Young adults with cerebral palsy and average intelligence are at risk of experiencing unfavourable developments in work participation. Rehabilitation services should offer support to prevent unemployment and occupational disability.

AIM The aim of the study was to evaluate the feasibility of a new intervention to improve work participation of young adults with physical disabilities, addressing (1) implementation and costs and (2) preliminary effectiveness.METHOD Twelve young adults with physical disabilities (six males, six females; age 19-28y, median age 21y 6mo) participated in a 1-year multidisciplinary vocational rehabilitation intervention. In a pre-post intervention design, we assessed implementation and costs as well as preliminary effectiveness in terms of employment and occupational performance using questionnaires and interviews. We tested pre-post differences with the McNemar test for proportions and the Wilcoxon signed-rank test for scores on occupational performance; p-values less than 0.05 were considered statistically significant. Additionally, we assessed work participation at follow-up after 2 years and 3 years. RESULTSThe intervention was implemented in an outpatient rehabilitation clinic for young adults. The median cost per participant for 1 year was €3128, which is an equivalent to the cost of 72 contact hours per participant. Post intervention, and at 2 years and 3 years followup, a significantly higher proportion of participants were employed (8/12 post vs 2/12 preintervention; p<0.05), with the ratio of those in paid to unpaid employment being 4:4, 5:3, and 7:1 respectively. Participants showed improved occupational performance in work, self-care, and leisure.INTERPRETATION Feasibility and preliminary effectiveness of the intervention are promising.Employed participants seemed to have achieved suitable and continuous employment.With increasing numbers of young people with physical disabilities living into adulthood, the focus of health care has moved from survival to adequate treatment to support these young adults to make the transition into adulthood and become autonomous individuals who participate in society and manage their own life. A successful transition to adulthood may reduce lifelong dependency on others, unemployment, lack of achievement, and poor quality of life. [1][2][3] In the process of transition to adulthood one of the challenges is to find employment. Employment provides financial independence and promotes psychological well-being, by structuring the day, providing social interaction and a meaningful contribution to society, and developing selfidentity. 4,5 Although data on the employment situation of people with physical disabilities are not always readily comparable across countries, an employment rate of about 30% is reported in both Europe and the USA. 6,7 In the Netherlands, the employment rate among young adults (15-25y) with physical disabilities is 39% (26% and 12% in those with moderate and severe disabilities respectively). 8Young adults with physical disabilities may experience substantial difficulties in the area of employment, such as being offered work that is physically too demanding, inadequate transportation facilities, inaccessibility of buildings and toilet space, lack of assist...

Participants showed improved occupational performance after the intervention. The goal of employment and the broad integrated approach of the intervention seemed to motivate participants to resolve problems in work, as well as self-care and leisure. Unemployed persons faced problems in all three areas of occupational performance at start. Although they seemed to catch up during the intervention, they did not achieve employment within 1 year.