Work and Employment
Introduction
Employment remains one the most important topics that have been studied since the early 50’s when the importance of returning to work after SCI was recognized (Guttmann, 1959). Not only does gainful employment help to achieve economic self-sufficiency but it is considered a source of personal growth (Ville and Ravaud 1998), disability adjustment (Krause 1992) and it is associated to social integration and life satisfaction (Vogel et al, 1998). Exact employment figures in published studies are difficult to capture due to variations in sample characteristics such as the participants age, duration of injury, work experience prior to injury as well as differences in the definition of the concept itself (Ottomanelli and Lind 2009). Even though, variation is observed in the employment rate (2 – 80%) (Ottomanelli and Lind 2009), it is likely that the most accurate overall figure since the 70’s is between 30-50%. It does vary based on the severity of injury in addition to regional disparities. Recent data from the U.S. Model Systems suggests that35% of people with SCI are employed 20 years post-injury (https://www.nscisc.uab.edu).
There is a tangible need to explain why involvement in employment is significantly lower than that observed in the population without disabilities while a significant proportion of unemployed people with SCI judged themselves able to work (Tomassen et al. 2000). In a context of the development of environmental features (technology, robotics, environmental controls, universal design), the attenuation of prejudices and the opportunity for job accommodation, it is astonishing that the employment rate did not evolve much over the past decades to an extent that this could have counteract the detrimental effect of non-modifiable consequences of SCI.
On the other hand, this reveals the complexity of the process of returning to work. Given that it results from the interaction of some personal and environmental characteristics (Fougeyrollas et al. 2002; Chan and Man 2005), it remains inappropriate to state that people with SCI experience low employment rate only because of intrinsic or personal characteristics (Fougeyrollas et al., 2002). To ensure a higher likelihood of success in return to work, interventions must target several factors including work retraining and other types of environmental interventions.A major domain to explore is vocational (re) training, which includes vocational rehabilitation. Acondensed definition has recently been suggested [Escorpizo et al. 2010, under revision] which takes into account the objective of vocational rehabilitation as suggested by the International Labour Organization: “to enable a disabled person to secure, retain, and advance in suitable employment”. Therefore, vocational rehabilitation refers to a multidisciplinary intervention which aims to return or re-engage individuals who have a previous work history into the job market. Another goal of vocational rehabilitation is early and sustained participation in employment in any form- either remunerative (paid) or non-remunerative (nonpaid).
The objective of this chapter is to identify modifiable and non-modifiable factors related to the person and the environment that influence employment and to evaluate the evidence of interventions designed to promote return to work post-SCI. Similar to the other SCIRE chapters that have a focus on an area relevant to community reintegration, the methods used for the development of this review expanded upon the traditional SCIRE methods (see SCIRE Methods). Specifically, two new databases with a focus on the social sciences were searched (Social Sciences Abstracts and Social Work Abstracts), and the inclusion criteria were broadened to include any relevant qualitative studies.
