Introduction

Young people who are Not in Education, Employment, or Training (NEET) represent a societal concern worldwide [1]. The term NEET is used as a broad category covering a heterogeneous population of young people aged between 15 and 29 and is associated with a range of life difficulties [2]. Being identified as NEET is associated with poorer health and well-being in the short- and long term and also has a negative impact on the economic growth and welfare of countries [3–6]. Previously, studies have reported that NEET status is associated with increased risk behaviors [7, 8], poorer self-perceived health and poorer mental health, and increased risk of injury due to self-directed violence and violence from others [3, 9–11] compared to their non-NEET peers. A systematic review and meta-analysis confirmed that being in the NEET category was associated with substance use and severe mental health problems and that mental health problems in early youth predicted later status as NEET, while evidence for the inverse relationship was equivocal and sparse [12]. Moreover, results from primary care services have shown that young NEET adults seeking psychological treatment for common mental disorders had worse treatment outcomes than young adults who were not NEET [13]. As expected, studies have documented lower socioeconomic status among those in the NEET population compared to their peers in school, which may partly explain differences in health status [10, 14].

Recently, there has been a major concern about how young people will be affected by the economic consequences of COVID-19 [15–17]. Globally, the COVID-19 pandemic had particularly severe and wide-ranging impacts on young people, which is reflected by NEET rates of 24.9% in 2020 and 23.5% in 2022, well above their pre-pandemic levels [18]. EU countries have also reported an increase in NEET rates during the pandemic, but the long-term trend is a significant decrease during the last decade, falling from 16.0% in 2012 to 11.7% in 2022 [19]. Nevertheless, reducing the NEET rate to 9% by 2030 is one of the targets of the European Pillar of Social Rights [20]. According to the Sustainable Development Goals (SDGs) 8.6, the proportion of youth (aged 15–24 years) not in employment, education, or training should have been substantially reduced worldwide by 2020 [21].

Although NEET rates have been reduced in EU countries, it is still considered a significant challenge because of the risk of health deterioration posed by this state [4], its long-term "scarring” effect [22], as well as the labor market’s unmet supply of workers due to an ageing working population [23].

To ensure effective outreach to young people in the NEET category, it is highly important to use measures which are designed and tailored to their background and needs. Worldwide, NEET rates vary according to regional affiliation and individual background characteristics. Two thirds of NEETs are women; the NEET rates and gender gap is higher in rural compared to urban areas; higher among certain ethnic minorities; and NEET rates are inversely related to country income and individual educational attainment [18, 24–27]. Vulnerable NEETs with serious mental health conditions who are disengaged and not actively looking for work and/or training opportunities, may also experience other challenges, which often require special outreach activities for psychiatric rehabilitation [28]. Furthermore, lessons from the COVID-19 pandemic have shown that governments must invest in social safety net programs that focus on supporting those most at-risk [29]. The International Labour Organization identified a total of 73 countries as having widespread social partner engagement in their national youth strategy across several stages of youth employment policymaking [30]. Longitudinal analyses based on data from Eurostat and World Bank have also demonstrated that the measures targeting NEETs in order to facilitate access to education, the labor market, and social inclusion, must be coordinated with measures alleviating poverty and any type of exclusion, the support given to employers (i.e., subsidizing jobs), the family and the local community [31].

According to the literature, a range of different approaches have been used to increase the likelihood of youth to return to education, employment or training, including financial support, intensive support from trained advisors, and tailored education, employment and training solutions [32]. A systematic review and meta-analysis of re-engagement interventions for the NEET population concluded in 2017 that there was a need for research to adopt high-quality evidence methodologies to determine what works best for this population [33]. A recently published evidence and gap map based on systematic reviews and impact evaluations concluded that most youth employment interventions originate from high-income countries, have an experimental study design, and provide low quality evidence [34]. Thus, due to the limited knowledge base for developing recommendations for policy and practice, it is crucial to continually identify programs using methods and strategies that effectively contribute to re-activate NEETs into employment, education and/or training. The present systematic review seeks to address these gaps by identifying, synthesizing, and evaluating evidence of effects from randomized and quasi-randomized re-engagement interventions targeting NEETs.

Methods

To ensure a rigorous review process, we followed the guidelines from the Joanna Briggs Institute [35]. The protocol for the review was registered in the PROSPERO database 25. September 2023 (record ID 463837). The principles underlying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) framework for data retrieval, were adopted in terms of identification, screening, eligibility, and inclusion [36]. The PRISMA 2020 checklist is available as S1 File.

Data synthesis

Findings from the included studies were synthesized based on results from the critical appraisal process and the results from the data extraction. According to the protocol, we intended to conduct a systematic review and if possible, a meta-analysis, of interventions targeting NEETs. However, the data extraction process revealed that there was not sufficient homogeneity in the types of intervention and/or study designs included to conduct a meta-analysis.

Search results, screening outcomes, and selection decisions have been documented and presented in a PRISMA 2020 flow diagram format for systematic reviews (Fig 1).

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Fig 1. PRISMA 2020 flow diagram.

https://doi.org/10.1371/journal.pone.0306285.g001

Results

Database searches identified 15442 records. Some duplicates (n = 2252) were removed automatically through Ovid; the rest of the duplicates (n = 6530) were removed through EndNote 21. Additional duplicates were found through the screening process in Rayyan (n = 65). In total, 6595 records were screened by title and abstract. A total of 6567 records were excluded during the screening of titles and abstracts. Full-text versions of the remaining 27 papers were obtained and assessed against the inclusion criteria. Of these, 18 papers did not meet the inclusion criteria and were excluded. In addition, full-text versions of four papers after manually screening of the review by Mawn et al. [33] were obtained and assessed against the inclusion criteria. All these papers were excluded.

Reasons for exclusion is presented in S3 File. A total of 9 articles were included after thorough evaluation of methodological quality (Tables 1 & 2).

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Table 1. Critical appraisal of randomized controlled trials.

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Table 2. Critical appraisal of quasi-experimental studies.

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Background information

Only information related to background, methods, sample characteristics comparators and process described in the template for data extraction, which was provided by all included studies, is reported in Table 3.

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Table 3. Background information about study sample, study design, program components and outcome measures.

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Discussion

The present systematic review provides information about the effectiveness of interventions with a randomized controlled design targeting young adults not in education, employment, or training (NEET). The papers included did not provide sufficient data to conduct a meta-analysis. Studies included in the present systematic review reported outcomes of employment, education, or training, as well as factors that may facilitate transition to these states. Findings in the included studies reported various types of interventions, characteristics of target groups, regional affiliation, and degrees of effectiveness on outcomes.

The Individual Placement and Support (IPS) model demonstrated notable effectiveness in enhancing job acquisition and stability for individuals with severe mental illness [39] and those on long-term health benefits [46]. This consistency in effectiveness, including improved mental health and decreased health complaints and drug use, was observed across various age groups. While IPS aids young adults with serious mental illness in securing stable employment, its generalizability beyond patient populations needs further exploration [48].

Contrasting with IPS, other interventions presented varied outcomes. For instance, the approach by Robert et al. [45] focusing on social and preventive medicine consultations, showed moderate improvements in work status and training program participation, particularly benefiting specific subgroups such as younger adults and those with lower educational levels. Similarly, the study by Ehlert and co-workers [47], indicated that an innovative combination of individual coaching, classroom training and temporary work program was successful in increasing employment rates after 6 and 18 months, but only for participants who stayed on during the complete program. In line with these results presented in the current review, Mawn and coworkers [33] have previously emphasized the importance of program adherence, using a sufficient ‘intervention dose’ and concluded that multi-component interventions seemed to increase employment rates more effectively than single-component interventions.

In contrast, the youth training program by Card et al. [40] focusing on basic skills and technical/vocational training among NEETs in the Dominican Republic showed no significant effect on employment, and only a very modest impact on earnings per month. No sub-group differences in estimated impact on employment were observed according to gender, age education or location, but for those with higher education and living in urban areas, the program seemed to have a positive effect on earnings. Although it has been reported that training impacts in Latin America are on average more positive than those implemented in European countries and the US [49], Card and co-workers conclude that similar programs can most likely not be successfully implemented in Latin American and Caribbean countries due to the many barriers and problems related to financial and operational constraints [40].

Similarly, Eppel and Mahringer [41] reported that intensified support for NEETs did not have a significant impact on the overall extent of integration into employment after the three-year follow-up period. However, their primary objective was to encourage NEETs to pursue education and training to improve their long-term labor market opportunities instead of quickly placing them in random unskilled jobs. Thus, an increase in basic training was observed during the intervention period, but no improvement in further training or education.

The study by Le Gallo et al. [42] focused on improving the degree of mobility among NEETs to avoid social exclusion and improve access to employment, and results indicated only a weak positive effect on access to temporary jobs but not permanent jobs. The high cost and low impact of the program implies that focus on increasing mobility as an approach to increase re-engagement should be re-evaluated or be part of multi-component, cost-effective intervention studies.

Results from the Youth Employability Program (YEP) reported by Patel et al. [44] showed increased job-seeking activities that may be explained by increased job-search resilience, self-esteem, self-efficacy and future orientation, after receiving employability training and coaching with additional focus on increasing financial capability, compared to participation in traditional YEP programs. Based on their findings, Patel and co-workers suggested that future studies should focus on adaptive programming and management [44]. This suggestion is in line with a previous study of re-engagement initiatives for NEETs which emphasized the need of holistic and flexible services to help NEETs gain confidence and competence [50].

Finally, the Youth Unemployment Program (YUP) by Jensen et al. [43], which focused on the use of benefits, incentives and sanctions to decrease youth unemployment, showed only weak short-term effects. Active labour market policies are found in almost all countries worldwide, but varies in amplitude, design and implementation [51]. Results presented by Jensen and co-workers which indicated limited effectiveness in facilitating the transition from unemployment to employment, emphasize the need for further investigation into long-term effects and more adaptive labor market policies as proposed by the European Commission. [52].

The interventions described in this review span simple transactions such as offering vouchers for the driving test [42], changes in active labor market policies [43], intensifying existing counselling practices [41, 44, 45, 47], increasing training [40, 44, 47], and structured, manual-based methodologies requiring cross-sectoral collaboration (IPS) [39, 46]. The two latter studies show the most promising results on re-engagement, but studies are few. Their findings are, however, in line with meta-analyses and reviews of IPS for both adults and young persons with severe mental illness, showing a notable difference between IPS and TAU [48, 53].

The included studies also exemplify the span in approaches within the work rehabilitation field. Re-engagement approaches can broadly be categorized into train-place approaches or place-train approaches [54]. Train-place approaches emphasize stepwise approaches to employment, using unpaid work practice, apprenticeship, or sheltered training to increase participants’ employability. Place-train approaches, on the other hand, emphasize real-world training by pursuing competitive employment based on participant’s goals, while ensuring continual support also after employment has been obtained (ibid). These approaches are present in the included studies in the current review, with the train-place approach exemplified by Card et al. [40] and Eppel and Mahringer [41], while the place-train approach is exemplified in the IPS studies by Bond et al. [39] and Sveinsdottir et al. [46]. Eppel and Mahringer [41], criticize the place-train (or work-first) approach, due to concerns that quickly obtaining employment may channel young people into unsustainable employment, and that this may be avoided by providing training first, in the form of subsidized apprenticeships or qualification measures prior to the job search. In the study by Sveinsdottir et al. [46], on the other hand, sheltered work practice has a much lower success rate than IPS, which is attributed to the lock-in effect of sheltered programs and apprenticeships. Another critique towards using sheltered work practice and apprenticeships is that this benefits the employer, but it does not commit them to engage the young people after the training period is over. This is exemplified in the study by Card et al. [40], where field teams anticipated that nearly all participants were let go from the workplace after the subsidized training period ended.

The widely different approaches to re-engaging NEETs demonstrated in the current review points to a fundamental weakness in the field that needs to be addressed, namely the lack of a guiding theoretical framework for the specific interventions. The absence of theory-driven approaches to increase re-engagement may have limited the methods and strategies used and consequently, possibly limiting intervention effects. This is crucial in the development, implementation, and evaluation of intervention studies, as it provides transparency into intervention components and the linkage between them, as well as enabling learning across contexts.

Another notable weakness across most studies included in this review is the lack of agreement on how to measure reengagement in work or education, and what outcomes are relevant pre-employment measures. Most studies use self-report, and it is unclear how participants were queried re-engagement. This is a threat to both the internal and external validity of the outcome measures.

It is important to note the substantial variation in the methodological quality of the studies reviewed. While some well-documented and robust RCTs were found, it is important to underscore that the majority of the included articles show methodological issues that compromise the validity and generalizability of their findings. Several studies did not conduct true randomization, and instead resorted to related techniques such as propensity score matching. Furthermore, the lack of blinding among participants, practitioners, and researchers to treatment assignment also diminishes the reliability of findings from studies. Compounding these issues, the reliability of assessments was often difficult to evaluate due to the sparse information provided. The findings from this systematic review highlight the critical need for improved methodological rigor. Although implementing robust designs may present ethical and practical challenges, the field would benefit significantly from fewer studies but higher-quality RCTs that incorporate treatment blinding, to the extent possible, and utilize well-documented outcome measures. Indeed, prioritizing the quality over the quantity of studies could transform research outcomes, providing more definitive and generalizable results.

The program and methodological challenges addressed in this review demonstrate the need for different approaches to designing and testing interventions for the NEET group. Innovative approaches such as Sequential Multiple Assignment Randomized Trials (SMARTs)[55], multiple baseline designs [56], and Bayesian sequential testing [57] offer promising avenues for achieving more rigorous RCT designs without imposing excessive burdens on participants or practitioners. SMARTs have been suggested to represent an adaptive intervention approach to design high-quality data after adjusting the type, dosage or delivery mode of an intervention based on participant characteristics and background and make further adjustments according to their ongoing performance, intervention adherence and changing needs [58]. Thus, the SMART involves multiple stages of randomizations and is a design that experimentally assesses the efficacy of the decisions, components, and sequence of an adaptive intervention [59].

Conclusion

The studies included in this review show a variety in intervention designs, study designs and outcome measures in studies of interventions targeting young people in the NEET category. The review shows some characteristics of the research and practice field that future intervention developers should make note of. Firstly, there are not many studies employing a rigorous design to test the effect of interventions for this target group, despite the attention that this group receives at the political level. It is worrying that efforts directed towards this group are not tested for effect, given the potential long-term detrimental outcomes of being in this situation. Secondly, the intervention studies included in this review do not seem to be guided by theoretical frameworks. Theoretically underpinned interventions would enable efforts in different contexts to learn from each other, by investigating and discussing how intervention components are linked to each other and to the selected outcomes. Thirdly, there are no standardized outcome measures for re-engagement for the NEET group, which should be the primary target of efforts directed at this group. Future studies should aim to develop interventions and measurements that generalize learning across studies and across contexts.

Supporting information