Abstract
This study examines how managers and lead practitioners in Norwegian day activity centres facilitate the participation of individuals with intellectual disabilities in the labour market. Thirteen participants took part in focus groups, and the qualitative data was analysed using reflexive thematic analysis. Three main themes emerged: (a) No one else takes responsibility for people who do not fit in, highlighting why centres take on this role; (b) Being solution-oriented and proactive – Taking responsibility for labour market participation, describing how staff actively facilitate transitions to the labour market; and (c) Challenging and complex – Experiences of adapting pathways from day activity centres to the labour market, reflecting the difficulties involved. Findings are discussed in light of case management theory. The study emphasises the crucial role of day activity centres in promoting inclusion and calls for their recognition within Norway’s political and organisational frameworks for employment support.
Introduction
The right to work for people with disabilities, including the right to equal treatment, is enshrined in Article 27 of the UN Convention on the Rights of Persons with Disabilities (CRPD) (United Nations, 2006). In Norway—the context of this study—employment for all is a central political goal (Meld. St. 8 [White Paper 8], 2022–2023). Nevertheless, internationally, as well as in Norway, people with intellectual disabilities are rarely employed in the competitive labour market (Almalky, 2020; Domin and Butterworth, 2013; Olsen, 2009; Wendelborg and Tøssebro, 2018). Earlier studies have shown that approximately 96.7% of people with intellectual disabilities in Norway receive disability pension (Wendelborg and Tøssebro, 2018). The Norwegian Labour and Welfare Administration (Nav) is a state agency responsible for supporting people -including those with intellectual disabilities- into employment, as well as administering labour market measures and disability pensions (Tiltaksforskriften [Regulation on Labour Market Measures], 2015). Relatively few individuals in this group receive labour market support in practice – either through employment in sheltered workshops or permanent support in the open labour market. Notably, Wendelborg and Tøssebro (2018) found that only 425 individuals (2.4%; n = 17,650) were employed in the open labour market with permanent support. The employment opportunities most commonly available to people with intellectual disabilities are typically found in sheltered and segregated settings (Almalky, 2020; Gjertsen et al., 2021; McConkey et al., 2017; Tuckerman et al., 2012). In Norway, this includes labour market measures in sheltered workshops or participation in municipal day activity centres—both of which are typically offered to individuals who also receive disability pensions (Engeland et al., 2021; Reinertsen, 2015; Tøssebro and Olsen, 2020).
While these settings are not part of the labour market, recent research has highlighted that day activity centres may play a meaningful role in promoting work inclusion. This research argues that day activity centres contribute to labour market participation for people with intellectual disabilities and should be recognised for their efforts in this area (Barøy et al., 2024).
Building on this perspective, the present study examines the specific efforts made by day activity centres to facilitate labour market participation for people with intellectual disabilities.
Day activity centres typically provide non-vocational activity for adults with disabilities who are not part of the open labour market (Tøssebro and Olsen, 2020). According to a study by Engeland et al. (2021), 2,822 individuals with intellectual disabilities (n = 12,735) were registered as participants at day activity centres in Norway. These centres are administered by the municipalities (Tøssebro and Olsen, 2020). They are anchored in the Health and Care Services Act (Helse-og omsorgstjenesteloven, 2011, § 3-3) as providing health-promoting and preventive work. One of their purposes is to contribute to an “active and meaningful existence in community with others”. Municipalities are not obligated to establish day activity centres and may choose to scale down or close them in the event of budget cuts, and they also have the discretion to decide whether to offer day activity centres at all. As of 2025, Norway has 357 municipalities. Of these, 253 participated in a survey conducted by Barøy et al. (2024), and 65 reported that they did not provide day activity services for individuals with intellectual disabilities.
The content provided by day activity centres varies between handicrafts and production, social activities and training (Engeset et al., 2015). According to Tøssebro and Olsen (2020), day activity centres are primarily perceived as a social measure within the welfare system. Engeset et al. (2015) point out that these centres are viewed as having correspondingly low status. At the same time, studies show that day activity centres are significant for people with intellectual disabilities (Langemyhr et al., 2023; Langemyhr and Haukelien, 2022; Luthra et al., 2025; Lysaght et al., 2017). Participants in day activity centres or similar services emphasise the importance of daily routines, social interactions, and the opportunity to influence their activities (Frounfelker and Bartone, 2021; Luthra et al., 2025).
In Norway, facilitating participation in the labour market is not stated or defined as an objective for the day activity centres, nor is it an explicit aim in the Health and Care Services Act (Helse-og omsorgstjenesteloven, 2011). This contrasts with the neighbouring country Sweden, where day activity centres (daily activity programs) are mandated by the Swedish Disability Act (Lag, 1993) to promote participation in the labour market. However, findings from a study in Sweden indicate that most participants remain in day activity centres, with only a minority successfully transitioning to paid employment (Luthra et al., 2024). A somewhat different picture emerges in Norway. Reinertsen (2012) revealed that 20 per cent of day activity centre participants in Norway were eligible for a labour market measure specifically developed to support people with intellectual disabilities in entering the open labour market. This suggests a certain degree of alignment between day activity centres and broader labour market initiatives. Further evidence of this can be found in a national survey of day activity centres, which shows that approximately half of the municipalities in the study’s sample (n = 168) facilitate labour market participation for people with intellectual disabilities (Barøy et al., 2024). However, the nature of this participation is not synonymous with paid employment. Adding to this complexity, Langemyhr et al. (2023) discuss whether the extensive facilitation provided within day activity centres might, paradoxically, hinder individuals’ opportunities to transition into the open labour market. Their findings highlight a potential tension between support and independence, suggesting that while day activity centres play a crucial role in enabling participation, they may also inadvertently limit pathways to employment in the open labour market.
To fully understand the implications of this, it is essential to consider the broader significance of employment. Beyond income, employment contributes to a range of life-enhancing outcomes. Work significantly improves the quality of life (Almalky, 2020; Kocman and Weber, 2018), fosters social participation, and provides valued social roles, structure, and predictability in daily life for people with intellectual disabilities (Garrels and Sigstad, 2021). According to Waddell and Burton (2006), work plays a central role in adult life—not only as a source of income, but also as a key contributor to health, identity, and social inclusion. Their comprehensive review demonstrates that employment has a consistently positive impact on both mental and physical well-being. For people with disabilities, work also serves therapeutic and rehabilitative purposes, strengthens human rights, and enhances overall life satisfaction (Waddell and Burton, 2006). These benefits are equally relevant for people with intellectual disabilities (Kocman and Weber, 2018).
In this study, we aim to examine more closely the efforts made by day activity centres to facilitate labour market participation for people with intellectual disabilities.
The research questions are. • How do managers and lead practitioners describe their work? • What are the reasons they give for enabling access to the labour market for people with intellectual disabilities? • What are the opportunities and challenges they face in this endeavour?
Theoretical perspectives
The concept of case management is employed in this study as an analytical tool to understand and illuminate the work carried out in day activity centres that support labour market participation for people with intellectual disabilities. Case management is a flexible and widely applicable approach, adaptable to a range of populations and service contexts. Broadly defined, it involves a structured system of outreach, assessment, planning, monitoring, linkage, and advocacy (de Vet et al., 2013).
The form and function of case management vary depending on the setting and the needs of the client group. This diversity has led to the development of multiple models and theoretical frameworks, reflecting differences in sectors, age groups, and health conditions. As a result, the role of the case manager is known by many titles—such as community coordinator, support facilitator, or clinical case manager— each reflecting different emphases in practice. The specific tasks and responsibilities of case managers are shaped by the characteristics of the individuals they support and the complexity of their needs (de Vet et al., 2013).
In this study, we draw on elements from the direct care model described by Lukersmith et al. (2016), which is particularly relevant for understanding the work of managers and lead practitioners in day activity centres. This model encompasses clinical, collaborative, strategic, and communicative roles involving both clients and key stakeholders, such as service providers and employers. It sets out clear goals, interventions, and outcomes within defined timeframes and includes both direct clinical support and coordination of external services. The model emphasises tailoring interventions to individual needs, addressing barriers, teaching skills, and ensuring continuity of care through coordinated efforts. Key components of this model include building rapport, conducting assessments, planning and navigating services, implementing and coordinating interventions, monitoring progress, advocating for clients, and providing education, counselling, and community development (Lukersmith et al., 2016).
Despite its strengths, case management also faces several challenges. As Teper et al. (2020) note, its effectiveness can be influenced by a range of factors, including policy frameworks, resource availability, and the clarity of the case manager’s role. Establishing trust with clients and their families is essential, but time constraints and heavy workloads can hinder it. Communication within interdisciplinary teams is often demanding, and case managers must balance professional autonomy with institutional expectations while continuously keeping up to date with developments in their professional field. These complexities underscore the importance of ongoing support, reflection, and adaptability in case management practice.
Method
The study is designed as a qualitative examination of the context of day activity centres in Norway, focusing on the perspectives of managers and lead practitioners who facilitate the participation of people with intellectual disabilities in the labour market. All participants provided informed consent to participate in the study, and the qualitative information was anonymised to protect their identities.
The study has been assessed by the Norwegian Agency for Shared Services in Education and Research (Norwegian abbreviation: Sikt) to be in accordance with their guidelines for the handling of personal data and privacy legislation (369805).
Participants and sampling
Participants were managers and lead practitioners at day activity centres who had indicated in a previous study that they were involved in facilitating labour market inclusion for people with intellectual disabilities (Barøy et al., 2024).
The first author sent a request for participation to 27 individuals, and a total of 13 consented to participate in the study. Ten of them were managers, and three were lead practitioners. While some managers were solely responsible for the day activity centre, others had broader responsibilities, overseeing additional units. The lead practitioners provided regular support to individuals attending the day activity centre. All participants had a bachelor’s degree in health and/or social work. The sample included twelve women and one man. The centres varied in size and assisted people with different levels of disability and intellectual disability.
Given that there are differences between municipalities in how they organise and provide services to people with intellectual disabilities in Norway (NOU [Official Norwegian Reports]2016: 17), we considered it essential to include participants who represented a geographical spread and variation in municipality size based on population. The 13 participants represented twelve municipalities from nine of Norway’s fifteen counties. There was a variation in population size among the municipalities, ranging from 2,000 to over 50,000 inhabitants.
The qualitative data was collected from October 18 to December 1, 2022.
Data collection
Focus group discussions were chosen as the method because they provide a rich source of information and stimulate group discussion and interaction among participants, thereby prompting genuine responses that reflect the reality of the group in question (McLafferty, 2004; Vaughn et al., 1996). Four audio-recorded digital focus group discussions, each with three to four participants, were conducted using the Microsoft Teams tool. Participants met digitally on one occasion and for one and a half hours. Before the focus group discussions, they received information about the study and submitted signed consent forms.
The first author served as moderator, with the second author as co-moderator. A semi-structured interview guide, incorporating thematic and follow-up questions, was developed to ensure that the qualitative data collected would meaningfully address the research question, following the guidance of Braun and Clarke (2022). The guide included questions aimed at exploring the informants’ awareness of individuals with intellectual disabilities, particularly regarding their employment aspirations, job placements, the support provided, as well as perceived success factors and challenges. All focus group discussions were transcribed verbatim by the first author.
Data analysis
Process of theme development.
In phase five, ‘refining, defining and naming themes’, the seven themes were placed into a digital mind map and printed in A3 format to examine what the qualitative information represented and what was unique about each theme. Subsequently, new tables were created in Microsoft Word, where the codes, initial themes, and developing and reviewing themes were systematically organised. This led to the discovery of themes that told parts of the same story, such as ‘focused on finding strategies and solutions, ‘working systematically with mapping and assessing’ and ‘supporting collaboration partners’. Three of the original theme names were retained during the fourth phase. The qualitative information was then systematically reviewed again. The first author primarily conducted this work, and the second author participated as a discussion partner throughout the process. The final phase, ‘writing up’, involved a back-and-forth process between the transcription, the initial codes and the themes to work reflectively in line with Braun and Clarke’s (2022) descriptions. After the process, we were left with three main themes: (a) No one else takes responsibility for people who do not fit in, (b) Being solution-oriented and proactive – Taking responsibility for labour market participation, and (c) Challenging and complex – Experiences of adapting pathways from day activity centres to the labour market.
Findings
Overall, the analysis shows that the informants’ understanding of the significance of work is reflected in their efforts to facilitate participation in the labour market. The informants emphasised that work is significant in many areas of people’s lives, such as providing a sense of usefulness through participating in production, fostering experiences of mastery and personal development, and serving as a setting for social participation. These perspectives suggest a fundamental recognition among the informants of the value of work, not merely as a means to an end but as a vital component of human well-being and inclusion. Notably, this understanding appears to persist even though facilitating employment is not formally part of their professional responsibilities. Additionally, the informants described people at day activity centres who did not fit in, either at the day activity centre or in sheltered workshops. As one informant stated: They fall between these two chairs: they are not suited for a sheltered workshop, but they have too much work capacity for a day activity centre. What are we supposed to do with them?
The informants found that some individuals with intellectual disabilities have greater work capacity than typically associated with participants at day activity centres. Yet, they also require more support than those associated with being in sheltered workshops. They also noted that some individuals with intellectual disabilities express a desire for ‘ordinary’ work. Not fitting in is also attributed to the day activity centre not being tailored to the needs of younger participants. The informants mentioned young individuals who do not wish to engage in typical day activity tasks, such as woodwork or carpentry. Several informants believed that these individuals do not feel a sense of belonging to the day activity centre and have different expectations. At the same time, several informants experienced that the criteria for accessing labour market measures have become more stringent compared to earlier periods. It appears that higher demands on individuals’ work capacity result in them not gaining access to work through labour market measures, whether in sheltered workshops or open labour markets with support. This results in them “falling into a municipal system”, as one informant stated. Informants expressed that society in general, but Nav especially, contributes little to enabling individuals with intellectual disabilities to participate in the labour market. One informant stated: I also experienced that Nav is conspicuously absent. Like, there’s no point in doing an assessment here, no point in even involving them. They get a disability pension, and then that’s it - plop - they’re out of the system. They kind of go under the radar, and we see they have work capacity. We see that very clearly.
The informants expressed a sense of responsibility for those individuals who, for various reasons, did not seem to fit in. This included recognising work capacity in individuals who had been granted a disability pension, as well as identifying a lack of responsibility from Nav or society in general.
The analysis showed that, although facilitating access to the labour market is not a formal or mandated responsibility of day activity centres, the informants expressed a strong sense of engagement with the issue. As mentioned in the introduction, Norwegian day activity centres are not specifically tasked with supporting labour market inclusion for people with intellectual disabilities, nor are there earmarked funds allocated for this purpose. Nevertheless, managers and lead practitioners described how they actively prioritised this work within the broader framework of their municipal responsibilities and available resources. As one informant put it: “In our municipality, we realised that no one was taking the responsibility, so a few of us decided it was time to step up and do something about it.”
This reflects a locally driven commitment to inclusion, where professionals take the initiative and adapt their practice to address unmet needs—even in the absence of formal mandates or dedicated funding.
The analysis indicates that the informants employed a variety of solution-oriented and proactive approaches to facilitate the transition of individuals with intellectual disabilities into the labour market. Firstly, this involved a shift in their understanding of what a day activity centre entails today, compared to what it was in the past. Informants perceived that, previously, day activity centres were considered a permanent solution but are now viewed as opportunities for development and progression into the labour market. One informant stated: “We are trying to create a system that does not exist. We need to think innovatively, and we need to develop.”
Secondly, the analysis demonstrates how informants developed solutions that facilitated participation in the labour market. This is illustrated through examples such as establishing workplaces in the labour market within their municipality or private companies or initiating projects related to labour market participation. Being solution-oriented and proactive is demonstrated by how informants talked about enabling individuals to participate in the labour market. They facilitated work training and provided instruction on relevant job tasks. One informant stated: We also have those who want to work in a café, so we offer a café where they can work and receive training. This can be extended to a sheltered workshop and eventually to employment in the open labour market with support – this is also part of the development process.
Informants helped assess whether employment settings in the open labour market were appropriate for people with intellectual disabilities. The previous quote also illustrates that informants considered further development and career paths from the day activity centre towards participation in the labour market. The informants also mentioned that the day activity centres assisted with placements or internships in the labour market. Additionally, informants highlighted that they provided and facilitated to ensure that individuals were able to get to work. This included preparing individuals to wake up early and assisting with getting up, going to work, or practising getting to work. One informant expressed: We have used a memo assistant to help them wake up, arrive at work on time, and manage their work route. Now, they get on the correct bus, and so on. This is something we assist with in relevant cases. We create a step-by-step action plan that they can follow.
Informants worked both within the day activity centre and externally to prepare individuals for participation in the labour market. They described how staff at the day activity centre followed and assisted individuals, including as companions at workplaces. It emerged that staff could be present initially and then gradually phased out, or they could remain as companions over time. Some informants noted that their role was limited to occasional check-ins to monitor progress.
Regardless of the level of involvement, the presence of a trusted person was consistently highlighted as a key factor for successful work participation. Informants described providing support and guidance, assisting with training on job tasks and offering instruction as examples of how they supported individuals with intellectual disabilities at workplaces in the labour market. For example, they practised observing basic workplace rules, assisted with making plans and writing job descriptions, or identified job tasks that may fit within the company. One informant illustrated what companionship can lead to: An example that worked well for us is a person who received very close follow-up in the beginning, which was probably a key success factor. She was very insecure and needed someone by her side to provide constant support. But now, she is very independent, working at the cash register, interacting with customers, and is very outgoing, all while excelling in her job.
This illustrates how follow-ups with a companion contributed to a sense of security in the workplace and how it could lead to development and the opportunity to work independently, allowing the companions’ presence to be phased out eventually. Several informants discussed individuals with intellectual disabilities who participated in both the day activity centre and the labour market. This ongoing contact with the day activity centre made it easier to capture and follow up on how things were going in the workplace.
The informants believed that facilitating and supporting participation in the labour market should be prioritised. They pointed out that having staff from the day activity centre in companies incurred increased costs, but they were convinced that this should be done: It is essential to be a bit proactive and take some initiative -for example, by providing a companion from the day activity centre who can guide individuals at the start. In some cases, it may also be necessary for the companion to be present throughout. Furthermore, it requires a certain boldness and confidence that the initiative will succeed. At the same time, ensuring close and continuous follow-up is essential. One should also be sufficiently generous in allocating salary resources to this, as deploying staff to external workplaces is not without cost.
This highlights a willingness to work with and prioritise within their budgets and participation in the labour market, even though, in practice, it means that “we simply have to prioritise away something else”, as one informant said. However, the informants did not specify which tasks or areas were deprioritised as a result. Several informants also mentioned the need to strengthen staff competence at the day activity centre in facilitating participation in the labour market.
In summary, the analysis shows that the managers and lead practitioners at the day activity centres were both solution-oriented and proactive in facilitating and assisting individuals with intellectual disabilities in participating in the labour market. This involved staff at the day activity centre establishing and creating solutions, contributing to enabling individuals to participate in the labour market, acting as companions, collaborating with staff at workplaces and being committed to prioritising this work.
Despite the solution-oriented and proactive efforts to facilitate participation in the labour market, the analysis also reveals challenges that highlight the complexity of issues related to this job. Informants expressed that the limited resources and finances of day activity centres were barriers to achieving participation in the labour market. One informant said: The challenge we face is simply getting enough time to work with participation in the labour market as all of us who provide follow-up for those outside the day activity centre also work here at the centre. Therefore, we must allocate time away from the centre to attend to those who require follow-up in the workplace, which presents a challenge. We would greatly appreciate having more resources for that.
Informants faced dilemmas regarding prioritisation due to a lack of resources. This affected follow-up within the day activity centre or among those participating in the labour market. Other organisational barriers were related to day activity centres being organised as health and care services, in contrast to labour market measures, which have associated rights relating to work in accordance with the Working Environment Act. The topic of work extends beyond traditional health and care tasks, leading to challenges in finding practical solutions for labour market participation among individuals with intellectual disabilities. Barriers related to the organisational location of the service were discussed in all focus groups. One informant noted that they go beyond mandated tasks and operate in a grey area: We are part of a health and care service, which presents its own set of challenges. Who insures them when they are at the workplace? They are not employees because they don’t have rights under the Working Environment Act. If they were part of a measure in the open labour market with permanent support, they would be employees, and the employer would receive support. That’s what I mean when I say that being part of a health and care service limits the possibilities.
The organisational location of the service created specific challenges in facilitating labour market participation for individuals with intellectual disabilities. Managers and lead practitioners at the day activity centre described how these challenges manifested in practice, including delays in labour market participation until responsibilities related to insurance, wages, and transportation had been clarified. The informants also experienced difficulties related to companies’ attitudes towards recruiting people with intellectual disabilities. Across the groups, experiences with companies that were sceptical about accepting people with intellectual disabilities were expressed. One informant explained: They are a bit afraid that it will become a burden, that they don’t have the time or capacity, and that it might be difficult. They see it as extra work for the company, which may stem from a lack of understanding.
This highlights an understanding that companies’ sceptical attitudes were rooted in a fear of additional work or lack of knowledge about the target group. Informants provided several examples of scepticism and uncertainty, such as questions about how to communicate with people with intellectual disabilities. The informants noted that many companies lacked experience with being inclusive workplaces for people with intellectual disabilities and, therefore, hesitated to take on the task. They described how they supported and guided companies to equip them better to include people with intellectual disabilities. However, previous negative experiences with inclusion efforts also explained the companies’ resistance and insufficient follow-up was said to contribute to their continued hesitance. An informant from a small municipality expressed that employees in some companies had negative experiences with specific people from many years ago, which affected recruitment: “There might be a history in the place that makes it difficult to find good workplaces.” Informants had also experienced companies terminating employment because it became “too much work and too much responsibility for them”, as one informant stated.
In summary, the results show that managers and lead practitioners at the day activity centres experienced barriers related to conditions at the centres, particularly due to the organisation’s role as a health and care service. They also encountered barriers associated with recruiting companies, as well as the companies’ lack of knowledge and negative experiences.
Discussion
Findings from this study suggest that managers and lead practitioners in day activity centres for people with intellectual disabilities engaged in what can be described as informal case management (Huntley et al., 2020). While the concept of case management is well established in many contexts, it is not commonly used as a framework within the health and care services in Norway. A reason for this may be related to the structure of the welfare state and the organisation of health and care services. With a strong public sector and a decentralised model where municipalities are responsible for a broad range of services, coordination is often expected to occur within existing systems—through interdisciplinary teams, coordinators, and individual care plans. Rather than introducing a distinct case manager role, Norwegian policy has emphasised task-sharing and collaborative practices as a means of achieving integrated services (Helsedirektoratet [The Norwegian Directorate of Health], 2024). Nevertheless, the practices observed in this study—such as coordinating services, tailoring support to individual goals, and facilitating transitions into the open labour market—align closely with core elements of case management theory (Draheim et al., 2021).
A particularly salient aspect of this informal case management is advocacy (Lukersmith et al., 2016). Managers and lead practitioners act on behalf of participants who fall between the cracks of the welfare system—individuals who are not eligible for labour-market measures and who lack adequate support from Nav. In these cases, the findings illustrate that managers and lead practitioners advocate for participants’ right to inclusion by creating alternative pathways into the labour market. This advocacy is not part of their official job description, nor is it institutionally supported; however, it reflects a strong ethical commitment to the goals expressed by the individuals they support and to the broader principle of social inclusion (Teper et al., 2020). Their efforts can also be seen as a response to the broader societal expectation that everyone must contribute to a more inclusive labour market. In Norway, this principle is embedded in national policy through the Inclusive Working Life Agreement (Government, 2019), which emphasises that inclusion is a shared responsibility between authorities, employers, and service providers. Although day activity centres are not formally mandated to support employment, the actions of these professionals reflect a local interpretation of this collective responsibility. This also aligns with Lukersmith et al. (2016), who highlight the coordinating role of case managers in bridging service gaps and ensuring continuity of care when formal systems fall short.
Another dimension of this informal case management role is the support and guidance provided to employers. Norwegian research on employer attitudes indicates that willingness to hire people with intellectual disabilities remains limited, with only a minority of employers expressing openness to inclusive hiring practices (Dean et al., 2022; Ellingsen, 2011) However, although relatively few companies express willingness, these still represent a significant number of potential workplaces. This suggests that a lack of available workplaces is not the main reason for the low labour market participation among individuals with intellectual disabilities (Dean et al., 2022; Ellingsen, 2011). Informants in the present study described how companies often expressed scepticism or uncertainty about including individuals with intellectual disabilities, citing concerns about communication, added responsibility, or lack of prior experience. In some cases, hesitation was rooted in negative past experiences or insufficient follow-up from public services. Managers and lead practitioners responded by educating, reassuring, and equipping employers, helping them understand the needs and strengths of the individuals involved.
This work reflects a key function of case management: building bridges between systems—in this case, between the health and care sector and the labour market. They not only supported the participants but also worked to transform the environment into one that is more inclusive and capable of accommodating diversity. This aligns with the case management principle of system-level advocacy, where the case manager works not only with the client but also with institutions and structures to remove barriers to participation (Lukersmith et al., 2016).
Operating beyond the formal mandate
While these efforts are commendable, they also raise important questions about legitimacy and responsibility. The managers and lead practitioners are, in effect, operating beyond their formal mandate. Compared to neighbouring Sweden, where labour market inclusion is an explicitly stated goal of day activity services (Lag (The Swedish Disability Act), 1993), the day activity centres in Norway are primarily designed to provide meaningful activities and social participation, in accordance with the Health and Care Services Act (Helse-og omsorgstjenesteloven, 2011) —not to facilitate employment in the open labour market. The use of time and resources for participation in the labour market is not explicitly sanctioned within the formal mandate of day activity centres. In addition, because participants are not formally employed, they are not covered by labour regulations or insurance schemes. Moreover, there are no formal oversight mechanisms in place. Managers and lead practitioners act primarily on their initiative without institutional backing or protection. Although there are no explicit sanctions for exceeding their mandate, the lack of formal recognition may discourage such practices or expose staff to criticism. This creates a structural vulnerability - the success of inclusive efforts depends on individual initiative rather than systemic support.
This reveals a broader paradox as well. On the one hand, there is a strong political and societal ambition to increase labour market participation among people with intellectual disabilities. On the other hand, the institutional frameworks that govern day activity centres offer limited structural support for this ambition. As a result, efforts to promote employment often depend on informal and locally driven practices, which may vary in visibility, consistency, and long-term viability. Efforts by day activity centres to include individuals with intellectual disabilities entering the labour market may thus inadvertently mask the insufficient availability of labour market measures with support. There are, therefore, a need for clearer structural support and recognition of the work being done in this context. To strengthen the role of day activity centres in promoting inclusive employment and supporting labour market participation, several strategic developments are necessary. This includes clarifying and expanding their formal mandates to encompass activities that support participation in the labour market, thereby aligning institutional goals with broader inclusion policies. In addition, more robust and structured collaboration between day activity centres, Nav, and employers is essential to create coherent pathways into the labour market. Finally, there is a need to recognise advocacy and coordination as legitimate and necessary components of inclusive practices—potentially through the adaptation of case management roles to better fit the Norwegian context.
Strengths and limitations
This study contributes to a deeper understanding of how day activity services can support the inclusion of individuals with intellectual disabilities in entering the labour market. One of the main strengths lies in the use of focus group discussions, which allowed participants to reflect collectively and build on each other’s experiences. This method provided access to rich, practice-based insights that might not have emerged through individual interviews alone (McLafferty, 2004; Vaughn et al., 1996).
The participants were drawn from a range of municipalities, which adds contextual diversity and helps illuminate how local variations in service organisation and policy implementation may influence opportunities for labour market participation. This geographical spread strengthens the relevance of the findings across different settings.
Nonetheless, the study has some limitations. The sample size was relatively small, and the findings are not intended to be generalised to all contexts. Moreover, the perspectives represented are primarily those of managers and lead practitioners. While their insights are valuable, the absence of voices from individuals with intellectual disabilities themselves limits the study’s ability to capture user experiences and preferences fully. Additionally, group dynamics in focus discussions may have influenced what was shared, potentially leading to consensus-oriented responses rather than divergent views.
Despite these limitations, the study makes significant contributions to the field. It highlights the need for further research that incorporates the perspectives of people with intellectual disabilities and examines the long-term impact of inclusive day activity services on employment participation.
Footnotes
Acknowledgements
Authors would like to thank managers and lead practitioners at day activity centres for their contributions to the study.
Ethical considerations
The study has been assessed by the Norwegian Agency for Shared Services in Education and Research (Norwegian abbreviation: Sikt) to be in accordance with ethical guidelines and guidelines for the handling of personal data and privacy legislation (369805).
Consent to participate
Written informed consent was obtained.
Funding
The project has been funded by the National Competence Centre for Intellectual Disabilities (Norwegian abbreviation: NAKU).
Declaration of conflicting interests
The authors declare that there are no potential conflicts of interest with respect to the research, authorship and/or publication of this article.