evidence that women with disabilities are less likely to find work and be properly compensated for their work compared to their male and nondisabled counterparts (Mona, Cameron, & Crawford, 2004; National Center for Health Statistics, 2002), our findings show that, because women are significantly less likely than men to experience autonomous working conditions in the context of greater functional limitation, they experience greater depressive

220

ROBYN LEWIS BROWN ET AL.

symptoms than men, on average. Notably, this finding is only observed when disability is operationalized in terms of variation in level of functional limitation, which further raises questions concerning how continuous, categorical and other measures of disability may be qualitatively different, as we have discussed. To be sure, these findings reinforce other work highlighting the salience of control and autonomy among women with disabilities (Brown, 2014; Nosek & Hughes, 2003). It seems intuitive that the perceived ability to direct and regulate one’s work may further affect one’s more global self-appraisals of competence or mastery, which are linked with psychological well-being among women with disabilities (Abraido-Lanza, Guier, & Colon, 1998; Nosek, Howland, Rintala, Young, & Chanpong, 2001). Additional study is needed to develop a better understanding of how employment circumstances impact these self-appraisals, thereby perpetuating depressive symptomatology among women with physical disabilities. This set of findings also raises important questions concerning the conditions that give rise to gender- and disability-based disparities in autonomous working conditions in the first place. Further consideration of how such disparities may reflect both outright and indirect forms of workplace discrimination is strongly recommended. Efforts to reduce this form of discrimination would be a highly promising prevention or intervention target for workplace advocacy policies and programs aimed at people with disabilities, especially women. Several limitations of the present study merit further comment. First, it is important to emphasize that the data employed in this study are from two waves of data collected three years apart and likely provide only a snapshot of the complex processes underlying variation in psychological distress among people with and without physical disabilities. Future research would ideally consider how changes in disability status or functional limitation and the range of factors considered influence psychological distress across multiple points in time. This approach could also situate our understanding of physical disability and working conditions within a life course framework and better articulate the salience of disability-related transitions and turning points for employment experiences and vice versa. Additionally, it should be noted that this study represents the relatively unique Hispanic population of Miami-Dade County and it is uncertain whether the findings are generalizable to Hispanic groups in other areas. There is also a need to consider the potential for bi-directional relationships among the factors considered. Although recent study indicates that functional limitation predicts depressive symptoms whereas no evidence of a reverse association is found over a three-year period (Gayman, Turner, & Cui, 2008), it also seems plausible that depressive symptoms may influence changes in work characteristics among people with and without physical disabilities. Depressive symptoms such as feelings of worthlessness and a loss of interest and pleasure, indeed, might exacerbate feelings that one’s work is not autonomous or creative. Further understanding of the antecedents of working conditions, thus, may ultimately broaden our understanding of their psychological consequences.

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These limitations notwithstanding, this study furthers our understanding of the psychological impact of job autonomy and job creativity. It provides evidence that these work characteristics are particularly salient among persons with physical disabilities, demonstrating that these characteristics contribute to an understanding of variation in depressive symptoms associated with physical disability, regardless of the way in which disability is measured. It also specifies that women with greater functional limitations are psychologically disadvantaged because they disproportionately do not experience autonomous working conditions.

ACKNOWLEDGMENT This research is supported by grants RO1 DA13292 and RO1 DA016429 from the National Institute of Drug Abuse to R. Jay Turner ([email protected]).

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689.

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APPENDIX A. ITEMS USED IN CONSTRUCTION OF FUNCTIONAL LIMITATION MEASURE Item

Type of Measure

Reference

Reach up and get a five pound object (such as a bag of sugar) from just above your head

Mobility-Physical Performance

Fries et al. (1980)

Bend down to pick up an object (like a piece of clothing) from the floor

Mobility-Physical Performance

Fries et al. (1980)

Turn faucets on/off

Mobility-Physical Performance

Fries et al. (1980)

Walk ¼ mile

Mobility-Physical Performance

Rosow and Breslau (1966)

Stoop or crouch down

Mobility-Physical Performance

Nagi (1976)

Lift 10 pounds

Mobility-Physical Performance

Nagi (1976)

Sit for more than two hours

Mobility-Physical Performance

*7-Items asked of all respondents; response range: 1 ¼ “Easily” to 4 ¼ “Unable to do” Can you prepare your own meals

IADL

Lawton and Brody (1969)

Can you do your housework

IADL

Lawton and Brody (1969)

Can you dress/undress self

ADL

Katz et al. (1970)

Can you get in/out of bed

ADL

Katz et al. (1970)

Can you take bath/shower

ADL

Katz et al. (1970)

Can you get to the bathroom on time

ADL

Katz et al. (1970)

Can you climb up stairs

Mobility-Physical Performance

Rosow and Breslau (1966)

*7-Items asked only of screened disabled; response range: 1 ¼ “Easily” to 5 ¼ “Completely Unable to do” Standing for long periods such as 30 minutes

Mobility-Physical Performance

Nagi (1976)

Standing up from sitting

ADL

Jette (1980)

Walking more than a mile

ADL

Jette (1980)

Moderate activities such as moving a table, pushing a vacuum cleaner, bowling or playing golf

ADL

Jette (1980)

Vigorous activities such as running, lifting heavy objects or participating in strenuous sports

ADL

Jette (1980)

*5-items asked of all respondent in the last 30 days; response range: 1 ¼ “none” to 5 ¼ “Extreme/ Cannot Do”

CHAPTER 8 DISABILITY AND COMMUNITY LIFE: MEDIATING EFFECTS OF WORK, SOCIAL INCLUSION, AND ECONOMIC DISADVANTAGE IN THE RELATIONSHIP BETWEEN DISABILITY AND SUBJECTIVE WELL-BEING Sara E. Green and Brianna Vice ABSTRACT Purpose
The Social Model of Disability, which views social and economic barriers rather than individual bodily differences as the main sources of disadvantage faced by people living with impairments, has gained considerable traction in the literatures of both disability studies and the sociology of disability over the past several decades. Despite this success, however, concern has been expressed that there is a dearth of empirical evidence to back Social Model claims that people with disabilities are not emotionally distressed by their bodily differences or functional limitations, but rather by the layers of social and economic disadvantage imposed on top of their impairments.

Factors in Studying Employment for Persons with Disability: How the Picture can Change Research in Social Science and Disability, Volume 10, 225
246 Copyright r 2017 by Emerald Publishing Limited All rights of reproduction in any form reserved ISSN: 1479-3547/doi:10.1108/S1479-354720170000010010

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SARA E. GREEN AND BRIANNA VICE

Design/Methodology/Approach
Using results of a community survey in a small town in Florida, we examine the degree to which workforce participation and other social and economic disadvantages mediate the relationship between subjective well-being and the presence of functional impairments or self-described disability identity. Findings
We find that study participants who report functional impairments or identify as disabled report lower levels of subjective well-being than participants who do not. Findings also suggest, however, that these differences in subjective well-being can be explained by lack of workforce participation and other aspects of social inclusion and economic disadvantages that are associated with functional impairment and disability identity. Results indicate that work is one, but not the only, important aspect of community participation that mediates between disability experience and well-being. Results also problematize the conflation of functional impairment and disability identity. Implications
Findings point to a need for future qualitative and quantitative research to address differences between functional impairment status and disability identity and to evaluate the relative importance of work and other forms of social inclusion and access to economic recourses to the well-being of people living with impairments and disability. Originality/value
Findings of this study provide empirical support for, but also add complexity to, the Social Model perspective. They can be used to provide guidance to community leaders in terms of ways in which the lives of residents with disabilities might be improved. Keywords: Disability; work; inclusion; participation; well-being; community

INTRODUCTION The Social Model of Disability views disability as a social construct in which social and economic barriers, rather than individual bodily differences or functional limitations, are the main sources of disadvantage faced by people living with impairments. This way of viewing disability has gained considerable traction in the literatures of both disability studies and the sociology of disability over the past several decades. The Social Model has fueled the fires of disability activism, provided the basis for a beneficial sense of disability pride among many members of the disabled community, and guided a good deal of academic scholarship (Berger, 2013; Priestley, 2003). Despite this success, however, concern has

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been expressed that there is a dearth of empirical evidence to back Social Model claims that people with disabilities are not emotionally distressed primarily by their bodily differences or functional limitations, but rather by the layers of social and economic disadvantage imposed on top of their impairments (Darling, 2013; Shakespeare, 2014; Siebers, 2006). In this chapter, we seek to contribute to the body of empirical evidence for the Social Model approach to disability in three ways. First, we examine the mediating effects of social and economic resources on the relationship between disability experience and subjective well-being. That is, we investigate the degree to which disadvantages in employment, social inclusion, and economic resources account for lower subjective well-being among people living with disability. Second, while there is a good deal of scholarship, including the chapters in this volume, in which the relationship between work force participation and disability experience is examined, a number of disability scholars have cautioned against using work as the sole marker of community inclusion (see, e.g., Beckett, 2006; Priestley, 2003; and Shakespeare, 2014). In answer to this caution, we conceptualize work as one among several interrelated potential sources of social and economic disadvantage that accrue to people living with disability and that may, in turn, combine to produce lower levels of overall well-being. Third, following recent research showing that not all people with significant functional impairments develop a disability identity (see, e.g., Darling, 2013), we disarticulate “functional impairment” and “disability identity” and compare results of analyses in which they are treated as separate in dependent variables. In order to address these goals, we address the following specific research questions using data from a community-wide survey conducted in a small town on the edge of a major metropolitan area in Florida: 1. Do survey participants with and those without functional impairments or disability identity differ in terms of overall subjective well-being? 2. Do survey participants with and those without functional impairments or disability identity differ in terms of workforce participation? 3. Do survey participants with and those without functional impairments or disability identity differ in terms of social inclusion (partnership status; level of participation in social, recreational and community activities; and perception that people with disabilities are stigmatized by members of the community)? 4. Do survey participants with and those without functional impairments or disability identity differ in terms of economic resources (household income; money for discretionary spending; home ownership)? 5. Do workforce participation, levels of social inclusion and economic recourses mediate in the relationship between disability/impairment and subjective well-being?

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DATA Data for this project are drawn from results of an open access, online survey of residents of Dunedin, a small town on the West Coast of Florida. The survey is part of an ongoing multi-year collaboration among the City of Dunedin, the Dunedin Committee on Aging (DCoA) which is a citizen’s advisory committee, and the first author. All aspects of the project were reviewed for Human Subjects Research Compliance by the University of South Florida Institutional Review Board (IRB) and received approval as USF Research Project #18878. The project provided an undergraduate research and community engagement experience for students enrolled in Senior Seminar in Sociology. The second author was a student in this class and also used project data for her Undergraduate Honor’s thesis on disability and community participation. The DCoA was responsible for participant recruitment and used a variety of strategies to invite adults who live in Dunedin to complete the online survey: (1) Flyers were included in all City of Dunedin utility bills; (2) A public service announcement was made on the city television channel; (3) Flyers were distributed to a variety of locations throughout the city including public venues such as the library and senior, recreation, and community centers; (4) An email version of the flyer was sent to local community groups and “civil society” organizations which were asked to send the email to members who were, in turn, asked to forward the email on to family and friends who live in Dunedin; and (5) Information and assistance in accessing the online survey were offered at the Dunedin Public Library and public recreation and community centers. When the survey was closed for data collection, 674 adults had agreed to participate and completed the first page of the survey (demographic data only). Eighty-six percent (579) of these people went on to complete the substantive portions of the very complex, 46 page survey. Ninety-five percent of these participants (548) live in Dunedin at least part time. This amounts to just under 2% of the population of approximately 30,000 adults who live in Dunedin. A comparison of the demographic characteristics of these 548 participants to census data on all residents of Dunedin and the United States is displayed in Table 1. The table shows that survey participants are fairly representative of the population of Dunedin on a number of key demographics, but are less representative on other characteristics
particularly the percent reporting college degrees and home ownership. The table also shows that Dunedin itself is not very representative of the United States as a whole on a number of variables including age and race/ethnicity. Demographic variables are, therefore, included as controls in our multivariate analyses in order to help assess the degree to which results are dependent on characteristics that are unique to Dunedin.

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Table 1. Characteristics and Representativeness of Dunedin Study Participants. Survey Participants (N ¼ 548)

City of Dunedina

United Statesa

(N>18 yrs ¼ 30,088)

(N>18yrs ¼ 234,656,160)

Male

38.9%

46.4%

49.2%

Female

61.1%

53.6%

50.8%

Demographic Characteristics

Sex:

Schooling: High school graduate or higher

99.1%

91.4%

86.3%

Bachelor’s degree or higher

61.9%

29.0%

29.3%

7.2%

10.0%

Foreign born Median household income

$50,000
74,999 $46,310 (2010
2014)

13.1% $53,482 (2010
2014)

Age Group: Under 65

61.7%

72.1%

87.0%

65 and over

38.3%

27.9%

13.0%

Race/Ethnicity: White (only)

93.4%

91.6%

72.4%

Black or African American (only)

1.3%

3.3%

12.6%

American Indian or Alaskan Native (only)

0.2%

0.3%

0.9%

Asian (only)

0.4%

1.6%

4.8%

Native Hawaiian or Other Pacific Isl. (only)

0.0%

0.1%

0.2% 16.3%

2.7%

5.9%

Has Disability (< age 65)

Latino/a or Hispanic (all)

14.7%b

7.9%

8.5%

Owner occupied housing

91.1%c

62.5%

64.4%

a

Retrieved 9/21/2016 1:35 pm from http://www.census.gov/quickfacts/table/PST045215/1218575,00. Population estimates as of April 1, 2010 used except where otherwise noted. b Survey participant reports at least one functional impairment on the Washington Group series of measures. c Survey participant reports owning current residence.

MEASUREMENT OF MAJOR VARIABLES Disability Identification and Functional Impairment Disability identification was measured by the question: “Do you yourself have a disability or impairment (or a difference that other people consider to be a disability or impairment)?” This question was included with other background

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SARA E. GREEN AND BRIANNA VICE

characteristics at the very beginning of the questionnaire and answers are coded “1” for yes (had a disability) and “0” for no (does not have a disability). Twelve percent of survey participants identified themselves as disabled using this measure. Functional impairment was measured by the series of questions developed and validated by the Washington Group (Madans, Loeb, & Altman, 2011). These items were included later in the questionnaire along with other questions about health and healthcare access. Seven percent of participants reported having serious difficulty hearing; 3% said they have serious difficulty seeing, even when wearing glasses; 4% reported having serious difficulty concentrating, remembering or making decisions; 7% said they have serious difficulty walking or climbing stairs; 2% reported having serious difficulty dressing or bathing; and 2% reported having serious difficulty doing errands alone such as visiting a doctor’s office or shopping. Seventeen percent of survey participants identified as having at least one functional limitation using this series of items. These participants are given scores of “1” on the composite measure of impairment used in the analyses reported in the findings section while those who answered “no” to all of the functional limitation questions were given scores of “0” on the impairment measure. Using the measures described above, there is considerable, but not complete, overlap between disability identification and functional impairment in this group of survey participants. Seventy-nine percent of survey participants neither identified as disabled nor reported any of the functional impairments included in the Washington Group Series (neither disabled nor impaired). Twenty-one percent either identified as disabled or reported at least one functional impairment (disabled or impaired). Nine percent of participants both identified themselves as disabled and reported at least one of the functional limitations in the Washington Group series (disabled and impaired). Another nine percent reported at least one functional limitation but did not identify as disabled (impaired but not disabled). Only 4% of survey participants identified as disabled but did not report one of the functional limitations measured in the Washington Group series (disabled but not impaired).

Subjective Well-being Subjective well-being was measured using a three component instrument described and validated by Pontin, Schwannauer, Tai, and Kindeman (2013). This instrument was selected because it has been widely and internationally used to indicate individual and community well-being and the measure has well established psychometric properties. The 24-item instrument measures subjective feelings of well-being in three categories: Physical well-being, psychological well-being, and relationship well-being. All items are coded such that “1”

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represents the lowest level of well-being and “5” represents the highest. Scores on the 24 individual items are averaged for a measure of overall subjective wellbeing. The average score on the 24-item measure for participants in this survey project was 3.90 with a minimum score of 1.49, a maximum score of 5, a standard deviation of 0.59, and a Chronbach’s Alpha of 0.95.

Workforce Participation Workforce participation was measured by the single question: “Are you currently working for pay?” with response categories: “Yes, I work full time;” “Yes, I work part time;” and “No.” Fifteen percent of the participants reported working part time and 40% reported working full time. Among participants under the age of 65, 16% were working part time, and 59% were full time workers. In the analyses reported in the findings section, participants who work at least part time are coded “1” and those who do not are coded “0.”

Social Inclusion Three indicators of social inclusion are included in our analyses: Partnership status; level of social, recreational and community participation; and perceived stigma towards individuals with disabilities. Partnership status was measured with the question: “Which of the following best describes your current relationship status?” Response categories were: (1) Married; (2) Widowed; (3) Divorced; (4) Separated; (5) In a domestic partnership, civil union, or cohabiting with a significant other; (6) Single never married; and (7) Other. Seventy-two percent of all participants reported being married or in a domestic partnership, civil union, or cohabiting with a significant other at the time of the survey. These participants were give scores of “1” on the partnership variable included in our analyses and all others were coded “0.” Level of social, recreational and community participation was measured by an index developed in collaboration with the DCoA and includes activities specific to Dunedin as well as more general social and recreational activities. Participants were asked how often during the last year they had engaged in a list of 20 activities including: Socializing with friends and neighbors; going to the movies; working on hobbies; participating in sports or other outdoor activities; shopping for fun; eating out for fun; spending time at the beach or a park; attending concerts or music festivals; visiting museums or galleries; attending street festivals or parades; attending sporting events; attending classes or training sessions; using a community or recreation center; going to the library; club

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or networking activities; fund raising events; political rallies or advocacy activities; local civic activities; religious services or related activities; and volunteering or community service. Response categories were: (4) one or more times a week, (3) one or more times a month, (2) one or more times a year, and (1) never. Scores on the 20 items were added together to create an index with a minimum possible score of 20 and a maximum possible score of 80. The average score on the composite measure was 48.96 with a minimum score or 20, maximum score of 80, and a standard deviation of 8.78. Perceived Stigma was measured using a three component adaptation of the Link, Cullen, Struening, Shrout, and Dohrenwend (1989) devaluation and discrimination instrument (Green, 2007a, 2007b; Green, Davis, Karshmer, Marsh, & Straight, 2005). The three components measured in this instrument (Labelling, Discrimination and Status Loss, and Separation) correspond to the multidimensional concept of stigma described by Link and Phelan (2001). Items are coded such that “1” represents low levels of perceived stigma and “5” represents the highest levels of perceived stigma. Chronbach’s Alpha for the eight item instrument among participants in the current study is 0.78 which is similar to that reported in other studies. Descriptive statistics for the three components among survey participants are as follows: Labelling
Mean ¼ 2.88, minimum ¼ 1, maximum ¼ 5, SD ¼ 0.94; Discrimination and Status Loss
Mean ¼ 2.64, minimum ¼ 1, maximum ¼ 5, SD ¼ 0.79; Separation
Mean ¼ 2.03, minimum ¼ 1, maximum ¼ 4, SD ¼ 0.67.

Economic Resources Three types of economic resources were examined. Household income; degree to which the participant has enough money for discretionary spending on entertainment, recreation, and nonessential purchases; and home rental vs. ownership. Household income was measured by the question: “How much total combined income did all members of your household earn last year?” Response categories were: (1) $0 to $9,999; (2) $10,000 to 24,999; (3) $25,000 to $49,999; (4) $50,000 to $74,999; (5) $75,000 to $99,999; (6) $100,000 or above. The average score was 4.33 with a minimum score of 1, maximum score of 6, and a standard deviation of 1.40. Money for discretionary spending was measured by the question: “Do you have enough money to pay for recreational activities, entertainment and things you want to buy.” Response categories were: (1) Never; (2) Rarely; (3) Sometimes; (4) Most of the Time; (5) All of the Time. The average score was 4.17 with a minimum score of 1, maximum score of 5, and a standard deviation of 1.06.

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Home rental vs. ownership was measured by the question: “Do you own or rent the place where you live?” with response categories: (1) Own with a mortgage; (2) Own free and clear (no mortgage); (3) Rent. Only 9% of all participants reported renting their current place of residence. Renters were given scores of “1” on the home rental variable included in our analyses and all others were coded “0.”

FINDINGS In order to address the first four research questions, two sets of independent samples t-tests were performed: (1) Tests in which participants who reported at least one functional limitation on the WGS list are compared to those who report no impairments on subjective well-being, workforce participation, social inclusion, and economic resources and (2) Tests in which participants who reported themselves to be disabled on the single item measure are compared to those who did not on subjective well-being, workforce participation, social inclusion, and economic resources. Results for the impairment status groups are presented in Table 2a and results for the disability identity groups are presented in Table 2b. In the sections that follow, we report results related to each of our research questions.

Question 1: Do survey participants with and those without functional impairments or disability identity differ in terms of overall subjective well-being? Results of the independent samples t-tests show that compared to participants without impairments, those with impairments report lower levels of overall subjective well-being (see Table 2a). Table 2b shows similar results for the analysis in which participants who identify as disabled are compared to those who do not. Disabled participants report significantly lower levels of subjective well-being than do those who do not identify as disabled.

Question 2: Do survey participants with and those without functional impairments or disability identity differ in terms of workforce participation? Results of independent samples t-tests presented in Table 2a indicate that participants who reported at least one impairment were less likely to have been employed (even part-time) at the time of the survey. Table 2b shows that when participants who identify as disabled are compared to those who are not, disabled participants are also significantly less likely to have reported being employed at least part time at the time of the survey. Because these differences in workforce participation could be due to higher levels of impairment and/or disability identity among retirement aged participants,

234

Table 2a.

Comparison of Participants With and Without Functional Impairments (Washington Group Series of Items). Participants Participants Without With Functional Functional Impairments Impairments Mean

SD

Mean

SD

3.66

0.82

3.94

0.53
2.74**

0.33

0.47

0.59

0.49
4.67***

0.64

0.48

0.74

0.44
1.73

47.60

8.52

49.14

8.91
1.39

3.02

1.07

2.84

0.91

1.52

2.83

0.87

2.60

0.77

2.37*

2.23

0.67

1.99

0.66

2.88**

t-test

Overall well-being Composite measure (Average of 24 items) Social inclusion Workforce participation

(1 ¼ married or in a domestic partnership, civil union or cohabiting with significant other; 0 ¼ single, widowed, divorced, separated, not in another domestic partnership) Participation in social recreational and civic activities Composite measure of participation (Total of 20 items) (Min. possible score ¼ 20, Max. possible score ¼ 80) Perceived stigma overall Labelling Composite measure (Average of 2 items) Discrimination and status loss Composite measure (Average of 3 items) Separation Composite measure (Average of 3 items)

SARA E. GREEN AND BRIANNA VICE

Are you currently working for pay? (0 ¼ no; 1 ¼ yes, full- or part- time) Partnership status

Household income How much total combined money did all members of your household earn last year? (1 < $10,000; 2 ¼ $10
24,999; 3 ¼ $25
49,999; 4 ¼ $50
74,999; 5 ¼ $75
99.999; 6 > /¼$100,000)

4.03

1.49

4.35

1.37
1.91

Do you have enough money to pay for recreational activities, entertainment, things you want to buy (1 ¼ never; 2 ¼ rarely; 3 ¼ sometimes; 4 ¼ most of the time; 5 ¼ all the time)

3.93

1.17

4.19

1.04
2.06*

Rents current residence (1 ¼ yes, 0 ¼ no)

0.15

0.36

0.08

0.28

1.52 0.88

Money for discretionary spending

Demographic variables Gender (1 ¼ male, 0 ¼ female)

0.42

0.50

0.37

0.48

Bachelors degree (1 ¼ yes, 0 ¼ no)

0.58

0.50

0.63

0.48
0.71

Born in US (1 ¼ yes, 0 ¼ no) 65 Years of age or older (1 ¼ yes, 0 ¼ no) Identifies as white only (1 ¼ yes, 0 ¼ no)

0.96

0.19

0.93

0.26

1.42

0.48

0.50

0.36

0.48

1.90

0.92

0.28

0.94

0.24
0.79

Disability and Community Life

Economic resources

*p < .05; **p < .01; ***p < .001.

235

236

Table 2b.

Comparison of Participants Who Do and Those Who Do Not Identify as Disabled (Single Item Measure). Participants Who Do Identify as Disabled

Participants Who Don’t Identify as Disabled

Mean

SD

Mean

3.59

0.79

3.94

0.54
3.22**

0.32

0.47

0.57

0.50
3.91***

0.54

0.50

0.75

0.44
3.11**

45.92

9.39

49.36

8.67
2.68**

3.21

0.99

2.84

0.93

2.78**

2.88

0.27

2.60

0.77

2.45*

2.31

0.67

1.98

0.67

3.41**

t-test

SD

Overall well-being Composite measure (Average of 24 items) Social inclusion Workforce participation Partnership status (1 ¼ married or in a domestic partnership, civil union or cohabiting with significant other; 0 ¼ single, widowed, divorced, separated, not in another domestic partnership) Participation in social recreational and civic activities Composite measure of participation (Total of 20 items) (Min. possible score ¼ 20, Max. possible score ¼ 80) Perceived stigma overalld Labelling Composite measure (Average of 2 items) Discrimination and status loss Composite measure (Average of 3 items) Separation Composite measure (Average of 3 items)

SARA E. GREEN AND BRIANNA VICE

Are you currently working for pay? (0 ¼ no; 1 ¼ yes, full- or part- time)

Household income How much total combined money did all members of your household earn last year? (1 < $10,000; 2 ¼ $10
24,999; 3 ¼ $25
49,999; 4 ¼ $50
74,999; 5 ¼ $75
99.999; 6 > /¼$100,000)

3.69

1.53

4.43

1.36
3.91***

3.85

1.24

4.22

1.02
2.25*

0.15

0.36

0.08

0.27

1.43 1.51

Money for discretionary spending Do you have enough money to pay for recreational activities, entertainment, things I want to buy (1 ¼ never; 2 ¼ rarely; 3 ¼ sometimes; 4 ¼ most of the time; 5 ¼ all the time) Rents current residence (1 ¼ yes, 0 ¼ no) Demographic variables Gender (1 ¼ male, 0 ¼ female)

0.48

0.50

0.38

0.49

Bachelors degree (1 ¼ yes, 0 ¼ no)

0.53

0.50

0.63

0.48
1.46

Born in US (1 ¼ yes, 0 ¼ no)

0.97

0.17

0.92

0.27

1.85

65 Years of age or older (1 ¼ yes, 0 ¼ no)

0.43

0.50

0.38

0.49

0.84

Identifies as white only (1 ¼ yes, 0 ¼ no)

0.92

0.27

0.94

0.24
0.42

Disability and Community Life

Economic resources

* p < .05; ** p < .01; *** p < .001.

237

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SARA E. GREEN AND BRIANNA VICE

we repeated the analyses for participants between the ages of 18 and 64. Results show that disability and impairment have a negative impact on employment even among those of working age. This disadvantage is greater among those who identify as disabled. Among survey participants younger than 65 in the neither disabled nor impaired group, 63% were employed at least part time. Among those in the impaired but not disabled group, 61% of those 65 and under were working at least part time. The percentage of employment in the disabled but not impaired and the disabled and impaired groups were significantly lower at 50% and 56% respectively.

Question 3: Do survey participants with and those without functional impairments or disability identity differ in terms of social inclusion (partnership status; level of participation in social, recreational and community activities; and perception that people with disabilities are stigmatized by members of the community)? Partnership Status. Slightly different patterns emerged in terms of differences between groups on the partnership status variable. Results presented in Table 2a show that partnership status did not differ significantly between those who did and those who did not report at least one of the functional impairments included in the WGS measure. Participants who identified as disabled were, however, less likely than those who did not to report being married or in a domestic partnership or civic union at the time of the survey (see Table 2b). Level of Participation in Social, Recreational and Community Activities. Similarly, while impaired and nonimpaired participants did not differ significantly in terms of scores on the participation measure (see Table 2a), participants who identified as disabled had significantly lower participation scores than those who did not (Table 2b). Perceived Stigma. Results presented in Table 2a also show that participants who report at least one of the WGS functional impairments perceive higher levels of stigma toward people with disabilities on two of the three stigma components. Participants with functional impairments were significantly more likely than those without to believe that: Others in the community discriminate against people with disabilities (status loss) and that others in the community blame or “think less of” people with disabilities (separation). Participants who did and those who did not report at least one impairment did not differ significantly in their belief that other people in Dunedin feel sad or awkward in the presence of people with disabilities (labelling/stereotyping). Table 2b shows on the other hand that participants who identified as disabled differed significantly from those who did not on all three components of stigma. Summary of Relationships between Impairment Status and Disability Identity and Social Inclusion. Participants who identified as disabled reported significantly

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239

less social inclusion than those who did not on all measures of social inclusion. They were less likely to be employed, less likely to be partnered, had lower participation scores and higher scores on all three components of perceived stigma (Table 2b). Participants who reported at least one of the impairments included in the WGS measure also had significantly higher scores than those who did not report at least one impairment on two of the three stigma components (discrimination/status loss and separation). Impairment status, however, had no significant relationship to partnership status, social and recreational participation, or the labelling/stereotyping component of stigma (Table 2a).

Question 4: Do survey participants with and those without functional impairments or disability identity differ in terms of economic resources (household income; money for discretionary spending; and home ownership)? Household Income. Results presented in Table 2a show that participants who report at least one of the WGS impairments do not differ significantly from those who do not report any impairments in terms of household income. Table 2b shows, however that participants who identified as disabled had lower household incomes than those who did not. Money for Discretionary Spending. Results presented in Tables 2a and 2b show that both impairment and disability identity are negatively related to the availability of money for discretionary spending. Participants who reported at least one impairment were less likely than those who did not to report having enough money to spend on entertainment, recreation, and things they want to buy. Similarly participants who identified as disabled had lower scores that those who did not on the discretionary spending measure. Home Ownership. Tables 2a and 2b show that neither impairment nor disability identity are significantly related to home ownership in this group of survey participants. This may be due to the fact that levels of home ownership are extremely high and are not representative of the level of home ownership in the general population of Dunedin. Summary of Relationships between Impairment Status and Disability Identity and Economic Resources. Results presented in Tables 2a and 2b show that impairment and disability identity are related to some, but not all, measures of economic disadvantage. Both participants who reported at least one impairment and those who identified as disabled were less likely than those who did not to report having adequate resources for discretionary spending on entertainment, recreation, and shopping. Total household income, on the other hand, was related only to disability identity and not to impairment status while home ownership was related to neither of these indicators of economic disadvantage in this group of survey participants.

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In general, results presented in Tables 2a and 2b suggest positive answers to the first four research questions. Impairment status and disability identity are related to indicators of subjective well-being, workforce participation, social inclusion, and economic disadvantage in this group of research participants. Results also indicate, however, that the relationship between impairment status and disability identity and these variables are not identical and suggest that slightly different dynamics may be at play. We now turn to our main goal of examining the possibility that the lower levels of subjective well-being reported by participants with disability experience are explained by social and economic disadvantages.

Question 5: Do workforce participation, levels of social inclusion and economic recourses mediate in the relationship between disability/ impairment and subjective well-being? We address the final research question through a series of multiple regression models in which either impairment status or disability identity is regressed on the well-being measures in step 1, social inclusion measures are added in step 2, economic resource measures are added in step 3, and background variables used as controls are added in the final step 4. Table 3a presents the results of the regression analyses for impairment and Table 3b presents the results for disability identity. As can be seen from the bivariate correlations presented in Table 3a, with the exception of employment, the social and economic characteristics on which disabled participants are disadvantaged are significantly related to overall subjective well-being
thus meeting criteria for potential mediators. While there are significant bivariate correlations among mediators, tests for multicollinearity did not produce results that would preclude including them in our planned multivariate regression models. The multiple regression results for steps 2 through 4 show that when social inclusion and economic resources are entered in the equation the relationship between impairment and disability status and overall well-being is reduced. When all variables are in the equation, the regression coefficient for impairment status is reduced in size by over one half (from
0.15 to
0.07) and is no longer significant. These results suggest that the significant differences between people with and without impairments in terms of overall well-being are, indeed, mediated by the social and economic disadvantages that accrue to disability. Similar patterns can be seen for disability identity in Table 3b.The relationship between disability identity and overall subjective well-being is reduced to insignificance with the introduction of the social inclusion and economic variables and the regression coefficient is reduced in size from
0.18 to
0.10. These results suggest that the relationship to well-being of both impairment status and disability

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Disability and Community Life

Table 3a. Mediating Effects of Social Inclusion and Economic Resources in the Relationship between Functional Impairment and Overall Subjective Well-being Controlling for Background Characteristics.

Reports at least one impairment (1 ¼ yes, 0 ¼ no)

Correlation (Pearson’s r)

Step 1 Beta


.17***


.15**

Step 2 Beta
.10

Step 3 Beta
.08

Step 4 Beta
.07

Step 1 adjusted R2 ¼ .02** Social inclusion variables Works at least part-time (1 ¼ yes, 0 ¼ no)

.09*

—

.11

.13*

.08

Partnership status

.14**

—

.13*

.10

.09

Participation in social, recreational and civic activities

.19***

—

.19***

.19***

.21***

Perceived Stigma Labeling


.07

—


.02


.03


.03

Discrimination and status loss


.18***

—


.17*


.18**


.17*

Separation


.11*

—

.10

.12

.12

Step 2 adjusted R ¼ .10*** 2

Economic resources Household income

.20***

—

—

.04

.04

Enough money for discretionary spending

.31***

—

—

.23***

.24***

—

—

Rent


.11**


.02


.03

Step 3 adjusted R2 ¼ .15*** Control variables Gender (1 ¼ male, 0 ¼ female)


.04

—

—

—

.03

.04

—

—

—


.02

Born in US (1 ¼ yes, 0 ¼ no)


.00

—

—

—


.04

Age


.06

—

—

—


.12

—

—

—

.07

Bachelors degree (1 ¼ yes, 0 ¼ no)

Identifies as white only

.08*

Step 4 adjusted R2 ¼ .15*** * p < .05; **p < .01; ***p < .001.

identity is mediated by differences in social inclusion and economic resources. In other words, participants with impairments and those who identify as disabled have experienced social inclusion and economic disadvantages that are in turn detrimental to overall feelings of well-being.

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SARA E. GREEN AND BRIANNA VICE

Table 3b. Mediating Effects of Social Inclusion and Economic Resources in the Relationship between Disability Identification and Overall Subjective Well-being Controlling for Background Characteristics.

Identifies as disabled (1 ¼ yes, 0 ¼ no)

Correlation (Pearson’s r)

Step 1 Beta


.19***


.18**

Step 2 Beta
.12*

Step 3 Beta
.10

Step 4 Beta
.11

Step 1 adjusted R2 ¼ .03** Social inclusion variables Works at least part-time (1 ¼ yes, 0 ¼ no)

.09*

—

.12*

.13*

.09

Partnership status

.14**

—

.11*

.08

.08

Participation in social, recreational and civic activities

.19***

—

.20***

.19***

.21***

Perceived Stigma Labeling


.07

—


.03


.03


.04

Discrimination and status loss


.18***

—


.14*


.16*


.14*

Separation


.11*

—

.09

.11

.11

Step 2 adjusted R2 ¼ .09*** Economic resources Household income

.20***

—

—

.03

.02

Enough money for discretionary spending

.31***

—

—

.23***

.24***

—

—


.11**

Rent


.02


.03

Step 3 adjusted R2 ¼ .14*** Control variables Gender (1 ¼ male, 0 ¼ female)


.04

—

—

—

.02

.04

—

—

—


.03

Born in US (1 ¼ yes, 0 ¼ no)


.00

—

—

—


.02

Age


.06

—

—

—


.12

—

—

—

.07

Bachelors degree (1 ¼ yes, 0 ¼ no)

Identifies as white only

.08*

Step 4 adjusted R2 ¼ .14*** * p < .05; ** p < .01; ***p < .001.

DISCUSSION AND CONCLUSIONS There are many obvious limitations to this study. The sample is small and specific to a particular time and place. Home owners and people who report having college degrees are seriously over-represented in the group of Dunedin residents who chose to participate in the online survey. In addition, there are a number of ways in which Dunedin is not representative of many other communities nor is it representative of the United States as a whole. It is a very white

Disability and Community Life

243

community, and its location on the Gulf of Mexico in Florida attracts a large number of retirees. While age and race/ethnicity were included as controls in our regression analyses, care should be taken in generalizing to communities with younger and more racially and ethnically diverse populations. Dunedin is also a town that has made a concerted effort to include people with disabilities in the life of the community. There is an advisory committee to the city commission tasked with this goal. The pedestrian crossings in the down town shopping, dining, and entertainment area are very wheelchair friendly, and the crossing lights provide audible sounds for the benefit of blind pedestrians. Despite these efforts, however, the findings of this study suggest that even in Dunedin, residents who have impairments and those who identify as disabled are less happy than their nonimpaired, nondisabled neighbors. Findings also show, however, that the differences in subjective well-being associated with disability experience can be explained by lack of social inclusion and economic disadvantages that are associated with impairment and disability
even in this relatively privileged group of survey participants living in a relatively inclusive community. Disability and impairment are expensive. Adaptive equipment that facilitates social participation is extraordinarily costly and is, at best, usually only partially covered by insurance and government assistance programs
for those lucky enough to have such coverage at all. Companion and caregiver services that could increase community participation are also hard to come by and costly. Asking for assistance from friends and family can put a strain on relationships and be a source of embarrassment and reduced feelings of self-worth and independence. Even when these sources of personal assistance are available, they can involve hidden costs. When someone who needs the physical assistance of another person wants to attend a ticketed event, for example, he/she may need to buy two tickets in order to avoid being a financial burden on an underpaid caregiver or unpaid friend or family member. Many disabled participants simply can’t afford to participate in the kinds of community activities that are shown here to increase feelings of well-being. Findings of this study clearly indicate that survey participants with disability experience are not as happy as those without such experience mostly because of the social and economic disadvantages associated with disability. Findings of this study also problematize the conflation of disability identity and functional impairment in interesting ways. Participants who reported themselves to be disabled were disadvantated in terms of workforce participation, partnership status, community participation, household income, and availability of adequate funds for discretionary spending. They also perceived higher levels of disability-related stigma on all three components (labelling, discrimination/status loss, and separation). When participants who reported at least one functional impairment on the WGS list were compared to those who did not, on the other hand, they were disadvantaged only in terms of work force participation, money available for discretionary spending, and two of the three components of stigma (discrimination/status loss and separation).

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Further, while both disability and impairment were found to have a negative impact on employment even among those of working age, the disadvantage was greater among those who identify as disabled. These findings could suggest that workplace discrimination contributes to disability identity. Workplace discrimination was, in fact, reported significantly more frequently among participants who reported both disability and impairment and among those who identified as disabled but did not report impairments in the WGS series than among members of other groups. Only four percent of those who reported neither disability nor impairment said they had experienced discrimination on the job that was related to disability or impairment. Three percent of those reporting at least one of the WGS impairments but who did not identify as disabled reported disability-related or impairment-related workplace discrimination. Twenty-seven percent of those in the disabled but not impaired group said they had been discriminated against in the workplace due to disability or impairment and 50% of those who both identified as disabled and reported at least one of the WGS impairments reported this kind of discrimination. On the other hand, Rosalyn Benjamin Darling’s study (2013) suggests that individuals with lifelong impairments are more likely than those with more recently acquired impairments to develop a sense of disability pride. It may be that these folks are also both more likely to report themselves to be disabled and less likely to find employment. Our findings suggest that for some participants, illness and pain may also co-exist with impairment and disability identity and make it difficult to work. In addition to the measures of disability identity and functional impairment that are the major variables investigated here, we also asked whether participants had a chronic health condition (such as heart disease, cancer, diabetes, etc.) and whether they experienced chronic pain (pain that is constant, interferes with your ability to carry on with your normal activities, has lasted for more than a year, and is not relieved by over the counter medications). Twenty-four percent of participants reported a chronic health condition and 15% reported chronic pain. Either chronic health conditions or pain were reported by: 22% of those who reported neither disability nor impairment, 43% of those in the impaired but not disabled group, 53% of those in the disabled but not impaired group, and 83% of those who identified as disabled and also reported at least one of the impairments in the Washington Group Series. It may be that the higher rates of chronic pain and illness in the group that identified as disabled explains some of the results. Further research, quantitative and qualitative, is needed to more clearly differentiate among impairment status and disability identity in relation to workforce participation and perceptions of workplace discrimination. A number of scholars have argued recently that the Social Model has discouraged scholarship on the co-existence of impairment with chronic illness and/or pain and the issues these may present for those living with disability (see, e.g., Shakespeare, 2014; Siebers, 2006). These findings suggest that this kind of complex intersectionality

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among impairment, disability identity, chronic illness/pain and structural barriers to full participation warrants further investigation. Despite its limitations, findings of this study clearly support the Social Model perspective that social and economic disadvantages present significant problems for people living with disability (functional impairment and/or disability identity). Further, findings presented here indicate that whether disability experience is measured by functional impairment status or disability identity, the negative relationship between disability experience and subjective well-being can be largely explained by these structural disadvantages. These findings suggest, in fact, that the well-being of residents with disabilities can be significantly improved by making community inclusion more affordable for people with impairments and those who identify as disabled. Increasing opportunities for workforce participation is one way this might be accomplished, but reducing the cost of meaningful participation in community activities and taking steps to actively reduce disability-based stigma are others. We are currently working with city staff, elected officials, and community groups to develop creative ways to increase opportunities for social participation and reduce barriers to full inclusion in community life.

ACKNOWLEDGMENTS A previous version of this chapter was presented at the Annual Meetings of the American Sociological Association in 2016. This research was supported in part by the Dunedin Committee on Aging (DCoA), Dunedin, Florida. Many thanks to committee chairs Michael Whalen, Sharon Williams, and Andrew Demers, members of the DCoA, and the staff and city council of the City of Dunedin.

REFERENCES Beckett, A. (2006). Citizenship and vulnerability: Disability and issues of social and political engagement. New York, NY: Palgrave Macmillan. Berger, R. J. (2013). Introducing disability studies. Boulder, CO, and London: Lynne Rienner Publishers. Darling, R. B. (2013). Disability and identity: Negotiating self in a changing society. Boulder, CO: Lynne Rienner Publishers. Green, S. (2007a). “We’re tired, not sad”: Benefits and burdens of mothering a child with a disability. Social Science and Medicine, 64, 150
165. Green, S. E. (2007b). Components of perceived stigma and perceptions of wellbeing among university students with and without disability experience. Health Sociology Review, 16, 328
360. Green, S., Davis, C., Karshmer, E., Marsh, P., & Straight, B. (2005). Living stigma: The impact of labeling, stereotyping, separation, status loss and discrimination in the lives of individuals with disabilities and their families. Sociological Inquiry, 75, 197
215.

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Link, B., Cullen, G., Struening, E., Shrout, P., & Dohrenwend, B. (1989). A modified labeling theory approach to mental disorders. American Sociological Review, 54, 400
423. Link, B., & Phelan, J. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363
385. Madans, J., Loeb, M., & Altman, B. (2011). Measuring disability and monitoring the UN Convention on the Rights of Persons with Disabilities: The work of the Washington Group on Disability Statistics. BMC Public Health, 11, 54
61. Pontin, E., Schwannauer, M., Tai, S., & Kindeman, P. (2013). A UK validation of a general measure of subjective well-being: The modified BBC subjective well-being scale (BBC-SWB). Health and Quality of Life Outcomes, 11, 150
158. Priestley, M. (2003). Disability: A life course approach. Cambridge, UK: Polity. Shakespeare, T. (2014). Disability rights and wrongs revisited. (2nd Ed.). London, UK: Routledge. Siebers, T. (2006). Disability in theory: From social constructionism to the new realism of the body. In L. J. Davis (Ed.), The disability studies reader (pp. 173
184). New York, NY: Routledge.

PART 4 THE FUTURE OF WORK

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CHAPTER 9 DISABILITY AND THE FUTURE OF WORK: A SPECULATIVE ESSAY$ Richard K. Scotch and Charles E. McConnel ABSTRACT Purpose
To identify likely trends in American society and the economy and discuss their implications for the inclusion of people with disabilities in the paid workforce. Design/Methodology/Approach
An overview of recent and likely future trends relevant to the workforce participation of Americans with disabilities. Findings
While some trends in policy, technology, and culture are likely to promote wider participation by individuals with disabilities in paid employment, other factors in the emerging economy, labor markets, and workplaces may constrain such participation. Research limitations/Implications
Uncertainty over future changes does not allow accurate forecasting of labor market trends for people with disabilities. Originality/Value
Many previous analyses have focused on developments within single arenas such as communications or transportation technology that might enable people with disabilities to participate more easily in paid employment. Our essay suggests the relevance of multiple contextual factors

$

The authors would like to thank Brett Cease for his research assistance in the preparation of this chapter.

Factors in Studying Employment for Persons with Disability: How the Picture can Change Research in Social Science and Disability, Volume 10, 249
266 Copyright r 2017 by Emerald Publishing Limited All rights of reproduction in any form reserved ISSN: 1479-3547/doi:10.1108/S1479-354720170000010011

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in shaping labor markets for potential workers with disabilities, but also identifies some likely constraints in expanding employment opportunities for people with disabilities. Keywords: Accessibility; Disability; Discrimination; Employment; Technology; Workforce

DISABILITY, ACCESS, AND WORK When the Americans with Disabilities Act was passed in 1990, disability advocates hoped that it would help to end the economic marginalization of disabled Americans, and promote parity between workers with and without disabilities by mandating reasonable accommodations and prohibiting discrimination on the basis of disability in private employment (Scotch, 2000). Beyond the impact of this landmark statute on employment, the future for workers with disabilities also may be shaped by advances in assistive technology and telecommunications which could enable broader workforce participation. Further, many jobs in the US post-industrial information-based economy may require far less physical strength and stamina and thus be more easily accessible to disabled workers. However, despite the potential impact of legal changes and technological advances, significant work disparities related to disabilities have persisted and may even have increased in recent decades. Maroto and Pettinicchio (2015) examine employment trends reported in Current Population Survey data, and note that the employment rate for working age people with disabilities declined from 50% in 1988 to 22% in 2014, substantially below employment among nondisabled workers. Based on the American Community Survey, the U.S. Census Bureau (2013) reported that between 2008 and 2010, individuals without disabilities were about three times more likely to be employed than individuals with disabilities. These figures suggest that barriers to workforce participation by people with disabilities may be increasing, and that the future of work for disabled Americans may be far grimmer than was earlier anticipated. Of course, any overall employment trends and disparities incorporate tremendous variation among workers and workplaces, and such variation is likely to be even greater in relation to disabilities, which are heterogeneous along many dimensions. So it may be true that various physical or mental impairments have greater or less salience for getting and keeping employment, just as

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different jobs, workplaces, employers, or public programs may offer varying prospects for workers who have disabilities. In this chapter, we speculate on the employment prospects for people with disabilities in the United States in light of the changing nature of the American economy and world of work. We begin with some general observations on the alignment of work and impairments, and continue by considering several trends that are likely to influence workforce participation for people with disabilities. We first consider those trends likely to enhance access to the workplace by disabled workers, and then examine trends that we believe may further constrain access. We conclude with some comments on the future workforce and how individuals with disabilities are likely to fare in the decades to come.

DISABILITY AND EMPLOYMENT Disability and work both have changed considerably in the last half century, and both are likely to continue to evolve in the future with shifts in the general economy and the broader society. Dramatically better health care and medical advances have contributed to marked improvements in individual functioning, longevity, and quality of life for many people with chronic conditions, allowing some conditions to be better managed and rendering other impairments far less disabling (Lorig et al., 2001; Manton & Gu, 2001). Rapidly changing economic conditions, including global competition, deregulation, and the growth of the service sector and “uberization” of service sub-sectors, e.g., Uber’s smartphone app driven ride-hailing services and Airbnb’s nontraditional home or room rental services for travelers, have led to considerable turbulence in work relationships, job longevity, and the organizational, geographic, and spatial settings in which work is done. (Baldry et al., 2007; Lee & Trimi, 2016; Wooldridge, 2015) Accelerated technological change, including automation in both manufacturing and service industries and increasingly sophisticated infrastructures utilizing computers and telecommunications are changing the very nature of work for many individuals, demanding fewer physical skills but greater levels of education and enhanced flexibility in task performance. (Brynjolfsson & McAfee, 2014; Hulten & Ramey, 2015) Another facet of this new economy that has been underway for some time is the 24 hour economy whereby work during evenings, nights and on rotating shifts affects at least one out of five employees (Presser & Altman, 2002). In their research using a nationally representative data set to examine this expansion of the workday, Presser and Altman were able to establish that there was little difference between the disabled and nondisabled in 24 hour participation and with few exceptions parity in the level of wages.

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LEGAL PROTECTIONS AGAINST DISCRIMINATION With the civil rights revolution of the 1960s, some arbitrariness and built-in biases in labor market processes have been reduced. With the enactment and ultimate enforcement activities of federal and state equal employment opportunity (EEO) policies, labor markets have become more transparent and institutionalized EEO procedures have made it far less likely that prejudices based on stigma shape hiring and promotion processes. Specific civil rights employment guarantees against discrimination in race, religion, national origin, and gender were enacted in the Civil Rights Act of 1964 (Burstein, 1985). Building on the model of the Civil Rights Act, equal employment opportunity on the basis of disability was required in federally supported programs and activities in Section 504 of the Rehabilitation Act of 1973, while federal agencies and federal contractors were required to engage in affirmative action in Sections 501 and 503 of the same act, respectively (Scotch, 2001). Protection against discrimination on the basis of disability was extended to most private sector employment by the Americans with Disabilities Act of 1990 (Davis, 2015). While many individuals with disabilities have benefitted from these civil rights protections, the laws do not in themselves appear to have had broad impact on workforce participation (Blanck, Schwochau, & Song, 2003; Deleire, 2003; Kruse & Schur, 2003). One explanation that has been offered is the complexity of employment for people with many types of impairments, a complexity that requires a number of changes beyond simply prohibiting discrimination (Schur, Kruse, & Blanck, 2013). Another factor cited is the very narrow statutory interpretations that federal appeals courts have used to grant legal standing to seek redress (Krieger, 2003). Some conservative critics of the ADA and its predecessors have contended that their mandates might actually discourage employers to hire disabled employees, since they would then be required to accommodate them, although there is limited empirical evidence to support this assertion (DeLeire, 2003). The enactment of EEO laws prohibiting discrimination on the basis of disability has not led to a significant increase in overall paid employment by people with disabilities. The remainder of this chapter discusses nonlegal factors that influence employment patterns, and how these factors may shape employment in the future.

WORK IN POST-INDUSTRIAL SOCIETY The United States has undergone substantial institutional, demographic and economic changes over the last half century. Although overall performance of the economy has been less than optimal and increases in productivity disappointing, economic growth has been, with short episodes of stalling, continuous

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and for the population as a whole economically rewarding (Gordon, 2016; Maddison, 2006). With economic growth, the accompanying structural change has been characterized as a transformation from an industrial to a postindustrial society, where the world of work is dominated by a progressive service sector and a wholly altered composition and educational requirements of available jobs, commercial and banking arrangements, and the workplace (Bjork, 1999; Maroto-Sanchez, 2012; Maroto-Sanchez & Cuadrado-Roura, 2009; Sposi & Grossman, 2014). Of the major markets in an advanced market society, perhaps the most complex and dynamic are the markets for labor. Over short periods of time these markets experience an enormous churn as men and women enter and leave jobs, switch jobs, switch employers or permanently leave the labor force (Faberman, 2009). Along with economic development, technological change has been both disruptive and transformative, imposing demands on society for a more highly skilled, better educated labor force with a concomitant reduction in the need and demand for less educated labor (Beaudry, Green, & Sand, 2016). The labor force faces new conditions induced by continuous increases in productivity that shifts the demand for labor out of industry, where fewer more productive employees are needed, into the occupationally diverse service sector. While low-skilled service jobs such as home health aides are unlikely to disappear and in fact are likely to increase in the near future (Bureau of Labor Statistics, 2015), such jobs typically offer low wages and scant benefits. The most critical aspect of this structural transformation for workers with disabilities is the substantial reduction in manufacturing jobs. Many surviving service occupations may be less likely to offer accommodations than those available to workers with higher skill and education levels (Stein, 2000). There are few surveys documenting the labor market experiences of employees with disabilities. A major one, appearing in the federal government’s Monthly Labor Review (Yelin & Tupin, 2003), reveals a convincing portrait of the worker with a disability. The survey and related information suggests in detailed quantitative terms that workers with disabilities confront a number of significant workforce risks relative to their counterparts without disabilities. Results of the survey indicate that workers with disabilities often have a more partial or irregular attachment to the labor market where they are disproportionately represented in part-time employment, are more likely to work at home, and are less likely to enjoy higher level and more lucrative jobs where person to person communication is required. The risk of job loss for people with disabilities is twice as great as that experienced by those without, and they are more likely to be self-employed and working solely at home. Perhaps most importantly, an employee with a disability is more likely to have earnings below the official poverty line. There is little doubt that information and communication technology (ICT) has provided individuals with disabilities with remote control over their environment and reduction of the many problems of mobility and related demands

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of physical activity. However, there are more ominous problems for the workplace that will accompany the introduction of sophisticated information technologies as instrumental for the management of production (Michaels, Natraj, & Van Reenen, 2014). In “Mindless,” (Head, 2014) Simon Head argues that the information revolution in the workplace is already underway. Computer business systems, for example, utilize digital communication technology to control and monitor every facet of business activity including, in an inordinately intrusive way, the work processes of employees, principally through surveillance of time and motion during periods of work. Head contends that a critical aspect of the modern digitalized workplace is the overriding concern for speed in the flow of work, be it an office environment, the work floor of the warehouse or an industrial production line. The pace of work is being quickened, not by ruthless and uncaring foremen, but by the rhythm of a digitized expert system set for speed of detection of variations from “ideal practices,” the underlying reason for the variation and ultimately corrective action. As Head notes: “In [computer business systems] product manuals, there is an unrelenting emphasis on the need for speed in the execution of processes and for speed in the detection and correction of process error … (T)his preoccupation with speed is simply the transfer to a service-dominated economy of a practice deeply rooted in manufacturing” (Head, p. 25). As the result of these changes, workplaces may be becoming less rather than more accessible to workers with disabilities. Many employers utilize production and human resource policies that promote flexibility in organizing work processes to enhance productivity (Florida, 2014), but such policies may also constrain workers. Work schedules, hiring and promotion procedures, and intensive, continuous performance reviews, often stressful for all employees, could have more damaging consequences for disabled employees whose capacity to quickly respond to changes may be limited by their need for corresponding accommodations. The redesign of work to optimize efficiency may have the functional effect of discouraging the accommodation of exceptional cases. Such accommodation most obviously involves employees with disabilities, but also includes others who require individually adjusted assignments or schedules, such as those responsible for dependent care, or those who seek to develop new job skills or engaging in educational opportunities. Individuals who can contribute to the work of a firm, but in nonstandard ways or with special accommodation, may be less welcome in many workplaces. It seems plausible to assume that in the near future the same rules-oriented quickened pace that now characterizes the regulation of the workers productive activities will readily be transformed by artificially intelligent capital assets into a workplace with fewer if any workers (Kaplan, 2015). America’s workshops of the future may no longer require the rational allocation of labor but will contend along with society at large with establishing an equitable distribution of an increasing supply of leisure (Skidelsky, 2014).

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THE ROLE OF TECHNOLOGY Ubiquitous technological change has transformed everyday life, work, and the economy in the past half century, and this change is likely to accelerate in future decades with advances in computer design, 3D printing, telecommunications, the development of new materials and processes, and medicine and genetic engineering (Kearney, Hershbein, & Boddy, 2015; Rahman, 2016). For many people with disabilities, emerging technologies have been particularly important, limiting the consequences of impairments and allowing greater participation in society. The federal government promoted the dissemination of new technologies to assist people with disabilities by passing the Technology Assistance for Individuals with Disabilities Act of 1988 (P.L. 105-394, commonly known as the “Tech Act”) and subsequent reauthorizations, which funded states to educate people with disabilities about available products (Administration for Community Living, 2015). Schur, Kruse, and Blanck (2003) cite improvements in technology related to mobility (such as improved wheelchairs) and computer access and telecommunications (such as screen readers and voice recognition software). They write “It is well recognized that these technologies can improve opportunities for employment …” (138). Individuals with chronic illnesses may benefit from medications that allow them to better manage the symptoms associated with their conditions, AbleData, a resource and website supported by the federal National Institute for Independent Living, Disability, and Rehabilitation Research currently lists about 45,000 assistive technological devices for use by people with disabilities (AbleData, 2016). New technologies that are created incorporating universal design features may require little or no adaptation for use by people with disabilities (Schur et al. 2013, pp. 142
146). Accessible website design, for example, allows use by those with visual or hearing impairments, and also by those with cognitive limitations who may require more basic levels of explanation for effective use (Blanck, 2015). However, unless new products or services are created within the context of universal design, there may be a lag between their availability to nondisabled users among the general public and the incorporation of accessible features that make them usable by people with disabilities.

ENHANCED TELECOMMUNICATIONS People with mobility impairments are likely to benefit from the impact of enhanced telecommunication on work, both from the ability to work at home and the increased proportion of jobs that demand far less physical activity. Thus, the recent revolution induced by information and communication technology, which has provided enhanced access through cell and smartphone

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availability and networking, has provided a means to reduce the barriers to many types of employment. For example, while it has been reported that workers with disabilities are less likely to have higher paying jobs that require person to person customer-to-client negotiations (Kaye, 2009), the means are now available to deal with clients or customers in the immediate and relatively intimate contact provided by electronic devices. Additional changes have been driven by desktop digital computer technology and the network capabilities provided by the Internet. The giant leap occurred in the mid-90s with the Internet medium, Windows 95, which offered ease in operating desktop computers and utilized a browser, Netscape, for access to the network and content around the world. For those with mobility impairments, the introduction of these technologies was liberating. Remote controlling devices that allow communication of commands facilitate a technological environment that compensates for any limitation in mobility.1

ATTITUDES Over the past few decades, the social isolation of people with disabilities has lessened in American society. The Individuals with Disabilities Education Act (IDEA), was a 1990 extension of the 1974 federal Education for All Handicapped Children Act (Public Law 94-142) which required universal access to public education. IDEA has had an important impact on American schools, bringing many children with disabilities into school who might earlier have been excluded altogether (Dorn & Osgood, 2009). The law also led to growing numbers of students with disabilities being included in regular classrooms with nondisabled children. IDEA has not only enhanced the human capital of disabled individuals by improving their educational attainment, but it also has meant that individuals without disabilities have become more accustomed to interacting with disabled peers in school. Similarly, nondiscrimination laws such as Section 504 of the Rehabilitation Act and the Americans with Disabilities Act have opened up public accommodations and civic life to disabled participants, while governmental support for independent living programs has increased the presence of many people with disabilities in the broader community (Scotch, 2000, 2001). As disabled people have become more integrated into civic and economic life and interaction has become more common between disabled and nondisabled individuals, the stigma associated with disability may have been reduced and negative stereotypes may be undermined by actual experiences. As discussed above, assistive technology has supported greater economic and social participation as well. In the same period, popular culture increasingly has included people with disabilities in representations of everyday life, and has depicted disabled individuals more positively and less in terms of

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incapacity and tragedy. While stigma persists, it would appear that people without disabilities have become more accustomed to having disabled classmates, friends, coworkers, and neighbors. Schur et al. (2013) report on anecdotal observations of improved attitudes in their interviews. They quote Congressman James Langevin, the first quadriplegic to serve in Congress, as saying “I think attitudes really have changed. … The passage of the ADA has changed the mindsets of people in general, while Bobby Silverstein, one of the authors of the ADA notes “a revolution and dramatic improvements” in the acceptance of people with disabilities in society (Schur et al., p. 213). Also quoted is and Jim Dickson, a leading disability rights advocate, who states “The most important thing about the ADA is the change in attitude” (Schur et al., p. 215). However, they also quote skeptics such as Richard Scotch, a disability studies scholar, who comments that “a lot of judges don’t understand disability and a lot of employers, particularly small employers, don’t [either]” (Schur et al., p. 214). Unfortunately, there is little systematic public opinion data on the changing attitudes (or accompanying behaviors) of employers and managers who are the gatekeepers for employment decisions.

INCREASING DEMANDS FOR HUMAN CAPITAL As economies develop, growth is generally driven by the accumulation of physical capital that in turn relies on increasingly sophisticated technology. Complementary to higher levels of technology is the extent of skill development and educational attainment, or human capital, of the labor force (Becker, 1994). Human capital is generally rewarded by an economic return to the individual’s investment in education in the form of higher incomes and lower levels of unemployment. A recent report by the Educational Testing Service highlights the growing importance of education and skills in the context of the larger technological, economic, social, and political forces that have been reshaping America for the past 40 years. The report states that “Since around 1975, those who have acquired the highest levels of education and skills have become the big winners, while those with the lowest levels of education and skills have fared the worst” (Goodman, Sands & Coley, 2015).

Many workers with disabilities have lower educational attainment than those without disabilities, and thus face a decided disadvantage in a competitive labor market. (Kaye, 2009) Considering the variety of barriers that confront the individual with a disability engaged in a job search, rising educational requirements in the post-industrial economy may make employment prospects worse as the skill requirements of jobs rise. Currently, according to Stephen Kaye, “workers with disabilities are overrepresented in lower status occupations due to lower levels of so-called human capital, such as educational attainment and work experience” (Kaye, 2009, p. 116). Although achieving a higher

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level of educational attainment will be necessary if people with disabilities are to compete in labor markets, it is unlikely that it will be sufficient. The world of work is volatile and all labor is being squeezed from two directions. Labor market research indicates that the increasing supply of higher skilled better educated workers have been moving down the occupational ladder occupying positions that lower skilled labor once held (Beaudry et al., 2016). For workers with disabilities to improve their employment prospects, they will need to gain better access to the variety of new personal technologies and global information connectivity that has become available. Automation is finding a place both in the routinized category of jobs as well as some of the more creative, knowledge intensive areas (Brynjolfsson & McAfee, 2014). Moreover, recent research that has examined a broad array of detailed occupational categories and estimated the probability of computerization of each category predicts that “about 47 percent of total US employment is at risk” [as the result of automation] (Frey & Osborne, 2013).

DISABILITY AND COMPLEXITY2 Disability frequently introduces complexity and disequilibrium into individual lives, family relationships, and the various social systems in which people live, learn, play, and work (Scotch & Schriner, 1997). When a child is born with a severe impairment, for example, more complex support systems may be required to support the child and her family. Additional resources and new approaches to the challenges of daily life may need to be developed because economic, social, and cultural systems are rarely geared to the needs of the child and the family. In instances where systems have incorporated routinized mechanisms for meeting needs associated with a disability, systemic strain may never occur, nor will the conflict that can accompany such strain. More frequently, some systems can integrate disability without substantial effort, while others may not. Under the prevailing (in disability studies at least) social model of disability, we might consider the problems faced by people with disability in participating meaningfully in the economy as the consequence of the incapacity of economic institutions (and their physical and cultural manifestations) to respond to a narrower range of variation than is in fact present among any given population. Thus, those individuals whose mobility, communication, medical needs, or cognition differs from social norms find themselves confronting workplaces and/or employers poorly prepared to accommodate their abilities and potential. Historically, all societies have adapted to some types of human variation, while requiring adjustment from others or imposing marginalization on others. Of the various possible social structural arrangements, large scale bureaucratic institutions may be the employers most resistant to dealing positively with

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individual level variation because of technologies that “rationally” emphasize standardized inputs and routinized behavior to maximize productivity. Large scale institutions whose underlying values stress efficiency and whose operating technologies emphasize standardization thus may be less likely to easily adjust to the variability introduced by disability. While such systems can deploy substantial resources, those resources are frequently dedicated to processing standardized inputs. Institutional structures may feature highly interdependent units where apparently trivial change generates the need for many additional adaptations, and business, industrial and institutional culture often discourages responses to exceptional cases. However, an emerging post-industrial global society typically cannot afford to invest heavily in fixed and standardized technology and must have the capacity to adjust to diverse and changing contexts (Ilgenayeva & Elbeshausen, 2014). With decentralized and digitized technologies that are constantly being redefined, economic and social systems are more likely to require far more flexibility, but typically under the discipline of efficient or productivity considerations (Kagermann, 2015). Since the 1960s, the disability rights movement has advocated that society in general and workplaces in particular should more proactively adapt to human variation by promoting inclusion and accommodation. Public policies have mandated inclusive practices, while new technologies (including ramps and elevators, psychotropic drugs, and telephone relay systems) have enhanced participation (Scotch, 2000, 2001). The adoption of universal design principles can reduce the relevance of impairments at relatively low social or economic cost (Schur et al., 2013). However, where the alignment between individual needs and the environment is limited or strained, secondary effects may ripple through family and community systems as ad hoc or partial adaptations are made, exacting financial, time, and emotional costs from those affected. Consider, for example, how work schedules in several industries have evolved in recent years. Many firms have adopted just-in-time (JIT) approaches to maximize productivity. In manufacturing or some other industries, that may mean highly variable production schedules that require overtime some weeks and less than full time work in others. In retail, JIT has meant frequent lastminute adjustments of working hours
employees may be called in or sent home based on fluctuations in customer demand, or to keep their hours below the threshold triggering eligibility for benefits or overtime pay. These calculations can optimize productivity for employers, but at the cost of greater uncertainty for workers, typically in low-wage positions, about when and for how long they need to work on any given day. That uncertainty may have greater consequences for employees who take more time to prepare for workdays, or who rely on complicated support systems to get ready, to get to work, to manage medical conditions, or to arrange for care of dependent children or other family members. Such uncertainty also is likely to have repercussions for those

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who serve in the support networks that often maintain people with disabilities in their jobs. Disability represents tremendous variability in how people manage their conditions and approach tasks at home and at work, even among people with similar impairments. Frequently, people with disabilities may require extra time for morning routines, or to travel to jobs, or to adjust to new routines (Scotch and Schriner, 1997). Many workers with disabilities adopt creative and distinctive solutions to the various tasks they face, solutions which in many cases involve assistance from others. Customized solutions often involve considerable complexity, and highly variable work schedules may introduce additional challenges that can, on the margin, limit the ability to work effectively. When both work processes and the everyday lives of employees’ with disabilities involve complexity, they may fail to align in ways that promote productive employment patterns. While some complex systems may be inherently adjustable to the needs of people working with them, in other cases, institutional rigidity or a narrow and shortterm focus on efficient use of production inputs may disadvantage participants who cannot quickly adjust to the changing demands of variable systems. While workers with disabilities may be more flexible in some ways than other employees, since they have already experienced the need to adapt their personal circumstances to job demands, there may be some adaptations demanded by employers that undermine the support systems required by disabled individuals for effective workforce participation. Some employers may prefer to only hire people already prepared to utilize emerging technologies rather than to assist workers or even allow them the time necessary to adapt. Beyond the actual capacity of people with disabilities for work flexibility is the perception by employers that disabled people may not be able to keep up with changes. For example, a study by the Wisconsin Center for Education Research found that employers can hire based on a perceived “cultural fit,” a process that rejects potential workers believed unlikely to be able to work within a particular firm. The study observed that “An applicant could look great on paper, but if that individual doesn’t fit with the organizational culture, doesn’t share the same hobbies and interests of other employees, it’s possible that person won’t get the job” (Armitage, 2016). Accommodations may appear more reasonable when they involve generic and easily programmed adaptations, but such efforts may only resolve issues for “average” people with disabilities. Without proactive designs that can routinely accommodate the personal needs of employees, many gatekeepers over work processes may be unresponsive systems for all but the most generic of requested accommodations. It is not just workplaces and work that are increasingly complex
so is disability. Disability is a broad, diverse, complex, and dynamic. Facilitating better access to workforce participation and mobility within the economy is not achievable with any one time transformations, even if such transformation is

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attainable. Promoting the inclusion of people with disabilities requires a commitment to work with employees on an individualized and ongoing basis, a commitment that may be less amenable to governmental mandates than more nominal means of compliance. As the American knowledge economy continues to evolve and the demand for workers increases, those yet to enter the world of work as well as the current workforce, will certainly be confronted with much greater uncertainty regarding the acquisition of the future preferred but unknown training, education and skill-set that will lead to or sustain employment (Brynjolfsson and McAfee, 2014). This uncertainty could be especially difficult for some of the disabled who because of their unique problems in securing employment that accommodates their limitations may be less nimble in adjusting to the changes the ICT economy will demand. Needless to say, there is substantial controversy regarding the future trends of technology but there is little disagreement of the extraordinary variety of highly sophisticated products and processes emanating for artificial intelligence (AI) with “deep learning,” as manifested in robotics. In some cases AI will substitute for the input of better educated labor while in others higher-level cognitive skills will be required as employee complements to production processes dominated by advanced information technologies (Schwab, 2017). The resilience, reliability, perseverance and creativity brought to the workplace by people with disabilities (as well as many others in the new economy) may not be sufficient in this uncertain transformational environment. Some workers with disabilities may have limited capacity to change course with the speed required by major shifts in the pattern of industry’s human resource needs and are likely to suffer additional disadvantages as the contours of the work environment is shaped by information technology disruptions. As Hulten and Ramey (2015) point out at length, even industrial preferences and future needs for certain categories and levels of educational achievement are ambiguous. The recent deluge of publications on AI and the robotics revolution, the pessimistic speculation of a future of “workerless” workplace and major societal changes induced by electronic informational oriented consumption goods and services, such as the universal adoption of smart phones and GPS, clearly suggest the potential for tumultuous changes in the workplace as well. Future advocacy efforts must incorporate a strategy that reflects this uncertainty and the necessity of public policies that will buffer the changes in the employment environment, by assuring that the disabled with their skill-set and highly varied limitations will have a place to earn a living.

DISABILITY AND THE FUTURE OF WORK Most workplaces and work processes in the United States have changed in important ways in the past half century driven by technological innovation and

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changes in the global division of labor, and they are likely to continue to change for the foreseeable future (Ford, 2015). Because many of these changes make work less physically demanding and spatially constrained, accommodating people with many types of impairments who have the requisite knowledge and skills will become easier. More inclusive public schools resulting from IDEA, and greater access at all levels of education as the result of Section 504 and the Americans with Disabilities Act make it more likely that individuals with disabilities can attain higher levels of education and more marketable skills. Further, the implementation of IDEA, Section 504, and the ADA appears to have been associated with greater cultural acceptance of disability-related diversity, as have parallel changes in popular culture and public opinion. All of these trends may mean that people with disabilities face far greater employment opportunities than was possible in the past. But the economy has also developed in ways that will make the goal of increasing workforce by people with disabilities more challenging. Incorporating employees’ individual variations requires greater initial effort than following top-down standard operating routines, and administrative control may be compromised if employers engage in a dialogue with other employees to identify individual needs. In such instances, short-term costs are incurred due to system adaptation, shortterm interruptions or interim productivity losses as skills are acquired, but long term gains will be achieved. Individualized employment may be impractical or costly in industries based on complex and inflexible technologies such as assembly lines, but in the most developed economies such technologies are generally becoming obsolete. However, in industries built on emerging technologies, adapting to the situations of individual employees could have substantial payoffs in enhancing productivity and reducing turnover. Since the workplaces and jobs of the coming century will require constant redesign to cope with rapid technological changes and the demands of a global economy, employers that can maximize productivity by adjustment to individual needs should be at a competitive advantage. In the context of constant environmental and technological change, many if not most accommodations due to disability will be trivial, and should be easily incorporated into the overall process of needed organizational adaptation. Even where productivity for individual firms may be limited by adaptations required for universal design and universal access, society must broadly consider the social costs (or externalities) imposed by narrow conceptions of the need for short-term profitability by individual firms. Independence and full social participation of people with disabilities entail important multiple gains to society at large, gains that easily justify investment in systems that promote inclusion. As work changes, adopting inclusive policies will require cooperative efforts within communities and society at large and greater demands on resources brought to bear on fostering inclusion. The decision to make such investment may be the result of calculation of economic advantage, labor market needs or in response to policy mandates.

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Another factor, however, must be considered. Over the past few decades, the overall American labor market has bifurcated into one segment made up of jobs for the highly successful educated workforce and another of jobs for relatively unskilled workers in service occupations and industries that either still require demanding physical work, or offer variable hours and unappealing working conditions, or both. Jobs in the latter segment pay poorly, typically do not offer benefits, and do not offer reliable full-time year-round employment. Many Americans with disabilities lack the human capital to compete successfully for jobs in the more privileged portion of the economy. They may be left with the jobs that remain, or may choose to opt out of the workforce and not take the risk of giving up Medicaid coverage for low-wage marginal employment. The future of work for people with disabilities may be comprised of two noninterchangeable pools of opportunity
one that is steadily growing but limited to those who have the human capital to compete, and the other that may be more accessible for many but which will not offer the capacity for upward mobility and full social participation. If this is the scenario that is emerging, policy interventions to improve workforce access must go beyond the traditional employmentfocused vocational rehabilitation program and the anti-discrimination mandate of the ADA. We should revisit the operation of IDEA by states and local school districts to ensure that students with disabilities are tracked into programs that maximize their ability to participate in the high-skilled segment of the workforce, including effective expansion of early childhood education and developmental programs that allow them to participate effectively in their subsequent schooling. And to provide an evidence base for such policies, further research on the intersection of disability and the emerging economy is needed, research that addresses both the increasingly complex economy and that takes into account the diverse population of Americans with disabilities.

NOTES 1. One imaginative glimpse at the road ahead is offered by Kaplan (2015). 2. Much of the following section is adapted from material originally presented by one of the authors in Scotch and Schriner, 1997.

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31.

ABOUT THE AUTHORS Tindara Addabbo (e-mail: [email protected]) is Associate Professor in Economic Policy at the University of Modena and Reggio Emilia (Italy). She is member of CAPP (Centre for the Analysis of Public Policies), RECent (Center for Economic Research), of the Scientific Committee of Fondazione Marco Biagi, of the European Gender Budgeting Network and of the International network on leave policies and research. Amongst her most recent publications: “A microsimulation model to measure the impact of the economic crisis on household income,” (co-authors Rosa Garcı´ a-Ferna´ndez,Carmen Llorca-Rodrı´ guez, Anna Maccagnan), International Journal of Manpower, 2016; “Education capability: A focus on gender and science,” (co-authors: Maria Laura Di Tommaso & Anna Maccagnan), Social Indicators Research, 2016; “Healthy life, social interaction and disability,” (co-authors Elena Sarti, Dario Sciulli), Quality & Quantity, 2015; “Gender differences in Italian children’s capabilities,” (co-authors Di Tommaso, Maccagnan) Feminist Economics, 2014. web site: http://personale.unimore.it/rubrica/curriculum/addabbo Barbara M. Altman is a Sociologist with a Ph.D. from the University of Maryland. Retired from the National Center for Health Statistics, she currently serves as a consultant on disability statistics issues. She has played a key role in the development of both national and international measurement of disability in Censuses and Surveys. She served on the original organizing board of the Society for Disability Studies in 1984, served as the organization’s third President, was founding Chair of the American Sociological Association (ASA) Section on Disability and Society and has been member and Chair of ASA Committee on Status of Persons with Disability. Her disability research interests focus primarily on disability definition and measurement, access and utilization of health care services by persons with disabilities, and disability among minority groups, particularly Native Americans. She is the author of numerous articles, book chapters and federal publications on disability topics. She is coeditor of the series Research in Social Science and Disability and has edited a new book on measures created by the Washington Group entitled International measurement of disability: Purpose, method and application (2016). Her current project is a text book on disability statistics. Robyn Lewis Brown is an Associate Professor of Sociology and Co-Director, Health, Society, and Populations Program. She received a Ph.D. in Sociology 267

268

ABOUT THE AUTHORS

from Florida State University in 2010. Her research interests lie primarily within the sociologies of health, illness and disability, and connect in significant ways with the fields of social psychology, disability studies and psychiatric epidemiology. Her current work examines two broad topics, which are: (1) The impact of adversity in one’s social environment on mental and physical health outcomes and (2) How social context, stressor exposure and psychosocial resources influence mental and physical health, more generally, and in ways that are patterned by gender and one’s position in the life course. Gabriele Ciciurkaite is an Assistant Professor of Sociology at Utah State University. She received a Ph.D. in Sociology from the University of Kentucky in 2016. She is a medical sociologist with research expertise in the social determinants of health, social stratification and quantitative methods. Her recent interdisciplinary work informs public health efforts to disparities. Her current research focuses in two primary areas: (1) The intersection of gender, race and socioeconomic status and the ways these social factors create and sustain health disparities and (2) Chronic illness prevention and management among vulnerable populations. Aref N. Dajani is a Mathematical Statistician in the Center for Disclosure Avoidance Research at the U.S. Census Bureau. He earned his Ph.D. in Statistics at the University of Maryland, Baltimore County. He has conducted research in complex survey variance estimation, statistical computing, coverage estimation, nonresponse bias analysis, and interviewer falsification. He recently conducted sampling and estimation training in Jordan and Nepal to professional statisticians in those two nations. He has published in the Journal of Official Statistics, Poverty & Public Policy, and the International Business and Economics Research Journal. Sara E. Green is Director of the Interdisciplinary Social Sciences Program and an Associate Professor in the Department of Sociology at the University of South Florida. She is co-chair, with Dr. Thomas J. Gerschick, of the American Sociological Association (ASA) Committee on the Status of Persons with Disabilities in Sociology; and 2016
2017 chair of the ASA Section on Disability & Society. Her research and teaching interests center on various aspects of the social experience of health, illness, and disability across the life course including: Identity, community participation, humor, stigma, health beliefs, organizational membership and satisfaction, and care giving and receiving. Her work has been published in a number of edited volumes and a wide variety of peer reviewed journals. She is co-author, with Shawn Bingham, of Seriously funny: Disability and the paradoxical power of humor (Lynne Rienner, 2016), and co-editor (with Sharon Barnartt) of Sociology looking at disability: What did we know and when did we know it?, Research in Social Science and Disability, Volume 9 (Emerald Group Publishing, 2017).

About the Authors

269

Barbara A. Haley is a Sociologist who recently retired after more than two decades of government service. She has an earned Ph.D. from the University of Southern California, where she specialized in studies of social stratification and gerontology and produced one of the first spatial analyses of residential burglary in that region. Since then, she presented numerous papers at professional meetings and authored five book chapters. Her publication record includes contributions to the American Journal of Public Health, Poverty and Public Policy, Journal of Urban Technology, the Encyclopedia of Housing and The Annals of the American Academy of Political and Social Science. She also co-authored American health care in transition: A guide to the literature and Section 202 supportive housing for the elderly: Program status and performance measurement. She managed more than $2 million in research grants and contracts that focused on assisted housing programs and measurement of public awareness of lead-based paint hazards. She is a past-president of the District of Columbia Sociological Society. Shakira Hanif is an Occupational Therapist with VHA Home Healthcare working with children and youth in schools. Her work focuses on helping students with various needs engage and participate fully in their academic curriculum. Jaya Krishnakumar is a full Professor of Econometrics at the University of Geneva, Switzerland. Her research interests include panel data econometrics, multivariate models, and quantitative methods for multi-dimensional well-being analysis. She has publications in international econometrics/economics journals such as Econometric Theory, Journal of Econometrics, Oxford Bulletin of Economics and Statistics, Computational Statistics and Data Analysis, Journal of Public Economics, European Economic Review, Health Economics, Review of Income and Wealth, Social Indicators Research, World Development, Journal of Human Development and Capabilities. She is both an editor and an author of chapters in books and collections such as Lecture notes in Economics and Mathematical systems (Springer), Contributions to economic analysis (Elsevier) and Advanced studies in theoretical and applied econometrics (Kluwer Academic, Springer). She is a Fellow of the Human Development and Capability Association, an Associate Editor of the International Journal of Public Health, the Journal of Human Development and Capabilities, and a referee for several top journals. She is a member of the International Scientific Committee of COSA, the Committee on Sustainability Assessment. She has supervised several research projects in theoretical and applied econometrics, in particular in the area of modeling and measurement of well-being and capabilities in health, education, work and living conditions, in recent years. Sally Lindsay is a Senior Scientist in the Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital who leads the TRAIL (Transitions and Inclusive Environments) lab. She is also an Associate Professor in the Department of Occupational Science and Occupational

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Therapy at the University of Toronto. Her Ph.D. is in Medical Sociology and the Sociology of Work and Occupations. Her research focuses on the inclusion of children and youth with disabilities at school, work and in the community. Michelle Maroto is an Assistant Professor in the Department of Sociology at the University of Alberta. Her recent projects have focused on the causes and consequences of bankruptcy, wealth disparities in the United States and Canada, the effects of incarceration on wealth, and labor market outcomes for people with different types of disabilities. Charles E. McConnel, Ph.D. is a Professor of Health Care Sciences , and Family and Community Medicine at the University of Texas Southwestern Medical Center in Dallas, Texas. His research, teaching and publication interests are in health services research, health economics and occasionally in the medical science areas. Carolyn McDougall is an Occupational Therapist at Holland Bloorview Kids Rehabilitation Hospital. Mairead Eastin Moloney is an Assistant Professor of Sociology at the University of Kentucky. Since receiving a Ph.D. in Sociology from the University of North Carolina at Chapel Hill in 2009, she held postdoctoral fellowships in both research (2009
2011, Program on Integrative Medicine in the School of Medicine at the University of North Carolina at Chapel Hill) and teaching (2011
2013, Department of Sociology at North Carolina State University). Her research utilizes mixed methods to examine medicalization processes, patient-physician interactions, and sleeplessness, emphasizing variation by gender and age. Nceba Ndzwayiba is an organizational transformation and change specialist with Ph.D. in Interdisciplinary Studies which he completed at the University of the Witwatersrand’s Centre for Diversity Studies. He has 12 years’ experience in human resource development, organizational transformation and change, and organizational diversity. His work experience spans over the corporate and public sector including Netcare Limited, Parliament of the Republic of South Africa, Airports Company South Africa, and Services Sector Education and Training Authority. He serves on a few boards including the Health and Welfare Sector Education and Training Authority (HWSETA) Board. He is particularly interested in critical philosophy, postcolonial and decolonial thought, social and organizational justice, intersectionality with a sharp emphasis on the intersections of race, gender, sexuality, and disability. Lieketseng Ned graduated as an Occupational Therapist (B.Sc. OT, UWC) in 2009 and completed her M.Phil in Disability Studies at the University of Cape Town in 2013 focusing on livelihoods of disabled youth in rural areas. Her

About the Authors

271

passions are rural community development, Indigenous Knowledge Systems and Disability and Rehabilitation in under-resourced areas. She is a Lecturer at the Centre for Rehabilitation Studies of Stellenbosch University and is currently busy with her Ph.D. focusing on the potential relevance of indigenous knowledge within the current education system to contribute to health and well-being. She is also currently leading a research project focusing on developing a coordinated collaborative response to rehabilitation needs of persons with disabilities. Halie Peters is an Occupational Therapist working in private practice with children and families in both community and clinic settings. Her work focuses on helping children and youth with various needs achieve their personal, social and academic goals. Halie received her Masters in Occupational Science and Occupational Therapy from the University of Toronto. David Pettinicchio is an Assistant Professor of Sociology at the University of Toronto and an affiliated member of the School of Public Policy and Governance. His current work examines the relationship between political institutions, social policy and economic inequalities among people with disabilities. Elena Sarti is research collaborator at Marco Biagi Foundation – University of Modena and Reggio Emilia (Italy). She received her B.A. in Economics and Social Sciences from Bocconi University (Italy) in 2006 and her Master’s degree in Economics from the University of Modena and Reggio Emilia in 2009. She completed a Ph.D. in Labor Relations at Marco Biagi Foundation in 2013. One year before finishing her Ph.D., she was appointed as research assistant at the University of Geneva (Switzerland), where she worked for two years on a project titled “The impact of globalization on opportunities for human development.” In 2014, she was teaching assistant at the University of Modena and Reggio Emilia and research collaborator at Marco Biagi Foundation for a project on labor market access of people with mental health disorders and impact of the crisis on mental health. Her research interests are on well-being evaluation and distribution, labor economics, health economics, human development, and econometric methods for program and policy evaluation. Richard K. Scotch, Ph.D. is Professor of Sociology and Public Policy and Political Economy in the School of Economic, Political, and Policy Sciences at the University of Texas at Dallas. His research focuses on disability policy and politics and on social policy reform movements. Brianna Vice is an honors graduate of the Department of Sociology at the University of South Florida in Tampa. She received her Bachelor of Arts degree in 2015, and accepted a position with Polk County Schools as an eighth grade teacher in the Social Sciences Department at Westwood Middle School in Lakeland, Florida. Brianna presented a paper based on her honors thesis at

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the Annual Meetings of the American Sociological Society in Seattle, Washington in 2016. Douglas Waxman is a Ph.D. student in Critical Disability Studies at York University. With a focus on organizational behavior and disability policy, Douglas’s work includes a range policy research in the social, employment and disability sectors. Under the leadership of some of Canada’s top-ranked scholars, some of Douglas’s recent studies look at: How to effect corporate culture change to integrate employees with disabilities; Policy analysis of provincial welfare systems and their impact on persons with mental illness; Employers’ attitudes toward persons with disabilities; Supply and demand side barriers to employment for persons with disabilities. Prior to his doctoral program, Douglas received his Juris Doctor degree from Osgoode Hall Law School and a Masters in Public Administration from NYU’s Wagner Graduate School of Public Service. He was awarded the York Graduate Scholarship and his continuing research on employers’ attitudes in Canada has earned him an Ontario Graduate Scholarship. Douglas is the First Vice President and Chair of the Policy Committee at the ARCH Disability Law Centre. He has also devoted portion of his volunteer career to policy, with the Learning Disability Association of Ontario, where he has had roles ranging from committee member to President.

INDEX AbleData, 255 Ableist attitudes, of employees, 161 Accelerated technological change, 251 Accelerating transformation, 134 Accessibility, 250
251, 254, 255, 263 Accommodations, 168 actual and unknown costs, 172 lack of, 183 uncertainty of, 159 Activities of daily living (ADLs), 207, 214 ADLs. See Activities of daily living (ADLs) Adolescent, results of studies, 195 AHS data, 71 American Community Survey (ACS), 12, 250 American economy, 251 American Housing Survey (AHS), 37, 39 Americans with Disabilities Act of 1990, 4, 83, 158, 252, 254 Artificial intelligence (AI), 261 Asthma, 84 Autism spectrum disorder (ASD), 198 Average marginal effects (AME), 12 Awareness program, 148

Black employees, 139, 148 Business Administration, 137 Canada’s employment rate, 156 Canadian Association for Community Living 2010, 183 Canadian business leaders, 159 Census Region, 40 Center for Epidemiological Studies Depression Scale (CES-D), 213 Certificate primary school, 101 secondary school, 93, 104 Chronic diseases, 84, 112 disabilities, 91 women with, 102 Civil Rights Act of 1964, 4, 252 Climate diversity, 162 Collective beliefs, 160 Commission on Employment Equity (CEE), 129 Community inclusion, 227 Convention on the Rights of Persons with Disabilities (CRPD), 149, 165 Corporate commitment, 168 Corporate culture change, 160, 161, 168, 174 beliefs and culture, 158
163 business case for hiring persons with disabilities, 163
164 coworker attitudes, 168
171

Behavioral concerns, 159 Best practices, 157, 160, 164, 166, 168, 169, 172 Biopsychological model, 132

273

274

disability employment improvement, 173 employees, 172
173 implications for research, 174 integrating employees with disabilities, 156 leadership, from top, 167
168 methodology, 157
158 organizational values, 158
163 recruitment, 171
172 supervisor attitudes, 168
171 Corporate social responsibility (CSR), 157, 164
167 Corporate values, 162 Currently Population Survey (CPS), 6 analyses of, 8 Annual Social and Economic Supplement data, 12 descriptive statistics, 13 Demographic variables, 228 Department of Labor, 36 Depressive symptoms, 207, 209, 213, 220 partial correlation matrix, 215 structural equation model, 217 Disabilities, 84, 250
251 attitudes, 256
257 binaries, 128 bio-psycho-physio-pathology of, 147 and complexity, 258
261 definitions of, 16 and earned income, 51
52 and employment, 251 enhanced telecommunications, 255
256 experienced labor market disadvantages, 16 future of work, 261
263 gendered effects of, 8, 10
12 identification, 229
230

INDEX

increasing demands, for human capital, 257
258 inequality, 9 labor market outcomes, 7 legal changes impact/technological advances, 250 men, employment/income, 16 rights movement, 259 role of technology, 255 self-care, 40 by sex, 90 Social Model approach, 227 status, 213 structural equation model, 217 supply and demand side, 6 types of, 142 women economic inequalities, 4 employment and income, 16 equal rights and antidiscrimination legislation, 4 labor market barriers, 4 work limiting, 12 persons reporting percentage, 15 Disability awareness, 138 committees, 175 Disability Visibility Project, 23 Disabled participants report, 233 Disabled workers, 168 Discrimination, legal protections, 252 Diversity management, 161, 169 Dunedin Committee on Aging (DCoA), 228 Dunedin residents, 242 Dunedin study participants characteristics and representativeness, 229 Earned income, 37, 38, 40, 41, 44
51, 52
55, 62
66, 68
69 car ownership, 55
57

Index

children under age, 5, 52
54 demographic profile, 41
44 and disabled children, 55 Earnings employed men/women with disabilities disadvantages, 20 gaps, 4 income (See Earned income) linear regression models, 20 disability status and gender, 21
22 percent difference, by disability status and gender, 23 women with disabilities, earnings of, 210 Economic dependency, 36 Economic disadvantage, 227, 239, 240, 241, 243, 245 Economic inequality, gender/ disability, role of, 9 Economic resources, 232, 233, 239, 241, 242 discretionary spending, money for, 232 home rental vs. ownership, 233 household income, 232 mediating effects of, 242 Economic self-sufficiency, 71 Educational attainment, 15, 26, 57 Education levels, 101 and cause of daily limits, 94 EEO laws, 252 Employer preferences, 6 Employers’ attitude, 84 Employment agencies, 171 benefits of, 182 circumstances, 206 disability, 251 indicator of successful transition, 182 logistic regression models, 16

275

by disability status and gender, 17
18 rates by disability status and gender, 19 rates for women without disabilities, 16 social and economic level, 182 Employment Equity Act (EEA), 129, 130, 149 Employment opportunities, 147 Employment rates, 16, 95, 156 Employment strategies, 169 Employment trends of persons with disabilities, 141 Equal employment opportunity (EEO) policies, 252 Equity employees, 149 European Network for Corporate Social Responsibility and Disability, 166 Experience, lack of, 183 Family Employment Awareness Training (FEAT) program, 191 Federal Housing Administration (FHA), 38 Feminization of employment norms, 10 Firm size, 15 Florida, community-wide survey, 227 Functional impairment, vii, viii, ix, x, 227, 229, 230, 241, 243, 244 Gender disabilities by, 140 disadvantage of, 10
11 employment, quantitative labor market research, 8 earnings gap, 4, 23, 92 employment relations, 10 hypothesized associations, 216 as moderator, 209
210

276

supply and demand side, 6 General Managers, 167 Government employee, 15 GPS, 261 Great Recession, 36, 41 Gross domestic product (GDP), 129, 183 Guidelines for Critical Review Form
Quantitative Studies, 186 Handicapped Children Act, 256 Health care, 251 Health/disability, demographic profile, 51
52 Health problems, daily activities, 91 High school diploma, 104 Hiring persons, 171 with disabilities, 165 Households, earned income of, 52 Housing and Urban Development (HUD), 36 administrative data, 69 administrative records, 38 assisted housing, 36 programs, 38 assisted housing work, 37, 38
39 car ownership, 55 demographic profile, 41
44 demonstrations, 37 earned income for household heads, 66 economic self-sufficiency, 71 health/disability status, 65 predictors of receipt of earned income, 69 SNAP (food stamp) benefits, 58 socioeconomic status (SES), 70 young adults, 41 average educational attainment of, 41 characteristics of, 58
63 earned income receipt, predictors of, 63
67

INDEX

young householders, 53 comparison of, 53
54 Housing assistance, 39 Housing subsidy, 38 HUD. See Housing and Urban Development (HUD) Human capital, 257 IDL. See Independent living or self-care (IDL) Independent living or self-care (IDL), 14 limitation, 14 Individuals with Disabilities Education Act (IDEA), 256, 262 Information and communication technology (ICT), 253 Institutional Review Board (IRB), 228 Instrumental activities (IADLs), 207, 214 Internal human resource systems, 138 International Classification of Functioning, Disability and Health (ICF), 81, 132 capability approach, 82 Internet medium, 256 Intersectionality, 8
12 disadvantage, multiple dimensions of, 9 labor market inequalities, 8 Italian National Institute of Statistics (ISTAT), 86 ISTAT, 2004, 93 IT- SILC, 2004, 83, 92
94 Job market conceptual framework, 81
82 data source, 86
87 disability, and employment, 93
97 disabled people, sub-sample of, 103

Index

277

Knowledge gained, 194, 196, 197

impact of disability on willingness, 85 inequalities, 8 Italian data set, 81 needs, 262 outcomes, 7, 8 disability, gendered effect of, 8 outcomes of persons, 81, 82 participation, 80 research, 25 worse education, outcome of, 102 Larry Greiner’s Model, 131 Learnerships, 135, 137, 147 Legal protections, against discrimination, 252 Legislation concerning employment protection, 85 Lewin’s model, 131, 132 LGBQT status, 10 Limited awareness, 168 Linear regression models, 20 Living in Ireland Survey, 2000, 82 Location, demographic profile, 44
51 Logistic regression models, 63 Low-wage jobs, 37

Labor force participation, 4, 6 Labour force, 102 employment, 80 multinomial logit model, 89 participation, 97 willingness to participate, 82 Labour market, 10, 80, 253 activity, 10 British, 103 disability laws, implementation of, 109 disadvantage for people with mental health, 82 double discrimination, 101 full-time/part-time, 107

Management practices, 157, 161, 162 Managerial commitment, 173 Marital status, 15, 88, 101, 103, 120 Maximum Likelihood, 65
67 estimates, analysis of, 67, 69 function, 88 Medical advances, 251 Mental health, 207, 210 Mentors, 159, 170 skills of, 171 Mentorship, 197 Miami-Dade County demographic structure, 211 Miami-Dade County population, 211

multinomial/sequential logit models, 110
114 sequential logit model, for working conditions, 104
110 disabled population in Italy, 115 estimation results, probit regression model, 97
102 evidence, 89
93 Italy, legislation on disability, 85
86 literature review, 82
84 methodology, 87
89 Jobs, 263 autonomy, 207, 214, 215, 218, 221 characteristics, 209 structural equation model, 217 choice, 8 composition and educational requirements of, 253 creativity, 214, 218, 221 market (See Job market) placements, in labor market, 199 position, for disability people, 96 switch, 253

278

Miami-Dade County residents, 211 Mobility, 11, 40, 84, 87, 90, 93, 103, 115, 157, 214, 253, 255, 256, 258, 260, 263 Mobility impairments, 87, 90, 255, 256 Modern discrimination, 5 Mplus software, 214 Multidisciplinary vocational rehabilitation intervention, 191 Multinomial logit model, 110, 111
112 alternative, 113
114 Multinomial logit tree, 110, 113 Multiple disabilities, 6, 9, 12, 14, 16, 20, 22, 24 Multiple regression, 240 National Health Interview Survey (NHIS), 12 National Longitudinal Transition Study of Special Education Students, 71 National Qualifications Framework (NQF), 137 Netcare, 139 case study, 134 disability integration program, 144 draft disability strategy, 135 education, 148 processes, 131 New York City, 39 Nondisabled group, 84 Nondisabled people, in strict sense, 92 Non-Hispanic black/white, 13, 15, 18, 21, 211, 214 Non-standard work arrangements, 7 Occupational therapist, 189, 191 OECD countries, 85

INDEX

Online survey, 228 Ordinary least squares (OLS) regression, 12 Organizational citizenship behaviors, 160 Organizational culture, 145
147, 161, 260 Organizational development (OD) model, 131 Organizational justice, 144, 145 Participation, in social recreational, 227 Partnerships, 138 Partnership status, 231 who do/do not identify, as disabled, 236
237 with/without functional impairments, 234 Part-time employment, 107 Physical disabilities, 207, 208, 209, 210, 212, 215, 218
221. See also Vocational intervention future research, 200 limitations, 199 participant characteristics, 187 review of, 198
199 skills/knowledge gained, 197 studies characteristics, 187 characteristics/overview of, 188 results of, 194
196 vocational intervention characteristics, 187 vocational programs common components of, 192
197 employment achievement, 197 employment, knowledge/ perceptions of, 198 youth, vocational interventions, 182

Index

Physical impairments, 141 Physical/mental disability, 82 Planned behavior theory, 158 Poverty, 36
38, 40, 129, 146, 253 AHS data, 71 deep, 41 Great Recession, 41 for women, 10 Predicted probability, 12 Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA), 184 Pre-labor market inequalities, 26 Pre-work training, 172 Principles on Business and Human Rights, 165 Probit models, marginal effects, 99
100 Probit regression model, 97 PsychInfo, 184 Psychological disabilities, 170 Public assistance, 5 Public Housing Authorities (PHAs), 37, 38 admission policies, 71 Public policies, 259 Quantitative labor market, 8 Race, 5, 9, 25, 26, 63, 64, 68, 70, 128, 133, 136, 139, 140, 146, 148, 161, 210
214, 217, 228, 243, 252 disabilities by, 140 ethnicity, 214 Reasonable accommodation, 142, 143 Recruiting policy, 171 Rehabilitation Act of, 1973, 252, 256 Rental housing, 45, 51 Response, categories, 232 Retention rates per program, 137 Rust Belt, 71

279

Safety, pre-employment training, 173 Scholars interest, 9 Scopus, 184 Search terms, overview of, 186 Self-sufficiency, 36, 37 economic, 36 Self-sufficiency programs, 70 SEM analysis, 216 Senior management, 167 Sensitive groups, 162 Sensory, 87 limitations, 16 Sequential logit model, 88, 89, 97, 104, 105
106 multinomial, comparison, 110
114 for working conditions, 104
110 Sequential logit tree, 88 alternative, 107
109 Siebers theory, 133 Sinako initiative, 145 Sinako Project, 137 Skilled labor, 258 Skills, 197 employment-related, 198 through learnerships, 147 Skills Development Act (SDA), 129, 130 Smart phones, 261 SNAP (food stamp) benefits assistance, 44 housing and urban development, 58
60 program, 70 Social activities, 182 Social disadvantage, 227 Social inclusion, 233, 241, 242 level of social/recreational/ community participation, 231
232 mediating effects of, 241, 242 partnership status, 231 perceived stigma, 232 Social interaction, 170

280

Socializing, with friends/neighbors, 231 Social justice, 128 Social model, 81, 244 approach, to disability, 227 claims, 227 of disability, 226, 258 Social participation, 262 Social practices, 9 Social relationships, 169, 182 Social responsibility, 128 Socioeconomic disadvantage, 8 Socioeconomic status (SES), 70 South Africa democratically elected government, postcolonialpost-apartheid, 129 Integrated National Disability Strategy, 130 with Netcare, 138 South African organizations, 147 South African Qualification Authority’s (SAQA), 137 SSSI eligibility, 83 Stereotyping, 168 Subjective well-being, 227, 230
231, 233, 240, 241, 242, 243 Survey of Income and Program Participation (SIPP), 39 Systematic review process, flow of studies, 185 Tech Act, 255 Technology Assistance for Individuals with Disabilities Act of 1988, 255 TedWomen Talk, 5 Time limits, 71 Total household income, 239

INDEX

Training applicants, 172 to develop employable skills, 183 employment or vocational, 184 Transformational leadership, Netcare CEO, 145 Transition probabilities, 81 t-tests, 233 Turkish hospitality industry, 163 Uberization, 251 Uber’s smartphone app, 251 United States institutional, demographic and economic changes, 252 post-industrial information-based economy, 250 technological innovation, 251 US Business Leadership Network’s Disability Equality Index, 166 U.S. Census Bureau, 250 US Census estimates from 2010, 206 University degree, 104 Variables, 12, 14, 16, 19, 20, 38, 62, 64, 65, 68, 70, 80, 83, 89, 97, 98, 101, 103
105, 110, 112, 211, 213
215, 227
229, 233, 238, 240, 244, 259, 260, 263 description, 98 explanatory, 98 Vocational agencies, 173 Vocational interventions, 183, 186. See also Physical disabilities characteristics, 187 search terms, overview of, 186 study characteristics, 187

Index

vocational programs common components of, 192
197 employment achievement, 197 employment, knowledge/ perceptions of, 198 Vocational programs, 198 Vocational rehabilitation program, 189
190 physical disabilities, youth, 182 Voluntary transition, 7 Wage gap, gender, 4 Washington Group Series, 230, 244 Web of Science, 184 Welfare, demographic profile, 51
52 Well-being, 227 participants who do/do not identify, as disabled, 236
237 participants with/without functional impairments, 234 psychological, 208, 209 analytic strategy, 214
215 covariates, 214 depressive symptoms, 213 disability status, 213 functional limitation, 213 gender, 214 job autonomy, 214 job creativity, 214 limitations of, 220, 221 measures, 213 study procedures/sample, 210
212 work characteristics, 218, 219 subjective, 230
231, 240, 241, 242, 243, 245

281

WGS functional impairments, 238, 239 functional limitation, 233 Windows, 95, 256 Wisconsin Center for Education Research, 260 Within-group disparities, 9 Women experience, disadvantages, 7 Work characteristics, 216, 218 supply and demand side, 6 work-effort, 6 Workforce access, 263 Workforce participation, 231, 233, 250, 252, 260 Workforce risks, 253 Working conditions, 209, 210, 212, 219, 220, 221 Working environments, 85 Working hours, by sex, 95 Working situations, 88 Work, in post-industrial society, 252
254 Work-limiting disabilities, 12, 14, 19, 20 percentage of persons reporting, 15 Workplace, disability inclusion complexity definition, 132
134 implications for practice, 149
151 Lewin’s change model, 132 methodology, 130
131 Netcare case, 134
149 contradictions of, 144 disabilities, types of, 139
144 education and awareness program, 148 monitoring/evaluation, 138
139

282

persons, challenges limiting employment of, 135
136 question of intersectionality, 148
149 refreezing, 139 transforming, 137
138 unfreezing, 135 policy-practice gaps, 130 postcolonial-post-apartheid South Africa, 129 social justice issues, 128 Workplace discrimination, 244 Work requirements, 71 Work schedules, 254

INDEX

World Health Organization’s (WHO), 130, 156 World Health Survey, 156 Young Millennials, 70 Youth with disabilities, 182 with physical disabilities, 182, 183 survey participants, 238 vocational interventions with physical disabilities, 182