NNRC Research 3.2 million people live w/effects of brain injury: estimated that nearly half fail to return to work TBI and Employment: Colorado: state registry of patients hospitalized Critical Issues for TBI – about ½ return to work within a year Patricia Goodall, Ed.S., CBIST 2006 study: rate falls to 20% failure rate at 10 DARS Brain Injury Services Coordination Unit years post injury Community Based Services Division Virginia Department for Aging VR services helped only about 50% of those and Rehabilitative Services served achieve successful employment Vocational Rehabilitation Return to Work Strategies One size does not fit all: individualized approach 1997 sample of hospitalized TBI patients: only about 1/3 were even aware of the VR system Job placement staff must have knowledge of BI Better outreach from VR system is needed to newly injured and to those with long-time injuries Research suggests: (chronically unemployed) Provide VR services early in the rehab process Create a supportive work environment Better partnering between VR and researchers Cognitive training: compensatory vs restorative to identify “what works” – build a strong evidence Assistive Technology base (problems with assigning people to a 2009 study: Supported Employment; Case “control group” is a barrier) Coordination; Program-Based VR 1
NNRC Vocational Rehabilitation Process Vocational Rehabilitation Process Assumptions: Assumptions: Is individual medically and psychologically stable (to Does the individual with a brain injury request focus on employment goal)? Evaluate medical, assistance? physical, cognitive status. Do not rely on the family’s insistence that the Do not say “Come back in two years…” when you person wants to work! have recovered! Is individual eligible for services? (documented Can individual return to same job or find new job? disability; disability is a barrier to employment; Assess capacity to recover abilities and learn new things. Person may have difficulty recognizing financial need if there will be cost services) changed strengths, challenges. Where to start? Effects of Brain Injury Consider using a “support team” approach! Needs are long-term and complex – you will need help to Medical ensure continued success on the job! Physical Assessment – Start with recent and comprehensive neuropsychological evaluation – ALSO use “real life” assessments whenever you can! Cognitive / Intellectual Recommendations should be work-related but also include ways to improve daily functioning. Emotional / Behavioral Where to start? Medical Strategies should be compensatory in nature, Is the person medically stable? Has a not restorative! Individual must “buy into” physician “released” person for the use of any strategy or it will not be employment? effective. Is person receiving follow-along care by It’s all about SUPPORT and JOB MATCH! physiatrist (doctor who specializes in These are critical to success in employment! rehabilitation medicine)? 2
NNRC Medical Physical Is person still receiving outpatient medical What medications does person take? therapies? If so, which therapies and what are What are effects? Who is monitoring? goals? Fatigue, headaches, pain may affect What is prognosis in regard to physical issues – job performance how much healing, recovery is expected? “Real life” evaluations are usually informative. What about assistive technology, augmentative communication devices, orthotics? Cognitive / Intellectual Cognitive / Intellectual Post-injury, individual may score lower Concentration decreases; distractibility increases. on tests of intelligence, but not across all scales. Memory problems present a significant challenge in the ability to function on a Higher ability pre-injury, better outcome daily basis – and in employment setting. post-injury. Compensatory strategies and supports are Mental processes may be slower, not as key to success on job! accurate. Emotional / Behavioral Where to start? Team approach – always a good option!! This is typically the biggest challenge to successful employment – it is usually not Assessment – neuropsychological the inability to learn or perform job tasks. and “real life” evaluations are the most informative. Emotional instability. Strategies / Supports – keys to success! Inappropriate social behavior. It’s all about SUPPORT and JOB MATCH! 3
NNRC Assessment Assessment Vocational evaluation / situational Assessment within last two years, as assessment – always try “real life” feasible assessments, you will get valid information if done well! Evaluate status: medical, physical, cognitive/intellectual, and What are the recommendations? emotional/behavioral Counselor should request vocationally related reports, but also ask for daily Consult with / add to “support team” as functioning strategies – a life skills trainer needed: physician, therapist (OT, PT, SLP) can support person to function better in psychologist, behavior specialist, job coach non-work settings – this boosts employment success! Strategies Strategies Consumer participation and direction are critical Community living assessment: what strategies in choosing / implementing compensatory are needed to function better on daily basis? strategies! What does person use, what is successful? Are there any medical / neuropsychological It only works if it works! recommendations or strategies? Is behavior consultation needed? If so, what is consultant’s philosophy (Positive Behavior Support)? Employment Support Employment Support Employment Specialist is part Most people with significant brain injury benefit from ongoing employment of the TEAM! support: job coach training services at a minimum. Same strategies used at home and in community should be Supported employment is ideal: job used on job site (and vice versa): placement, on site training, long-term Life Skills Training can be follow-along. critical piece! 4
NNRC Job Match Job Match It’s all about the JOB MATCH! Individual with poor hygiene: Is solution to Work environment, job duties should be a find a job where odor is not noticed? Or to good “fit” with individual’s strengths, work with person to improve hygiene (life abilities, and challenges. skills training)? Maybe both? Example: If individual does not handle interruptions well, has poor interpersonal skills, is receptionist a good match? Where to end? What is success? Consider employment in context of person’s It may end for the rehab specialist, but for the person with a brain injury: there is NO END… life: it is not a separate “event” that begins and ends. Best practice is to re-assess in all areas on ongoing basis, individuals continue to improve over time (“…it’s been two years, and I’m still Long-term support, not just in employment. having problems…”) Even if currently employed, case closed, can Team approach!! Supportive people across refer person back to DRS: counselor can provide post-employment support or all of the individual’s environments. re-open case. Contact Information What is success? Patricia Goodall, Ed.S., CBIST Re-define success: demographics, Brain Injury Services Coordination Unit challenges. Community Based Services Division Department for Aging & Rehabilitative Services Rick Parente study: social support and 8004 Franklin Farms Drive, Henrico, VA 23229 supported employment are best indicators Phone: 804/662-7615; Cell: (804) 614-0284 of job success. E-mail: Patti.Goodall@dars.virginia.gov Website: http://www.vadars.org 5
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