Supported employment for persons with traumatic brain injury: A preliminary investigation of long-term follow-up costs and program efficiency.

Authors: Wehman, P., Lau, S., Molinelli, A., Brooke, V., Thompson, K., Moore, C., & West, M.
Year Published 2003
Publication Archives of Physical Medicine and Rehabilitation
Volume 84
Number 2
Pages 192-196
Publisher Elsevier

Research shows that individuals with traumatic brain injury (TBI) often experience great difficulty returning to competitive employment postinjury. Challenges arise from cognitive, physical, sensory and/or psychosocial problems. Supported employment is one approach in vocational rehabilitation that has been used to assist individuals with significant disabilities, including TBI, with returning to preinjury work or securing and maintaining new employment.In the individual placement approach typically a vocational professional known as an employment specialist or job coach, works one to one with the individual. The specialist assist the person with locating employment by developing job opportunities. Then, once the individual is hired the specialist provides and facilitates on-the-job supports such as: skills training and/or identifying various types of supports (ie. compensatory memory strategies, assistive technology) to help the new hire learn how to perform the job and meet the employer‚ performance standards. Furthermore, long-term follow-up services are offered throughout the duration of a person‚ employment. During this time, additional on-the-job assistance is available, and, as indicated, select case management services related to resolving off-the-job-site issues that if left unattended would impact job retention, are provided. Information on cost and benefits is needed to determine the efficacy of this approach for individuals with TBI.


The purpose of this study was to investigate the long-term follow-up costs associated with supported employment. It also examined wage and employment characteristics for individuals with moderate to severe traumatic brain injury (TBI) received supported employment services over a 14-year time span.Specifically, this research sought to answer the following questions:(1) What is the average cost of supported employment services for individuals with TBI? (2) What is the average length of employment for individuals with TBI who have received supported employment services? and (3) How do benefits (ie, participant income) compare with costs of supported employment during a 14-year time period (from 1985 to 1999)?


The setting was multiple employment sites where individuals worked.


The sample size included 59 individuals with moderate to severe TBI who were consecutively referred for supported employment services. The sample was restricted those who were employed in at least one job during the study period. The eligibility criteria for receiving supported employment services included the following: the person was between the ages of 18 and 64 years, and had sustained a moderate to severe TBI, as indicated by length of coma greater than 24 hours or a Glasgow Coma Scale score of less than 13 on admission to the hospital. In addition, individuals had to present clear indications of the need for ongoing vocational intervention to return to preinjury employment or to obtain and maintain new employment. These indications came from the individual‚ post injury employment history or from reports from his/her family, physician, or vocational rehabilitation counselor. The demographics of the group were as follows. The majority (81%) were males; (75%) were white. The average age was 33 years. The majority (64%) had a high school diploma or less education. The majority (71%) were working prior to injury.

Data Collection

Data were collected on individuals who used supported employment services to assist them with gaining and maintaining work anytime between 1985 to 1999.Data about each participant's length of employment, wages, and costs associated with service delivery were collected by the employment specialist assigned to serve the person. For those individuals who had been employed in more than one job over the years, data on length of employment and cost of service delivery were combined. Analyses were performed to examine the costs of supported employment, employment characteristics (e.g., wages, length of employment), and benefit-cost ratios of supported employment for individuals with TBI. Descriptive statistics were calculated for length of employment, costs associated with supported employment services, and wages earned. Subgroup comparisons were also performed to examine the influence of length of employment on wages and supported employment costs. Calculations were based on individual clients, not job placements. Therefore, employment and billing data were combined and averaged for individuals who worked in more than 1 job over the study period.


Subgroup comparisons were performed to take a look at the influence of length of employment on wages (less than and greater than 2 years) and cost of services.


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.


Supported employment is a cost effective way to assist individuals with TBI with gaining and maintaining employment. Over time the cost associated with long term services (ie. follow along) decreases.

Disabilities Traumatic brain injury (TBI)
Populations Black / African American | White / Caucasian | Male & Female
Outcomes Employment acquisition | Full-time employment | Part-time employment | Wages
NIDILRR Funded Yes
Research Design Single group, Quasi-experimental
Peer Reviewed Yes