Take Home Messages:

Welfare-to-work programs are aimed at assisting people with disabilities or chronic illness to re-enter the workforce.

Some elements of welfare-to-work programs seem to promote this aim. Helpful elements include:

• Education, training and work placement;
• Improved workplace accessibility;
• Vocational advice and support services; and
• Fostering a good relationship between the service provider and local employers.

However other aspects are less helpful. Ineffective initiatives include:

• Employer incentive – probably because the financial value of the subsidies are insufficient to provide a real incentive; and
• In work benefits – for example wage top-ups for low-status, poor-paying, part-time jobs. These are ineffective because people with disabilities want “proper” jobs that pay a fair wage.

It cannot be assumed that there will be a high awareness of welfare-to-work programs amongst potential participants: effective program promotion is a must.

Welfare-to-work programs were less successful in assisting people with a mental illness than people with a physical disability.

There is no conclusive evidence as to whether welfare to work programs increase participants’ chances of gaining employment. This is primarily due to the fact that most of the relevant studies did not use a control group.

In terms of policy, it may be more effective to focus on keeping individuals with a disability or chronic illness in the workplace, rather than concentrating on how to reintegrate them once they have left.

Why the study matters:

Disability and chronic illness are associated with poverty and social exclusion. This is largely because work is one of the main sources of income.

Patients with a disability or chronic illness also have lower employment rates and are out of work for long periods of time.

Barriers to return to employment are:

• Lack of experience or skills;
• Discrimination from employers;
• Problems with physical access to work;
• Loss of benefit entitlement; and
• Concerns over pay, hours and conditions.

‘Welfare-to-work’ refers to policies designed to promote the transition from out-of-work benefits to paid employment.

These policies are directed at:

• Raising education and vocational skills levels;
• Providing support and advice in locating and obtaining work;
• Overcoming financial concerns about the benefits of work transition;
• Providing incentives to employers to employ people with a chronic illness or disability; and
• Improving physical accessibility of the workplace environment.

What the study involved:

The researchers reviewed relevant research studies published in the UK regarding the effectiveness of welfare-to-work interventions, and summarised the findings. The reviewed studies were designed to help individuals with a disability or chronic illness move into work from welfare benefits. A total of 16 studies were included in the analysis.

Summary of study findings:

The study found effective programmes involved:

• Education, training and work placement initiatives;
• One-to-one vocational advice and support services;
• Improved accessibility in the workplace.

Less effective measures included:

• Employer incentive; and
• In work benefits – for example wage top-ups for low-status, poor-paying, part-time jobs.

Employer incentives were inadequate and employers who did take them up admitted that the incentives were used to fill only hard-to-recruit vacancies or part-time posts.

 In work benefits were ineffective because they presupposed that disabled people were likely to want to work shorter hours and at a lower rate of pay than non-disabled people. However, disabled people advised that they want “proper” full time jobs at a fair wage.

Patients with mental illness and those who had experienced a long period of unemployment had difficultly gaining employment despite welfare-to-work programs.

The researchers believed effective programs need to be;

• Non-discriminating in their recruitment;
• Provide high levels of training;
• Have good relations with local employers; and
• Offer ongoing support once employment is gained.

Original research:

Does ‘welfare-to-work’ work? A systematic review of the effectiveness of the UK’s welfare-to-work programmes for people with disability or chronic illness.

Bambra C, Whitehead M, Hamilton V.

Soc Sci Med. 2005 May;60(9):1905-18.

Link to PubMed abstract