The efficacy of acquired brain injury rehabilitation

Authors: 
D. L. Brucker, A. Boticello, J. O'Neill, & A. Kutlik
Year Published: 
2007
Publication: 
Brain Injury
Volume: 
21
Number: 
2
Pages: 
113-132
Publisher: 
Informa Healthcare
Background: 

There is very limited information available on how to assist individuals with acquired brain injury with return to work. Only 4 papers have published that review the literature on the efficacy of rehabilitation.

Purpose: 

The purpose of this review was to investigate the efficacy of rehabilitation interventions in acquired brain injury to inform best practices and identify gaps in knowledge.

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample: 

The study sample included nine studies involving adults with acquired brain injury.

Data Collection: 

A systematic review of the literature from 1980–2005 was conducted. A comprehensive search of four electronic databases (CINAHL, EMBASE, MEDLINE and PsycINFO) was conducted covering the years 1980–2005. All studies on the treatment or intervention related to the rehabilitation of acquired brain injury were evaluated for inclusion in the review.

Intervention: 

There were multiple rehabilitation interventions. The review looked at studies that included the following interventions impact on work: inpatient rehabilitation, vocational rehabilitation, and supported employment.

Control: 

There were no comparison or control conditions.

Findings: 

Based on the findings from a single RCT, there is moderate evidence that inpatient rehabilitation results in successful return to work and return to duty for the majority of military service members. There were three studies that looked at vocational rehabilitation: a cost-benefit analysis, a case series, and an outcome study. Reviews of these studies revealed that there is limited evidence that vocational rehabilitation results in greater total taxpayer benefits than either total program operational costs or government costs; that after vocational rehabilitation the majority of subjects have fair or good adjusted outcome; or that individuals with the most significant cognitive impairments benefit the most from vocational rehabilitation services. One study examined the effectiveness of supported employment. Based on this there is limited evidence that supported employment improves employment outcomes particularly individuals who are older, have more education, have no prior work experience or who have suffered more severe injuries.

Conclusions: 

More and higher quality research is needed to inform clinical practices related to return to work. The methodology for future studies needs to be improved. Randomized controlled studies are needed to support the efficacy of interventions to assist individuals with acquired brain injury with employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17364528
Populations: 
Outcomes: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

A 20-year longitudinal perspective on the vocational experiences of persons with spinal cord injury

Authors: 
Cullen, N., Chundamala, J., Bayley, M., & Jutai, J.
Year Published: 
2000
Publication: 
Rehabilitation Counseling Bulletin
Volume: 
43
Number: 
3
Pages: 
122-133
Publisher: 
Hammill Institute on Disabilities
Background: 

For many years, researchers have been interested in understanding the vocational experiences of persons with spinal cord injury (SCI). Their studies have helped build a body of knowledge regarding how frequently people with SCI become employed and what personal characteristics are related to successful outcomes. Re-entry into the workforce is considered a primary marker of rehabilitation success, both because of the value that society places on productivity and the fact that, for many people, work is linked to psycho-social and medical adjustment (Krause, 1990, 1991). Research findings have helped rehabilitation workers provide appropriate counseling and services to individuals with new SCI.

Purpose: 

The vocational experiences of 50 individuals 22 to 45 years after a spinal cord injury are recounted based on interviews conducted in 1974 and 1994.

Setting: 

Longitudinal study 22-45 years post spinal cord injury.

Sample: 

50 individuals with spinal cord injury.

Data Collection: 

Both quantitative and qualitative data were collected, including Life Story Interviews and work experience data.

Intervention: 

The 1974 interviews were conducted using a protocol developed for that study. It included a complete work history and other social, family, and adjustment related questions. The 1994 interviews used a similar longitudinal questionnaire that covered vocational, marital, social, and health history during the intervening 20 years.

Control: 

There was no control or comparison condition.

Findings: 

All but 7 participants have engaged in remunerative employment. At the time of the last interview, 58% were working full time and 16% were working part time.

Conclusions: 

Factors that contributed to the vocational accomplishments of this sample include early work experiences, comprehensive rehabilitation services, and work ethic.

URL: 
http://rcb.sagepub.com/content/43/3/122.full.pdf
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Does providing transition services early enable students with ASD to achieve better vocational outcomes as adults? 

Authors: 
Cimera, R., Burgess, S., & Wiley, A.
Year Published: 
2013
Publication: 
Research & Practice for Persons with Severe Disabilities
Volume: 
38
Number: 
2
Pages: 
88-93
Publisher: 
TASH
Background: 
One critical outcome typically achieved in adulthood is employment.  In response to low rates of employment across disability groups, many in the special education field have advocated that transition from school to work be given greater emphasis in the development of IEPs.
Purpose: 
The purpose of this study was to investigate whether receiving transition services early (i.e., by age 14) promoted better vocational outcomes than receiving transition services later (i. e., by age 16) for young adults with ASD.
Setting: 
State VR programs
Sample: 
906 young adults with ASD
Data Collection: 
Data for this study came from the Rehabilitation Services Administration 911 database.
Intervention: 
Early transition planning beginning at age 14.
Control: 
Transition planning starting at age 16.
Findings: 
In each of the four years examined, individuals from the early transition states were significantly more likely to be employed than individuals from the later transition group. Further, early transition individuals who became employed appeared to earn more wages and cost less to serve.
Conclusions: 
Findings presented here suggest that waiting until age 16 may be too late to begin transition planning.  Consequently, it would be beneficial to both individuals with ASD and taxpayers if the age at which transition services are mandated to be included in IEPs be returned to age 14.
URL: 
http://rps.sagepub.com/content/38/2/88.full.pdf
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Do sheltered workshops enhance employment outcomes for adults with autism spectrum disorder?

Authors: 
Cimera, R., Burgess, S., & Wiley, A.
Year Published: 
2012
Publication: 
Autism
Volume: 
16
Number: 
1
Pages: 
87-94
Publisher: 
Sage
Background: 

Individuals with ASD have difficulty gaining access to vocational services to assist them with gaining and maintaining work. As a result some individuals go to a place known as a sheltered workshop. The main premise behind this approach is a person with a severe disability must have certain skills prior to going to work. An individualized approach to supported employment believes a person does not have to get ready to work. Instead a unique array of individualized supports are used to assist an individual with a severe disability with gaining and maintaining competitive employment in the community.

Purpose: 

This study examined whether or not participation in a sheltered workshop could help prepare individuals with ASD for competitive employment.

Setting: 

The study took place in sheltered workshop settings and a variety of businesses.

Sample: 

The study sample included 430 individuals with ASD; 215 were being served in a sheltered workshop setting, the others were not. These groups were matched based on diagnosis and sex (20%) were female and 80% male.

Data Collection: 

Data was collected on a number of variables using the RSA 911 database. This included: disability, wages earned, hours worked, and cost of services. Vocational rehabilitation counselors are required to keep this type of documentation. The rate of employment was determined by dividing the number of individuals who had their case closed due to an employment outcome by the total number of job seekers in that group.

Intervention: 

The intervention was sheltered work.

Control: 

Individuals who attended a sheltered workshop to prepare for competitive employment were compared to those who received supported employment services to gain and maintain competitive work.

Findings: 

Individuals who received supported employment services, earned significantly more ($190 vs $129) and had lower service cost ($2,441 vs $6,065) than those in sheltered workshops. Individuals with ASD do not need to participate in a sheltered workshop to get ready to work before receiving supported employment services. In addition, these individuals are underemployed.

Conclusions: 

Individuals with ASD will have better work outcomes if they receive supported employment services and bypass attending a sheltered work or other facility based program.

URL: 
http://aut.sagepub.com/content/16/1/87
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Utilizing co-workers as "Natural Supports" evidence on cost efficiency, job retention, and other employment outcomes

Authors: 
Cimera, R. E., Wehman, P., West, M., & Burgess, S.
Year Published: 
2001
Publication: 
Journal of Disability Policy Studies
Volume: 
11
Number: 
4
Pages: 
194-201
Publisher: 
Hammill Institute on Disabilities and Sage
Background: 

Much discussion has taken place about the use of natural supports in supported employment. However, a review of the literature indicates empirical evidence supporting or refuting the concept is lacking.

Purpose: 

The purpose of this study was to provide empirical research on the use of natural supports, coworkers without disabilities, as a training strategy for supported employees.

Setting: 

A variety of job sites in Illinois where individuals who received supported employment services worked.

Sample: 

The initial sample included 166 individuals with a primary diagnosis of mental retardation, who were 21 to 69 years old. The majority or 66% were European American and 34% were African American. Of these 166 individuals 31 were replaced because they were lost to contact or the support agency refused to participate or the person did not want to participate. Of 197 (166 plus 31 replacement) surveys mailed, 111 were returned, resulting in a 56% return rate.

Data Collection: 

A survey was sent to the adult service providers of 166 people who were included in the Illinois Supported Employment Projects database. The survey include questions related to: worker characteristics, Job coach/Co-worker involvement, Benefit-cost analysis, and Job separation. Dependent variables included: cost efficiency, length of employment, job retention, hours worked per month, gross pay, IQ,level of mental retardation, gender, ethnicity, age and number of disabilities. The independent variable was collected by the coworker Involvement Instrument that assesses the Involvement of coworkers in training supported employees. There was no control. Four analysis took place. The first compared employment outcomes to the degree of coworker Involvement. The second compared the supported employee demographics to the degree of coworker Involvement. Both of these analysis were repeated using data from 1990 and 1994. In addition, an analysis of variance were performed for the nominal-scale variables and Pearsonian correlation coefficients were generated for continuous scale variables.

Intervention: 

The intervention was coworker supports.

Control: 

There was no control or comparison condition.

Findings: 

The study found that coworker involvement did not increase cost efficiency. However, it did seem to increase the length of time the supported employees maintained their jobs. No other employment outcomes were related to coworker involvement. Coworker involvement was not associated with any of the demographic variables.

Conclusions: 

Utilizing coworkers to train supported employees does not increase cost efficiency. Coworker involvement appears to increase the supported employees job tenure. Coworker involvement was not impacted by the demographics of the supported employees, meaning that coworkers are willing to aid in the training of individuals with diverse disabilities and functioning levels.

URL: 
http://dps.sagepub.com/content/11/4/194.full.pdf
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

State rehabilitation services tailored to employment status among cancer survivors

Authors: 
Cimera, R. E.
Year Published: 
2014
Publication: 
Journal of Occupational Rehabilitation
Volume: 
24
Number: 
1
Pages: 
89-99
Publisher: 
Springer Science + Business Media New York
Background: 

Studies have shown that certain vocational rehabilitation services are associated with return to work for unemployed patients with cancer. These include: counseling and guidance, job search assistance, and job placement. Patients who have a job return to post disability may require different interventions to assist them with return to work.

Purpose: 

The purpose of this study was to determine whether differences in the types of services were based on the employment status of those with a history of cancer at the time of application.

Setting: 

This study included individuals with cancer served by multiple vocational rehabilitation agencies in various settings.

Sample: 

Data on 1,460 people who had cancer were extracted from the Rehabilitation Services Administration Case Service Report.

Data Collection: 

Data on demographics and vocational services were analyzed. Multiple discriminant analysis was used to identify different services used by cancer survivors who were unemployed and those who were employed.

Intervention: 

There were multiple vocational rehabilitation services interventions. This included: assessment, diagnosis and treatment of impairments, vocational rehabilitation counseling and guidance, college or university training, occupational vocational training, on the job training, basic academic remedial or literacy training, job readiness training, disability related, augmentative skills training, miscellaneous training, job search assistance, job placement assistance, on the job supports, transportation services, maintenance services, rehabilitation technology, technical assistance services, information and referral services and other services.

Control: 

There was no control or comparison condition.

Findings: 

Vocational rehabilitation service plans can be individualized to meet the employment status and needs of cancer survivors.

Conclusions: 

Cancer survivors have the potential to return to work. Services received by cancer survivors who were unemployed and those who were at risk of losing their job received different services from state vocational rehabilitation services. This suggests that services were tailored to meet individual client needs. Vocational rehabilitation services are a resource to assist cancer survivors with employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/23504487
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Employment outcomes of transition-aged adults with autism spectrum disorder: A state of the states report

Authors: 
Escovitz, K., & Donegan, K.
Year Published: 
2014
Publication: 
American Journal on Intellectual and Developmental Disabilities
Volume: 
119
Number: 
1
Pages: 
64-83
Publisher: 
AAIDD
Background: 

Youth with Autism Spectrum Disorder (ASD) face a number of obstacles when transitioning from school to work. The cost to society to support individuals with ASD who do not work is very high. The incidence of ASD is on the rise. It is important to make sure vocational services provided by the states are leading to successful employment outcomes for these individuals.

Purpose: 

The goal of this study was to examine the employment outcomes of transition aged youth with ASD served by the states vocational rehabilitation system.

Setting: 

This study included individuals with autism spectrum disorder served by multiple vocational rehabilitation agencies in various settings.

Sample: 

Data was taken from the Rehabilitation Services Administration's (RSA); RSA-911 Case Service Report database. This database hold records of adults who apply for a states' vocational rehabilitation services. Demographics, vocational services received, and outcomes for closed cases (i.e. employed or not, hours worked etc...) are located there. The study examined the records of 34, 314 youth with ASD who were age 21 and under. Data was pulled for individuals whose cases were closed from 2002 to 2011.

Data Collection: 

A number of variables were examined in the study. This included: successful employment outcome, hours worked and wages and the cost of services. Data was pulled for all of the United States. Washington DC and US territories were excluded. Data from each state and year was reported for each study question. In order to identify trends data from 2002 to 2006 was compared to 2007 to 2011 and regression analysis was used to evaluate the data. Mean data for the total transition population served by VR was compared to the ASD group and t test statistics were used to compare outcomes between the two groups.

Intervention: 

The intervention was various vocational rehabilitation services provided to assist youth with ASD with achieving successful employment.

Control: 

There was no control or comparison condition.

Findings: 

Over a ten year time span, the number of transition aged individuals with ASD served by VR has increased over time. While employment outcomes, hours and wages have not improved for the group. Transition aged youth with ASD were more likely to receive a positive employment outcome if they received VR services as compared to all youth with disabilities served by VR. However, youth with ASD worked less hours and had lower wages. This means they were underemployed. The cost of VR services for this group remained stable. There is much variability between states.

Conclusions: 

Transition aged individuals with ASD are accessing VR services. However, their employment outcomes have not improved. More research is needed to determine what influences the variability between states and improve work outcomes for this group.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/24450322
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Additional interventions to enhance the effectiveness of individual placement and support: A rapid evidence assessment

Authors: 
Brooks, B. M., Rose, F. D., Atree, E. A., & Elliot-Square, A.
Year Published: 
2012
Publication: 
Rehabilitation Research and Practice
Volume: 
2012
Number: 
1
Pages: 
101-108
Publisher: 
Hindawi Publishing Corporation
Background: 

Individual placement and support (IPS) has been developed as a standardized approach to supported employment aimed at helping people with severe mental health problems find competitive work. IPS has proven very effective in improving vocational outcomes amongst people with severe mental illness when compared to other vocational services, with a recent review reporting that 61% of participants enrolled in IPS programs gained employment, compared to 23% of those on other vocational programs. IPS does have limitations, however. As the results above would suggest, around 40% of people on IPS programs do not gain employment despite the support. A second criticism of IPS relates to job tenure of the people employed through these schemes, which tends to be short

Purpose: 

To establish whether additional interventions improve the vocational outcomes of IPS alone for people with severe mental illness. The aim of this rapid evidence assessment was to identify studies which have sought to improve on the effectiveness of standard IPS by adding a supplementary intervention. The aims are to answer the following questions: (1) what supplementary interventions have been used with IPS? (2) What are the results and what is the quality of those studies? (3) Do supplementary interventions improve employment rates and job tenure compared to IPS alone? (4) Are any supplementary interventions superior to others?

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample: 

The search was for empirical studies conducted from 1980 to July 2011. Studies were considered for inclusion if they: involved people with a severe mental illness; indicated the use of IPS or IPS core principles; involved supplementary interventions categorised as skills training, education, cognitive training, or psycho-therapeutic techniques. Studies meeting these criteria were only included if the design compared IPS alone with enhanced IPS. The sample included 11 studies involving individuals with mental illness.

Data Collection: 

A Rapid evidence assessment provides an overview of existing research on a specific research topic, as well as a simple extraction and synthesis of the relevant data. The methods used to search for and appraise the research are systematic and rigorous, but the depth of the search is limited by the development of search terms and breadth of resources searched. This type of assessment is particularly useful to quickly gather existing evidence in a research area and determine what future research needs to be done.
Data regarding employment rates and job tenure were extracted directly from the papers. Odds ratios were calculated where possible using data on participants employed/not employed per experimental group in each study. Where necessary, authors were contacted for further clarification or information.

Intervention: 

A rapid evidence assessment of the literature was conducted for studies where behavioral or psychological interventions have been used to supplement standard IPS. Published and unpublished empirical studies of IPS with additional interventions were considered for inclusion.

Control: 

There were no comparison or control conditions.

Findings: 

In total 627 papers were identified and 246 remained after duplicates were removed, of which 241 were excluded at this stage (reasons are given below). References of the 5 included papers and relevant (excluded) systematic reviews were screened for potentially relevant titles, which identified a further 15 records for screening once duplicates had been removed. Of these, 6 further papers met the inclusion criteria. In total, 11 papers were included in the review and 250 papers were excluded. Averaging across the employment rates reported by four studies, enhanced IPS does appear to produce higher rates of competitive employment compared to IPS or control groups alone. The average enhanced rate of 76% would also appear to be higher than the average IPS employment rates reported in previous reviews [3], and this difference is accentuated when focusing on studies using skills training, where on average the employment rate is 25% higher. In addition, rates were moderately higher than previous reviews for studies involving cognitive training.

Conclusions: 

Six published studies were found which compared IPS alone to IPS plus a supplementary intervention. Of these, three used skills training and three used cognitive remediation. The contribution of each discrete intervention is difficult to establish. Some evidence suggests that work-related social skills and cognitive training are effective adjuncts, but this is an area where large RCTs are required to yield conclusive evidence.

URL: 
http://www.hindawi.com/journals/rerp/2012/382420/
Disabilities: 
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Difficulties with multitasking on return to work after TBI: A critical case study

Authors: 
Boycott, N., Schneider, J., & McMurran, M.
Year Published: 
2010
Publication: 
Work
Volume: 
36
Number: 
2
Pages: 
207-216
Publisher: 
IOS Press
Background: 

Cognitive functioning is a strong predictor of success at work. Every job requires a specific set of cognitive skills. Multitasking requires a person to switch between several concurrent tasks, requiring the application of a variety of cognitive strategies to succeed without errors. After a traumatic brain injury (TBI) a person may have problems processing cognitive information. This is one of the leading reasons for loss of work among individuals with mild TBI. People who return to work after injury have reported increased cognitive demand with associated stress. Occupational rehabilitation providers have noted organizational and planning of complex or multiple work tasks difficult for high functioning individuals post TBI. The difficulty seemed to not only stem from cognitive problems but also the ability to apply cognitive strategies on the spot or situations with increased cognitive load. While neuropsychological evaluations may prove useful in helping determine potential cognitive capacity to return to work, there are some limitations to its usefulness. Some believe that sampling work behaviors through observation or client and employer interview may be a much better way to obtain accurate evaluation of cognitive work demands for individuals who are attempting to return to work after TBI.

Purpose: 

The study examines the use of the Perceive, Recall, Plan, Perform@WORK:Questionnaire/interview with category rating response format, by an employer to determine information processing strategy application difficulties.

Setting: 

The study took place at a telemarketing company.

Sample: 

A thirty year old man who sustained a TBI nine months earlier. His Glascow coma score was 9/15 and he experienced post traumatic amnesia for 21 days post injury.

Data Collection: 

The participant's employer was interviewed by an occupational therapist using the PRPP@work questionnaire/interview format. The participant's case manager was also present to provide background information, and to corroborate interview data from other assessment sources like client observation and interview.

Intervention: 

A case study method using the PRPP at work questionnaire/interview format.

Control: 

There was no control or comparison condition.

Findings: 

The employer did not perceive that the employee with TBI, was adequately applying cognitive information strategies in any of the four areas (perceive, recall, perform, plan) to meet job requirements. The findings indicated specific areas of information processing strategy strengths and weaknesses during work performance as categorized by PRPP@WORK Employer Questionnaire/Interview.

Conclusions: 

More research is needed. A measure of mental effort should be included in future studies assessing a person's ability to apply cognitive information processing strategies in multitasking work environments. While it is not possible to generalize the findings to the broader population of individuals with TBI the findings contribute to targeting future research in the area of improving multitasking work behaviors. The PRPP@WORK may have potential to offer useful information about the capacity of a person to engage in complex information processing for multitasking work performance post TBI.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/20634614
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The quality of supported employment implementation scale (2008)

Authors: 
Bond, G. R., McHugo, G. J., Becker, D. R., Rapp, C. A., & Whitley, R.
Year Published: 
2008
Publication: 
Journal of Vocational Rehabilitation
Volume: 
14
Number: 
3
Pages: 
201-212
Publisher: 
IOS Press
Background: 

Introduced in the 1980s supported employment (SE) is an approach to helping people with severe disabilities work in competitive employment positions. Although its principles are well described in the literature, its implementation has been variable throughout the U.S.

Purpose: 

The purpose of this study was to develop a brief, self-explanatory checklist, suitable for use in a telephone interview format, and ultimately as an instrument completed by a program administrator or state planner, or as a self evaluation by a study site.

Setting: 

The setting were supported employment programs in Kansas and New Jersey.

Sample: 

The study sample included 32 supported employment programs across 2 states.

Data Collection: 

A 1.5-hour semi-structured interview using the Quality of Supported Employment Implementation Scale (QSEIS) was conducted with program directors in 32 supported employment programs. The QSEIS total scale and 4 sub-scales were correlated with 9 indicators of employment outcomes, obtained from a retrospective survey completed by program directors in 24 of the programs.

Intervention: 

The intervention was Fidelity of implementation of Individual Placement and Support model of supported employment.

Control: 

There was no control or comparison condition.

Findings: 

Substantial implementation of supported employment standards was found in these programs, with mean ratings exceeding 4.0 on a 5-point scale, for 18 of 33 items. Mean overall implementation was similar in both states, with somewhat different patterns, with NJ rating higher on Planning and Support, and KS rating higher on Integration of Mental Health and Rapid Job Search.

Conclusions: 

The QSEIS is a pragmatic tool for describing supported employment programs for people with severe mental illness, although more work on psychometric precision and predictive validity is needed. The survey provides norms by which other providers and other states can compare their achievement of the principles of supported employment.

URL: 
http://worksupport.com/Main/downloads/article5.pdf
Disabilities: 
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes