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Screening the Utah State Training School (a resident institution for the mentally retarded) for kindreds having at least two institutionalized sibs generated 54 sib groups. Of these, 20-male only sibships had histories compatible with sex-linked mental retardation without physical stigmata (Martin-Bell or Renpenning type). Affected males had no characteristic physical stigmata (an appreciable number did have speech problems and/or seizure disorders) and exhibited IQs ranging from 5 to 74 with a mean of 34.2. Obligate carrier females had a mean IQ score of 91.9 (range, 79 to 106), which is as would be predicted due to random X-inactivation. Carrier females were tested with the MMPI, and showed elevated profiles. The results also indicated that the FAM scale would differentiate between groups of carrier females and normal females and between groups of carrier females and other females who had retarded children. It is suggested that the extension of psychometric methods may be useful in the identification of high risk females. Identification of these females would then allow for accurate genetic counseling, an objective which has not yet been achieved.

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Vocational Rehabilitation (VR) had its beginning in 1918, when Congress granted to the Federal Board of Vocational Education the power to provide for the training of "any disabled veteran who was unable to carry on a gainful occupation, to resume his former occupation, or to enter upon some other occupation, or having resumed or entered upon such occupation was unable to continue the same successfully." (U.S. Department of Health, Education, and Welfare, 1972). Called the Soldiers Rehabilitation Act, this measure made clear the basic goals of vocational rehabilitation. In 1943, a milestone year, services were extended to all disabled individuals who met the basic criteria of (a) having a disability (physical, emotional, or mental) which (b) poses a substantial handicap to employment, and (c) for whom a reasonable expectation exists that upon receiving services the individual can again (or for the first time) engage in gainful employment.

This sandwich thesis contains 3 studies using three distinct methodologies: scoping review, quantitative study, and qualitative study. This program of research explores employment for people with disabilities who are in receipt of publicly funded disability income benefits. / Employment is a key determinant of socioeconomic inclusion and health. Yet, people with disabilities (PWD) have one of the lowest employment rates in advanced welfare states. This thesis consists of three manuscripts using three distinct methodologies to examine this phenomenon. This thesis advances knowledge in the field by examining the employment outcomes of PWD who are in receipt of public income benefits, often referred to as programs of last resort. This thesis is framed by the theory of wicked problems which serves to emphasis the stubborn problem of low employment participation rates. Despite the numerous enhancements made to social assistance programming over the last two decades to facilitate positive employment outcomes, people with mental illness remain one of the most marginalized worker populations. Manuscript one is a scoping review identifying what is known about active labour market policies within welfare to work programs for PWD. This research acts as the foundational piece upon which the other two papers build. The purpose of the review is to present the existing body of literature on this issue across all advanced welfare states and identify the gaps in the evidence base, summarize these findings and disseminate them to policy makers and other key stakeholders. Manuscript two is a quantitative study. It takes a narrower focus and examines a subpopulation of PWD. This study uses administrative data from Ontario’s Ministry of Community and Social Services to examine the system level factors associated with earnings-related exits from the Ontario Disability Support Program, Ontario’s public income system for PWD. The study draws on descriptive and inferential statistical procedures to provide an overview of income support recipients with mental illness who gain enough earnings to transition off social assistance. This study contributes data on the numbers behind system exits to inform program development within ODSP. While manuscript two answers who exits ODSP for employment, manuscript three provides insight into why and how individuals succeed in exiting the system. Through a series of semi-structured interviews with three participant groups, this study explores the process of transitioning off disability income support benefits among people with mental illness. This study adds to a small but emerging literature on the economic fate of former ODSP recipients, which will help inform policy development. / Thesis / Doctor of Philosophy (PhD) / Employment is a key determinant of socioeconomic inclusion and health. Employment paid at a competitive wage equips a person with the social and economic resources they need to enjoy a decent quality of life. Yet, people with disabilities (PWD) are often underemployed or excluded from the mainstream labour market. This thesis sets out to explore the barriers and facilitators to meaningful employment for PWD, with a focus on people living with serious mental illness who are in receipt of income benefits from the Ontario Disability Support Program. This body of work begins with a global exploration of active labour market policies that are used to assist PWD enter or remain in employment. It then narrows its focus to explore the system level factors that prevent or facilitate people living with serious mental illness to transition from income benefits to mainstream employment. The study findings have implications for policy development in all advanced welfare states that could enhance successful transitions from welfare to work.

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