Labour Force Participation Of People Research Articles

Understanding Persons With Disabilities’ Reasons for Not Seeking Employment

Unemployment is common for persons with disabilities but little is known about the different reasons why people with disabilities may not be seeking employment. This study identified the reasons that people living with disabilities in the United States report for not seeking employment, from the 2015 Kessler Foundation National Employment and Disability Survey (KFNEDS), and categorization of reasons by demographic, socioeconomic, and disability characteristics. We conducted a content analysis of responses to an open-ended question on the KFNEDS. The analytic sample ( n = 1,254) consisted of adults (ages 18–64) living with disabilities who self-identified as either unemployed or not seeking employment. Team coding used a hybrid inductive/deductive approach to identify nine meaningful reasons why people with disabilities may not seek employment. Overall, medical conditions, functional limitations, or their disability were more likely to be reported as reasons for not seeking work, rather than situational reasons associated with workplace engagement, such as “lack of job opportunities.” Bivariate comparisons of codes across demographic, socioeconomic, and disability characteristics noted variability in reasons reported by respondents by sex, race/ethnicity, age, household income, and disability. These findings provide an understanding of diverse reasons for not seeking employment, which can inform programs and policies that promote labor force participation of people with disabilities.

Evidence of a Hemophilia Employment Gap: Comparing Data from CHESS US+ and the 2019 Current Population Survey

INTRODUCTION Severe hemophilia A (<1% normal FVIII activity) and B (<1% normal FIX activity) are congenital bleeding disorders characterized by uncontrolled bleeding, either spontaneously or in response to trauma or surgery. Recent commentary has identified a number of patient-important and patient-relevant outcomes that have been understudied, namely the challenges faced by people living with hemophilia to participate in the labor force. The socio-economic impact of hemophilia is comparatively less well understood than clinical outcomes and therapy-related costs. Under-employment and under-utilization have long-term consequences to individuals' job prospects and psychosocial health, as well as an economic cost to the society. The objective of the analysis is to compare labor market participation, among people with severe hemophilia from the US and the general population. This analysis draws on household data derived from the 2019 Current Population Survey (CPS), and on patient-reported data from a patient-centric study conducted in 2019 of people with severe hemophilia, in the US: the 'Cost of Severe Hemophilia Across the US: A Socioeconomic Survey' (CHESS US+). METHODS A patient-centric framework informed the design of CHESS US+ a retrospective (12 months prior to study enrollment), cross-sectional dataset of adults with severe hemophilia in the US. Conducted in 2019, the study used a patient-completed questionnaire to collect data on patient-relevant clinical, economic, and humanistic outcomes. This analysis examines labor market participation (full-time, part-time, unemployed), and corresponding general population data derived from the 2019 Current Population Survey (CPS). Data on the general population were sourced from the 2019 CPS 'Employment status of the civilian noninstitutional population'. Persons 'not in the labor force' in the 2019 CPS and retired persons in CHESS US+ were not included in the analysis. We present data on the civilian labor force, in CHESS US+ and in the 2019 CPS. Results are presented as mean (standard deviation) or N (%). RESULTS Of 356 patients profiled in the CHESS US+ study, 97 (27%) had severe hemophilia B and 257 (73%) had severe hemophilia A. Mean age and weight (kg) of the cohort was 34.99 (12.15) and 85.71 (22.81), respectively. The labor force participation rates of non-retired people with severe hemophilia in CHESS US+ (N = 340) and the general population (161,458) are described in Table 1. Examining aggregate data on employment status observed a higher proportion of people with severe hemophilia in part-time employment (24.4% vs. 15.7%). Differences in the labor force participation of people living with severe hemophilia compared to the general population were most pronounced in the full-time employment rate and the unemployment rate. Compared to 80.7% of the general population (Table 1), only 53.5% of people with severe hemophilia in CHESS US+ had a full-time job. Moreover, the unemployment rate (Table 1) in the 2019 CPS compared with the rate observed in CHESS US+ (3.7% vs. 22.1%) provides a stark contrast in the employment experiences of people living with severe hemophilia relative to the general population. CONCLUSIONS This analysis of CHESS US+ illustrates the impact of severe hemophilia on labor force participation. People with severe hemophilia were more likely than the general population to be unemployed, or in part-time employment. A notable contrast was observed in the rate of full-time employment and unemployment, among the general population compared to people living with severe hemophilia. These data illustrate the need to quantify the impact of hemophilia using a holistic approach that considers the cost of involuntary illness-related part-time and unemployment. Disclosures Asghar: HCD Economics: Current Employment. Burke:HCD Economics: Current Employment; F. Hoffmann-La Roche Ltd: Consultancy; University of Chester: Current Employment. Misciattelli:Freeline: Current Employment, Current equity holder in publicly-traded company. Kar:Freeline: Current Employment, Current equity holder in publicly-traded company. Morgan:HCD Economics: Current Employment; uniQure: Consultancy. O'Hara:F. Hoffmann-La Roche Ltd: Consultancy; HCD Economics: Current Employment, Current equity holder in private company.

Adherence and a Potential Trade-Off Currently Faced in Optimizing Hemophilia Treatment

INTRODUCTION Severe hemophilia, i.e., <1% normal FVIII level (A) or FIX level (B), are congenital bleeding disorders characterized by uncontrolled bleeding. The clinical benefits of prophylactic FVIII/IX replacement therapy are well understood, but require adherence to a schedule of routine infusions. Optimal adherence is associated with better joint outcomes and lower rates of chronic pain. Nonetheless a lack of patient-reported data has to date limited our understanding of the patient burden associated with adherence to treatment, and the relationship between adherence and the ability to work, among people living with hemophilia in the US. Data from the Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) study reported a high proportion of adults with hemophilia B receiving routine infusions (at least one infusion per month), showing a negative impact on their ability to work, and people receiving routine infusions were more likely than people treated on-demand to report an inability to work in most situations. The ability of people living with hemophilia to participate in the labor force, without barriers to job choice or working hours, is a key outcome in the drive to achieve health equity. The objective of the analysis is to examine the relationship between adherence and the labor force participation of people with severe hemophilia in the US. METHODS This analysis draws data from a patient-reported study, the 'Cost of Severe Hemophilia Across the US: A Socioeconomic Survey' (CHESS US+). Conducted in 2019, the CHESS US+ study is a cross-sectional patient-centered study of adults with severe hemophilia in the US. A patient-completed questionnaire collected data on clinical, economic, and humanistic outcomes, for a 12-month retrospective period. This analysis examines labor force participation and employment status (full-time, part-time, unemployed, retired) and chronic pain categorized by 'none', low-level ('1-5'), and high-level ('6-10'). The analysis was stratified by adherence to treatment, self-reported on a 1-10 scale, from "not at all" to "fully", categorized into low (1-6), moderate (7-9) and full (10) adherence. Results are presented as mean (standard deviation) or N (%). RESULTS The analysis comprised 356 people with severe hemophilia A (73%) and B (27%) who participated in CHESS US+ study. In Table 1, the baseline characteristics of the study population are stratified by full adherence (N = 119), moderate adherence (N=134) and low adherence (N=103). Having no chronic pain was most prevalent in the full adherence group (37.7%), compared to moderate (8.3%) or low (13.9%) adherence cohorts. Chronic pain, both low- and high-levels were least prevalent among people with full adherence. Moreover, people with low adherence were disproportionately more likely to have high-levels of chronic pain relative to moderate adherence or full adherence (Table 1). Unemployment, however, was highest in full adherence (21.1%), and people with full adherence were also least likely to be in full-time employment (42%). The full-time employment rate decreased as adherence declined from full to moderate (Table 1), and was comparable in people with low adherence (57.3%) or moderate adherence (54.5%). CONCLUSIONS This analysis of CHESS US+ examined the complex relationship between labor market outcomes and adherence to treatment, among adults with severe hemophilia in the US. Adherence was associated with lower rates of chronic pain, representing the importance of achieving an optimal treatment strategy. Nonetheless, patients achieving optimal adherence were less likely to be in full-time employment, and more likely to be part-time or unemployed, comparatively. Together, these data characterize a trade-off in clinical outcomes versus workforce participation, and suggest that the goal of achieving health equity may currently still be unmet. Disclosures Burke: HCD Economics: Current Employment; University of Chester: Current Employment; F. Hoffmann-La Roche Ltd: Consultancy. Asghar:HCD Economics: Current Employment. Misciattelli:Freeline: Current Employment, Current equity holder in publicly-traded company. Kar:Freeline: Current Employment, Current equity holder in publicly-traded company. Morgan:uniQure: Consultancy; HCD Economics: Current Employment. Dhillon:HCD Economics: Current Employment; F. Hoffmann-La Roche Ltd: Other: All authors received editorial support for this abstract, furnished by Scott Battle, funded by F. Hoffmann-La Roche Ltd, Basel, Switzerland. . O'Hara:HCD Economics: Current Employment, Current equity holder in private company; F. Hoffmann-La Roche Ltd: Consultancy.

Book review

Book review

The employment concerns of Americans withmultiple sclerosis: Perspectives from anational sample.

The recent rehabilitation literature does not include a thorough assessment of the employment concerns of people with MS. This article presents descriptive findings from a national survey of the employment concerns of Americans with multiple sclerosis (MS; N = 1,924), representing nine chapters of the National Multiple Sclerosis Society. Respondents were asked to evaluate 38 employment concerns items on two dimensions, importance and satisfaction, for the purpose of identifying strengths and weaknesses in the employment policies and practices affecting the labor force participation of people with MS. Results revealed a total of 32 employment strengths and six employment weaknesses. In spite of a jobless rate of more than 60 percent, people with MS were satisfied with the majority of employment concerns. Implications of these findings for rehabilitation policy and service delivery are examined.

Function, health and psychosocial needs in job-seekers with anxiety, mood, and psychotic disorders who access disability employment services

Labour force participation of people with mental disorders varies according to the nature of their disorder. Research that compares function and psychosocial need in job-seekers with different mental disorders, however, is scant especially in the Australian setting. Identifying rehabilitation needs of job-seekers with mental disorders receiving employment services is of interest to providers of disability employment services in Australia. This study sought to identify differences in health, social needs and function in people with anxiety, mood, or psychotic disorders accessing disability employment services to inform disability service providers of vocational rehabilitation interventions. 106 adult job-seekers with anxiety (29%), mood (51%), and psychotic (20%) disorders receiving job placement services from a disability employment service provider consented to participate in this study. Self-report measures and the Executive Interview (EXIT) were used to document function. Differences between disorders were determined using one-way analysis of variance. Significantly better estimates of social functioning as measured by the Behaviour and Symptom Identification Scale (BASIS-32) were reported by job-seekers with psychotic disorders compared to those with anxiety or mood disorders. However, job-seekers with psychotic disorders reported longer periods of unemployment compared to those with mood disorders and longer estimates of the time it would take to obtain work compared to both the other groups. Perceived psychosocial problems, such as poor social function in job-seekers with anxiety and mood disorders and perceptions of poor employability in those with psychotic disorders, should be considered when developing vocational rehabilitation interventions, or where additional support may be required once employment is obtained.

THE IMPACT OF HIGHLY ACTIVE ANTIRETROVIRAL TREATMENT (HAART) ON EMPLOYMENT IN KHAYELITSHA

AbstractThis paper examines the impact of highly active antiretroviral treatment (HAART) on labour force participation of people living with HIV/AIDS in Khayelitsha, South Africa. Cox Proportional Hazard Models with stratum effects for three medical clinics, and Accelerated Failure Time Models with individual specific unobserved shared effects (frailty), are estimated for transitions from inactivity to unemployment, and transitions from unemployment into employment, using a longitudinal data set. The findings of this study indicate that HAART leads to greater activity in the labour market, but there was not a strong effect on re‐entry into employment.

Macro-economic indicators and labour force participation of people with schizophrenia

Background: People with severe mental illness are widely excluded from labour force participation. While most studies of factors influencing occupational integration are focused on characteristics of individuals, the effects of macroeconomic factors have been largely ignored by research.Aims: In an exploratory study across countries, associations were examined between employment rates of people with schizophrenia and macroeconomic indicators of (a) the labour market, (b) general economic wealth, (c) economic disincentives, and (d) welfare trap mechanisms.Methods: The employment rates of people with schizophrenia in 12 countries were correlated with general employment rates, per capita GDP, average net replacement rates (ANRR), average effective tax rates (AETR), expenditures for social benefits (ESB) and expenditures for active labour market policy (EALP).Results: For the majority of countries, the employment rate of people with schizophrenia was found to be related to the general employment rate, ANRR, AETR and ESB, but not to GDP and EALP.Conclusion: Macroeconomic factors are relevant for understanding labour force participation in people with schizophrenia. Further research is needed to link individual and macroeconomic effects in a multi-level approach.Declarations of interest: The Mental Health Economics European Network Phase I was supported by a grant (SPC.2002397) from the European Commission, Health and Consumer Protection Directorate. There are no conflicts of interest.

Clinical data illustrating the need for greater involvement of behaviourally-oriented psychologists in the design and delivery of rehabilitation services.

Post-injury vocational achievement is an important index of successful rehabilitation. This study involved the identification of factors reported to influence (positively or negatively) labour force participation of people with spinal cord injury (SCI). Forty participants were selected from a larger study of 450 based on the most extreme prediction errors from the application of a discriminant function analysis, which aimed to predict vocational achievement (both in and not in the labour force) post-SCI. Participants were interviewed to gain an understanding of their explanations for their labour force status. Factors nominated as most influencing post-injury achievements were family, friends and representatives of pre-injury employers. Implications of these findings for the delivery of rehabilitation services are presented, including the value of having service plans based on a behaviour analysis of the influence of environmental factors. Key words: vocational rehabilitation, social support, spinal cord injury. ********** In a previous paper (see Murphy, Young, & Reid, 2003) we proposed that, based on an analysis of the contents of selected contemporary behaviour therapy and rehabilitation journals, behaviourally-oriented psychologists at the start of the 21st century are far less involved in rehabilitation service delivery research than they were in previous decades. The current paper presents data from a recent study of vocational achievement following traumatic spinal cord injury that allows an examination of the extent to which behaviour analysis can usefully contribute to enhanced rehabilitation outcomes. Of all injuries, spinal cord injury (SCI) is arguably one of the most devastating. By definition, SCI implies permanent impairment and is associated with potential disabilities that affect not just mobility and sensation but also, inter alia, such diverse areas as sexual functioning, body temperature regulation, and bowel and bladder function. In addition, chronic pain is highly prevalent within the population. In order for persons with SCI to return to community participation and achieve a good quality of life, much new learning is required and new goals need to be set. In theory, behavioural psychologists are the best placed of the rehabilitation professionals to design environments supportive of identified rehabilitation goals. Because most spinal cord injuries occur to the young adult (see Stover & Fine, 1986), the achievement of vocational goals is especially important, as is a proper understanding of the antecedent and consequent stimuli that prompt and reinforce job-seeking behaviour. For almost all injury groups, return to work is the gold standard by which to judge the success of the rehabilitation effort (see Britell, 1991). However, in order for rehabilitation services to maximise their success in terms of vocational rehabilitation achievements made by clients, an understanding of the and environmental factors that impact on disability employment rates needs to be developed. The current study contributes to that more developed understanding through the examination of the post-injury experiences of a group drawn from a larger study involving the prediction of labour-force participation following spinal cord injury (see Murphy, Young, Brown & King, 2003). In that study, approximately 75% of the cases were able to be correctly classified in terms of their post-injury labour force status. The original study involved over 450 participants who were assessed on fourteen predictor variables, encompassing demographic, injury and psychological variables. Significantly, all these predictor variables involved attributes of the individual and excluded examination of any environmental variables. In an effort to learn more about the range of factors impacting on participants' lives post-injury, a sample was drawn from the most extreme prediction errors from the original study. …

Employment Barriers for Persons With Psychiatric Disabilities: Update of a Report for the President's Commission

A major public policy problem is the extremely low labor force participation of people with severe mental illness coupled with their overrepresentation on the public disability rolls. This situation is especially troubling given the existence of evidence-based practices designed to return them to the labor force. This article reviews research from the fields of disability, economics, health care, and labor studies to describe the nature of barriers to paid work and economic security for people with disabling mental disorders. These barriers include low educational attainment, unfavorable labor market dynamics, low productivity, lack of appropriate vocational and clinical services, labor force discrimination, failure of protective legislation, work disincentives caused by state and federal policies, poverty-level income, linkage of health care access to disability beneficiary status, and ineffective work incentive programs. The article concludes with a discussion of current policy initiatives in health care, mental health, and disability. Recommendations for a comprehensive system of services and supports to address multiple barriers are presented. These include access to affordable health care, including mental health treatment and prescription drug coverage; integrated clinical and vocational services; safe and stable housing that is not threatened by changes in earned income; remedial and postsecondary education and vocational training; benefits counseling and financial literacy education; economic security through asset development; legal aid for dealing with employment discrimination; peer support and self-help to enhance vocational self-image and encourage labor force attachment; and active involvement of U.S. business and employer communities.

Employer-Based Facilitators of Return to Work Following Disabling Injury

AbstractPostinjury vocational achievement is an important index of successful vocational rehabilitation. This study involved the identification of factors reported to facilitate labour-force participation of people with spinal cord injury (SCI) who, even though lacking the personal characteristics found to correlate with labour-force participation, were actually members of the labour force. The empirically identified subjects comprised the 20 most extreme prediction errors from the application of discriminant function analysis, which was conducted with the aim of predicting vocational achievement (in the labour force vs. not in the labour force) following SCI. Subjects were interviewed to gain an understanding of their explanations for their erroneously predicted labour-force status. Principal factors nominated as most influencing the postinjury labour-force achievements were the assistance of family, friends and representatives of preinjury employers. Implications of these findings for the delivery of rehabilitation services are presented, including the need for more community-based and employer-related services.

Managing an aging workforce and a tight labor market: views held by Dutch employers

Despite the strong growth in employment of the past years, the Dutch labor market faces a number of persistent problems. One such problem is the large number of people on disability benefits. Another problem is the low labor force participation of women, not so much in terms of people, but in terms of hours worked (Henkens et al. 2002). And, despite an increase since the mid-1990s, the labor force participation of people over 50 is also much lower than the European average (OECD 1996). These low labor force participation rates should be seen against the backdrop of a strong increase in labor demand in recent years. In many sectors of the Dutch economy, this has led to tightness in the labor market (CPB 2000). Given that the population of the Netherlands is aging, new imbalances are looming on the horizon. Structural changes need to be implemented to pay for the growing number of pensioners. [....]

Public policy and employment of people with disabilities: exploring new paradigms.

A "sea change" in public attitudes, legislation, and political power at the end of the 20th century in the United States has helped set the stage in the early 21st century for the entry of people with disabilities into the labor force. Major pieces of federal legislation have altered national policy with the intention of maximizing the work force participation of people with disabilities. At the same time, a new theoretical paradigm of disability has emerged, which emphasizes community inclusion, accommodation, and protection of civil rights. This "New Paradigm" of disability can be applied in concert with rigorous behavioral science methodologies to shed light on the outcomes of recent federal policy changes regarding the labor force participation of people with disabilities. In so doing, social science can be used in more meaningful ways to understand both the intended and unintended consequences of federal policy.