Vocational rehabilitation following traumatic brain injury

American Rehabilitation,  Summer, 1993  by Barbara Handler,  Sharon L. Mikrut

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Assisting people with traumatic brain injury (TBI) to engage in work or other prodcutive activities is a major challenge confronting the vocational rehabilitation system. In all six of the RSA Traumatic Brain Injury Regional Centers there has been a strong focus on vocational issues. Some of the activities common to the four original centers (those located in Denver, Chicago, New York, and Houston) include:

* training state vocational rehabilitation staff,

* improving the quality of supported employment services to survivors of TBI,

* addressing issues of funding on-going support services, and

* involving employers in the development of community networks to enhance opportunities for survivors to engage in productive activity.

Each center has taken a somewhat different approach to these tasks. The centers have also generated some collaborative efforts.

Inter-Center Networking

The four vocational rehabilitation coordinators have been meeting regularly via teleconference for the last year; representatives from the two new centers were added in December 1992. In addition to sharing information and resources, they have explored areas of potential policy development.

They concurred that one of the most common obstacles in the state rehabilitation system mentioned by counselors during training programs was case management. The coordinates jointly prepared an initial memorandum detailing their belief that rehabilitation clients who are survivors of TBI are perceived by counselors as requiring more case management services (e.g., assistance with family problems, housing, transportation, accessing state and federal systems) than clients with other disabilities. In many cases, this perception is accurate. However, even though the provision of case management services can often make the difference between successful and unsuccessful vocational outcomes, such services, unfortunately, take an inordinate amount of counselor time, a scarce commodity in most state rehabilitation offices. Counselors are not rewarded for expending time on these activities, and many counselors are not prepared to provide such services. The coordinators therefore recommended that recognition of the need for case management services as part of the spectrum of rehabilitation services be formally acknowledged and that mechanisms be established to allow for the provision of such services to survivors of TBI. Each coordinator is contacting the state rehabilitation offices in her region and asking for specific input on this issue. Action in this arena will be ongoing for the next year. When data have been collected, the coordinators will prepare recommendations for policy change.

Each center has its own unique vocational activities, as described in the following.

Comprehensive Regional Traumatic Brain Injury Rehabilitation and Prevention Center (TBI-NET)

New York, New York

TBI-NET's Grand Rounds is a case-study approach that provides technical assistance to counselors in regional vocational rehabilitation offices in New York, New Jersey, and Puerto Rico. Prior to each Grand Rounds session, cases are selected by a local rehabilitation office and submitted to the TBI-NET technical assistance team (confidentiality is protected). The team--which includes a neuropsychologist, the Chief of Vocational Rehabilitation Services of Mt. Sinai's Department of Rehabilitation Medicine, and a community resource consultant--travels to the rehabilitation office, where the neuropsychologist presents key information about the existing neuropsychological/psychological report, concentrating on the report's relevance and applicability to vocational issues. Both successful and problematic actions in the course of the rehabilitation process are reviewed, with input from the team. This forum provides participants the opportunity for an open exchange of ideas to facilitate the development of vocational strategies and to capitalize on existing resources. When possible, community agency representatives are invited to attend these meetings. Frequently, the participants become partners with the technical assistance team in developing innovative treatment strategies and interventions. Counselors benefit from the interactive approach, which produces a repertoire of ideas and new ways of thinking about the target population. Validation of counselors' efforts helps minimize doubts about their management of TBI cases.

TBI-NET's Vocational Mentoring Project provides counseling and placement in competitive employment for people with TBI and recruitment and training of volunteer mentors (co-workers or supervisors) who provide natural supports at the worksite. This project helps TBI survivors return to their pre-injury jobs or obtain new employment. Mentoring is an appropriate intervention that can remote job retention while fostering the employer's ability to provide the support needed by people with severe disabilities. It is a low-cost intervention that encourages the employer to meet the needs of the individual with TBI through the use of available professional support. This project, which has also been used in educational settings, includes outreach and special counseling for minorities.