Vocational Rehab: What Works and Doesn't Work with TBI
Sometimes learning a job on the job works best for people with brain injury.
I think larger and traditional vocational services are not designed to help people with brain injury very effectively. The dismal outcomes that state vocational rehab agencies show for people with brain injuries kind of attest to that. In many ways, traditional voc-rehab is oriented towards tuning the person up, and then getting them back to work. After a brain injury, it almost has to be the other way around. In fact, some of the seminal people in this field-- like Paul Wehman and the group at Stout, Dale Thomas-- really recommend a place-then-train model. In other words, get the person back to a job that it looks like they can do, and then help them learn how to do that job, on the job. Because people with brain injury have difficulty generalizing training from one setting to another, they really need to learn the job on the job. They also may need ongoing support almost indefinitely. Now, that doesn't have to be a lot of support, but they may need somebody to call if things start to fall apart. In our program at Mayo we found, not infrequently, that people would get on a job, be quite successful for a period of time, and then there'd be some change in procedures, and they would just fall apart. If we knew about that--if somebody called us back--that was not a hard fix. We could help them learn the new procedures and get things back on track and save the job. But if there's nobody to intervene, the employer just concludes that they're not able to do the job anymore, and they have to let them go. I think vocational services like that-- that involve support and employment, and developing a network of support for the person--both professional and non-professional-- we've engaged people from their church group, from their social clubs. If they need a ride to work, who are you going to call? If your car breaks down, you know--really working on the environment as much as the person is probably more successful in getting people back to work and helping them sustain those jobs than the more traditional intervention of tune-up and placement.
Posted on BrainLine November 1, 2012.
Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.
James Malec, PhD, is professor and research director in the Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and the Rehabilitation Hospital of Indiana. He is a professor emeritus of psychology at the Mayo Clinic.