The relation between VR services and employment outcomes of individuals with traumatic brain injury

Authors: Garcia-Villamisar D., & Hughes C.
Year Published 2003
Publication Journal of Rehabilitation
Volume 69
Number 3
Pages 31-38
Publisher National Rehabilitation Association

Individuals with severe traumatic brain injury (TBI) have poor vocational outcomes. Post injury employment rates have ranged between 22% to 55%. Many studies have looked at predictors for employment outcomes for this group. Other studies have looked at neuropsychological functioning, severity of injury, demographic characteristics, length of time from injury and return to work, assistive technology and rehabilitation outcomes. However, there are no studies about vocational rehabilitation services impact on employment outcomes for individuals with TBI.


The purpose of this study was to examine the relationships between the provision of six rehabilitation services and vocational outcomes for individuals with TBI. The research questions included: How many participants received assessment, college, counseling and guidance, job placement, restoration and work adjustment services? Are assessment, college, counseling and guidance, job placement, restoration and work adjustment services significantly related to closure status? Are there significant differences in weekly earnings based on the provision of assessment, college, counseling and guidance, job placement, restoration and work adjustment services?


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


The study sample included 1,073 individuals with TBI who received state vocational rehabilitation services from a southeastern state and whose cases were closed in either competitive employment or non-rehabilitated from 1992 to 2000. Forty nine percent of the participants were competitively employed when there case was closed by state vocational rehabilitation (VR) and 51% were not. The majority (89%) reportedly had a severe disability. Most were single (79%), Caucasian (78%), and male (70%). The ages ranged from 16 to 71 years. The majority had 11 years of education or better. At the times of services 91% reported no prior work experience.

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.


There was not control or comparison condition.


Counseling/guidance was the most frequently provided services (89%). VR services identified as positive predictors of closure status were: college, counseling/guidance, and job placement services. The odds of obtaining competitive employment after receiving college services was 5.21 times the odd for those not receiving services. The odds of obtaining competitive employment for those receiving counseling/guidance services was 3.03 times greater than those who did not receive the services and the odds of competitive employment among those who received job placement services was 20.77 times greater than those who did not. Notably, work adjustment was a significant negative predictor of closure status. Individuals who did not receive assessment or college services had higher earnings than those who receive college services alone. When job placement services were not provided the effect of college training on mean weekly earnings was different at each level of assessment.


College, counseling/guidance and job placement services were significantly and positively related to closure status.
Work adjustment services were inversely related to weekly earnings for competitively employed individuals and assessment, college, and job placements services interacted significantly on weekly earnings of those competitively employed. Job placement is the most important positive predictor of closure. Rehabilitation counselor education and training should focus on job placement services. College training benefited an small number of individuals in the sample. Additional research is needed to investigate the relationship between VR services and employment outcomes for individuals with TBI.

Disabilities Traumatic brain injury (TBI)
Populations Hispanic or Latino | Asian | Black / African American | White / Caucasian | Male & Female
Outcomes Employment acquisition | Return to work
NIDILRR Funded Not Reported
Research Design Observational
Peer Reviewed Yes