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

Journal of Rehabilitation, July-Sept, 2003 by David Gamble, Corey L. Moore

There is a substantial incidence of traumatic brain injury in the United States (Brantner, 1992; Taylor, Forbes, & Goodwin, 1998). It is estimated that between 500,000 and 1.5 million individuals sustain a traumatic brain injury each year (Brantner, 1992; Chandler, Czerlinsky, Moore, Rutman, & Schumacher, 1993; Taylor, Forbes, & Goodwin, 1998), with males under 35 years of age representing the majority of these individuals (Bullard & Cutshaw, 1991; Garske & Thomas, 1992). A traumatic brain injury (TBI) is a non-degenerative, non-developmental injury or disease of the brain caused by trauma, infectious processes, anoxia, or vascular abnormalities (Brantner, 1992; Preston, Ulicny, & Evans, 1992).

The impact of TBI is unique (Taylor, Forbes, & Goodwin, 1998). It has wide-ranging affects on physical, cognitive, psychological, and behavioral capacities (Taylor, Forbes, & Goodwin, 1998), and loss of function in a combination of these areas is not uncommon (Brantner, 1992; Kosciulek, 1991). These deficits are often displayed as persons with TBI attempt to return to work (Wehman et al., 1989) as they are likely to encounter environmental and attitudinal barriers, outdated or limited vocational assistance, and social separation (West, 1996). As a result of these multifaceted challenges, the rates of successful return to employment are low and decline more over time (Michaels & Risucci, 1992). In fact, few individuals with TBI "return to work at the same level, for the same pay, and at the same number of hours per week as before the injury" (Uomoto, 2000, p. 1).

An important indicator of recovery after TBI is return to work (Krankowski, 1993), and vocational outcome has therefore been a central focus of TBI research (Chandler et al., 1993). For the past 20 years, studies investigating employment outcomes of persons with severe TBI have produced disappointing results (Ben-Yishay, Silver, Piasetsky, & Rattock, 1987; Brooks, McKinlay, Symington, Beattie, & Campsie, 1987; Ellerd & Moore, 1992; Jellinek, Torkelson, & Harvey, 1982; Lam, Priddy, & Johnson, 1991; Peck, Fulton, Cohen, Warren, & Antonello, 1984; Rappaport, Herrero-Backe, Rappaport, & Winterfield, 1989; Weddell, Oddy, & Jenkins, 1980). Post-injury employment rates for these individuals have ranged from 22% to 55% (Wehman, Bricout, & Targett, 2000), and wage levels for those who returned to work post-injury have also been low (Groswasser, Melamed, Agranov, & Keren, 1999).

As a result of the low employment rates and earnings reported for persons with TBI, numerous studies have examined predictors of employment outcomes for these individuals. For instance, favorable employment outcomes were reported for individuals with TBI following participation in supported employment (Groswasser, Melamed, Agranov, & Keren, 1999; Preston, Ulicny, & Evans, 1992; Target, Wehman, Gorton, & Petersen, 1998; Wehman et al., 1990; Wehman et al., 1989). Other studies examined the effects of neuropsychological functioning (Fabiano, 1991; Lam et al., 1991; Morris, Ryan, & Peterson, 1982; Newnam, Heaton, & Lehman, 1978), severity of injury (Chandler, 1993; Fabiano, 1991), demographic characteristics (Chandler, 1993), length of time between injury and return to work (Brooks et al., 1987; Ip, Dornan, & Schentag, 1995; Oddy, Coughlan, Tyerman, & Jenkins, 1985), and assistive technology (Gamble & Satcher, 2002) on the rehabilitation outcomes of persons with TBI. Conversely, no studies were found which examined conventional vocational rehabilitation (VR) service correlates of employment outcomes for these individuals.

The purpose of this study was to identify the number of consumers with TBI that received six distinct VR services and investigate the relationship between the provision of these services and rehabilitation outcomes. Specifically, this study answered the following research questions: (1) How many of the participants received assessment, college, counseling/guidance, job placement, restoration, and work adjustment services? (2) Are assessment, college, counseling/guidance, job placement, restoration, and work adjustment services significantly related to closure status? (3) Are there significant differences in weekly earnings based on the provision of assessment, college, counseling/guidance, job placement, restoration, and work adjustment services?

Method

Data Collection

The data were obtained from client closure reports found on the RSA-911 database from the participating public rehabilitation agency and included (a) demographic characteristics, (b) VR services provided, and (c) outcomes achieved. Two measures of employment success were used-closure status and weekly earnings. The Rehabilitation Services Administration developed a standard for closure status on its database that includes rehabilitated (Status 26) and non-rehabilitated (Status 28) closures. An individual must maintain employment for a minimum of 90 days in order for the case to be closed as rehabilitated. However, a rehabilitated closure does not necessarily indicate that the person is working in competitive employment (Gilmore, Schuster, Timmons, & Butterworth, 2000). Consumers closed as rehabilitated are further categorized into (a) competitive employment, (b) sheltered employment, (c) self-employment, (d) business enterprise program, (e) homemaker, and (f) unpaid family worker statuses. In contrast, a non-rehabilitated closure indicates that the client was unemployed and not in one of the preceding groups following VR intervention.