Abstract
Purpose of Review
To explore transition to employment and social enterprise (SE) models for people labeled with intellectual and developmental disabilities (IDD), assess the benefits and drawbacks of SEs, and discuss the potential implications for realizing the United Nations Convention on the Rights for Persons with Disabilities (UNCRPD) in international contexts.
Recent Findings
Although the UNCRPD promotes employment as a human right, people labeled with IDD continue to experience barriers to labor market participation. Sheltered workshops and supported employment are common paths to employment. SEs are alternatives that are driven by a mission or cause that benefits the community.
Summary
SEs can address issues of unemployment and social exclusion of people with IDD. Drawbacks include limited transition to paid positions, lack of public awareness of their purpose, and unclear implementation guidelines. SEs can help in contexts where disability services are less developed, provide opportunities to challenge negative perceptions of disability, and promote inclusion and access to employment for people labeled with IDD.
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Introduction
Employment is considered a marker of adulthood. In most industrialized nations, labor market participation and financial independence are generally expected as part of adult life. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes employment as a human right and the rights of persons with disabilities to work “on an equal basis with others” [1]. However, disabled people,Footnote 1 particularly adults labeled with intellectual and developmental disabilities (IDD), continue to experience barriers to labor market participation. Examples of barriers include inadequate training, lack of ongoing support, employer and coworker discrimination, as well as finding and maintaining a job [2, 3•, 4]. There are a variety of efforts to address these barriers, such as disability accommodations in the workplace, job coaching, and training programs to prepare adults labeled with IDD with employment skills. Sheltered workshops, supported employment, and social enterprises are models that aim to promote skills and knowledge in preparation for transition to employment for adults labeled with IDD.
Sheltered workshops are specialized employment centers that provide task-specific training, prevocational services, and placement support, while supported employment provides ongoing individualized support or supervision in an integrated work setting, meaning integrated with nondisabled people [5••, 6]. Such settings come with benefits, but also some drawbacks. For example, sheltered workshops are characterized by low pay and task-specific training that is difficult to generalize to the open labor market (i.e., typical work environments without supports or day services). Supported employment is challenging to find and disabled people often experience workplace discrimination, including hiring bias, lower pay, dismissive language, pity, and paternalistic behaviors [5••, 7••]. Ideally, adults labeled with IDD find and maintain employment that provides them with income for the necessities of daily life and have a supportive work environment. Social enterprise (SE) models are alternatives that can address these drawbacks of sheltered and supported employment. Yet, they may also come with unique challenges and opportunities for supporting the transition to employment for people labeled with IDD.
In this review, we summarize literature on transition to employment for adults labeled with IDD and current employment models that can support their transition to open market employment. We then focus on reviewing the proposed aims of SE models, assessing the benefits and drawbacks related to transition to employment for people labeled with IDD, and consider the implications of adopting this model across international contexts toward realizing the UNCRPD.
Approach to This Review
Our literature search, selection, and review were informed by steps associated with the critical interpretive synthesis approach proposed by Dixon-Woods et al. [8]. This approach differs from other forms of knowledge synthesis, such as scoping or systematic reviews, with respect to the process of text selection, data extraction, and analysis. The literature sources were chosen based on the degree to which the objectives and aims aligned with our review aims, and included peer-reviewed, scholarly, and grey literature publications, such as journal articles, book chapters, reports, and websites. Our search strategy involved a web search of Google Scholar and database search of PubMed and the University of Toronto library using keywords. Combinations of keywords included: disability and social enterprise, employment and IDD, transition to employment and IDD, and IDD and social enterprise. The results of each web or database search were combined and duplications removed, which gleaned 83 sources (41 focused on the transition to employment + 42 on SE = 83 sources total). Abstracts and introductory texts to book chapters, reports, and websites were scanned for relevance to our review questions and included based on the following criteria: (1) focused on IDD specifically or was relevant to IDD even if focused on disability more broadly; (2) provided information about SEs and/or transition to employment; (3) in English; and (4) shed light on cultural or sociopolitical considerations. After applying these criteria, 29 sources remained that focused on SE, transition to employment, and IDD.
The literature for this review was published between 1999 and 2022 and included both empirical and conceptual articles, literature reviews, book chapters, employment reports, and websites from health sciences, social sciences, economics, and public policy. To address the review aims, key information and data was extracted from the texts and cataloged on a chart (e.g., title, author(s), date, location, study design, target group, social enterprise description, transition from/to, outcomes, criticism). The first author reviewed and extracted the data, entering notes on the chart, which included relevant text from the literature as well as reflections and ideas related to the questions guiding this review, such as benefits, drawbacks, and implications for application across international contexts. The first and second authors met to review the chart and discuss key ideas identified across the literature and reflect on assumptions about employment and the purposes of SE for people labeled with IDD. A series of questions guided our discussions and analysis: How are SEs implemented for people labeled with IDD as a form of transition to employment? What are the outcomes, benefits, and drawbacks of this model? Does it look different in different cultural/political contexts?
Modifications to Dixon-Woods et al.’s [8] proposed steps for conducting a critical interpretive synthesis were made based on the review aims. The step of determining quality of sources was not included as our aim was to explore how the concept of SE was described and represented in the literature. The following steps were taken for this review: (1) formulated the review questions, (2) searched the literature, (3) selected the sample of literature, (4) extracted the data, and (5) conducted the analysis. Refining the review questions was an iterative process as new ideas arose during data extraction and analysis. The review questions evolved with the review.
Results
Models for Transition to Employment for People Labeled with IDD
The right to employment for people labeled with IDD has been recognized internationally through the UNCRPD. This is one of the most widely accepted conventions in UN history; nearly, all UN member states have signed and ratified the UNCRPD [9]. Nevertheless, the global employment rates for people labeled with IDD are estimated to be three to four times lower than for people without a disability. People labeled with IDD are more likely to be unemployed and for more extended periods of time than nondisabled people [10,11,12,13]. This is significant because decreased participation in the labor market can negatively impact quality of life, leading to poverty, social exclusion, low self-esteem, and poor health [12, 14, 15•].
There are several social and structural factors contributing to this low employment rate, including employers’ negative perceptions about disability and disabled people’s capacities to contribute in the workplace, limited employment options that provide training and ongoing support, complexities in finding and maintaining a job, health issues having an impact on consistent working hours, and income restrictions to avoid loss of government disability benefits and subsidies [2, 3•, 4, 5••, 6, 15•, 16•, 17]. People labeled with IDD are more likely to be employed in segregated settings such as sheltered workshops or supported employment [4, 11, 15•].
Sheltered workshops are “designed to rehabilitate and train [disabled people] to enter the workforce” [7, p. 227]. They often involve repetitive work (e.g., folding, sorting, labeling), which has been criticized for consisting of meaningless tasks resembling a production line [4, 7••, 15•]. However, some employees, such as autistic employees, may prefer the repetitive nature of how work is structured in these settings [7••]. Sheltered workshops are also characterized by low wages because they are seen as a supplement to government subsidies rather than full income [4, 5••, 15•, 16•, 18]. Sheltered workshops are also criticized for segregating disabled people from nondisabled people and perpetuating community exclusion. On the other hand, Weikle [19] argues that sheltered workshops can be a positive setting bringing together people with similarities to foster friendships, which can be more challenging to foster in other forms of employment, such as supported employment [2, 15•].
Supported employment is another model for promoting the transition to labor market participation for people labeled with IDD. Supported employment provides training for specific tasks, accommodations, and ongoing support within a mainstream job [6]. This type of employment offers equal wages to nondisabled peers, more hours, and specialist support to find and maintain their jobs [13, 20]. It has been linked to improved quality of life, social belonging, and self-esteem for people labeled with IDD in comparison to those working in sheltered workshops [2, 4, 15•]. However, disabled people in this environment can also experience negative attitudes, segregation, and discrimination from nondisabled employers and coworkers, dissatisfaction with entry-level positions, and limitations in advancing within the company [4, 7••, 15•]. Supported employment has also been criticized by Lysaght et al. [6] for failing to meet the distinct needs of this population, as the nature and extent of supports for people labeled with IDD can vary greatly.
While other forms of employment exist for people labeled with IDD, such as self-employment, microenterprises, social entrepreneurship, apprenticeship, and traineeship [15•, 17, 21], this review focused on SEs as an alternative model. SEs have been used around the world (Canada, USA, England, Australia, Armenia, Hong Kong, South Korea, Spain, Italy, etc.) as a path to employment for disabled people more broadly, although they are less common for people labeled with IDD [4]. SEs can address the issues of unemployment and social exclusion experienced by people labeled with IDD, while combining the benefits of sheltered workshops and supportive employment [15•, 22].
What Are Social Enterprises and Their Aims?
A social enterprise (SE) is a business that is driven by a social mission or cause to benefit the community through the production and provision of goods and/or services [4, 10]. SEs utilize a commercial approach to making monetary profits while at the same time creating jobs and achieving social goals [6, 21, 22, 23•, 24]. The target groups for employment are not always specified, and may differ, but the overarching aim is to create opportunities for marginalized groups (i.e., racialized communities, women, disabled people) to enter the labor market [10, 22, 23•, 25]. Some authors also refer to this as work-integrated social enterprise (WISE) models [6, 26]. Regardless of the target employees, the SE model includes skills training, such as managing phones and pricing items [4, 6, 15•]. Some SEs also provide social services, such as therapy or remedial education, to their employees [24, 25]. One example of a SE for people labeled with IDD is the Aregak Bakery in Armenia [27]. Their mission is “to break down barriers by raising awareness of the rights of people with disabilities and modeling inclusive employment practice” [28]; thus, their SE goal is social transformation to address disability stigma. The Bakery employs adults labeled with IDD who previously attended their rehabilitation center. The employees participate in an education course that provides tools to succeed in the workplace, strategies to maneuver the labor market, as well as training in baking and service skills, which provides them with opportunities for meaningful occupation within the SE and for future employment, and contributes to community life.
Benefits of SEs
SEs combine the positive aspects of both sheltered workshops and supported employment [15•]. Like a sheltered workshop, SEs provide a supportive environment, training, and skill development with the benefits of competitive incomes and social integration that are linked to supported employment settings [4, 15•, 25, 29]. For example, Meltzer et al. [4] found that employees labeled with IDD felt more comfortable disclosing their support needs and trusted their employers in SEs; they viewed SEs as “particularly supportive” [4, p.236] in their qualitative study that compared experiences across Australian SEs, sheltered workshops, and supported employment. Unlike sheltered workshops, however, SEs also involve the benefits of interactions with community members and being involved in meaningful work connected to a social mission [4]. There are several examples of these benefits in the literature. For example, an investment report by Durie and Wilson [29] from one of the UK’s leading SEs found that disabled employees reported having improved wellbeing and social connectedness. Lysaght et al.’s [6] cross-case analysis of successful Canadian SEs for workers with IDD found that some SEs included their employees in decision-making processes, such as hiring, scheduling, and developing products and policies, which supported their entrepreneurial skill development. Thus, employees with IDD benefit from developing skills that can be carried over to other jobs and employment opportunities. Meltzer et al.’s [4] also found that people labeled with IDD in SEs had higher job retention and job satisfaction compared to sheltered workshops and supported employment. Thus, SEs can have psychosocial benefits for people labeled with IDD and promote their successful employment outcomes.
Drawbacks of SEs
Most drawbacks of SEs are related to their structure and operations. Meltzer et al. [4] found that SEs can have limited paid roles and employees can get stuck in training positions or experience long wait periods for a paid position. This drawback was often related to the business still being under development and not having the capacity to hire more employees right away [4]. Interestingly, some employees in their study reported that they enjoyed the work environment so much that they were willing to wait for a paid position. Meltzer et al. [4] also noted that a disabled employee may get temporarily bumped from the work schedule if a nondisabled peer needs training or needs to start in an entry level position. This practice suggests that the work and training of nondisabled employees may be prioritized or valued over the work and training of disabled employees in SEs. Thus, disabled employers can be disadvantaged in advancing to paid positions and can experience gaps in their employment; this has consequences for regular income and daily work routines. Hall and Wilton’s [10] critical examination of alternative work spaces for disabled people suggested that SEs employing disabled people may “… be faced with the challenge of balancing a commitment to employ people with more significant impairments with the need to satisfy the pressures of a broader market economy” [p. 874]. Such financial challenges call into question the sustainability of SE models. The social mission to decrease unemployment and social exclusion of disabled people may be at odds with commercial objectives [10]. However, the growth of SEs within the economic sector can potentially address this tension by supporting both employment of disabled people and commercial success [4].
An important critique of the SE model is that there are no concrete best practice guidelines or requirements, resulting in various models for SEs globally [6, 15•]. This makes it difficult to compare and measure outcomes, and to ensure that the SE is abiding by fair and inclusive practices [6]. Many sheltered workshops are rebranding themselves as SEs to address criticisms that sheltered workshops perpetuate segregation and fail to promote ideas about disabled people as active members of society who deserve equal salaries [6, 18]. However, this makes it difficult to distinguish the two models [30]. Along these lines, Morera et al. [31] described sheltered workshops as a type of SE. The distinction between models is ambiguous to the general public; some may confuse SEs with a standard commercial business while others may view it as a charity, devaluing its role in the mainstream market [4, 30]. Nevertheless, Meltzer et al. [4] noted that “business/market development and workplace change” [p. 237] can address these challenges.
SEs and Transition to Employment
Literature has shown that transition to the labor market for disabled employees is an outcome of some SEs [e.g., 4, 6, 21, 23, 26]. Spear and Bidet [26] found that disabled employees from SEs had better employment outcomes than those not involved in SEs. Chui et al. [23•] found that some disabled employees were able to transition to the open market from SEs. However, they also found that employees were often hesitant to leave an SE setting out of fear of not being able to find another supportive environment; thus, most returned to the SE after attempting to work in the open market [23•]. They criticized SEs for the inability “to achieve more permanent forms of inclusion or integration in the open market” [23, p.15]. According to Caldwell et al. [21], successful disability employment “refer[s] to individuals who have gained and retained integrated and competitive employment” [p. 206]. Yet, in a study by Lysaght et al. [6], some employees with IDD were unsuccessful in their transition to the mainstream labor market due to “general lack of suitable employment” [p. 26]. Additionally, the high level of social connectedness and belonging experienced in SEs resulted in some families advocating for their family members labeled with IDD to remain at (rather than leave) the SE [6]. As their family members generally experienced challenges with transitions, staying at the SE helped to avoid routine disruption and social instability [6]. High job satisfaction at a SE also contributed to low transition rates because some employees simply did not want to work elsewhere [4]. Thus, SEs may be a stepping stone to labor market participation for some people or the end goal for others. SEs can serve different purposes for different interests and needs.
Implications for SEs Internationally
Successful SEs are often viewed as those that promote independence and self-sufficiency amongst their employees [24]. These notions are very closely aligned with neoliberal ideologies, such as individualism and productivity [25], that underpin Western societies and the history of SEs, as they originated in USA and Europe [32]. What then are the implications of the SE model for non-western societies? Garrow and Hasenfield [24] criticized SEs for promoting neoliberalism “…because they express the dominance of market logic and the importance of the work ethic as guiding principles in integrating the poor and the vulnerable into society” [p.1476]. Kim [25] suggested that a nation’s policies will shape the version of the SE model when embedded in international contexts. Thus, local context, values, and beliefs about employment and disability need to be taken into consideration when adopting SE as an employment option for disabled people. For cultures that value financial independence, career advancement, and making a high income, SEs may not be a helpful model because some adults labeled with IDD experience challenges achieving independence in employment. People labeled with IDD who do not achieve or have challenges achieving the goal of independence in open labor market participation may feel devalued in societies that place high value on individualism and productivity as markers of adult citizenship. Supported employment, self-employment, microenterprises, and entrepreneurship can be alternatives to SEs, although these other models are more easily achieved in high-income countries with existing networks of disability support [13, 15•].
SEs can be beneficial in contexts where disability services are not very developed [10], as demonstrated in the Armenia example. If a society does not have the infrastructure to be able to support disabled people into the open labor market, SEs can help to promote community inclusion, challenge disability stigma, and highlight that people labeled with IDD can actively contribute to society when given the opportunity [10], as demonstrated in the Armenia example. When it comes to transition to employment for people labeled with IDD, economic benefits should not be the only priority [25]. Despite the potential economic disadvantage, SEs highlight that the social benefits of inclusion, meaningful activity, socialization, and community engagement can be valuable outcomes in and of themselves [10, 17]. The lack of best practice guidelines for SEs makes it difficult to know what contexts and genuinely geared toward promoting inclusive practices and making work environments accessible and accommodating [1, 10]. As Parmenter [13] stated, “good policies are based on good information” [p.60]. Further research is needed to examine SE models and outcomes in high-, middle-, and low-income countries for people labeled with IDD in an effort to establish international guidelines that ensure SEs are an equitable and available option for this population.
Reflections
It is important to note that SEs do not exist in a vacuum outside the social-political context of employment. Prevailing social values, beliefs, and ideologies about employment and disability shapes the purposes and aims of SEs, which then has implications for people with IDD and their labor market participation. This needs to be considered when assessing whether SEs are an appropriate fit for a person labeled with IDD. SEs can be a means to a particular end (i.e., open market employment) for some people with IDD. For others, SEs can be the end itself when the goal is social participation, community inclusion, and engagement in meaningful activities. Regardless of the purpose, SEs need to be contextually co-designed and co-developed with people with IDD to mitigate potential unintended harmful consequences (e.g., feeling devalued, low income, being perpetually “in training”) and to identify what counts as “success” for each person.
Conclusion
Employment is never a “one size fits all” situation; people with IDD need a range of options to meet their needs and to fulfill their rights to employment and be full active members of the community [1, 18]. To realize the UNCRPD, “… the central conclusion should be that all people, even those with the most significant disabilities, have the right to enjoy the same choices and options as other people in society” [18, p.24]. More research and advocacy are needed to understand how to create equal opportunities for employment for people labeled with IDD. SEs still have ways to go in terms of developing procedures and establishing their place in the economic sector. Nonetheless, the benefits experienced by SE employees labeled with IDD, (sense of belonging, higher job satisfaction and retention, development of entrepreneurial skills) are worth supporting and continuing to explore and understand. With further research and development, SEs can be a valuable employment option that provides people labeled with IDD with both financial and social benefits, realizing their human rights to employment as outlined in the UNCRPD.
Notes
We use the terms “disabled people” and “people labeled with IDD” to flag that disability is a complex and contested concept. While people-first language is more commonly used in the health sciences, some people prefer using identity-first language and highlighting that being “labeled” with IDD is related to being medically diagnosed and classified, which can be both beneficial and limiting in everyday life for disabled people.
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Funding
The Azrieli Adult Neurodevelopmental Centre, Armenian Relief Society (ARS) Eastern Region Lazarian Foundation, and the Armenian General Benevolent Union (AGBU) have supported AB’s PhD training. This review was undertaken to support AB’s scholarship related to developing rehabilitation and disability services from a global health perspective and the implications when collaborations involve researchers and clinicians trained in different sociopolitical contexts.
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Babikian, V.A., Hamdani, Y. Social Enterprises and Transition to Employment for People Labeled with Intellectual and Developmental Disabilities. Curr Dev Disord Rep 10, 40–46 (2023). https://doi.org/10.1007/s40474-023-00267-7
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DOI: https://doi.org/10.1007/s40474-023-00267-7