A Mega-Ethnography of Qualitative Meta-Syntheses on Return to Work in People with Chronic Health Conditions.

PURPOSE: The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies. METHODS: We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings. RESULTS: Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model. CONCLUSIONS: RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual's life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one's own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person's working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.

Preventing a Scarring Start into the Labor Market: Integration Strategies for Young Persons with Disabilities.

PURPOSE: Sociodemographic and structural conditions have consequences for the labor market participation of young persons with disabilities (YPWD) in vocational rehabilitation (VR). As the type of program determines the labor market chances, we analyze the processes of selecting active labor market programs (ALMP) in VR. Which factors determine the allocation to (1) programs in general and (2) moreover, the allocation to specific programs? MATERIALS AND METHODS: We conduct logistic (1) and multinomial regression (2) using register data of the German Federal Employment Agency. Besides variables on the micro level, we control for a wide range of structural and organizational influences. The sample comprises VR and employment biographies of 255,009 YPWD accepted to VR between 2010 and 2015. Program participation is restricted to start 180 days after VR acceptance. RESULTS: Sociodemographic factors, like age and the status before entering VR as well as the local apprenticeship market as a structural condition, highly influence the general allocation to ALMP. For the allocation to specific ALMP, sociodemographics (age, education, type of disability, status before entering VR) are highly relevant. Furthermore, structural conditions (regional structure of subsidized vocational training and of the apprenticeship market as well as local work possibilities on a special labor market for PWD) and - to a lesser extent - re-organization processes at the FEA (NEO, VR cohort) are important determinants. CONCLUSION: (Automatic) paths into VR programs for especially persons with mental disabilities in sheltered workshop are clearly shown. Furthermore, it is somewhat questionable that YPWD participate more often in sheltered workshops in regions where sheltered work possibilities are more common, as well as where NEO was implemented locally; and participate more often in company-external vocational training where VR service providers are commissioned to a greater extent.

[Challenges and Adaptation Strategies of Service Providers in Vocational Rehabilitation - A Mixed-Methods Analysis]. / Herausforderungen und Anpassungsstrategien von Leistungserbringern in der beruflichen Rehabilitation ­ Eine gemischt-methodische Analyse.

AIM OF THE STUDY: The aim of this study was to identify current challenges faced by service providers (SPs) as well as those likely to arise in the future and the coping strategies to deal with them. Challenges are requirements externally imposed on the SPs and perceived by them as central to their work. We focus on SPs that offered disability-specific programs financed by the Federal Employment Agency in December 2016. METHOD: The study is based on a mixed-methods design. In summer 2017, a quantitative online survey of SPs (n=266) was conducted, as well as in-depth qualitative guided interviews (44 representatives at 32 SPs) until mid 2019. Factor analysis (STATA) and analyses in the sense of Grounded Theory (MaxQDA) were carried out. RESULTS: The experts at the SPs addressed three main challenge contexts or types: 1. competitive framework conditions (such as decreasing numbers of participants, increasing price competition or rising cost pressure), 2. changes in the structure of participants (such as decreasing educational competencies, more participants with behavioral problems, mental illnesses or multiple disabilities) and 3. changing demands of the labor market (such as increasing importance of computer-based activities, higher demands on qualifications or decrease in simple tasks). For the first two types, SPs had clear and overarching strategies. For example, SPs responded to the first type by changing their facility portfolio or opening up to target groups. Concerning the second type, SPs responded - according to their specific contexts of action - with further training of the staff, arrangement of permanent positions or hiring of new staff (especially psychologically trained staff) as well as negotiations with the financers of vocational rehabilitation. The third type, however, presented a very broad picture with few clear, tangible, overarching strategies. In general, SPs also looked upon financers as having an obligation to further optimize the rehabilitation process, in particular, to adequate allocation of programs and the provision of more flexible and individualized program concepts. CONCLUSIONS: There is no one-size-fits-all response to current and future challenges. However, the COVID-19 pandemic has shown that strategies for expected developments - such as the need to further develop digitization - must not be put on the back burner.

Unemployment due to the SARS-CoV-2-pandemic among people with and without severe disabilities: a difference-in-differences analysis.

OBJECTIVES: Unemployment reduces health and impairs participation in important areas of life, especially for people with severe disabilities, who tend to have a longer duration of unemployment and are less likely to find new employment than their counterparts without such constraints. Our analysis examines the increase in unemployment due to the SARS-CoV-2 pandemic among people with and without severe disabilities in Germany. METHODS: Monthly cross-sectional data on unemployment for 2019 and 2020 were provided by the Federal Employment Agency. We used a difference-in-differences model to estimate the increase in unemployment attributable to the pandemic. The months April to December 2020 represented the months of exposure to the pandemic. Incidence rate ratios (IRRs) are reported. RESULTS: The increase in unemployment among people with severe disabilities due to the pandemic is 11.2% (IRR 1.112; 95% CI 1.107 to 1.117). People with severe disabilities receiving unemployment benefits due to unemployment lasting less than a year (Social Code III: short-term unemployment) and women have been most affected. Among people without severe disabilities, unemployment has increased by 24.8% due to the pandemic (IRR 1.248; 95% CI 1.246 to 1.249), while people receiving unemployment benefits according to social code III and men have been most affected. Both groups show a varying increase in unemployment depending on the region of residency. CONCLUSIONS: The findings show a particularly significant increase in unemployment among people without severe disabilities. People with severe disabilities might be less impacted due to the special legal protection against their dismissal. The clear regional differences in the increase in unemployment suggest a strong influence of regional economics.

Vocational Rehabilitation of Young Adults with Psychological Disabilities.

Objective Vocational rehabilitation measures support youth and young adults with disabilities to obtain vocational training and to enter the labor market. In Germany, a growing number of young people with psychological disabilities in vocational rehabilitation can be observed. The study at hand focuses on this group and examines their (un-)unemployment biographies before vocational rehabilitation, their access to vocational rehabilitation and identifies their individual challenges within the process of vocational rehabilitation. Methods Using a multi-methods approach, we analyze representative administrative data of the German Federal Employment Agency as well as biographical interviews conducted with young rehabilitants. We compare the population of young rehabilitants with psychological disorders to those with other disabilities in terms of vocational rehabilitation and initial labor market entry in order to get a representative picture about their school to work transitions. Since rehabilitants with psychological disabilities tend to be older than the remaining population, analyses are stratified by age groups. In addition, qualitative in-depth interviews provide an additional and deeper understanding of specific employment barriers youth with psychological disorders have to overcome. Furthermore, the individual perspective gives insight on how the crucial transition from school to work is perceived by the population under study. Results The pathway into vocational rehabilitation of youth with psychological disorders is often characterized by obstacles in their transition from school to work. During rehabilitation, it appears essential to provide psychological stabilization along with vocational training. Although their average level of education is higher than those of other rehabilitants, labor market transition after (often company-external) vocational training challenges many young people with psychological disabilities, leaving many of them with comparatively poor labor market prospects. Conclusions Young persons with psychological disabilities, who come from regular schools or dropped out from regular school or university, seem to find their way to vocational rehabilitation more indirectly. Furthermore, vocational rehabilitation itself is often prolonged for those with psychological disabilities possibly due to a corresponding stabilization process. However, vocational rehabilitation can be a core element within the stabilization process of a psychological disease.

[A Longitudinal Study on Labour Market Transitions and Sustainability of Employment After Further Training Measures in the Context of Vocational Rehabilitation]. / Eine Längsschnittstudie zu Arbeitsmarktübergängen und Beschäftigungsnachhaltigkeit nach beruflichen Weiterbildungsmaßnahmen im Rahmen von Leistungen zur Teilhabe am Arbeitsleben.

OBJECTIVE: The study examines employment prospects of persons who participate in further and re-training measures in the context of vocational rehabilitation in the responsibility of the Federal Employment Agency (FEA). METHODS: Using administrative data of the FEA (RehaPro), we focus on persons completing vocational rehabilitation between 2009 and 2012 (N=21,772). We employ event history analysis to present time and extent of employment transition and their sustainability. By using multivariate analyses, factors for taking up employment are identified. RESULTS: Within 500 days, 70 % of promoted persons gain contributed employment, often directly after rehabilitation. The median for employment duration within the observation period is 670 days. CONCLUSION: Further training measures are an important opportunity for the re-integration of persons with health limitations in the labour market.

[Vocational Rehabilitation - Comparing Clients of the Federal Employment Agency and the German Pension Insurance]. / Leistungen zur Teilhabe am Arbeitsleben ­ Rehabilitanden der Bundesagentur für Arbeit und der Deutschen Rentenversicherung im Vergleich.

OBJECTIVE: The Federal Employment Agency (Bundesagentur für Arbeit, BA) and the German Pension Insurance (Deutsche Rentenversicherung, DRV) are the major institutions responsible for vocational rehabilitation (VR) in Germany. The following paper compares the characteristics of persons in vocational rehabilitation and the utilization of rehabilitation services between those two institutions and presents short-term developments. METHODS: Administrative data of the BA and the DRV were made comparable. The study analyses persons who have completed VR between 2011 and 2015. RESULTS: We observe an increased use of VR services for both the BA and the DRV. Furthermore, the results show an absolute and proportional increase in persons being employed at the time of approval of VR and in persons receiving technical assistance. The clients of the BA are younger and better educated than the clients of the DRV. The clients of the DRV are more frequently employed at time of approval and receive mainly technical assistance. CONCLUSIONS: Though due to different regulatory responsibilities, BA and DRV clients in VR differ particularly in age, we observe comparable developments in the populations addressed and the interventions provided.

Labour Market Status and Well-Being in the Context of Return to Work After Vocational Rehabilitation in Germany.

INTRODUCTION: Although there is much empirical evidence for a given relationship between health and labour market status (LMS), the following study focuses on a group for which little is known in the German context: people with disabilities in vocational rehabilitation for the purpose of re-integration into the labour market. In this specific context, the article analyses how a change in LMS affects physical, mental and general health. METHODS: Using a panel survey, 857 people with disabilities in vocational rehabilitation and their subjective health condition were observed between 2008 and 2010. To reduce bias due to unobserved heterogeneity, fixed-effects panel regression is applied. RESULTS: Results show that a move from non-employment to employment positively affects-particularly general-subjective health. In addition to LMS, the level of occupational limitation due to disability appears to be of particular relevance in estimating health. Interacting both the level of occupational limitation and LMS reveals that non-employed people reporting serious occupational limitation due to their disability have the worst subjective health across all aspects. However, people in employment experiencing similarly serious limitations due to their disability do not differ much from this group. These may be regarded as having taken up disability-inappropriate employment. CONCLUSION: The results suggest that re-integration into employment particularly improves several health aspects if rehabilitants are integrated in an occupational environment where disability does not present an occupational limitation. Thus, placement in disability-appropriate employment needs to be particularly encouraged.

Employment effects for people with disabilities after participation in vocational training programmes: A cohort analysis using propensity score matching.

BACKGROUND: Vocational rehabilitation (VR) aims to help people with disabilities to return to the labour market. Though, there is not much evidence on its effectiveness. OBJECTIVES: We explore the effect of vocational training programmes in VR and the VR status itself on employment outcomes. METHODS: Using two samples from administrative data by the German Federal Employment Agency, we applied propensity score matching. We followed rehabilitants commencing VR in 2009/2010 (N = 7,905) for four years (comparison I) and general training participants with and without VR status completing training in 2012/2013 (N = 21,020) for one year (comparison II). For harmonisation purposes, we only considered individuals aged between 25 and 40 and excluded those in employment at the beginning of VR or training. RESULTS: Concerning the effect of training in VR (comparison I), we observe a lock-in effect during training (p < 0.001) due to an involvement in VR; after training, participants are more likely to obtain unsubsidised employment (0.05, p < 0.05) than non-participants, but there is no statistically significant income difference after four years. Regarding the effect of the VR status (comparison II), rehabilitants are more likely to take up (un-)subsidised employment (0.04, p < 0.01; 0.02, p < 0.001) after training, exhibit longer employment durations (19 days, p < 0.001) and achieve higher average incomes (2,414 euro/year, p < 0.001) compared to non-rehabilitants. CONCLUSIONS: Training participation helps to improve employment participation of rehabilitants. However, a longer observation period is recommended. Furthermore, the VR status itself leads to more sustainable and better-paid employment. This is due to more comprehensive support and longer-term subsidised employment opportunities.

Typical school-to-work transitions of young adults with disabilities in Germany - a cohort study of recipients of vocational rehabilitation services after leaving school in 2008.

PURPOSE: In Germany, vocational rehabilitation (VR) for young people with disabilities (YPWD) aims to counteract disadvantages on the training and labour markets. However, the school-to-work transitions (STWT) among YPWD are underexplored. This study investigates to what extent and for whom VR provides an institutional bridge into employment. MATERIALS AND METHODS: Based on representative administrative data of the German Federal Employment Agency, young people in VR are observed for 6.5 years after completing lower or intermediate secondary education in 2008. Using optimal matching and cluster analysis, six typical STWT trajectories are identified. RESULTS: Most of the YPWD completed company-external vocational training, some undertook regular in-firm training. These forms of training often lead to regular employment, albeit with a delay for some. Other young people are guided from training in sheltered workshops into sheltered employment. Another group exhibits problematic STWTs in which recurring unemployment and (non-training) programmes fail to lead to training or employment. CONCLUSIONS: VR combined with in-firm or company-external vocational training can facilitate the STWTs of people with disabilities. However, individuals from poor families are less likely to benefit from VR. Similarly, restricted capabilities and problematic STWTs are observed when young people drop out of VR due to poor cooperation.Implications for rehabilitationVocational training often is a prerequisite for labour market entry; however, if the structural conditions on the local labour market are unfavourable, young people with disabilities do not take up employment.Training within sheltered workshops often leads to highly institutionalised trajectories that should be reconsidered to permit greater permeability into the regular labour market.As young people with problematic STWT more often come from poor households, they should be targeted to a greater extent in the context of VR counselling.