What does research tell us about job
accommodations for persons with
psychiatric disabilities?
A webinar presented on April 25, 2011 by:
• Kim MacDonald-Wilson, Sc.D., CRC, CPRP, Assistant Professor,
University of Maryland
• Marianne Farkas, Sc.D., Director of Training and Technical
Assistance, Boston University Center for Psychiatric
Rehabilitation
Supported by Grant # H133B090014 from the National Institute on Disability and
Rehabilitation Research and the Center for Mental Health Services to Boston
University
Translating Knowledge to Practice:
Job Accommodation
• 5 year project under Research and Training
Center on Improved Employment Outcomes for
Individuals with Psychiatric Disabilities
• Process involves:
• Review and grade the research literature in terms of
rigor of research and meaningfulness of research on
critical topic
• Synthesize identified research into one document
• Develop dissemination plan (Who? How? What tools
needed?) with organizations
• Develop information tools
Background on Job
Accommodations
• Mandated by the Americans with
Disabilities Act, 1990 and Rehabilitation
Act of 1973
• Employers are required to provide
‘reasonable accommodations’ to
qualified individuals with disabilities
unless doing so would create an undue
hardship
• unreasonably high costs
• significant disruption to the nature of the business.
Definition of Job Accommodation
• Job accommodations are “any change in the
work environment or in the way things are
customarily done.”
• Typical modifications to:
• Hiring process
• Work environment or job duties
• Benefits and privileges of employment
• Accommodations are intended to remove the
workplace barriers for individuals with
disabilities.
Past Research on Job Accommodations
• Job Accommodations for people with various
disabilities are associated with:
• higher job retention rates
• satisfactory work outcomes
• Limited knowledge or understanding of people
with psychiatric disabilities and employers about
how to use the ADA and job accommodations
• Deciding about disclosure of psychiatric
disabilities may also interfere with requesting
and using job accommodations
Identifying the Research to Analyze
• 100 documents located using search terms
• 60 documents identified by title and abstract
• Screening Criteria for the 60 studies
• Focus on Job Accommodations
• Sample is exclusively or mostly people with psychiatric disabilities
• Approved Research Designs
• Experimental; Quasi-experimental
• Pre-test/Post-test; Observational cohort
• Correlational; Survey Research
• After screening, 19 Quantitative Studies selected for Systematic
Review
• 4 studies examined Outcomes of Accommodations
• All Correlational or Survey Designs
• Rated for rigor
• 15 studies described accommodations and related factors – Process
Studies
• 9 Qualitative Studies on job accommodations and disclosure
Challenge of the Analysis: Rigor
• Little rigorous research was available
• Only 4 studies focused on Effectiveness or Outcomes of
Accommodations
• None of these used Experimental or Quasi-Experimental Designs
• 3 out of 4 studies had sample sizes below 70
• Rigor Ratings conducted on these 4 studies revealed overall
ratings of methodology were adequate, however
• 4 studies insufficient to draw valid conclusions about the impact of
accommodations on employment outcomes
• Meaning Ratings were not conducted
• Of 15 other descriptive studies on Process of Accommodations
• No experimental designs focused on accommodations (only 2 on
disclosure)
• 2 Quasi-experimental designs
• 9 Survey or Correlational
• Therefore, instead of Systematic Review, a Structured Synthesis
of Research Literature was conducted, including the 15
descriptive studies, and 9 additional Qualitative Studies
Research Synthesis Findings:
Accommodations Outcomes
• There are very few well-controlled studies of the
effectiveness of job accommodations for people
with psychiatric disabilities.
• The question of how effective job accommodations are
for people with psychiatric disabilities remains open
• There is no evidence from well-controlled
studies that job accommodations result in
improved employment outcomes.
• Neither are there well controlled or rigorous studies
indicating that job accommodations are ineffective.
• Based on review of 4 Outcomes-Related Studies
Suggestive Evidence:
Accommodations Outcomes
• Unsatisfactory job terminations related to unmet
accommodation needs (i.e., flexible hours, more
training, and improved supervision and support)
• Employment tenure positively associated with number of
job accommodations for individuals in an SE program
• Inadequate accommodation is associated with
employees placed on disability leave for mental health
reasons
• Inadequate accommodation is associated with poorer
employment outcomes among working individuals
(lower job satisfaction, lower sense of mastery and wellbeing, and a lack of opportunity for promotion )
Summary of Research Synthesis:
Accommodations Outcomes
• While there is little strong evidence from
rigorous studies about a relationship between
accommodations and employment outcomes,
there is suggestive evidence from uncontrolled
outcomes studies that job accommodations are
positively associated with:
•
•
•
•
•
staying employed
job satisfaction
satisfactory job terminations
sense of mastery and well-being
opportunity for promotion
Research Synthesis:
Accommodations Process
• Accommodations Process findings from 15
descriptive and 9 qualitative studies
• Categories of Process Findings
• Nature and Process of Accommodations
• 5 Descriptive Studies
• 3 Survey/Correlational
• 2 Quasi-Experimental
• 6 Qualitative Studies
• 3 Individual Interview
• 1 Focus Group
• 2 Case Studies of Organizations
Research Synthesis:
Accommodations Process more
Categories of Process Findings (more)
• Attitudes about Accommodations
• 4 Descriptive Studies - Survey Design
• Disclosure and Requesting Accommodations
• 6 Descriptive Studies
• 2 Experimental on Disclosure only
• 4 Survey or Correlational
• 3 Qualitative Studies
• 2 Individual Interviews
• 1 Individual Interviews and Focus Groups
• Descriptive and qualitative studies suggest Promising
Findings, more research needed
Promising Process Findings:
Nature of Job Accommodations
• Job accommodations for people with psychiatric disabilities cost
little to nothing in direct costs to the employer
• Most frequently used Accommodations
• Flexible schedules
• Job assistance by vocational rehabilitation service providers
• Interpersonal or other support interactions provided by supervisors
and coworkers
• Changes in job tasks
• Changes in the training process
• Accommodated employees and supervisors tend to identify different
accommodations when asked
• Employees - flexibility in schedules or other support and supervision;
Supervisors - modifications in job tasks or demands, as well as flexibility in
schedules
• Relationship accommodation needs were least often met in the
workplace (vs. task or routine accommodation needs)
Promising Process Findings: Functional
Limitations and Accommodations
• Functional limitations leading to the need for job
accommodations primarily cognitive and social-interpersonal
functioning in the workplace, such as:
• Cognitive – learning job tasks, concentrating, working independently
• Social-interpersonal – interacting with coworkers or customers, responding to
supervisor feedback
• Emotional – managing stress, adjusting to changes in the workplace, lack of
confidence
• Physical – maintaining stamina, adjusting to low energy levels or fatigue,
experiencing physical side effects of medications
• The fewer the number of limitations that the employee has,
the fewer the number of accommodations needed
• Cognitive limitations are associated with accommodations
involving job coaching or other human assistance
• Cognitive and social-interpersonal limitations are positively
associated with interpersonal accommodations
• Educating coworkers , phone or other access to support personnel
Promising Process Findings:
Attitudes about Accommodations
• Employers are aware of the ADA and accommodations
for people with psychiatric disabilities
• Providing job accommodations (adjusting work hours, part-time jobs,
restructuring jobs) and are satisfied with these employees
• Coworkers generally supportive of job accommodations
for people with psychiatric disabilities (flexible work
hours, banking overtime for use as sick leave, and access
to counseling)
• Less supportive of longer or more frequent breaks
• More likely to intend to self-disclose a mental health condition and
seek treatment should they experience one in the future if they
believe the employer treats people with mental health condition fairly
• Some evidence that there remains some bias:
• Accommodations for people with physical disabilities viewed as more
‘acceptable’ and ‘reasonable’ than accommodations for people
with psychiatric disabilities
• Psychological conditions are perceived as “questionable” disabilities
Promising Process Findings:
Disclosure & Accommodation
• People with mental health conditions (depression and substance
use disorders vs. physical, sensory) are less likely to have
accommodations in the workplace
• Supervisor and coworker supportiveness are associated with
disclosure of disability and successful accommodations in the
workplace
• Desired as accommodations by terminated employees who identified
accommodations that would have made a difference in their jobs
• Over-accommodation (excessive supportiveness) may result in
employees leaving jobs due to feeling unchallenged and
overprotected in their work
• Self-accommodation is a successful employment strategy that
helps people avoid disclosure
Promising Process Findings: Impact of
Disclosing /Requesting Accommodations
• When SE Services involved:
• Providers frequently handle disclosure and accommodation requests
• Employees are more likely to receive accommodation
• Disclosure helps employees with psychiatric disabilities to do
their jobs better, makes work feel less stressful, and allows
employees to get support
• Disclosing may also increase stress with coworkers or being
treated differently by coworkers
• Using clear, assertive communication about accommodation
needs and using relationship accommodations are
associated with successful accommodation outcomes
Summary of Research Synthesis:
Accommodations Process
• Job accommodations for people with psychiatric disabilities are
low- or no-cost, and most often involve flexible scheduling and
interpersonal supports provided by job coaches, supervisors, and
coworkers.
• The functional limitations requiring accommodation are most
often cognitive or social-interpersonal in nature.
• Disclosure of psychiatric disabilities to employers is a complex
process for which individuals need guidance in order to make
decisions about whether to disclose, and what to say, when, and
to whom.
• Disclosure and requesting accommodations are less complicated
when supported employment (SE) service providers are involved
with employers, since SE providers often handle these processes.
Importance of Promoting New
Research on Job Accommodations
High unemployment and underemployment rates
among those with psychiatric disabilities:
Employment = Hope.
Need more rigorous research on effectiveness of
job accommodations for people with psychiatric
disabilities, employers, policy makers
Knowledge from Supported Housing and
Supported Employment shows the value of the
right supports in effecting positive outcomes.
Conclusions from the Synthesis of
the Research on Job Accommodation
• While there is currently no conclusive evidence that job
accommodations for people with psychiatric disabilities are
effective or not, evidence suggests that accommodations are
associated with positive employment outcomes.
• Additional research is available on the nature and process of
disclosure and job accommodations, yielding several
promising findings requiring further research:
• Most frequent accommodations are flexible scheduling and
interpersonal supports
• Accommodations are most often needed for cognitive and
interpersonal limitations.
• Disclosure and requesting accommodations is a complex process,
especially when service providers are not involved.
Supported by Grant # H133B090014 from the National
Institute on Disability and Rehabilitation Research and the
Center for Mental Health Services to Boston University