Vocational Issues Following Traumatic Brain Injury, Part II

As discussed in Part I of this series, a range of factors influence the likelihood of returning to work after a brain injury, including:

• severity of injury
• self-awareness
• pre- and post-injury characteristics (e.g., education level, work history, and overall cognitive abilities)
• complexity of job requirements
• environmental factors (e.g., workplace and social supports).

Although some of the challenges related to returning to work (RTW) cannot be changed, growing evidence suggests that many people can successfully return to work after a brain injury. This Fact of the Matter brief focuses on specific practices that contribute to successful reentry into the workforce.

Person-centered Planning

Person-centered planning (PCP) — in the context of RTW — is a process for clients to identify personally meaningful goals. PCP focuses on helping individuals understand their unique strengths and abilities to develop their vision of what they would like to do in the future. Self-directed goals are more likely to provide the motivation needed to succeed than goals set by others. However, a self-directed process still requires facilitation. A resource facilitator (see below) can provide the guidance needed to keep the process on track and identify challenges or compensatory strategies.

Resource Facilitation

Resource facilitation (RF) has been one of the most consistent predictors of successful employment after brain injury. A resource facilitator provides a comprehensive set of services that bridge the gaps among hospital, rehabilitation, and community agencies and services. RF services include: (a) coordinating services across agencies; (b) coordinating rehabilitation and vocational goals; (c) arranging transportation to and from potential work sites; (d) providing on-the-job evaluations; (e) providing employer education; and (f) on-going support as clients’ needs change over time. Although not currently provided by all states, RF complements and can be considered a part of PCP.

Matching Services to Client Needs and Available Resources

Individuals at high risk of failure, such as those with more severe or recent injury, will benefit from early and intense emphasis on preparation for employment. For individuals with mild injuries, less intense clinic-based services might be enough for them to return to work. Although funding for intense rehabilitation services might be scarce, matching the intensity of services with severity of the injury has proved helpful and allows for effective use of rehabilitation dollars. Some sources of possible funding include state vocational rehabilitation departments, worker’s compensation insurance, and other state and federal programs.

Specific Services to Use with Clients

Although the research evidence for the services listed below is not as strong as for PCP and RF, studies have found that each improves length of employment, income, or how quickly clients return to paid employment after injury. The local office of vocational rehabilitation or private rehabilitation facilities might be able to provide many of these services.

To summarize, person-centered planning, resource facilitation, matching intensity of services to severity of injury, and providing needed support services can significantly improve an individual’s chances of returning to work after a brain injury. These practices can also be helpful for those seeking first-time employment.

Where can I find more information?

• Brain Injury Alliance of Oregon - www.biaoregon.org
• Center on Brain Injury Research and Training - Fact of The Matter, Vocational Issues Follwing TBI, Part I - www.cbirt.org/ publications-products
• Center on Brain Injury Research and Training (CBIRT) Ask a Librarian - www.cbirt.org/ask-librarian
• Alabama Fact Sheet: TBI work accommodations - www.nashia.org/pdf/hotopics/al_fact_sheet_tbi_accommodations.pdf

References

• Fadyl, J.K., & McPherson, K.M. (2009). Approaches to vocational rehabilitation after traumatic brain injury: A review of the evidence. The Journal of Head Trauma Rehabilitation, 24(3), 195–212. doi: 10.1097/HTR.0b013e3181a0d458
• Kendall, E., Muenchberger, H., & Gee, T. (2006). Vocational rehabilitation following traumatic brain injury: A quantitative synthesis of outcome studies. Journal of Vocational Rehabilitation, 25(3), 149–160.
• Stergiou-Kita, M., Dawson, D. R., & Rappolt, S. G. (2011). An integrated review of the processes and factors relevant to vocational evaluation following traumatic brain injury. Journal of Occupational Rehabilitation, 21(3), 374-394. doi: 10.1007/s10926-010-9282-0
• Tyerman, A. (2012). Vocational rehabilitation after traumatic brain injury: Models and services. NeuroRehabilitation, 31(1), 51–62.
• Wehman, P., Targett, P., West, M., & Kregel, J. (2005). Productive Work and Employment for Persons With Traumatic Brain Injury: What Have We Learned After 20 Years? The Journal of Head Trauma Rehabilitation, 20(2), 115-127. doi:10.1097/00001199-200503000-00001
• Yasuda, S., Wehman, P., Targett, P., Cifu, D., & West, M. (2001). Return to work for persons with traumatic brain injury. American Journal of Physical Medicine & Rehabilitation, 80(11), 852-864.

Click here to see "Vocational Issues Following Traumatic Brain Injury, Part I."