Employment rates for individuals with disabilities are poor and contribute to the ongoing high poverty rates for this group. Although overall employment rates have risen over the years, work outcomes for young adults with disabilities still lag behind those without disabilities. Career development takes place overtime and is influenced by multiple variables such as individual, family, school, and community factors. However, for individuals with disabilities, career development is often complex, nonlinear, and chaotic. High school and post-school services can have a positive impact on employment for youth with disabilities. Students with disabilities who participate in vocational courses and community based work experiences are more likely to obtain and maintain employment after high school. Additionally, participation in adult services like vocational rehabilitation or post secondary education or training can lead to better job opportunities. Research studying patterns of career development for successfully employed adults with disabilities may be able inform clinical practices through the identification of common themes that influence employment in living wage occupations.
There were 2 hypotheses. The first was that vocational outcomes will meet or exceed those cited in prior research. Specifically, 75% of participants in community-based independent or supported community-based employment or education/training programs; and (b) 50% of individuals in independent community-based employment. The other hypothesis was vocational outcomes will be related to (1) severity of injury, (2) severity of impairment/disability, (3) ISA, (4) time since injury, (5) presence of additional injuries not related to the brain injury, and (6) preinjury educational/vocational status.
The setting was a Rehabilitation Center.
One hundred and thirteen individuals with brain injury, who were consecutively admitted to the CDT program from 1988 to 1998. This included 96 individuals who completed the program and 17 who did not. Traumatic brain injury accounted for the majority or 72% of the participants who completed the program and 71% of the drop outs. The severity of the TBI sample was 82% and 92% respectively. The mean time since injury (TBI, CVA or other) among those who completed the program was 4.6 years.
The subjects had myriad of problems in the following areas post injury: self awareness, cognitive, communication, social skills and emotional/behavioral.
They were also either unemployed or facing failure at work. Participants had mobility, functional communication skills and exhibited some capacity for applying new knowledge. The average length of stay among participants in the CDT program was 189.5.
Evaluation and outcome data were analyzed for each participant. For those who completed the program, work outcomes was measured using the Vocational Independence Scale at program end and 1-year follow-up and Rasch-analyzed Mayo-Portland Adaptability Inventory (MPAI-22) and goal attainment scaling (GAS) at program end. Data was collected from the Independent Living Scale, VIS, GAS and MPAI-22 when participants entered and exited the program to measure this factor. Logistic regression analysis was conducted for the ILS and VIS were for those who completed the program one year post completion with potential outcome predictors that included: age, education, severity of injury, type of injury, time post injury, degree of impairment prior to program participation.
Participants attended a CDT that followed guidelines developed by prior research for post acute brain injury rehabilitation programs, along with the following changes: combination of physical therapy and recreation therapy into a Life Skills Group, family education and use of a vocational counselor to provide employer education and support.
There was no control or comparison condition.
Significant goal achievement on GAS and improvement on MPAI-22; increased societal participation at 1-year follow-up for those treated post acutely and many years after injury: 72% of graduates living independently; 39% working independently, 10% in transitional placements, and 18% in supported or volunteer work. Long-term outcomes were modestly related linearly to preadmission MPAI-22 and nonlinearly to time since injury.
Community Day Treatment program improves participation in society for individuals with brain injury. Next steps needed are randomized control trials of active treatment components. Relationships of predictors to outcomes are not sufficiently strong for patient selection. More effective interventions for vocational reintegration are needed for individuals with severe brain injury.