Financial disincentives are gaining support as having a detrimental effect on return to work post-injury. For example, in British Columbia, Canada, social assistance deters recipients from returning to work because once more than $400/month is earned, benefits received while on social assistance such as dental care and prescription medication, are lost (Jongbloed et al. 2007). This also appears to be the case in Australia as the perceived disadvantages of losing social security benefits (which would lead to exclusion from accessing government funded equipment and medical supplies) seemed to deter people from seeking employment post-SCI (Conroy and McKenna 1999). Health insurance benefits which are considered threatened for abolishment or reduction with an increase in work-related income could be a deterrent for people with SCI considering going back to work.
Workplace discrimination can be further classified into ‘disability discrimination’ and ‘racial discrimination’, the latter being addressed in the personal factor section. Disability discrimination is due largely to negative or naïve employer perceptions about the potential productivity of individuals with SCI. Ravaud et al. (1992) found that companies tend to discriminate against individuals with SCI by offering interviews less frequently when the injury was disclosed. Similarly, 80% of Canadians agreed with the statement that “Canadians with disabilities are less likely to be hired for a job than those without disabilities, even if they are equally qualified” (Social Development Canada 2004). Not surprisingly, Jongbloed et al. (2007) found that individuals with SCI viewed the negative attitudes of employers regarding people with disabilities as a barrier to employment. The lack of physical accessibility to the workplace has also been found to hinder return to work.
There is level 5 evidence (see Table 5) that financial disincentives has a negative effect on employment post-SCI but financial incentives has a positive effect on employment except for when receiving social security benefits.
There is level 5 evidence (see Table 5) that health insurance, ‘disability discrimination’ and inaccessibility of the workplace are environmental barriers negatively influencing employment after SCI.
There is level 5 evidence (see Table 4) that ability to use transportation independently, ability to use technological devices, and having access to job accommodations positively influencing employment after SCI.
Environmental facilitators include having access to various assistive devices, using transportation independently, having social support (including being married), and having the possibilities of job accommodation including reduced work hours.
Environmental barriers to employment are social or physical and include financial disincentives, discrimination associated to negative attitudes toward people with disabilities and difficulties with physical access to workplace.
A single environmental factor can be perceived either as a barrier or a facilitator to employment based on its presence/absence in one’s environment and its impact on effective returning to work.