Vocational interventions and supports following job placement for persons with traumatic brain injury

Authors: Hedrick, B., Louise-Bender Pape, T., Heinemann, A. W., Ruddell, J. L., & Reis, J.
Year Published 2010
Publication Journal of Vocational Rehabilitation
Volume 32
Number 3
Pages 135-150
Publisher Journal of Vocational Rehabilitation
Background

Several treatment models have focused on assisting individuals with Traumatic Brain Injury (TBI) with employment. However, there is no standard way to define and measure the vocational treatment provided after job placement and their impact on individual outcomes. There is much variation among centers from no services to comprehensive services. Research to establish the efficacy of vocational services, should help more individuals with TBI find and maintain employment.
Purpose

A primary objective of the study was to create a "real time" (ie. time of service delivery), measure of the types and amounts of interventions provided to individuals with TBI after job placement.
The treatment data, case mix and outcomes data were used to determine:
1. How do post-placement vocational interventions differ across the 5 TBIMS programs, both qualitatively (e.g., type and location of service) and quantitatively (length, duration, number of contacts)?
2. How are treatments related to case mix variables such as injury severity and functional status or presenting problems at the time of job placement?<
Do clients with more severe TBI and/or worse functional status at the time of job placement receive more services overall?
b. How are service locations related to client factors?
c. How are specific treatments targeted to presenting problems?
3. How do short-term vocational outcomes differ across the 5 TBIMS sites, and how might outcomes relate to the amounts, types and locations of treatments received?
Measuring the treatment components that are considered important by staff involved with vocational interventions may improve practices.
Setting

Five geographically dispersed Traumatic Brain Injury Model System Sites.
Sample

Sixty five individuals with TBI were recruited from 5 geographically dispersed Traumatic Brain Injury Model System Sites. The majority were males 87%. The average age at time of injury was 36 years. The etiology of injury was vehicular (63%), followed by falls (19%), gunshot or assault (9%) and sports related (9%). The majority or 87% of the participants were white and 65% had at least some college education.
Data Collection

Job coaches and other clinical staff who provided services following the job placement of each participant recorded interventions that lasted one minute or more on treatment data forms as near to the day of service provision as possible.
Treatment data determined the number of days treatment was received during the 6 month study period and the summed durations in hours across all treatments received. Treatment types and location were based on summing the number of treatments by category and possible locations across all service days.
Summary statistics were computed for each variable. Next, associations among variables were tested
for significance using Chi-square for nominal variables, and rank-order (Spearman) correlations for ordinal or
interval variables. Kruskal-Wallis tests were used to determine whether the 5 sites showed overall significant
differences on each treatment variable. For variables showing significant differences, pairwise Mann-Whitney U tests were then used to determine which centers differed from one another.
Control

There were no control or comparison conditions.
Findings

Related to question one about the patterns of vocational treatment across TBIMS sites the findings suggested substantial differences among the 5 TBIMS in the amount, types and location of services provided after job placement.
Regarding question two about the relationship of treatment to case mix variables, the results suggested that the difference in treatments across centers could be related in part due to disparities in case mix. Additionally, data suggested that emotional dysfunction was correlated not with more treatment in general but more treatment targeting emotional problems.
Finally, related to question 3 about the pattern and correlates of short term vocational outcomes by center the researchers found there was statistically significant differences across sites.
Conclusions

The researchers found that there was a large degree of variation in the amount and types of interventions provided to study participants and in the locations where treatments were given, across the five TBIMS. Centers either provided intensive treatment that included services on the job or less intensive treatment provided in a clinical setting supplemented by follow up phone contacts. The disparity in treatment components across clinical sites suggest that interventions such as job coaching and case management can not be assumed available to individuals referred for vocational services.
The most frequently used treatment were cognitive compensatory strategy training, case management and worksite accommodations related to scheduling and responsibilities. Reduced cognitive speed is associated with higher treatment intensity. Educating employers about slowed information processing and developing strategies to help the worker compensate should be considered in the treatment plan. The field will benefit from explicit guidelines on the optimal mix of services to assist individuals with TBI with employment. Large scale studies are needed to further examine the interaction between client and program features.
URL http://www.worksupport.com/documents/jvr_vocational_interventions_supports.pdf
Disabilities Traumatic brain injury (TBI)
Populations Male & Female | White / Caucasian
Outcomes Return to work
NIDILRR Funded Yes
Research Design Observational
Peer Reviewed Yes