Barriers and facilitators to employment as reported by people with physical disabilities: An across disability type analysis
by Carolyn W. Graham, Katherine J. Inge, Paul Wehman, Hannah E. Seward, and Matthew Bogenschutz
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Barriers and facilitators to employment as reported by people with physical disabilities: An across disability type analysis.
Journal of Vocational Rehabilitation,
Extant research has reported on the factors associated with seeking and maintaining employment for individuals with different types of physical disabilities, such as cerebral palsy (CP), multiple sclerosis (MS), and spinal cord injuries (SCI). Some of these factors are barriers and others are facilitators. However, research has not determined whether the inhibiting and facilitating employment experiences of people with physical disabilities are similar across type of physical disability.
The goal of this study was to compare the employment experiences of people with physical disabilities with three different disabilities including CP, MS, and SCI to determine whether these employment experiences are similar.
Homogenous focus groups were conducted with individuals with CP, MS, and SCI concerning their employment experiences. These 18 focus groups were conducted telephonically, audio recorded, and lasted approximately 60 minutes each. Data from each disability type was analyzed separately and across disability type.
Two themes were common among participants in the three disability types: 1) Health and 2) Barriers to Overcome. However, there were differences among the disability types within these themes. Some of these differences were unique to MS.
This study provides a perspective on working with CP, MS, or SCI informed directly by individuals living with these disabilities, whether they were employed or unemployed, and gives a voice to the employment experiences of the individuals. The findings present information on the similarities and differences that individuals with various physical disabilities face when working.
Work is a fundamental part of life and promotes financial stability, a sense of purpose, and an opportunity to interact with other people. For people with disabilities, it may increase mental stimulation, personal growth, and help individuals adjust to the changes and challenges that may come with having a disability (Ottomanelli & Lind, 2009). Work also provides social integration, which promotes a higher quality of life (Ottomanelli & Lind, 2009; Trenaman et al., 2014).
Despite decades of legislation and research, employment rates for individuals with disabilities remain much lower than for those without disabilities. The most recent statistics from the Bureau of Labor Statistics for 2016 show that 17.9% of people with disabilities had employment, while 65.3% of individuals without a disability were employed. The unemployment rate ins 2016 for individuals with disabilities was 10.5%, compared to 4.6% for those without a disability (Bureau of Labor Statistics, 2017). When comparing the data to the previous year, minimal changes are noted. In 2015, the unemployment rate for individuals with disabilities was 10.7%, compared to 5.1% for those without a disability. Unemployed individuals are those who did not have a job, were available for work, and were actively looking for a job in the four weeks preceding the survey conducted by the Bureau of Labor Statistics. In addition, individuals with disabilities are more likely to be underemployed, with 34% employed part-time in 2016 compared to just 18% for those without a disability (Bureau of Labor Statistics, 2016).
Individuals with physical disabilities, such as cerebral palsy (CP), multiple sclerosis (MS), and spinal cord injury (SCI), face major challenges with obtaining and maintaining employment (Achterberg, Wind, De Boer, & Frings-Dresen, 2009; Bal et al., 2016; Lindsay, 2011; Van Mechelen, Verhoef, Van Asbeck, & Post, 2008; Lindsay, 2011). Vocational Rehabilitation (VR) through the federal and state vocational rehabilitation programs is one option for obtaining the needed services that lead to successful competitive employment outcomes for individuals with physical disabilities. VR services work to reduce barriers and assist individuals in achieving employment outcomes (Huang et al., 2013).
Annually, each VR Agency funded by the Rehabilitation Act of 1973, as amended, submits to the Federal Rehabilitation Services Administration (RSA) the RSA 911 Closure Report (Achterberg et al., 2009). Data was analyzed from this report for FYs 2011, 2012, and 2013 on individuals with the primary disability of CP, MS, or SCI who exited the exited VR system. To be included in the analysis, individuals had to be between the ages of 24–64; signed an Individual Plan for Employment (IPE); and received VR services. For all three years, approximately one third of these individuals with CP, MS, or SCI exited the VR system with an employment outcome consistent with their IPE. Conversely, the other two thirds exited the VR system without an employment outcome after receiving VR services (Inge, Cimera, Revell, Ward, & Seward, 2015; Inge, Cimera, Revell, Wehman, & Seward, 2015; Inge, Rumrill, Cimera, & Revell, 2016). This data does not reveal why individuals with these disabilities are not achieving their employment outcomes consistent with their IPEs. However, a review of the literature provides some information on the barriers that these individuals with physical disabilities may encounter when attempting to achieve competitive employment outcomes.
Employment rates for people with CP tend to be significantly lower than for people with other disabilities (Flippo & Gardner, 2011). They also continue to experience significantly lower rates in getting and keeping employment in comparison to individuals without disabilities (Huang et al., 2013; Magill-Evans, Galambos, Darrah, & Nickerson, 2008; Rutkowski & Riehle, 2009). Because CP may be associated with significant physical challenges, individuals with CP often need accommodations or personal care assistance in order to perform simple tasks (utkowski & Riehle, 2009). Another challenge is navigating employment without losing disability benefits. In a Minnesota study, Murphy and colleagues (2000) found that 53% of adults with CP were competitively employed, but 22% of those individuals risked losing disability benefits if they advanced in their careers. Disability benefits may be needed to pay for assistive technology and/or on-going personal care assistance.
People with MS face unique barriers to employment, since MS is associated with a wide range of physical, cognitive, and emotional symptoms that appear episodically and unpredictably (Raggi et al., 2016; Roessler & Rumrill, 2003; Rumrill et al., 2013). These symptoms have been reported by individuals with MS as the largest barrier to employment, particularly the relapsing and progressive characteristics of the illness (Roessler & Rumrill, 2003). Those who experience symptoms from MS most or all of the time, especially if those symptoms are more severe, are more likely to be unemployed (Raggi et al., 2016; Roessler, Rumrill, & Fitzgerald, 2004; Rumrill et al., 2013). The fatigue and weakness associated with MS affect employment skills and capacities. Workplace factors such as poor support towards accommodations, inflexible employment structures, and lack of employers /colleagues’ support have been found to present major barriers for individuals with MS (Sweetland et al., 2012).
Physical or structural barriers are the highest perceived barriers among people with SCI when it comes to employment and social participation (Tsai et al., 2017). A study by Cotner and colleagues (2017) found that barriers for veterans with SCI could be broken down into six categories. This included veteran-specific (personal characteristics, lack of transportation, fear of losing benefits), high caseload of employment specialists, lack of integrating the employment specialist into the SCI clinical team, employment specialist hiring and turnover issues, SCI clinical team unfamiliar with vocational rehabilitation, and difficulty obtaining resources (Cotner, Ottomanelli, O’Connor, & Trainor, 2017). However, having a good clinical team and employment specialists that specializes in SCI were major facilitators in employing individuals with SCI. Individuals with SCI who receive specialized VR services that include job development or placement, employment supports, and workplace follow-ups fare much better in employment outcomes (Ottomanelli et al., 2015.)
While the studies included in this literature review provide information on the barriers and facilitators to employment for individuals with CP, MS, and SCI, they present the information from the viewpoint of each specific disability group. What is not available is a comparison of the barriers and facilitators to employment as reported by people with disabilities themselves across different types of physical disabilities. In this paper, findings from a series of focus groups conducted with individuals with CP, MS, and SCI are compared, and their unique and similar barriers and facilitators to work are discussed. The research questions that guided this study include the following.
Research Question 1: What are the most commonly reported barriers and facilitators to employment identified by people with CP, MS, and SCI?
Research Question 2: What are the similarities and differences in employment experiences among the people with the three different types of physical disabilities?
Research Question 3: What employment experiences are unique to a specific physical disability?
A targeted recruitment approach was used for this study to identify participants. Five national organizations representing people with disabilities assisted in the recruitment including the World Institute on Disability (WID), National Multiple Sclerosis Society, United Spinal Cord Injury Association, United Cerebral Palsy (UCP), and the National Council for Independent Living (NCIL). A standardized email was disseminated by these organizations explaining the purpose of the study. Participants also were recruited through their organizational websites and other internet methods such as social media. The recruitment materials specified that potential participants must have a physical disability (e.g., CP, MS, SCI, or other physical disability) and reside in the United States. In addition, participants had to be (a) in the age range of 18–65; (b) employed or unemployed; and (c) willing to participate in an hour-long telephone focus group. These electronic notices contained a link to an online database that provided specific information on the study, the study questions, and a place for the potential participant to consent or decline participation.
After potential participants read the study information online, they clicked on an electronic button to decline or consent to participate. Individuals that declined to participate were re-directed to a screen where they were thanked for their time. Individuals that consented to participate were re-directed to a screen where they selected their physical disability and their employment status: employed or unemployed. In addition, they entered their e-mail address, telephone number, and mailing address for contact purposes during the study and for mailing a gift card at the completion of the focus groups. This personal information was stored in a database housed on a password-protected server that required a unique username and password to access. Only the lead researchers had access to this information. Data collected during the focus groups was stored in separate files and not linked to participant information, which further protected the participants’ confidentiality.
As individuals consented to participate, the database sorted them into groups of 10 by disability type as well as by employment status. This created groups of potential participants: employed people with CP, unemployed people with CP, employed people with MS, unemployed people with MS, employed people with SCI, and unemployed people with SCI. A total of 152 individuals consented to participate in this focus group study and study criteria to be in one of the focus groups.
Telephone focus groups were scheduled using the online database to contact the individuals who consented to participate as having CP, MS, and SCI. Groups of 10 participants (by type of disability and employment status) were contacted by email asking them to select from a list of possible times to call-in to the focus group. If at least six individuals did not respond to an invitation to participate within one week, another notice was emailed with a new list of possible times. Once a minimum of six individuals by disability type and employment status responded that they were available, a follow-up confirmation e-mail provided information to the participants on how to call-in using a toll-free number at the scheduled time. All of these emails were managed through the password-protected database, and the lead facilitator could login and review who had responded regarding their availability. This process was repeated until 18 focus groups were conducted: three with employed individuals with CP, three with unemployed individuals with CP, three with employed individuals with MS, three with unemployed people with MS, three with employed individuals with SCI, and three with unemployed individuals with SCI. Of the 152 individuals who consented to participate, 85 individuals participated by calling into the focus groups using a toll-free number at the scheduled times and engaged in the telephonic focus groups. See Table 1 for recruitment and participation by disability and employment status.
Immediately after a focus group, participants were emailed thanking them for their time and requesting that they provide demographic information. Table 2 provides the demographic information on the participants who voluntarily provided their information by employment status and disability type. The lead researcher collected this data, added it to a spreadsheet without individual identifiers, and then deleted the email messages. Participants resided in all regions of the United States and ranged in age from 20 to 65. Of the participants who provided demographic information, 52% identified themselves as female and 48% as male.
|Employed n = 14||Unemployed n = 13||Employed n = 12||Unemployed n = 15||Employed n = 16||Unemployed n = 15|
|Age Range||f (%)||f (%)||f (%)||f (%)||f (%)||f (%)|
|20–29||2 (14.29)||4 (30.77)||2 (16.67)||0 (0.00)||1 (6.25)||3 (20.00)|
|30–39||5 (35.71)||1 (7.69)||3 (25.00)||2 (13.33)||6 (37.50)||3 (20.00)|
|40–49||0 (0.00)||1 (7.69)||3 (25.00)||4 (26.67)||3 (18.75)||3 (20.00)|
|50–59||3 (21.42)||1 (7.69)||3 (25.00)||7 (46.67)||3 (18.75)||2 (13.33)|
|60–69||2 (14.29)||1 (7.69)||0 (0.00)||1 (6.67)||1 (6.25)||1 (6.67)|
|Did Not Respond||2 (14.29)||5 (38.47)||1 (8.33)||1 (6.67)||2 (12.50)||3 (20.00)|
|Female||6 (42.86)||6 (46.15)||10 (83.33)||9 (60.00)||5 (31.25)||8 (53.33)|
|Male||8 (57.14)||7 (53.85)||1 (8.33)||5 (33.33)||9 (60.00)||4 (26.67)|
|Did Not Respond||0 (0.00)||0 (0.00)||1 (8.33)||1 (6.67)||2 (12.50)||3 (20.00)|
|African American||1 (7.14)||0 (0.00)||1 (9.10)||5 (33.33)||2 (12.50)||0 (0.00)|
|Asian American||0 (0.00)||0 (0.00)||0 (0.00)||0 (0.00)||1 (6.25)||0 (0.00)|
|Bi-racial||1 (7.14)||0 (0.00)||1 (8.33)||0 (0.00)||0 (0.00)||1 (6.67)|
|Caucasian||9 (64.29)||5 (38.46)||9 (75.00)||9 (60.00)||10 (66.67)||9 (60.00)|
|Hispanic||1 (7.14)||2 (15.39)||0 (0.00)||0 (0.00)||1 (6.25)||1 (6.67)|
|Native American||0 (0.00)||0 (0.00)||0 (0.00)||0 (0.00)||0 (0.00)||1 (6.67)|
|Did Not Respond||2 (14.29)||6 (46.15)||1 (8.33)||1 (6.67)||2 (12.50)||3 (20.00)|
|Highest Level of Education|
|Occupational Certificate||0 (0.00)||1 (7.69)||0 (0.00)||0 (0.00)||0 (0.00)||0 (0.00)|
|GED||1 (7.14)||0 (0.00)||0 (0.00)||0 (0.00)||0 (0.00)||0 (0.00)|
|High School Diploma||1 (7.14)||1 (7.69)||0 (0.00)||3 (20.00)||1 (6.25)||3 (20.00)|
|Some College||0 (0.00)||0 (0.00)||3 (25.00)||3 (20.00)||2 (12.50)||1 (6.67)|
|Bachelor’s Degree||4 (28.58)||4 (30.78)||6 (54.54)||5 (33.33)||3 (18.75)||5 (33.33)|
|Master’s Degree||4 (28.58)||2 (15.38)||2 (16.67)||3 (20.00)||7 (43.75)||2 (13.33)|
|Doctorate/Professional||2 (14.28)||0 (0.00)||0 (0.00)||0 (0.00)||1 (6.25)||1 (6.67)|
|Did Not Respond||2 (14.28)||5 (38.46)||1 (8.33)||1 (6.67)||2 (12.50)||3 (20.00)|
2.2Focus group interview protocol
The research team collaboratively developed a focus group interview protocol for this study. See Bogenshutz, Inge, Rumrill, Hinterlong, and Seward (2016) for more detailed information on the development of the interview protocol. The final interview protocol had 13 core questions for the employed group and 12 core questions for the unemployed group. The interview protocol included probing questions that were used at the focus group facilitator’s discretion. The interview protocol included questions concerning participant process of finding or looking for employment with a disability, the barriers or facilitators for finding work, how career choices have been affected by their specific disability, workplace accommodations, and recommendations for other job seekers or professionals. The focus group interview questions are found in Table 3.
|Employed Participant Version|
|1. What do you do, and what is a typical day at work like?|
|2. Tell me about the steps you took to find your job.|
|3. What were the key factors in getting a job?|
|4. Give me an example of how you disability affected your finding a job.|
|5. Give me examples of how you overcame your challenges to find a job.|
|6. Tell me about any accommodations you have requested for your job.|
|7. Tell me about things that help you do your job.|
|8. What would make your job easier to do well?|
|9. How have your career choices been affected by your disability?|
|10. What do you need to find and obtain your ideal job?|
|11. What advice would you give to someone with physical disabilities who is looking for a job?|
|12. What advice would you give to a professional who is helping people with physical disabilities find jobs?|
|13. What would you like to tell me that I have not asked?|
|Unemployed Participant Version|
|1. Tell me about your ideal job. What would you like to do?|
|2. What supports and services (such as people, agencies, and information) have you used to look for a job?|
|3. Tell me an example of a service or support that has been helpful in your job search.|
|4. Tell me an example of a service or support that wasn’t helpful.|
|5. What information do you need to find a job?|
|6. Give me an example of how your disability has affected your finding a job?|
|7. How have your career choices been affected by your disability?|
|8. What supports and services will you need to find a job and stay employed?|
|9. Where will you go to find these supports and services?|
|10. What advice would you give someone with a physical disability who is looking for a job?|
|11. What advice would you give to a professional who is helping people with physical disabilities find jobs?|
|12. What would you like to tell me that I have not asked?|
All study procedures used in this study were approved by the university Institutional Review Board (IRB) at the authors’ university. The importance of confidentiality was emphasized in the online consent information. In addition, the facilitator discussed confidentiality with the participants at the beginning of each telephone call and asked that they not share their name or other identifying information. Using a telephonic method of conducting focus groups allows people from across the country to be included in the study. The use of telephones also allows participants to feel more comfortable and open about sharing thoughts and feelings since there is a sense of anonymity (McCoyd & Kerson, 2006; Novick, 2008; Sturges & Hanrahan, 2004).
The lead researcher or a research associate facilitated the focus groups using a toll-free telephone conference system. Permission to audio record a focus group was obtained at the beginning of each call by the facilitator. In obtaining permission, the facilitator told the group that the audio recording would be transcribed and all names or personal identifiers would be deleted from the transcripts. Participants also were told that they could skip any question that made them uncomfortable or that they did not want to answer. Finally, the facilitator told participants that their involvement in the study was appreciated.
The facilitator then began the recording and proceeded through each of the core questions, as well as related follow-up probes as needed. To ensure that all participants were able to respond to the question, the facilitator asked participants whether they had any more information to add once a conversation ended. Most of the focus groups ran for approximately one hour with a few calls extended to 90 minutes upon request of the participants. Identifying data such as names, addresses, and employers were removed from the transcripts during the transcription process so that only de-identified data were used in the analysis. All participants were compensated in the form of a $50 gift card that could be used at a retailer of their choice after a focus group was conducted.
Audio recordings of the telephone focus groups were transcribed verbatim by a professional transcription service. The transcri