Paid employment is one of the most frequently cited goals for adults with traumatic brain injury (TBI) regardless of age, injury severity, or prior work experience. But it remains one of the most challenging goals to achieve; more than half of those employed pre-injury are not working five years post-injury (John Corrigan, Ph.D., 2012 NASHIA Conference). This Fact of the Matter brief is the first of a two-part series focusing on vocational issues following TBI. Part I provides an overview of this topic. Part II will review specific types of vocational services.
How do common challenges following TBI affect paid employment?
The cognitive, communication, behavioral, sensory, physical, psycho-emotional, and social changes commonly experienced following TBI can significantly affect one’s ability to effectively engage in paid employment, as illustrated by these examples:
Daniel is a married, 55-year old high-school teacher, who sustained a mild TBI in a fall while repairing his roof.
He attempted to return to work one month following his injury but struggled with dizziness, distraction, and impulsivity leading to angry outbursts in the classroom. He was put on temporary leave from his job.
Laura is a single, 32-year old army veteran, who sustained a mild-moderate TBI in an IED blast while serving as a medic in Iraq.
One year following her injury, she continued to experience persistent fatigue, double vision, headaches, and memory loss that prevented her from returning to work as a medic.
Jamal is a 19-year old, who sustained a moderate-severe TBI in a car crash during his senior year of high school.
Following his in-patient rehabilitation, he returned home to live with his parents and two siblings. He had significant memory loss and lack of initiation with minimal insight into these deficits. He had no pre-injury work experience.
What does current research us tell about successful employment following TBI?
A complex mix of pre- and post-injury characteristics makes it difficult to predict success in the workplace. That said, research shows that injury severity and self-awareness are two of the strongest predictors of successful employment; a severe injury and/or lack of insight into one’s deficits can make it difficult to hold down a job.
- Other factors that affect employment include:
- Pre-injury work history
- Independence performing activities of daily living
- Overall cognitive ability
- Ability to take in and process information
- Executive functioning (self-regulation, planning, and problem solving)
- Emotional status
- Social skills
What does current research tell us about the role of vocational services following TBI?
For individuals with mild injuries, clinic-based services might be enough for them to return to their existing jobs — if services are delivered early post-injury. Individuals with moderate to severe injuries are likely to require intensive, long-term services and supports. This may include changing to a less demanding job that requires a different set of skills.
What are the basic components of vocational service delivery?
Vocational Rehabilitation (VR) services are designed to help individuals with disabilities prepare for, seek, and maintain employment. Typically a case coordinator or VR counselor helps direct and support clients through the VR system. Services include, but are not limited to, the items below.
VR Components and Descriptions
Intake - Gathering client’s background information — including medical, rehabilitation, work experience, and family history. Developing a list of client’s strengths and challenges.
Accommodations - Developing a list of individualized supports and strategies (see “Alabama Fact Sheet: TBI work accommodations” below).
Resume development - Developing the client’s resume to emphasize strengths and job preferences.
Job placement - Looking for potential job sites that meet the client’s profile. This might include a volunteer position as an important first step to paid employment.
Interview practice - Practicing interviewing skills.
Job coaching - Providing on-going assessment to determine which job sites and tasks are a good fit for the client.
Assessment - Unfortunately, state VR services are not routinely funded at the level needed to support all individuals with TBI who want and need paid employment. In Part II of this series, we will address this issue as well as provide an overview of specific types of vocational programming and accommodations.
Where can I find more information?
- Brain Injury Alliance of Oregon — www.biaoregon.org 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
- Hart, T., Dijkers, R. et al, (2006). Vocational services for traumatic brain injury within model systems of care, Journal of Head Trauma Rehabilitation, 21, 467-482
- Tyerman, A. (2012) Vocational rehabilitation after traumatic brain injury: Models and services, NeuroRehabilitation, 31, 51-62.
Click here to see "Vocational Issues Following Traumatic Brain Injury, Part II."