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Целью нашего исследования явилось изучение эффективности и безопасности препарата лазолван 30мг у амбулаторных больных с ХОБЛ.

Деформирующий остеоартроз (ДОА) в настоящее время является наиболее распространенным дегенеративно-дистрофическим заболеванием суставов, которым страдают не менее 20% населения земного шара.

Целью работы явилась оценка анальгетической эффективности препарата Кетанов (кеторолак трометамин), у хирургических больных в послеоперационном периоде и возможности уменьшения использования наркотических анальгетиков.

Для более объективного подтверждения мембранно-стабилизирующего влияния карбамезапина и ламиктала нами оценивались перекисная и механическая стойкости эритроцитов у больных эпилепсией

Нами было проведено клинико-нейропсихологическое обследование 250 больных с ХИСФ (работающих в фосфорном производстве Каратау-Жамбылской биогеохимической провинции)

C использованием разработанных алгоритмов и моделей был произведен анализ ситуации в системе здравоохранения биогеохимической провинции. Рассчитаны интегрированные показатели здоровья

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Parental employment in families with disabilities: assessment, factors, solutions


Object: Purpose of this paper is to assess the factors affecting the ability of a parent with a disabled child to find employment to develop approaches to addressing this issue, including in the framework of the Employment Center activities.

Methods: This study includes a sociological survey conducted in 5 regions (300 families) of Kazakhstan, processing of the results using structural analysis and SmartPLS statistical methods.

Results: According to the results of a sociological survey, the share of working mothers after the birth of a child with special needs is found to be decreasing from 86 % to 42 %. Of the 58 % of those unemployed, 31 % would like to realize their human potential and increase family income. A PLS-PM model processing of the survey results allowed to identify significant factors: time spent on childcare, his diagnosis, and family income. Authors of the article have affirmed two hypotheses about the relationship between mother’s status and the family income with the mother’s willingness to find employment, mainly in the form of partial or temporary one. They have also confirmed the hypothesis about the influence of “Additional government free of charge family services” on the mother’s ability to work. A significant number of respondents expressed a desire for government support to provide employment opportunities in a form accessible to the parent and additional income. This led to the conclusion that the Employment Centers are not working effectively enough with this category of citizens. In this regard, for Employment Centers, the authors propose three algorithms of actions for the employment of this social group, which maximizes the range of possible solutions for each individual case.

Conclusions: Realization of the human potential of parents with a disabled child is related to their employment and labor income. Employment Centers need to take an active position on the issue of employment of target groups by introducing a profiling methodology and fixing the specialization of specific employees on groups with social issues for targeted individual work with each case. We suggest the possibility of addressing the issue within the framework of social entrepreneurship.


Families with disabilities have started getting attention in the social policy of the state since the 1970s. Combination of factors that reduce the living standards in these families compared to an ordinary family has identified them as an object of socio-economic research (Rimmerman, 2015).

The issues of families are investigated by international organizations, and according to the UNICEF estimates in 2013, the proportion of children with disabilities in the group of children under 14 in the world varies from 4.1 % to 7.4 % (UNICEF, 2013, UNICEF, 2005).

In 2/3 of the OECD countries, poverty level in the group of families with disabled children is higher than in ordinary families. The largest gap in the value of the poverty level indicator is in Portugal (11.9 %), the USA (11.2 %), and the Czech Republic (6 %). However, in some countries, such families live better. The poverty rate among ordinary families is 3 % higher in Belgium, 4.1 % higher in Iceland, and 1.5 % higher in Germany (OECD, 2011). This is the result of social policy, specifically the promotion of parental employment.

According to official statistics of Kazakhstan, the share of children with disabilities is 1.5 % of the number of children under 18 years old and this trend remained same over the past decade. The number of families raising children with disabilities is growing along with the population. In 2019, the number of such families is about 90 thousand, considering the fact that some families have more than one such child (UNICEF, 2014).

The level of employment in Kazakh families with disabilities is low. In the 2014 UNICEF sample survey, no one works in 10 % of families, one person works in 53 %, and both parents work in 33 % of families (UNICEF, 2015).

One of the limitations for the family is the parent’s reduction (in 90 % of cases, the mother) of the opportunity to realize their human potential and find employment in the desired volume. This also entails indirect losses in the family since family income is reduced, in some cases, significantly. If the family is incomplete, a critical level of dependence on state transfers and a passive model of life activity may form. Realization of the human potential of the child’s mother in employment allows not only to increase family income, but also to form an active life position for the child in adulthood.

Literature Review

Despite the array of family policy research, there is still no answer to the question, is the model of support for families with disabilities an independent direction of family policy or an addition to the standard one. The discussion has been raised by J.Y. Kang (2019), K. Bogenschneider and Corbett (2010), T. Ooms (2019), R. Giulio, D. Philipov, I. Jaschinski (2014). These authors believe that for the most developed countries, this is one of the directions of holistic family policy focusing on the family raising children with disabilities.

Problems of realization of human potential family members with disabilities, including employment, were considered by D. Kirton (2009), N. Bourke-Taylor, C., Cotter, R. Stephan (2014), Mary D., K. Grace (2015), P. Loprest, A. Davidoff (2004), M. Olsson, S. Hwang (2006), and G. Preston (2006). These authors consider that parental employment in such families is desirable, but possible in cases where the state provides a significant number of available services that address the issue of a child’s day stay in a specialized center or providing home-based carers.

A number of studies focus on the health and social issues of single-parent families with disabilities, which are explained by high poverty rates, e.g., the one by Campbell M., Thomson H., Fenton C., etc. (2016).

By assessing the relationship between the employment requirement of a parent and the receipt of additional social benefits for single-parent families, the authors conclude that there is no unambiguous positive relationship between employment, well-being and health status of members of such a family. If the job is low-skilled and low-paid, then it does not effectively address the issue of family poverty. Although the very participation in employment promotion projects increases self-esteem for some participants.

Perry-Jenkins M. and Gillman S. (2000) emphasize that the assessment of the impact of employment outcomes on socio-economic well-being in single-parent families with disabilities in comparison with full families does not return unambiguous and statistically reliable results, because, in their opinion, the social context and human characteristics are more important.

In the post-Soviet space, family policy issues are considered in demographic, gender, socio-cultural aspects by V.V. Yelizarov, N.G. Janayeva, A.L. Sinitsa, and Yu.A. Potanin (2018), however, these studies lack obvious emphasis on the situation of families with disabilities. Many authors consider the family policy of post-Soviet and European countries from the standpoint of the basic family model by V. Gribovsky (2019). Others emphasize the socio-cultural features of family relations and the need to take them into account in family support programs (V. Sidorov, 2016).

A.O. Tyndik, S.A. Vasin (2016), and Yu.S. Nenakhova (2015) chose families with disabled children as the object of research as well. They consider limitations of realizing human potential possibilities for families with disabled children from different positions. The paper by A.O. Tyndik and S.A. Vasin based on population census data provides the detailed analysis and assessment of the structure of families with disabled children, parental education and employment, sources of income and accessibility of educational services for children. In particular, they conclude that there is inequality in terms of the living standards of ordinary families and families with disabilities, but ways to promote parental employment are not considered. Yu.S. Nenakhova analyzes the data of a sociological study and focuses on the shortage of rehabilitation services for children, however, overlooks ensuring parental employment.

Currently Kazakhstan authors would mainly research the issues of children with disabilities, available services and regulatory features of rehabilitation practices, but not the socio-economic situation of the family as a whole. The issues of realizing the human potential of parents do not receive an update in the works by T.P. Pritvorova, J. Kaidarova (2011), Temirbaeva D.M. (2019), T.P. Pritvorova, D.E. Bektleeva (2014).

M.P. Ayaganova (2019) and N. Gelashvili (2019) consider some methods of addressing the issue of parental employment in families with the disabled children in the context of social entrepreneurship, for which such citizens are the target group.

The novelty of our research lies in the fact that we identify not only the share of employed parents in families with disabled children, but also factors affecting the employment of a parent taking care of a child, using the structural modeling method. Previously, only statistical sampling studies would be undertaken in Kazakhstan without assessing the factors affecting employment in families with disabilities and developing recommendations to address the difficulties of parents who want to find employment.


The study implies a sociological survey of 300 families from five regions of Kazakhstan (Almaty, Karaganda, Pavlodar, East Kazakhstan, and Akmola regions) and processing the results using the PLS-PM structural modeling method, which allows assessing complex networks of causal relationships with latent variables.

This method allows the assessment of the impact of several groups of independent X variables combined within a single factor, on the Y variable within the framework of one model. This means, we can assess the impact of both group of factors and each factor individually.

The structural analysis of the open questions of sociological research helps to clarify the qualitative assessment by respondents of some factors acting on the side of the family and on the side of the state.


According to the results of a sociological study, reduction or termination of employment in families with disabilities is common.

Before the birth of a child, 86 % of the surveyed women would work (Table 1).

Table 1. The opportunity to work for the mother (or father, if there is no mother) of a child with disabilities

Mother’s status before the birth of a disabled child



Didn’t work anymore

Never worked


86 %

2 %

12 %

100 %

Mother’s status at the time of a survey

Job description:

Works: 42 %

Does not work: 58 %

In % of the total of unemployed:

In % of the total of employed:


Of these:


Of these:




Quit because of a child’s disability




Part-time (halfpay or less)


Unemployed now, because of another child under three years of age (plans to start)






Unemployed as never was



Of these:


Of these:

Quit for other reasons (health, family circumstances)




Has childcare options




Of these:



Child can stay alone


Does not plan, because there is neither the opportunity nor the desire



Of these:


Of these:

Does not plan, because it requires professional training, which also takes time




Employed, mother of multiple children


There is a desire, there is no job opportunity




There is a desire, plans to start soon



Note: Compiled by the authors based on the results of a sociological survey

After the birth of a child with a disability, 42 % worked at the time of the survey, i.e., almost half as much. Of all employees, 78 % were employed full-time, 14 % were employed at 0.5 % or less, and 8 % were self-employed. That is, non-standard employment is actively in demand in such families.

At the time of the survey, 58 % of women are unemployed. Out of 100 % of unemployed women:

  • 66 % noted that they quit working due to a child’s disability;
  • 21 % of women, which is equivalent to the same 12 % in the total, noted that they had never worked;
  • 5 % of women have another child under three years of age;
  • 8 % of women have quit working for other reasons (health, family circumstances, etc.).

Potentially, realization of their human potential in the labor market is important for 53 % of women out of 66 % who do not work due to the birth of a disabled child.

Of those 66 % who have stopped working because of a child’s disability, 46 % express willingness to work, but currently do not see such an opportunity for themselves. 7 % say that they will get a job in the near future. Another 16 % say that they need to pass or update professional training to get out, however that requires time and opportunity.

If we consider the totality of women with children with disabilities, 31 % currently do not work, but have a desire to work in some acceptable form. The projection on the number of families with disabilities means that this is approximately 27,900 potential job seekers in Kazakhstan.

Let us determine the factors affecting the employment opportunities of women with disabled children and form research hypotheses.

On the part of the family, the possibility of employment is affected by “Family characteristics” and “Status of family members in the context of child care”.

On the part of the state, “Other services for the child” and “Additional government free of charge family services”.

Let us formulate hypotheses according to the predicate analysis.

  • 1: There is a significant relationship between “Additional government free of charge family services” and “Opportunity to work”.
  • 2: There is a significant relationship between “Family characteristics” and “Opportunity to work”.
  • 3: There is a significant relationship between “Other services for the child” and “Opportunity to work”.
  • 4: There is a significant relationship between “Status of family members in the context of child care” and “Opportunity to work”.

We have processed personal data and verified the hypotheses using specialized SmartPLS software (Figure 1). SmartPLS helps to provide identification of characteristics that have the greatest impact on the dependent variable “Opportunity to work” using PLS analysis.

The PLS model is analyzed and interpreted in two stages:

  1. Assessment of the reliability and validity of the measurement model.
  2. Evaluation of the structural model.

Internal reliability of the model is checked using the following built-in coefficients: Cronbach's Alpha, rho_A, AVE, and Composite Reliability.

We have obtained the following values:

  • Cronbach’s Alpha: from 0.651 to 0.91 (best at 0.7 or higher).
  • rho_A: from 0.027 to 1.563 (best at 0.5 or higher).
  • AVE: from 0.292 to 0.821 (best at 0.5 or higher).
  • Composite Reliability: from 0.146 to 0.932 (best at 0.7 or higher).

Accordingly, the model reliability and validity analysis have given adequate results. This confirms the internal consistency of the survey and the strong influence of indicators on the latent variable. The deviation from the standards has been confirmed by the group of factors “Family characteristics”, since their values are heterogeneous and are largely spread. At the same time, the assessment of the reliability and validity of the measurement model as a whole has illustrated satisfactory results. This allows us to proceed to the assessment of the structural model.

Let us proceed to Bootstrapping.

In order to check the effectiveness of all the obtained coefficients we use the Bootstrapping command built into SmartPLS to test the statistical significance of the analysis results. The Bootstrapping procedure initiates the step-by-step verification from simple events to complex ones and outputs the result of the study. This is how we get an estimate of the reliability of the hypotheses (Table 2).


Original Sample (O)

T Statistics (|O/STDEV|)

P Values

Hypothesis status

Н1. Additional government free of charge family services -> Opportunity to work





Н2. Family characteristics -> Opportunity to work





Н3. Other services for the child -> Opportunity to work





Н4. Status of family members and child care -> Opportunity to work





Note: Compiled by the authors based on data obtained using SmartPLS program

Table 2. Path Coefficients

We have performed evaluation of the significance of the obtained coefficients of the model using Student’s t-statistics. The observed t-statistics values are compared with the critical value of the Tobs > Tcrit = 1.96. Having checked this condition, we confirm statistical significance of the coefficients of the following variables: “Additional government free of charge family services” (0.193), “Family characteristics” (0.357), and “Status of family members in the context of child care” (0.326).

For the independent variable “Other services for the child”, the coefficient equal to 0.092 is statistically trivial since Tobs = 0.860 < 1.96.

Significance of the coefficients is determined by P Values, the value of which should not exceed 0.05. Bootstrapping has shown that the most significant one is the coefficient of the variable “Family characteristics” equal to 0.357 (Figure 2). P Values of this coefficient is 0.018.


“Family characteristics” coefficient’s high value (0.357) confirms its significant impact on the opportunity to work.

The test result demonstrates that hypotheses H1, H2 and H4 are supported.

This means that additional government free of charge family services, family characteristics (income and diagnosis of the child), status of family members in the context of child care affect the opportunity to work. Therefore, we can argue that improvement of the above-mentioned factors shall contribute to the employment of mothers caring for children with disabilities.

The Y variable reflects the willingness to work (human potential realization) of the parent who provides the most care for the child. In assessing possible employment options, respondents prioritize the status of an employee in the amount of temporary/part-time employment (Y10 = 0.889) followed by full-time employment (Y12 = 0.574). The smallest number of people who would like to work (Y11 = 0.331) prefer selfemployment; these are mainly those already experienced in such work.

The possibility of getting a job by 36 % is described by the factors included in the model, which is a sufficient value, since the model describes only the factors acting within the family and in the immediate environment. While the outside world suffers from a number of other factors: the unemployment rate in the region of residence, the demand for the parent’s profession in the labor market, etc.

Family characteristics have the greatest influence on Y (0.357), among which the diagnosis of the child (X25 = 0.826) and family income (X22 = 0.283) were paramount. The first characteristic is the defining one, since there is a direct link between the time spent on daily care and the diagnosis of the child. Complex diagnoses require additional funds for the rehabilitation of the child, since the services provided by the state for children with medium and high needs are insufficient (this is confirmed by the weak connection of services for children and the opportunity to work, the hypothesis H3 was not confirmed.) This also determines the desire of the family for additional income. Hypothesis H2 Family Characteristics -> Opportunity to work was confirmed with P Values = 0.018.

The second most important factor is the status of a person in the family with its influence value of 0.326. In the vast majority of cases, the opportunity to work while having a child with a disability and the care they require is a mother’s problem (X15 = 0.929). In some cases, the second family member also faces employment issues, but the coefficient (X14 = 0.365) is much less significant. This does not affect the capabilities of other family members in any way possible. Hypothesis H4 The status of family members in the context of child care -> Opportunity to work was confirmed with almost perfect P Values = 0.001.

The variable we have defined as “Additional government free of charge family services” would include a whole range of the following services: short-term respite (a visiting social worker), long-term respite (payment for care services for the period of the parent’s leave), and other services (an open position). The first two services did not receive substantial attention from respondents, which determined a low value of 0.193, compared to the previous two factors. Many families do not receive social worker services (they are in the process of obtaining disability status, or reside in rural areas, or do not have residence permit, etc.) or they do not feel the social effect from it (X16 = -0.741). Current practice does not include long-term respite service, and many people assess the probability of receiving it in the near future negatively; therefore (X17 = -0.415). At the same time, the desired support from government to provide employment opportunities in a form accessible to the parent and to receive additional income has been expressed by a significant number of respondents (X18 = 0.951). Hypothesis H1 Additional government free of charge family services -> Opportunity to work was confirmed with P Values = 0.036.

We believe that the solution to the employment issue is associated with the modification of the Employment Centers activities and the development of social entrepreneurship.

The way Employment Centers work is currently based on the streaming service of applicants and their allocation to the projects of the state employment program (Petrenko E.S., Pritvorova, T.P., Spanova, B.K., 2019). An individual approach to the applicant considering his life circumstances is practically nonexistent, i.e., the applicant from the problematic target group is served on a general basis.

We propose several options for Employment Centers that will help to get results in the form of employment of a problematic target group, of which parents with disabled children are part of (Figure 3).

The algorithm of actions in this case is assumed in several variants depending on the level of education, qualifications and desires of the applicant.

The first option is employment in the private sector on the terms of partial or remote employment. Digitalization of many business processes makes it possible to attract part-time workers on a rolling schedule. Many trading companies and shops, firms in the service sector at the present time have websites and employ consultants. They can connect from home and work part-time with a flexible schedule.

If necessary, the opportunity for such employment can be ensured by the visiting social worker who provides childcare for 3–4 hours while the parent is working.

Such a workplace can happen under the “Social Workplaces” project, so that the employer can assess the employee during the trial period.

However, if an employer wants to take an advantage of preferential taxation and other opportunities provided to social entrepreneurs (SE) in Kazakhstan, they can hire several employees from target groups according to the standards laid down in the legal act (disabled people, parents with disabled children, persons serving sentences, low-income citizens, etc.) (the Law of Republic of Kazakhstan dated June 24, 2021). In this case, an ordinary trading company, a mass catering company, or any other company with a consultant position can apply for the status of a social entrepreneur.

For the second option, a non-profit organization (NPO) can be involved as an intermediary in employment, because such organizations work with target groups, are aware of their specifics and can quickly find a job for an applicant in any sector of the economy. In this case, it is necessary to subsidize employment services from the state to an NPO according to unit cost standards.

For the third option, the Employment Center can immediately appeal to a social entrepreneur for employment of an applicant from the target group, however, this requires an information base (in this case, the register) of social entrepreneurs.


The results of our sociological research confirm that a significant proportion of women after the birth of a child with a disability reduces employment or completely abandons it. There are 44 % of them in our sam-

ple, 20 % in OECD countries (Giulio P., Philipov D., Jaschinski I., 2014), which is most probably explained by a large number of supportive measures. For example, France offers free babysitters for toddlers up to three years of age and individual allowances, the size of which takes into account the diagnoses of the child by the cumulative method (Report “Family Policy in the 28 EU Member States”, 2018).

In addition, a large proportion of employed parents is explained by the active policy of employment services, which, owing to a developed profiling system, determine belonging to the target group and work in a targeted manner considering all the employment opportunities of the applicant for non-standard employment regimes (European Commission, 2021).

In our study, the share of employed parents was 42 %.

The above-mentioned UNICEF survey in Kazakhstan illustrates 53 % of families in which one parent works, and 10 % of families in which no one does. However, it should be noted that the statistical review does not specify the reason for parents’ lack of employment. It is worth mentioning that there may be other reasons for staying unemployed, e.g. another small child, health issues and others, we have indicated in Table 1. By providing specific reasons for the lack of employment in our survey, we trust our data to be more accurate and reliable.

We believe that the difference between developed countries and Kazakhstan in the scale of employment of parents with disabled children is due to the fact that the volume of available day rehabilitation services in many countries, especially Scandinavian ones, Germany, France, is much higher (Olsson M., Hwang C., 2006, Rimmerman A., 2015).

We think another reason is the lack of real use of profiling techniques and individual selection of the form of employment for groups with social issues in Kazakhstan’s Employment Centers (Petrenko E.S., Pritvorova T.P., Spanova B.K., 2019).

We shall identify employment issues that parents with disabled children face diagnosed by Loprest P., Davidoff A. in our further studies.


Modern social policy in relation to families with disabilities considers the issues of all family members, and, above all, the parent who provides most childcare. One of the options for realizing the parent’s human potential is employment. According to the results of a sociological study conducted in five regions of Kazakhstan, the main factors determining the possibility of working for a mother are the time spent on childcare (due to the diagnosis of the child) and the family characteristics, its income above all. Income is the paramount factor for single-parent families with no other sources of income other than transfers. Of 58 % of unemployed parents, 31 % would like to find a job. If we extrapolate this to the number of families with disabled children, we shall find approximately 28 thousand people in Kazakhstan.

The factor limiting the opportunities of parents with disabled children in the external environment, according to verified hypotheses in the PLS-PM model, is the lack of an individual approach and adequate offers from the Employment Center.

For this, in our point of view, we need Employment Centers to take an active position on the issue of employment of target groups by introducing a profiling methodology, fixing the specialization of the employee (if necessary, 2–3 employees in the centers of large cities) on groups with social issues for targeted individual work with each case.

There are three possible options:

  • Employment in the private sector at a social workplace (part-time employment with full subsidy);
  • Involvement of a non-profit sector as an employment agent with subsidized services for each employed applicant;
  • Employment with a social entrepreneur, who could become such if they employ several (at least four) citizens from target groups. In this case, digitalization of business processes can facilitate to ensure remote employment in a flexible mode. For instance, consultants on the marketplace website, a mass catering facility, and a number of other services can work from home on a rolling schedule on a part-time basis. This will allow the entrepreneur to get an official status and give them access to benefits.

Implementation of the proposed algorithms will address the difficulties of parents in families with disabilities in finding employment in the official labor market.


The results of the study have been obtained as a part of the grant funding project supported by the Science Committee of the Ministry of Education and Science of the Republic of Kazakhstan, “The system of support for households with disabled children: conceptual foundations, effective practices, development mechanisms in Kazakhstan” 2020–2022. (Grand No. AP0880566).


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International relations

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Philology is the study of language in oral and written historical sources; it is the intersection between textual criticism, literary criticism, history, and linguistics.[

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