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Q - Employment and Vocation

Factors Associated with Employment Among Individuals with SCI Current research has focused on identifying the factors that predict employment status and return to work. Employment following SCI was found to be related to personal, health, environmental and policy-level factors (Table 1.0). Surprisingly, few studies to date have examined how these factors interact to influence involvement in paid work. Table 1.0 Summary of Factors Related to Emplo yment. Factor Description Personal Age, educational attainment, pre-injury job experience, perceived control, gender and ethnicity. Health Injury severity, secondary health complications, injury duration, cause of injury. Environment Perceptions of others, access to the physical work environment, transportation and work conditions. Policy Access to social assistance and health benefits, and enforcement of employment equity legislation. Personal factors Being younger at the time of injury, having attained more education and pre-injury work experience and greater perceptions of control are associated with being employed.5,9,10 In addition, older adults may exit the workforce at a younger age. Longitudinal research highlights a sharp decline in participation in paid work at 40 years of age, for individuals with SCI, compared to those without any disability, who tend to leave their jobs around 50 to 60 years of age.8,11 Gender and race have been studied extensively in Americans with SCI. These studies report that being male and Caucasian are related to a greater likelihood of postinjury employment and greater wages.9,11 Research is required to examine demographic trends of this nature in Canadian samples. Health factors Injury severity or neurological impairment plays a significant role in employment participation. Research has found that neurological level of injury (NLI) (e.g., paraplegia), lower pain and fatigue, and fewer secondary health conditions are associated with functional independence, fewer activity limitations and improved employment outcomes, compared to those with a more severe injury.8,9,11 Having an injury for a longer period is also related to an increased likelihood of being employed. However, this trend plateaus after the first decade and those who remain unemployed, 10 to 12 years post-injury, are more likely to remain out of the workforce.10,11 Work environment and policy Aspects of the work environment, including the attitudes of others, physical access to the workplace, transportation and work conditions, may pose the most significant barriers to employment participation, when controlling for health and personal factors. Negative attitudes and misconceptions towards employees with SCI in the form of prejudice (e.g., a negative overgeneralized image) or discrimination (e.g., negative behaviours or treatment), reduce opportunities to enter the workforce. In addition, discrimination may also lower an individual’s perceptions regarding their ability to work.1 Aspects of the physical environment such as transportation (e.g., commuting to and from work - See Figure 1.0), access to and within workplaces (e.g., presence of ramps, curb cuts on sidewalks and elevators), accessible workspaces (e.g., wheelchair accessible desks and adapted computers) and adequate toilet facilities produce significant challenges to working,12 and are rated as one the most critical barriers to employment. Work conditions, including acts (e.g., sitting for long periods, lifting and reaching) and tasks (e.g., filing and typing for long periods or moving boxes and transporting goods) required for work, as well as the schedule and pace of work, can also dictate employment experiences. Research has found that individuals living with SCI tend to work in less labor-intensive job sectors, like business and administration or sales and service sectors, suggesting that work conditions play an important role in post-injury work choices.11 More research on the role of work conditions and the influence of workplace accommodations (e.g., flexible schedules, part-time work with full benefits and work-at-home arrangements), on employment participation of individuals with SCI is required. The policy environment may also significantly influence employment. A major barrier to employment, cited in research, is access to social assistance and health benefits. Among those not covered by private disability insurance or worker’s compensation, there exists a dependence on disability supports and health benefits (e.g., prescription drug coverage, rehabilitation services, assistive devices and medical supplies), which are free to individuals with SCI on social assistance. In the absence of social assistance, health benefits may be extremely costly and cannot be sustained by those who are working part-time or in jobs that pay lower wages. Thus, the current structure of social assistance often creates a disincentive to returning to work or working long term.1,13 In addition, there are gaps in legislation that support the employment participation of individuals with SCI. Employment equity laws, which promote the hiring of individuals with disabilities, improve accessibility in the workplace and reduce discrimination, contain few enforcement mechanisms and are applied to only a small proportion of Canadian businesses.1,13 Outcome Measures in Employment Research A majority of research has tended to assess employment dichotomously (i.e., employed and not employed), neglecting to capture the variability of employment experiences, including the range of tasks required for work, changes made to work because of health (e.g., reduced work 178 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


Q - Employment and Vocation
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