Vocational Rehabilitation – A realist synthesis of findings
Abstract
Background: An increasing number of people in the developed countries are not in employment or education due to health related issues or social problems. It is estimated by the OECD that the OECD countries on average spend... [ view full abstract ]
Background: An increasing number of people in the developed countries are not in employment or education due to health related issues or social problems. It is estimated by the OECD that the OECD countries on average spend about 2 per cent of their GDP solely on disability and sick leave benefits. A large share of the member states have vast experiences with vocational rehabilitation interventions (VR) aimed at reintegrating these people on the labour market but have yet to significantly decrease the number of persons receiving these benefits. The puzzle on how to get this diverse group to participate on the labour market has yet to be entirely solved. There is no one-size-fits-all solution to this problem and the problems of the target group are often diverse, multifaceted and complex which makes it even more challenging to produce evidence on which interventions work in this regard.
There is however a growing literature on VR – including both qualitative studies and quantitative impact studies. This makes it possible to piece together these nuggets of information to get a clearer understanding of what works for whom under which circumstances. Using the realist approach to synthesizing evidence the present review aims at piecing the nuggets of information together to provide us with greater knowledge of which mechanisms are to be activated, in particular contexts, in order to achieve the desired outcome (employment or education).
Methods/design: Using the five steps to conducting realist synthesis proposed by Pawson, the present review aims to develop, test and refine a “generic individual-oriented” program theory for VR interventions. The term “generic” is used to clarify that the program theory will not be guided by the diagnosis of the clients participating in VR but rather focus on the general mechanisms that further labour market integration of groups with varying health related issues in specific contexts.
Results: Despite still being a work in progress, a multitude of mechanisms that may help to improve the outcomes (return to work or education) in VR interventions have however already identified. These include among others the individuals’ motivation in VR and return to work, expectations of gaining employment, self-efficacy, self-confidence, fear-avoidance beliefs and the working alliance between the client and the caseworker. A series of contextual factors that may either impede or promote the succes of VR were further identified. On the individual level these include: Age, educational attainment, severity of health issues, prior employment, duration of benefit recipiency and sick leave. On the interpersonal level these include quality of relationship with case worker or VR counsellor, the quality and frequency of communication between parties, expectation management, and coordination between various stake-holders. On the institutional and infrastructural level the contexts that moderate the success of VR include the demand for specific types of labour, employer and colleague attitudes, work environment and the match between both the VR intervention and the individual and the match between the employer and the individual.
Authors
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Rasmus Ravn
(Aalborg University, Department of Political Science)
Topic Areas
Please select one of the following:: Realist synthesis , Please select a maximum of two themes from the following list:: Exploring 'Mechanisms' , Please select a maximum of two themes from the following list:: Other
Session
PS-1 » Poster Session and Reception (15:00 - Tuesday, 4th October, Garden Room and Conservatory)
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