Full-time employment

There were 20,249 records found after the initial search. After screening, 70 records remained to be evaluated in full-text. Of those 70, 58 records were excluded with reasons. This left 12 studies to be evaluated in the quantitative synthesis. Of the 10 studies that included measures of employment status, those that were randomized controlled trials (RCTs) showed no significant difference when examined alone. When combined with Quasi Experimental Designs (QEDs) the weighted mean effect size for employment status was OR= 2.18, p=.002. Two studies measured number of hours worked, and showed no significant results, OR = 0.89, p =.67. Four RCTs measured sick leave and results were nonsignificant OR = 1.18, p =.39.

Results indicate that attachment and hope were significantly related and predictive of full-time employment. Hope was also a significant mediator between attachment and full-time employment.

The findings of this study were preliminary. The final enrollment count for the study was 301 subjects. At the time of this publication, 93 participants had reached study completion. Some of the challenges faced included exhausting the study pool earlier than expected, staff turnover, and slow process of culture change within the centers.

he MVCCS evaluated in this study appeared to substantially improve employment outcome for persons with BI without interventions. Results were better than projections based on the previous literature 80% of those served were placed in community-based work with 46% in independent community-based employment. Employment outcomes for persons who received vocational services through this project approached or exceeded outcomes reported previously for intensive rehabilitation interventions. Just as importantly, initial vocational placements were maintained at 1-year follow-up. At the follow-up interview, 81% were working in the community and 53% were employed independently without job supports. Although the results were equivalent to those of other rehabilitation programs that are based on best practices the authors could not make direct comparisons with those programs because we did not investigate specific interventions. Primary predictors of initial placement in the present study were time since injury and overall impairment/disability as measured by the Staff MPAI. Return to previous work should be considered especially for the more recently injured who have retained ties to their previous employer. Results indicate that more severe impairments and disabilities, as measured by the MPAI, are significant barriers to employment in the general population of persons with BI. However, for persons with TBI, the presence of additional non-brain injuries appears to be a more important factor.

The best predictor of employment level at 1-year follow-up was the level of initial placement. ISA (as measured by the difference between Rasch Staff MPAI and Rasch Survivor MPAI) did not contribute to the prediction of either initial placement or job maintenance. This finding is inconsistent with some other studies reporting an association between ISA and long-term employment after BI. The results suggest that ISA may be a barrier to employment that can be overcome through rehabilitation, through education and support for employers, and by discriminating placement of those persons with ISA in work environments that are more tolerant of limitations in self-awareness. Overall level of impairment and disability also appears to be a factor in time required for placement. In some cases, more intensive rehabilitation efforts, such as a CI day rehabilitation program, were required for more severely disabled persons so they could develop cognitive compensation, communication, behavioral self-management, social, and other pre-vocational skills required for eventual placement. Because of the time required for participation in such an intensive rehabilitation program, most individuals who participated in CI day rehabilitation required 6 to 12 months from the time they were admitted to services to their eventual placement. Our data suggest that most placements (92%) can be made within 1 year of admission to services. Preinjury years of education also contributed slightly to prediction of time to placement, with more highly educated individuals being placed more quickly.

Clients who completed their plan of treatment earned more than those who did not. Those clients who received vocational services, in addition to completing treatment, earned more than those who completed treatment only.

None of the three models produced significantly greater employment or better overall rehabilitation.

The results indicated that while participants view return to work as an important goal of rehabilitation following TBI, they also valued other means of feeling successful , not having a stressful work life affect their personal life, and feeling successful without full time pay (previously considered the goal) to be of near equal importance.

It was found that employed persons reported an improved sense of mastery in the completion of work tasks, improved satisfaction with work supervision, and decreased satisfaction with advancement and job security. Unemployed participants reported improved expectancy for employment success.

Participants worked an average of 30 hours per week. and earned between $3.35 (minimum wage at the time) and 11.99 an hour. The average length of employment was 43 months. Average earnings were cited as $633.63 per month. Average gross earnings was $26,129.74. The majority of the sample worked over 2 years and approximately 25% had worked 7 years or more.The average hourly billing cost associated with the provision of supported employment services was $10,349.37; with a mean cost of $8614.00. This resulted in a mean monthly cost of $202.00 per participant.The subgroup cost-earning comparison revealed that cost were substantially less for those who maintained employment for 2 or more years. Individuals earned an average of $17,515.00 more than the cost associated with service implementation.

Twenty seven or 82% of those served went to work in an entry level occupation. They earned between $7.25 and $10.50 per hour.Mean hours worked was 23 per week.The average intervention time for various interventions was as follows:completing a job seeker profile was about 9 hours; job development around 30 hours (notably some of the individuals went to work where they interned which reduced the hours needed to develop a job); job site training and support 107 hours; and long term support 27 hours.