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A Systematic Review of the Characteristics of Programs and Services Resulting in Competitive Employment Outcomes for Young People with an Intellectual Disability

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Title: A Systematic Review of the Characteristics of Programs and Services Resulting in Competitive Employment Outcomes for Young People with an Intellectual Disability
Language: English
Authors: Alison Enticott, Angela Dew
Source: Journal of Intellectual & Developmental Disability. 2026 51(1):27-38.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 12
Publication Date: 2026
Document Type: Journal Articles
Information Analyses
Reports - Research
Education Level: Postsecondary Education
Descriptors: Intellectual Disability, Employment, Employment Programs, Postsecondary Education, Vocational Rehabilitation, Age, Educational Attainment, Foreign Countries
Geographic Terms: United States, Austria, Norway
DOI: 10.3109/13668250.2025.2499674
ISSN: 1366-8250
1469-9532
Abstract: Background: Transitioning to paid employment is part of the natural progression to adulthood, yet the number of people with an intellectual disability who are competitively employed globally is low. This study systematically reviewed the literature to understand characteristics of programs that support competitive employment outcomes for young people with an intellectual disability. Method: Five databases were searched. Two quality assessment tools were used: the Effective Public Health Practice Project (EPHPP) tool; and the Mixed Methods Appraisal Tool (MMAT). Content analysis was conducted using Braun and Clarke's theoretical thematic analysis framework. Results: Key findings demonstrated the importance of early career planning, work exposure, post-secondary education and certification, and on-the-job training. Conclusion: Further research, along with the application and adaptation of existing international studies presented in this systematic review, could drive system-wide changes prioritising competitive employment outcomes for young people with intellectual disability, enabling them to experience the benefits of competitive employment.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1505222
Database: ERIC
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  Value: <anid>AN0192006719;ddi01mar.26;2026Mar05.05:33;v2.2.500</anid> <title id="AN0192006719-1">A systematic review of the characteristics of programs and services resulting in competitive employment outcomes for young people with an intellectual disability </title> <p>Background: Transitioning to paid employment is part of the natural progression to adulthood, yet the number of people with an intellectual disability who are competitively employed globally is low. This study systematically reviewed the literature to understand characteristics of programs that support competitive employment outcomes for young people with an intellectual disability. Method: Five databases were searched. Two quality assessment tools were used: the Effective Public Health Practice Project (EPHPP) tool; and the Mixed Methods Appraisal Tool (MMAT). Content analysis was conducted using Braun and Clarke's theoretical thematic analysis framework. Results: Key findings demonstrated the importance of early career planning, work exposure, post-secondary education and certification, and on-the-job training. Conclusion: Further research, along with the application and adaptation of existing international studies presented in this systematic review, could drive system-wide changes prioritising competitive employment outcomes for young people with intellectual disability, enabling them to experience the benefits of competitive employment.</p> <p>Keywords: Intellectual disability; young people; employment policy; legislation; competitive employment programs; systematic review</p> <p>Transitioning to paid employment is a part of the natural progression to adulthood. Article 23 of the Universal Declaration of Human Rights (1948) states that everyone has the right to work and to free choice of employment. For young people leaving secondary school, employment provides benefits of economic security, personal wellbeing, meaningful occupation, and social engagement (Xu & Stancliffe, [<reflink idref="bib35" id="ref1">35</reflink>]). The right to employment is one of the fundamental human rights identified in Article 27 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (United Nations, [<reflink idref="bib31" id="ref2">31</reflink>]), which states:</p> <p>Parties recognize the right of persons with disabilities to work on an equal basis with others; this includes the right to gain a living by work freely chosen or accepted in a labour market and work environment that is open, inclusive and accessible to persons with disabilities.</p> <p>The United States of America (USA) Department of Education, Rehabilitation Services defines competitive employment as working at or above the minimum wage in full or part time employment in an integrated setting, a state-managed Business Enterprise Program, or in self-employment (Iwanaga et al., [<reflink idref="bib15" id="ref3">15</reflink>]). In Australia, the United Kingdom, Scandinavia, Canada and New Zealand, the term open employment is more common.</p> <p>The alternative to competitive employment is segregated or sheltered employment, specifically designed for people with disabilities and typically offering low wages (Grossi et al., [<reflink idref="bib12" id="ref4">12</reflink>]). Intellectual disability, which begins before age 22 years, can significantly impair skill development in areas such as motor skills, communication, social interaction, and cognition, affecting a person's ability to learn and participate in society ((World Health Organization [WHO]), [<reflink idref="bib34" id="ref5">34</reflink>]). People with intellectual disability working in sheltered workshops miss out on the benefits of competitive employment, which include participating in society on an equal basis with others and earning at least the minimum wage (Grossi et al., [<reflink idref="bib12" id="ref6">12</reflink>]). To access the benefits of open employment, people with intellectual disability should begin their pathway to employment before finishing high school. A study by Siperstein et al. ([<reflink idref="bib28" id="ref7">28</reflink>]), which surveyed over 1,000 participants with intellectual disability, found that only 2% of those competitively employed began their first job after age 30 years. In contrast, the average age for individuals who went on to secure successful competitive employment was 19.7 years. Therefore, highlighting outcomes of competitive employment experiences for young people with intellectual disability is the focus of the systematic review reported in this paper.</p> <p>The USA is a signatory to the CRPD but despite not having ratified it, has a history of policy and legislation that is in keeping with the principles of the CRPD to support people with disability to work in competitive employment (Broda et al., [<reflink idref="bib3" id="ref8">3</reflink>]; Iwanaga et al., [<reflink idref="bib16" id="ref9">16</reflink>]). Australia has ratified the CRPD, operationalised through the Disability Strategy 2021–2031 (DSS, [<reflink idref="bib8" id="ref10">8</reflink>]). The Nordic countries have also ratified the CRPD however their approaches to supporting people with a disability to achieve competitive employment differ from other Global North countries (Garrels & Sigstad, [<reflink idref="bib10" id="ref11">10</reflink>]). For example, Denmark provides extensive Employment Services to help people with disability secure jobs in the open labour market while Finland's disability policy focuses instead on support for income protection. Iceland has a reliance on sheltered employment and limited labour market integration for people with disability. Many other European countries also have legislation and policies in place to support competitive employment. In Austria, the Federal Social Welfare Office collaborates with the Public Employment Service and vocational rehabilitation organisations to help people with disabilities enter the job market (Fasching, [<reflink idref="bib9" id="ref12">9</reflink>]). Spain's first law recognising the right to full integration for people with disabilities, including employment, was enacted in 1982. The United Kingdom's (UK's) journey began with the Disabled Persons Act of 1944, evolving into the Equality Act 2010 (Peña-Quintana & Santana-Vega, [<reflink idref="bib24" id="ref13">24</reflink>]).</p> <p>Despite these policy and legislative measures, rates of competitive employment for people with an intellectual disability globally are persistently low. From 2018-2019, just 17% of working-age adults in the USA supported by State intellectual and development disability agencies were employed in paid community jobs (NCI, [<reflink idref="bib19" id="ref14">19</reflink>]) compared with their peers without a disability who were employed at a rate of 72.1% (BLS, [<reflink idref="bib4" id="ref15">4</reflink>]). Data from participants aged 15–24 years with intellectual disability who joined Australia's National Disability Insurance Scheme (NDIS) between July 2016 and December 2021 showed participation in the scheme had minimal impact on employment outcomes, with the employment rate increasing from only 11% to 20%, while rates for other age groups remained static or declined (NDIS, [<reflink idref="bib20" id="ref16">20</reflink>]).</p> <p>A similar trend is evident in Europe. Inclusion Europe provides data on the rights and inclusion of people with intellectual disability in European countries (Inclusion Europe, [<reflink idref="bib14" id="ref17">14</reflink>]). The data was gathered through a survey sent to Inclusion Europe's member organisations, which include self-advocacy and family organisations. The indicators cover seven key topics: right to decide and vote, right to live independently and be included in the community, housing and support, education, employment, healthcare, and representation. The first report was based on data collected in 2023 from 29 European countries and will be updated annually to track progress and allow for comparisons over time. It reported that people with intellectual disability have much lower employment rates than those without. In 20 of 29 European countries surveyed, fewer than 10% of people with intellectual disability were employed. Austria and England scored 1 out of 10 for open labour market employment, with Spain slightly higher at 2.5. These ratings reflect both employment rates and the impact of income on social security benefits. Drawing on data published in Norwegian by Wendelborg et al. ([<reflink idref="bib33" id="ref18">33</reflink>]) on employment of students with intellectual disability, Wass et al. ([<reflink idref="bib32" id="ref19">32</reflink>]) and Sigstad and Garrels ([<reflink idref="bib27" id="ref20">27</reflink>]) noted that in Norway, 81% of adults with intellectual disability rely on disability support pensions, 10% work in sheltered workshops, and fewer than 3% are competitively employed (Wass et al., [<reflink idref="bib32" id="ref21">32</reflink>]; Sigstad & Garrels, [<reflink idref="bib27" id="ref22">27</reflink>]). In the Inclusion Europe survey, Denmark scored 2.3, Finland 3.3, and Norway 1.8 out of 10 indicating low rates of competitive employment of people with intellectual disability.</p> <p>Given the CRPD emphasis on open employment outcomes, and the persistently low global rates of open employment despite widespread policy and legislative efforts, this systematic review examines the key characteristics of services that governments should invest in to achieve the CRPD's goal of increasing competitive employment opportunities for young people with intellectual disability. While government-funded services are not the sole factor in influencing open employment outcomes, the research question underpinning this review was to identify from the published literature, what the characteristics of programs or services are that resulted in competitive employment outcomes for young people with an intellectual disability who were transitioning from school to work. We hypothesised that understanding what is currently working would provide valuable direction to future policy and funding decisions to improve competitive employment rates and experiences for young people with intellectual disability.</p> <hd id="AN0192006719-2">Method</hd> <p>This systematic review was completed as part of a Master of Health Economics program thesis and was registered on the INPLASY register, DOI number 10.37766/inplasy2023.9.0077. Box 1 outlines the inclusion and exclusion criteria used.</p> <hd id="AN0192006719-3">Box 1 – Inclusion and exclusion criteria.</hd> <p></p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Inclusion criteria</td><td>Exclusion criteria</td></tr></thead><tbody><tr><td><list list-type="Bullet"><list-item><p>Peer-reviewed systematic reviews and empirical studies, including qualitative, quantitative, and mixed methods designs.</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Book reviews, theses, conference presentations and project reviews</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>Published between January 2013 and April 2023</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Outside this date range</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>Young people with intellectual disability as their primary disability</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Populations without intellectual disability as their primary disability or with multiple disabilities</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>Young people transitioning from school to work</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Programs or services supporting older adults or those not transitioning from education to work</p></list-item></list></td></tr><tr><td><list list-type="Bullet"><list-item><p>Programs or services supporting young people to transition from school or PSE to open employment</p></list-item></list></td><td><list list-type="Bullet"><list-item><p>Programs or services only resulting in sheltered or customised employment outcomes</p></list-item></list></td></tr></tbody></table> </ephtml> </p> <hd id="AN0192006719-4">Literature search</hd> <p>The key concepts from the research question were: intellectual disability, program, and employment. Alternative descriptions of the main concepts were considered. The term "learning disability" was included, with studies using a narrower definition focused solely on the understanding or use of language, excluding learning problems primarily resulting from intellectual disability, omitted during the full-text review. Various terms in the literature refer to competitive integrated employment, including "open", "competitive", or "integrated" employment. To avoid missing relevant studies, the term "employment" was used, without limiting the search to "open", "competitive", or "integrated" employment outcomes. Studies not describing competitive employment outcomes were excluded during screening and full-text review, in line with the selection criteria. Similarly, the search terms "young people", "transition", or "school" were excluded, as different terms describe young people transitioning from school to work. Studies not including this population were excluded during screening and full-text review. A selection of relevant articles was reviewed to identify key terms, and the search strategy was refined through two additional preliminary searches. The following MESH headings were included: MH "Intellectual Disability/Learning disability", with concept 1; MH "Employment+"), with concept 3; and MH "Occupations+", with concept 3.</p> <hd id="AN0192006719-5">Database search</hd> <p>The search terms were structured using Boolean operators to refine the search. A systematic review of five databases was conducted: Medline, Embase, CINAHL, ERIC, and AMED. Medline and Embase were selected for their extensive coverage of international health and medical literature, while CINAHL, AMED, and ERIC were chosen for their relevance to education and employment for people with disabilities.</p> <hd id="AN0192006719-6">Limiters</hd> <p>To capture the most recent literature, the date range was limited to a 10-year period from January 2013 to April 2023. The search was limited to English, human studies, and peer reviewed literature (Box 2).</p> <hd id="AN0192006719-7">Box 2. Search terms by concept</hd> <p></p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Concept 1: Intellectual disability OR</td><td>AND</td><td>Concept 2: Program<bold />OR</td><td>AND</td><td>Concept 3: Employment<bold />OR</td></tr></thead><tbody><tr><td>intellectual* disab* or</td><td /><td>program* or</td><td /><td>Job or</td></tr><tr><td>intellectual disabilit* or</td><td /><td>service* or</td><td /><td>vocational outcome or</td></tr><tr><td>intellectual* impair* or</td><td /><td>Training or</td><td /><td>Employee or</td></tr><tr><td>learning* disab* or</td><td /><td>educat* or</td><td /><td>on-the-job</td></tr><tr><td>learning disab* or</td><td /><td>opportunit* or</td><td /><td /></tr><tr><td>learning* impair*</td><td /><td>support* or</td><td /><td /></tr><tr><td /><td /><td>strateg*</td><td /><td /></tr></tbody></table> </ephtml> </p> <p>The results of the database searches were imported to the online software product Covidence <sups>TM</sups> (Covidence systematic review software, veritas Health Innovation, Melbourne, Australia <ulink href="http://www.covidence.org">www.covidence.org</ulink>). As shown in Figure 1, an initial 1,387 references were imported for screening, 65 duplicates were removed, 1,322 studies were screened against title and abstract, 1,199 studies were excluded; 123 studies were assessed for full-text eligibility. Covidence screening was completed by two reviewers. Differences were discussed and resolved. Finally, 14 studies were included.</p> <p>Graph: Figure 1. PRISMA Flowchart.</p> <hd id="AN0192006719-8">Quality assessment methods and results</hd> <p>Of the 14 studies included, 12 were quantitative, 1 qualitative, and 1 used mixed methods. The Effective Public Health Practice Project (EPHPP) (https://<ulink href="http://www.ephpp.ca/quality-assessment-tool-for-quantitative-studies/">www.ephpp.ca/quality-assessment-tool-for-quantitative-studies/</ulink>) tool was selected to appraise the quantitative studies, and the Mixed Methods Appraisal Tool version 18 (MMAT) (Hong et al., [<reflink idref="bib13" id="ref23">13</reflink>]) was used to appraise the qualitative and mixed methods studies. EPHPP can be used to evaluate a range of quantitative study designs and the final 12 quantitative studies included cohort analysis, case control design, and quasi-experimental design. Content and construct validity and reliability has been demonstrated for the EPHPP (Armijo-Olivo et al., [<reflink idref="bib1" id="ref24">1</reflink>]; Thomas et al., [<reflink idref="bib29" id="ref25">29</reflink>]). It was designed for use in public health studies, but it has also been used to evaluate other programs such as education initiatives (Nowell et al., [<reflink idref="bib21" id="ref26">21</reflink>]). The MMAT has been validated for use in appraising qualitative and mixed methods research and so was appropriate for appraising the remaining two studies (Pace et al., [<reflink idref="bib22" id="ref27">22</reflink>]).</p> <p>The quality assessment was completed by one reviewer and a random sample (30%) by the second reviewer. Cimera et al. ([<reflink idref="bib6" id="ref28">6</reflink>]), Iwanaga et al. ([<reflink idref="bib15" id="ref29">15</reflink>]), Park and Bouck ([<reflink idref="bib23" id="ref30">23</reflink>]), and Sannicandro et al. ([<reflink idref="bib26" id="ref31">26</reflink>]) were rated as strong. Daviso et al. ([<reflink idref="bib7" id="ref32">7</reflink>]), Grigal et al. ([<reflink idref="bib11" id="ref33">11</reflink>]), Kaya ([<reflink idref="bib17" id="ref34">17</reflink>]), Moore and Schelling ([<reflink idref="bib18" id="ref35">18</reflink>]), Qian et al. ([<reflink idref="bib25" id="ref36">25</reflink>]), Sigstad and Garrels ([<reflink idref="bib27" id="ref37">27</reflink>]) and Siperstein et al ([<reflink idref="bib28" id="ref38">28</reflink>]) were rated as moderate. Braun and Clarke's ([<reflink idref="bib2" id="ref39">2</reflink>]) six stages of thematic analysis was used to identify and report patterns in the studies. An inductive approach was employed to code results and understand their relevance to the research question. Themes were analysed to assess their relevance across key transition stages – secondary school, post-secondary education, and vocational rehabilitation. This approach involved translating concepts and results from one study and recognising similar concepts in another study, as described by Thomas and Harden ([<reflink idref="bib30" id="ref40">30</reflink>]) for systematic analysis methods in systematic reviews. Subthemes were also identified and mapped to capture all relevant information. The findings were then analysed in relation to the research question, with main themes discussed in the context of each transition stage for young people with an intellectual disability.</p> <hd id="AN0192006719-9">Findings</hd> <p>An overview of the included studies and summary of the main findings are shown in Table 1:</p> <p>Table 1. Included studies.</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Author & Year</td><td>Location</td><td>Purpose of the study</td><td>Participants</td><td>Data source</td><td>Results relating to research question</td></tr></thead><tbody><tr><td>Broda et al. (<xref ref-type="bibr" rid="bibr3">2021</xref>)</td><td>USA</td><td>To demonstrate the potential of Machine Learning to predict outcomes based on national survey data.</td><td>21,492 adults over 18 with IDD who use at least one publicly funded IDD service in the USA in addition to case management or support coordination.</td><td>National Core Indicators In-Person Survey (NCI-IPS), 2017–2018.</td><td>Characteristics of programs supporting open employment outcomes: <list list-type="Bullet"><list-item><p>Having an employment goal in the IEP.</p></list-item><list-item><p>Holding a volunteer position.</p></list-item><list-item><p>Making choices about what to do during the day.</p></list-item></list></td></tr><tr><td>Butler et al. (<xref ref-type="bibr" rid="bibr5">2016</xref>)</td><td>Kentucky, USA</td><td>To understand life outcomes for students who attend college or university compared with those who do not.</td><td>Students (n = 19) who had completed at least two semesters of college in Kentucky. The non-student group (n = 158) were between the ages of 18–30 and had not completed college or university.</td><td>National Core Indicators (NCI) Adult Consumer Survey (ACS).</td><td>Participating in PSE at a university or college increased competitive employment outcomes for students with an intellectual disability when compared with the non-student group.</td></tr><tr><td>Cimera et al. (<xref ref-type="bibr" rid="bibr6">2014</xref>)</td><td>USA</td><td>To compare the impact of including transition services in the IEP at age 16 versus age 14.</td><td>7,520 individuals from states commencing transition services by age 14 and 7,520 from states required by age 16.</td><td>RSA 911 data from 2006 to 2009.</td><td>Starting employment transition services at age 14 significantly increased the likelihood of achieving open employment when compared with students commencing at age 16.</td></tr><tr><td>Daviso et al. (<xref ref-type="bibr" rid="bibr7">2016</xref>)</td><td>Ohio, USA</td><td>Assesses if career and technical education, work-study, or school-supervised work significantly predict employment for students with various disabilities, accounting for gender and minority status.</td><td>The sample included students with a disability who graduated or aged out of special education in the years 2005–2010 across all local education agencies in one Great Lakes state.</td><td>National Longitudinal Study for Transition</td><td>Career-tech, Work-study, or supervised work were not positively correlated with achieving a competitive employment outcome for people with an intellectual disability when compared with students from other disability groups.</td></tr><tr><td>Fasching (<xref ref-type="bibr" rid="bibr9">2014</xref>)</td><td>Austria</td><td>To examine the impact of labour market policy measures on employment outcomes.</td><td>625 people with an intellectual disability (average age 24.4 years old) who accessed a labour market policy measure.</td><td>A nationwide quantitative online survey with Organisations implementing labour market policy support measures in the reference year 2008. Surveys were compared with the Federal Ministry of labour, Social Affairs and Consumer Protection data-set.</td><td>People attending inclusive schooling were more likely to participate in PSE than people who attended specialised schools. The measure which most successfully supported competitive employment was work assistance / supported employment (first placement, then qualification).</td></tr><tr><td>Grigal et al. (<xref ref-type="bibr" rid="bibr11">2019</xref>)</td><td>USA</td><td>To identify predictors of employment while in an employment transition program and at exit.</td><td>686 students who had completed a TPSID program and completed at least one inclusive course were included. Mean age was 21.8 years old.</td><td>National Coordinating Center (NCC) data from TPSID programs between 2010 and 2015.</td><td>The following increased the likelihood of obtaining employment within 90 days of exit from an employment transition program: <list list-type="Bullet"><list-item><p>Attending a 4-year tertiary program compared with a 2-year program.</p></list-item><list-item><p>Obtaining a paid job while enrolled in higher education.</p></list-item><list-item><p>Earning a credential</p></list-item><list-item><p>Having a paid job prior to entering an employment transition program.</p></list-item></list></td></tr><tr><td>Iwanaga et al. (<xref ref-type="bibr" rid="bibr16">2021</xref>)</td><td>USA</td><td>Examines the effect of supported employment on employment outcomes of young adults with intellectual disabilities who receive state VR services.</td><td>Intervention group received supported employment = 2162, comparison group did not = 2191. Inclusion criteria; Aged 16–36 at intake, intellectual disability, received special education in high school.</td><td>Rehabilitation Services Administration Case Service Report database (RSA-911) (program year 2018)</td><td>Supported employment increased the likelihood of obtaining work in competitive employment when compared with those who did not receive supported employment.</td></tr><tr><td>Kaya (<xref ref-type="bibr" rid="bibr17">2018</xref>)</td><td>USA</td><td>To examine the relationship between demographic factors, VR services, and employment outcomes for youth with intellectual disabilities (ID).</td><td>8320 young people aged between 19 and 25 who have an intellectual disability, were unemployed at the time of application for VR services, received at least one VR service and exited the VR service in 2013.</td><td>Rehabilitation Services Administration (RSA) 2013.</td><td>The following increased the likelihood of achieving competitive employment: <list list-type="Bullet"><list-item><p>Technical assistance, job placement, on the job support, on the job training, and maintenance services.</p></list-item><list-item><p>Having an associate degree, bachelor degree or higher.</p></list-item><list-item><p>The higher the level of education the more likely the person is to achieve competitive employment.</p></list-item><list-item><p>A larger number of VR services and remaining in the VR program for a shorter period.</p></list-item></list></td></tr><tr><td>Moore and Schelling (<xref ref-type="bibr" rid="bibr18">2015</xref>)</td><td>USA</td><td>Surveys with graduates from two PSE programs with an intellectual disability to determine employment outcomes.</td><td>2 schools participated: 2 program directors and 26 graduates. One program was a specialised program and the other an integrated program.</td><td>2009 National Longitudinal Transition Study 2</td><td>Employment outcomes for students attending integrated (100%) or specialised programs (93%) are higher than the comparison group (59%).</td></tr><tr><td>Park and Bouck (<xref ref-type="bibr" rid="bibr23">2018</xref>)</td><td>USA</td><td>To examine the relationship between employment status and in-school services for people with intellectual disability.</td><td>Adolescents aged 13–16 in 2000, and who were 21–25 years old at the time of find data collection in 2009. Participants selected had an intellectual disability.</td><td>National Longitudinal Transition Study-2 (NLTS-2).</td><td><list list-type="Bullet"><list-item><p>Positive correlation with post-school paid employment;</p></list-item><list-item><p>Job readiness training</p></list-item><list-item><p>Instruction in looking for jobs</p></list-item><list-item><p>Placement support</p></list-item><list-item><p>Including competitive employment in the transition plan</p></list-item><list-item><p>Gaining employment experiences</p></list-item><list-item><p>Career counselling</p></list-item><list-item><p>Negative correlation with post-school paid employment;</p></list-item><list-item><p>School-sponsored work</p></list-item><list-item><p>Including sheltered employment in the transition plan</p></list-item></list></td></tr><tr><td>Qian et al. (<xref ref-type="bibr" rid="bibr25">2018</xref>)</td><td>USA, Midwentern</td><td>To identify predictors of paid employment outcomes for community and technical college students with intellectual disability (ID).</td><td>228 students (average age = 21 years) attending college who received supports based on the Check & Connect model in community and technical colleges in two rural Midwestern communities.</td><td>National Coordinating Center (NCC) data from TPSID programs between 2011 and 2015.</td><td>Students in inclusive classes were 4.65 times more likely to make at or above minimum wage compared to students who took some specialised classes. Students with prior work experience paid at or above minimum wage were 3.30 times more likely to have a job paid at or above minimum wage during college.</td></tr><tr><td>Sannicandro et al. (<xref ref-type="bibr" rid="bibr26">2018</xref>)</td><td>USA</td><td>To examine the effect of postsecondary education on employment earnings for individuals with ID.</td><td>Included: people with a primary diagnosis of intellectual disability aged 16–30 who received VR services from state agencies. Intervention group = 5,640 people who participated in PSE, control group = 5,640 people who did not participate in PSE.</td><td>Rehabilitation Services Administration 911 (RSA-911) files for 2008–2013</td><td>People who participated in PSE were more likely to be employed.</td></tr><tr><td>Sigstad and Garrels (<xref ref-type="bibr" rid="bibr27">2022</xref>)</td><td>Norway</td><td>To examine which success factors young adults with mild intellectual disability highlight in their school-work transition.</td><td>10 young adults aged 18–25 with a mild intellectual disability who transitioned from upper secondary school to competitive employment.</td><td>Qualitative data through semi-structured in-depth interviews with ten young adults with intellectual disability.</td><td>Environmental factors which promoted employment outcomes included wider network support, school-workplace collaboration, an inclusive work environment, and individual accommodations at the workplace.</td></tr><tr><td>Siperstein et al. (<xref ref-type="bibr" rid="bibr28">2014</xref>)</td><td>USA</td><td>To identify characteristics of adults with intellectual disabilities who are employed, and to understand their employment path.</td><td>1,055 parents/guardians of adult children (21 years of age or older) with an intellectual disability surveyed by Gallup.</td><td>Telephone interviews using a scripted protocol. 1,000 randomly dialled USA households per night were called over a 16-month period in 2011–2012.</td><td>Age was significantly negatively related to competitive employment. Every decade after age 21, the odds of being competitively employed were 1.3 times less likely. 73% competitively employed received some form of job training in high school. 10% whose first job was in sheltered employment were competitively employed.</td></tr></tbody></table> </ephtml> </p> <p>Of the included studies, 12 reported on research in the USA, and two in European countries (Austria and Norway). Review findings are discussed under three themes: (i) age of commencing programs and services; (ii) quality and quantity of education prior to receiving programs and services; and (iii) method of service provision.</p> <hd id="AN0192006719-10">Age of commencing programs and services</hd> <p></p> <hd id="AN0192006719-11">Impact of age on employment transition services</hd> <p>Cimera et al. ([<reflink idref="bib6" id="ref41">6</reflink>]) reported that high school students commencing employment transition services at age 14 years were significantly more likely to be competitively employed than those commencing at age 16 years, even when differences in employment rates in the general population were considered. While Cimera et al.'s study design controlled for differences relating to seven demographic variables, it did not control for differences in the employment rate in the general population, which differed between groups. Despite having a lower employment rate in the general population, the early transition group achieved a higher employment rate (58.8%) compared to the later transition group (45.6%), with this difference being statistically significant and of large effect size.</p> <hd id="AN0192006719-12">Impact of age on commencing first paid employment</hd> <p>Four papers reported that age of first employment is significantly correlated to competitive employment. Two studies reported similar outcomes using the same dataset over a similar timeframe; National Coordinating Centre data between 2010–2015 (Grigal et al., [<reflink idref="bib11" id="ref42">11</reflink>]) and 2011–2015 (Qian et al., [<reflink idref="bib25" id="ref43">25</reflink>]). Students who had paid work prior to college were 2.8 times (Grigal et al., [<reflink idref="bib11" id="ref44">11</reflink>]) or 3.30 times (Qian et al., [<reflink idref="bib25" id="ref45">25</reflink>]) more likely to have a paid job within 90 days of completing a post-secondary transition program than students who had never had a paid job. Grigal et al. ([<reflink idref="bib11" id="ref46">11</reflink>]) also found that students who had a paid job during college were almost 15 times more likely to have a paid job within 90 days of completing the program than students who did not. Siperstein et al. ([<reflink idref="bib28" id="ref47">28</reflink>]) found that a significant majority (72%) of competitively employed people with intellectual disabilities started their first job before age 21 years. Those who did not were 1.3 times less likely to achieve competitive employment.</p> <hd id="AN0192006719-13">Quality and quantity of education prior to receiving programs and services</hd> <p></p> <hd id="AN0192006719-14">Participating in post-secondary education</hd> <p>The more education a young person with an intellectual disability has the more likely they are to achieve competitive employment (Sannicandro et al., [<reflink idref="bib26" id="ref48">26</reflink>]). Kaya ([<reflink idref="bib17" id="ref49">17</reflink>]) and Sannicandro et al. ([<reflink idref="bib26" id="ref50">26</reflink>]) both analysed data from the Rehabilitation Services Administration dataset. Kaya ([<reflink idref="bib17" id="ref51">17</reflink>]) for the 2013 fiscal year with an age range of 19–25, and Sannicandro et al. ([<reflink idref="bib26" id="ref52">26</reflink>]) from 2008 to 2013, age range of 16–30. Kaya ([<reflink idref="bib17" id="ref53">17</reflink>]) found that level of education was the strongest variable related to improving the rate of competitive employment for young people with an intellectual disability. Young people with special education or less than a high school qualification achieved an employment rate of 43.7%, students with a high school degree 52.1%, and students with an associated degree or higher 59.4%. Kaya ([<reflink idref="bib17" id="ref54">17</reflink>]) did not control for level of disability with the authors noting this may be a confounder. Sannicandro et al. ([<reflink idref="bib26" id="ref55">26</reflink>]) controlled for level of disability and found that post-secondary education improved rates of competitive employment. Moore and Schelling ([<reflink idref="bib18" id="ref56">18</reflink>]) also found that graduates from an integrated and specialised program in a college setting achieved higher competitive employment outcomes compared to the non-student group. Therefore, participating in post-secondary education resulted in an increased likelihood of achieving competitive employment.</p> <hd id="AN0192006719-15">Length and quantity of services</hd> <p>Completing at least two semesters of college increases the likelihood of competitive employment (Butler et al., [<reflink idref="bib5" id="ref57">5</reflink>]; Grigal et al., [<reflink idref="bib11" id="ref58">11</reflink>]). Students who completed four years at an institute of higher education at either college or university were more likely to be employed following program completion than students who completed a two year program (Grigal et al., [<reflink idref="bib11" id="ref59">11</reflink>]), however the authors hypothesised that the outcome may be the result of opportunities students had to prepare for employment during the program rather than the number of attendance years. Earning a recognised credential available to students not participating in the employment transition program almost doubled the odds of the student achieving employment (Grigal et al., [<reflink idref="bib11" id="ref60">11</reflink>]).</p> <p>All studies agreed that more education leads to higher rates of competitive employment, but they varied on the influence of attendance duration or service quantity. The type and quality of services likely matter more than the time spent or number of services used.</p> <hd id="AN0192006719-16">Method of service provision</hd> <p></p> <hd id="AN0192006719-17">Vocational rehabilitation or training services</hd> <p>Vocational rehabilitation describes a range of services designed to improve employment outcomes. In the included studies, not all vocational rehabilitation services achieved similar outcomes. Services directly related to finding and maintaining a specific job resulted in higher rates of competitive employment than services that did not. Park and Bouck ([<reflink idref="bib23" id="ref61">23</reflink>]) and Kaya ([<reflink idref="bib17" id="ref62">17</reflink>]) analysed different datasets with similar conclusions. Both agreed that the odds of achieving competitive employment were greater with job placement services or support (odds ratios of 5.37 and 3.15, respectively). The most important services were instruction in looking for jobs (odds ratio 7.95) and job readiness services (odds ratio 7.36) (Park & Bouck, [<reflink idref="bib23" id="ref63">23</reflink>]). Kaya ([<reflink idref="bib17" id="ref64">17</reflink>]) found that on-the-job support services (odds ratio 2.78) and on-the-job training (odds ratio 2.16) achieved higher rates of employment. Practical support through maintenance services also improved employment outcomes (Kaya, [<reflink idref="bib17" id="ref65">17</reflink>]). None of these services involved classroom training or support unrelated to a specific job. Fasching ([<reflink idref="bib9" id="ref66">9</reflink>]), and Iwanaga et al. ([<reflink idref="bib15" id="ref67">15</reflink>]) reported that supported employment resulted in higher competitive employment outcomes when compared with those who did not use this service. The approach of supported employment is "place then train" (Iwanaga et al., [<reflink idref="bib15" id="ref68">15</reflink>]). In the study by Iwanaga et al. ([<reflink idref="bib15" id="ref69">15</reflink>]) 71% of people who accessed supported employment achieved a competitive employment outcome, compared with 43% in a matched control group who did not use this service.</p> <p>Career and technical education, occupational, and vocational training prepare students for employment or postsecondary education (Daviso et al., [<reflink idref="bib7" id="ref70">7</reflink>]). Work-study programs let students earn money or credits without school supervision, while school-supervised work involves direct training or oversight by special educators (Daviso et al., [<reflink idref="bib7" id="ref71">7</reflink>]). According to Daviso et al. ([<reflink idref="bib7" id="ref72">7</reflink>]), Kaya ([<reflink idref="bib17" id="ref73">17</reflink>]) and Park and Bouck ([<reflink idref="bib23" id="ref74">23</reflink>]) none of these services supported competitive employment outcomes for young people with an intellectual disability. However, qualitative interviews with young people with an intellectual disability in Norway showed school-workplace collaboration had a positive impact on the transition from school to work (Sigstad & Garrels, [<reflink idref="bib27" id="ref75">27</reflink>]). In the Austrian study (Fasching, [<reflink idref="bib9" id="ref76">9</reflink>]), more students from inclusive high schools accessed vocational education and training when compared with students from special schools. For students attending college programs, a higher number of specialised courses designed for and offered only to students with intellectual disability was associated with a slight reduction in the likelihood of obtaining a paid job while in the program. However there was no statistical difference observed between the number of specialised courses taken and the employment outcome after exiting the program (Grigal et al., [<reflink idref="bib11" id="ref77">11</reflink>]). Moore and Schelling ([<reflink idref="bib18" id="ref78">18</reflink>]) found that students participating in specialised or integrated courses at college had higher rates of competitive employment when compared with people who had not completed post-secondary education, but high outcomes were achieved for both the specialised program (93%) and the integrated college program (100%).</p> <hd id="AN0192006719-18">Discussion</hd> <p>The current study identified the characteristics of programs and services that resulted in competitive, rather than sheltered or segregated, employment outcomes for young people with an intellectual disability transitioning from school to employment. Three variables were identified as important in achieving competitive employment outcomes: early planning for and exposure to work, post-secondary education and certification, and on-the-job training.</p> <hd id="AN0192006719-19">Early planning for and exposure to work</hd> <p>The reviewed studies demonstrated the importance of starting the transition to paid work at a young age. Engaging in post-secondary education increased the likelihood of achieving competitive employment and may enable a young person to retain employment or change jobs over a longer period. Low employment rates for young people with an intellectual disability may be reflective of insufficient support available for competitive employment experiences during secondary school. Providing transition services and support to find a job from age 14 or 15 is likely to improve competitive employment outcomes.</p> <hd id="AN0192006719-20">Post-secondary education and certification</hd> <p>Completing a college or university program for at least two years increases the likelihood of achieving a competitive employment outcome. The difference between the integrated and specialised programs may not be as significant as expected, meaning that the more important factor relating to employment outcomes is participation in a post-secondary education program and obtaining a recognised certification. The study by Grigal et al. ([<reflink idref="bib11" id="ref79">11</reflink>]) found higher rates of competitive employment for students who completed the four-year employment transition program when compared with the two-year program, but the study does not comment on differences between the credentials offered. If more four-year programs offer recognised credentials than two-year programs, it may be that the credential influenced the higher rate of employment for students completing a four-year program, rather than the length of the program. Given the findings by Kaya ([<reflink idref="bib17" id="ref80">17</reflink>]) that education was the strongest variable in improving rates of competitive employment, this would suggest that introducing policy to create more opportunities and a clear pathway to participate in higher education and earn a recognised credential is likely to improve outcomes.</p> <hd id="AN0192006719-21">On-the-job training</hd> <p>Results differed regarding the optimal length of vocational rehabilitation services, with evidence demonstrating that the type of service provided is likely to be more important than the duration. Kaya's ([<reflink idref="bib17" id="ref81">17</reflink>]) analysis showed that young people who completed more vocational rehabilitation services had significantly better outcomes than those who completed less. However, remaining in a vocational rehabilitation program over a longer period resulted in less favourable employment outcomes when compared with attending for a shorter period. The data analysed by Kaya ([<reflink idref="bib17" id="ref82">17</reflink>]) does not enable assessment of differences in programs or the quality of services provided. Variations in quality may have influenced the outcomes. There may be a difference between programs that retained students for a longer period when compared with programs that supported students to complete a higher number of services in a shorter period. Therefore, the characteristics of programs that result in competitive employment outcomes are likely to be more important than the duration or quantity of services.</p> <p>The results from Grigal et al. ([<reflink idref="bib11" id="ref83">11</reflink>]) and Qian et al. ([<reflink idref="bib25" id="ref84">25</reflink>]) showed that students who had a paid job prior to commencing a post-secondary program were more likely to achieve competitive employment. Work-study programs and school-supervised work in secondary school did not support competitive employment outcomes in studies by Daviso et al. ([<reflink idref="bib7" id="ref85">7</reflink>]), Kaya ([<reflink idref="bib17" id="ref86">17</reflink>]) and Park and Bouck ([<reflink idref="bib23" id="ref87">23</reflink>]). This indicates that there is a difference between these school sponsored work placements and paid work in an integrated setting. Supporting students to find a job in the open labour market and then providing on the job support to maintain the job may be more beneficial than organising work placements (Daviso et al., [<reflink idref="bib7" id="ref88">7</reflink>]; Kaya, [<reflink idref="bib17" id="ref89">17</reflink>]; Park & Bouck, [<reflink idref="bib23" id="ref90">23</reflink>]). For young people with an intellectual disability, participating in vocational rehabilitation and training services directly related to finding and maintaining a specific job, is more likely to support an competitive employment outcome than classroom training or general skills training unrelated to a job the person has attained (Kaya, [<reflink idref="bib17" id="ref91">17</reflink>]; Park & Bouck, [<reflink idref="bib23" id="ref92">23</reflink>]).</p> <hd id="AN0192006719-22">Limitations</hd> <p>A limitation of this review is that most studies were US-based. However, the consistency of results from two European studies suggests the findings may apply to other contexts. Eleven of the 14 studies involved retrospective analysis of national datasets, and while several studies controlled for confounders in the study design and statistical analysis, there are likely to be confounders that impacted outcomes to an unknown extent. Examples include differences in program structures, service quality, participant disability levels, and variations in outcome recording and definitions across services and states. Limiting the search to studies written in English may have resulted in exclusion of relevant studies conducted or published in other languages. Finally, most of the studies only assessed outcomes 90 days after service closure. Assessment six or 12 months after service closure would provide better insight into the characteristics of programs and services that result in sustained competitive employment outcomes for young people with an intellectual disability over a longer period.</p> <hd id="AN0192006719-23">Recommendations for policy and practice</hd> <p>This systematic literature review identified characteristics of services and programs to improve competitive employment outcomes for young people with an intellectual disability transitioning from school to work. Services and programs' characteristics described here as beneficial for competitive employment should form the basis for prioritising government funding and service provision with implications for policy and practice. For example, continuing to support training online or in a classroom setting that is unrelated to a job the person has attained was shown not to improve open employment outcomes for young people with an intellectual disability. Indeed, this approach will continue to result in escalating costs without a subsequent increase in employment outcomes. Improving the transition from education to employment will require collaboration and coordination between services such as the education system, institutes of higher education, and employment and disability service providers. Improving coordination and collaboration would provide opportunities for young people with an intellectual disability to start their journey towards competitive employment much earlier and gaining a recognised credential, as their peers do, is likely to improve competitive employment outcomes.</p> <hd id="AN0192006719-24">Recommendations for future research</hd> <p>Most studies reviewed were US-based and measured outcomes 90 days after service completion. Longer-term studies are needed to identify program characteristics that lead to sustained competitive employment outcomes and to guide funding for effective services for young people with intellectual disabilities. Further research is recommended to investigate if there is a statistical difference in competitive employment outcomes for young people with an intellectual disability who had a paid job in the open labour market during secondary school, when compared with young people who did not or who participated in school sponsored work experience. This research would have implications for the education system and the role that secondary schools could play in improving long term competitive employment outcomes. Further research is also recommended to investigate the impact that the duration or quantity of services has on competitive employment outcomes. This would have implications for the design of programs and services and inform policy decisions regarding funding allocations for these programs.</p> <hd id="AN0192006719-25">Conclusion</hd> <p>Despite policy and legislation to support competitive employment, the number of young people with an intellectual disability competitively employed globally is very low. To drive meaningful improvements, governments should invest in programs and services that emphasise early career planning, exposure to work, post-secondary education and certification, and on-the-job training. Implementing evidence-based practices aligned with these program characteristics will require substantial transformation and integration of service delivery models by service providers and the education system.</p> <hd id="AN0192006719-26">Author contributions</hd> <p>First author, led the design and implementation of the research, the analysis of the results, and the writing of the manuscript. Second author, supervised first author, contributed to the design and implementation of the research, the analysis of the results, and the writing of the manuscript. Contributed expertise in research with people with intellectual disability.</p> <hd id="AN0192006719-27">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0192006719-28">Ethics statement</hd> <p>This article does not contain any studies with human participations performed by any of the authors therefore ethics approval was not required.</p> <ref id="AN0192006719-29"> <title> References </title> <blist> <bibl id="bib1" idref="ref24" type="bt">1</bibl> <bibtext> Armijo-Olivo, S., Stiles, C. R., Hagen, N. A., Biondo, P. D., & Cummings, G. G. (2012). 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  Label: Title
  Group: Ti
  Data: A Systematic Review of the Characteristics of Programs and Services Resulting in Competitive Employment Outcomes for Young People with an Intellectual Disability
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Alison+Enticott%22">Alison Enticott</searchLink><br /><searchLink fieldCode="AR" term="%22Angela+Dew%22">Angela Dew</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Intellectual+%26+Developmental+Disability%22"><i>Journal of Intellectual & Developmental Disability</i></searchLink>. 2026 51(1):27-38.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 12
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Information Analyses<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Employment%22">Employment</searchLink><br /><searchLink fieldCode="DE" term="%22Employment+Programs%22">Employment Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink><br /><searchLink fieldCode="DE" term="%22Vocational+Rehabilitation%22">Vocational Rehabilitation</searchLink><br /><searchLink fieldCode="DE" term="%22Age%22">Age</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Attainment%22">Educational Attainment</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink><br /><searchLink fieldCode="DE" term="%22Austria%22">Austria</searchLink><br /><searchLink fieldCode="DE" term="%22Norway%22">Norway</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.3109/13668250.2025.2499674
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1366-8250<br />1469-9532
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Transitioning to paid employment is part of the natural progression to adulthood, yet the number of people with an intellectual disability who are competitively employed globally is low. This study systematically reviewed the literature to understand characteristics of programs that support competitive employment outcomes for young people with an intellectual disability. Method: Five databases were searched. Two quality assessment tools were used: the Effective Public Health Practice Project (EPHPP) tool; and the Mixed Methods Appraisal Tool (MMAT). Content analysis was conducted using Braun and Clarke's theoretical thematic analysis framework. Results: Key findings demonstrated the importance of early career planning, work exposure, post-secondary education and certification, and on-the-job training. Conclusion: Further research, along with the application and adaptation of existing international studies presented in this systematic review, could drive system-wide changes prioritising competitive employment outcomes for young people with intellectual disability, enabling them to experience the benefits of competitive employment.
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  Data: As Provided
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  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1505222
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1505222
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  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.3109/13668250.2025.2499674
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 27
    Subjects:
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Employment
        Type: general
      – SubjectFull: Employment Programs
        Type: general
      – SubjectFull: Postsecondary Education
        Type: general
      – SubjectFull: Vocational Rehabilitation
        Type: general
      – SubjectFull: Age
        Type: general
      – SubjectFull: Educational Attainment
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      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: United States
        Type: general
      – SubjectFull: Austria
        Type: general
      – SubjectFull: Norway
        Type: general
    Titles:
      – TitleFull: A Systematic Review of the Characteristics of Programs and Services Resulting in Competitive Employment Outcomes for Young People with an Intellectual Disability
        Type: main
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          Name:
            NameFull: Alison Enticott
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            NameFull: Angela Dew
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            – D: 01
              M: 01
              Type: published
              Y: 2026
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              Value: 1469-9532
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              Value: 51
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            – TitleFull: Journal of Intellectual & Developmental Disability
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