Effects of active labour market programs for long-term social assistance recipients

A systematic review

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SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Assessment teams include professional practitioners and academics. Before publication the report is reviewed by external experts, and scientific conclusions approved by the SBU Board of Directors.

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Published: Report no: 351 Registration no: SBU 2020/226 ISBN: 978-91-88437-95-2 https://www.sbu.se/351e

Conclusions

  • Training received at workplaces is more effective than interventions as usual or no intervention for long-term social assistance recipients to take and hold an employment (moderate certainty of evidence).
  • Extensive or long-term training is more effective than interventions as usual or no intervention for long-term social assistance recipients to take and hold an employment (moderate certainty of evidence).
  • Work supporting program in regular/ordinary municipal activities is more effective than work supporting programs outside regular work activities for long-term social assistance recipients to take and hold an employment (moderate certainty of evidence). Working in business that are government controlled during recession can be non-existent or negligible for young people compared to no intervention (low certainty).
  • Reduced case manager workload i.e., less clients and a possibility of intensified management for each client, supports long-term social assistance recipients to take and hold an employment compared to working as usual (low certainty of evidence).
  • The effect on entry or return to work for long-term social assistance recipients can be non-existent or negligible regarding the following interventions:
    • classroom training (low certainty of evidence)
    • work program with bonus (low certainty of evidence)
    • employer subsidies (low certainty of evidence)
    • extensive case manager assessment and follow up (low certainty of evidence).
  • The effect on entry or return to work for long-term social assistance recipients could not be assessed regarding following interventions:
    • various supportive preparatory programs including start-up-capital intervention (very low certainty of evidence)
    • job search assistance (very low certainty of evidence).

Background

Persons in working age that do not regularly take part on the labour market may need support from the society through labour market interventions. One such group is individuals with lasting social assistance, i.e., long-term social assistance recipients.
For most adults, holding a job means taking part in meaningful tasks and having a better financial situation. Work can also affect health or vice versa.

Aim

The purpose of this project was to investigate the body of evidence regarding labour market interventions for persons outside the labour market. A broad definition of this was adults, aged 18-64 years, on long-term sick leave or long-term social assistance, respectively. This review presents the results regarding long-term social assistance recipients. Another review presents the results regarding persons on long-term sick leave due to mild or moderate depression, anxiety, or reactions to severe stress.

Method

This systematic review is conducted in accordance with the PRISMA statement and SBU’s methodology (www.sbu.se/en/method). The protocol is registered in Prospero, CRD42021235586. Quantitative and qualitative studies with low or moderate risk of bias published during the period 2000 to 2021 were included. Dialogues were held with reference groups representing client or patient perspectives, as well as perspectives from some different Swedish authorities of relevance. The certainty of evidence was assessed according to the GRADE-system.

Inclusion criteria:

Population

Adult persons, aged 18-64 years being outside of the labour market, receiving social assistance during at least six months, alone or combined with other financial replacements. They should be assessed as having the ability to work.

Intervention

Labour market interventions that are, or could be, used in Sweden. Four types of interventions, lasting for at least one month, were defined as:

  • preparatory programs, e.g., job search assistance or counselling
  • training
  • workplace practice
  • other interventions such as work-related rehabilitation, self-employment etc.

Control

No intervention, intervention as usual, or other measures.

Outcome

Primary: employment in the labour market, started or finalized education, income.
Secondary: health measures such as sleep, depression, anxiety, stress, quality of life or capacity for work.

Study design

Randomized controlled studies, RCT, quasi-experimental observation studies based on register data as well as studies based on qualitative data.

Language: English, Swedish, Norwegian, Danish.

Search period: 1995 to 2022. Final search was conducted on February 2, 2022.

Databases searched:

  • Scopus (Elsevier)
  • Ebsco Multi-Search (SocINDEX with Full Text; Academic Search Premier; ERIC)
  • Sociological Abstracts (ProQuest)
  • EconLit (Ebsco).

Client involvement: No.

Results

The effects of one or more active labour market interventions are based on 26 quantitative studies, seven randomized controlled studies and 19 studies based on register data. The studies were from ten countries, seven from Germany, four from USA and Denmark, respectively, three from the Netherlands, two from Norway and Argentina, respectively, and one from Australia, UK, Spain and Sweden, respectively. In total, about 5.8 million persons participated in the studies. 14 studies with qualitative data were also included in the review, out of which five were relevant to a Swedish context.

Table 1 Summary of findings – preparatory programs
Outcome Effect GRADE – assessed certainty of evidence
Employment
Intervention=
preparatory program		 Various preparatory program interventions result in more persons to take and hold an employment for follow up at ≤ 20 months compared to job search support. Low certainty of evidence
EmploymentIntervention=
support + training		 The effect of preparatory program in the form of individual support and work-training could not be assessed on employment. Very low certainty of evidence
EmploymentIntervention=
support + start your own business-capital		 The effect of preparatory program in the form of work-support and capital to start your own business on employment could not be assessed. Very low certainty of evidence
IncomeIntervention=
temporary job		 Preparatory program in the form of temporary job interventions results in higher income for the participant for follow up at ≤ two years compared to direct hire. Low certainty of evidence
IncomeIntervention=
support + training		 The effect of preparatory programs in the form of individual support and training on income could not be assessed. Very low certainty of evidence
IncomeIntervention=
support + start-up-capital		 The effect of preparatory programs in the form of support and capital to start your own business on income could not be assessed. Very low certainty of evidence

 

Table 2 Summary of findings – training programs
Outcome Effect GRADE
Employment
Intervention=
classroom training		 The effect on employment from classroom training can be non-existent or negligible compared to a usual or no intervention. Low certainty of evidence
Employment
Intervention=
workplace training		 Workplace training results in more persons holding an employment after 12-28 months compared to a usual or no intervention. Moderate certainty of evidence
Employment
Intervention=
extensive training		 Workplace training results in more persons holding an employment after 12-28 months, compared to a usual or no intervention. Moderate certainty of evidence
Income
All forms of training		 All forms of training leads to increased income after 12 months compared to usual intervention. The effect was more pronounced for males. Low certainty of evidence

 

Table 3 Summary of findings – workplace practice
Outcome Effect GRADE
Employment
Intervention=
workplace practice + a direct financial incentive for the person		 The effect on employment from workplace practice combined with a direct financial incentive for the person can be non-existent or negligible compared to a usual or no intervention. Low certainty of evidence
Employment
Intervention=
workplace practice without a direct financial incentive for the person		 Workplace practice without a direct financial incentive for the person results in more adults and young people holding an employment for follow up at ≤ three years. Moderate certainty of evidence
Employment
Intervention=
workplace practice without a direct financial incentive for the person		 Workplace practice in the public sector without a direct financial incentive for the person results in more immigrants receiving and holding an employment for follow up at ≤ five years. Low certainty of evidence
Employment
Intervention=
workplace practice without a direct financial incentive for the person (recession)		 The effect on employment or education from workplace practice (without a direct financial incentive for the person) can be non-existent or negligible, for young persons during a recession, for follow up at ≤ three years compared to no intervention. Low certainty of evidence
Income
Intervention=
workplace practice + a direct financial incentive for the person		 The effect on income from workplace practice combined with a direct financial incentive for the person can be non-existent or negligible for follow up at ≤ five years compared to a usual or no intervention. Low certainty of evidence
Income
Intervention=
workplace practice without a direct financial incentive for the person		 Workplace practice without a direct financial incentive for the person results in higher income for both adults and young persons for follow up at ≤ three years compared to a usual intervention. Low certainty of evidence

 

Table 4 Summary of findings – employer subsidies
Outcome Effect GRADE
Employment
Intervention=
employer subsidies		 The effect of employer subsidies compared to a usual or no intervention on employment can be non-existent or negligible at follow up ≤ 12 months compared to a usual or no intervention. Low certainty of evidence
Income
Intervention=
employer subsidies		 The effect on income from employer subsidies could not be assessed. Very low certainty of evidence

 

Table 5 Summary of findings – case manager interventions
Outcome Effect GRADE
Employment
Intervention=
less clients per case manager		 Fewer clients per case manager results in persons having the ability to work longer hours at 12 months follow up compared to case manager routine work. Low certainty of evidence
Employment
Intervention=
comprehensive assessment and client follow up		 The effect on employment can be non-existent or negligible from comprehensive assessment and client follow-up at ≤ 30 months compared to case manager routine work or no intervention. Low certainty of evidence
Income
Intervention=
comprehensive assessment and client follow up		 The effect on income can be non-existent or negligible from comprehensive assessment and client follow-up after six months compared to other case manager intervention. Low certainty of evidence

Health Economic Assessment

Two financial evaluations of the studied labour market interventions were included. Both studies evaluated interventions in the category workplace practice combined with financial bonus for the individual. Both evaluations were simpler financial analyses focusing on whether the income increase for the participants exceeds the intervention costs.

Ethics

The main purpose of a labour market intervention is to increase the possibility that an individual, who are outside of the labour market, receives an employment. From an ethical perspective, however, this purpose is an instrumental goal whose fulfilment is only of value if it in turn leads to other states that have final value. There are two different perspectives on what could constitute this final value. One perspective is strictly socioeconomical and the other is an individual perspective based on the needs of the individual.

Discussion

The studies were performed in the Nordic countries, other European countries, North and South America and Australia. These countries have different labour market policy and welfare subsidies. Thus, the study results from the different studies should be interpreted with some caution, particularly results from studies in countries with welfare systems which obviously differ from the ones in Swedish and other Nordic countries.

The results in this review indicate that immigrants may benefit more from training and workplace practice than non-immigrants. Further, there is very little information in the included studies concerning participant employment quality.

For a number of active labour market interventions, effects on entry or return to work could not be assessed. It depends, among other things, on that the interventions differ from one another and thereby their results cannot be added together. Other reasons are the various measurement of effect and insufficient study data that cannot be used for statistical syntheses. When the data about effects on employment from the interventions are insufficient, the authors have not assessed the certainty of evidence. A very low certainty of evidence should, however, does not necessarily mean that there is no effect. Instead, it emphasizes the need for further intervention evaluation in well performed studies.

It would be valuable with a consensus regarding what is most important to measure and how it may be measured in an agreed list of prioritized results, a Core Outcome Set (COS). According to the organization COMET (Core Outcome Measures in Effectiveness Trials), there is ongoing work to bring forth a COS for “work participation”, but at present nothing is yet published.

From studies based on qualitative data, there appears to be a discrepancy between official ambitions and descriptions of intervention designs and effects on the one hand, and participant experiences and skepticism on the other hand.

Conflicts of Interest

In accordance with SBU’s requirements, the experts and scientific reviewers participating in this project have submitted statements about conflicts of interest. These documents are available at SBU’s secretariat. SBU has determined that the conditions described in the submissions are compatible with SBU’s requirements for objectivity and impartiality.

Link to the Swedish report:
Effekter av arbetsmarknadsinsatser för personer med varaktigt försörjningsstöd

Project group

Experts

  • Tapio Salonen, professor, social work, Malmö university, Sweden
  • Per Johansson, professor, statistics, Uppsala university, Sweden
  • Elisabeth Furberg, associate professor, philosophy, Stockholm university, Sweden
  • Peter Thoursie, professor, political economy, Stockholm university, Sweden
  • Elisabeth Björk Brämberg, associate professor, occupational medicine, Karolinska institutet, Sweden

SBU

  • Elizabeth Åhsberg, project manager, PhD
  • Gunilla Fahlström, assistant project manager, Dr Med Sci.

External reviewers

  • Edward Palmer, Stockholm, Sweden
  • Ilse Julkonen, University of Helsingfors, Finland

Flow chart of included studies

 

Of 58 eligible full-text articles, 14 were included.

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