Productive work and employment for persons with traumatic brain injury: what have we learned after 20 years?

Virginia Commonwealth University Rehabilitation Research and Training Center on Workplace Supports, Richmond, VA 23284, USA.
Journal of Head Trauma Rehabilitation (Impact Factor: 3). 01/2005; 20(2):115-27. DOI: 10.1097/00001199-200503000-00001
Source: PubMed

ABSTRACT This article describes return to work outcomes for individuals with traumatic brain injury (TBI) through a selective review of the published literature and an examination of TBI labor force participation from the Rehabilitation Services Administration 91l and the Social Security Administration Benefits Planning, Assistance and Outreach databases. Implications and recommendations to further our understanding about the different parts of the work outcome profile of individuals with TBI are offered.

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Available from: Pamela Targett, Nov 20, 2014
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    • "An interesting finding was that contrary to the TBI rehabilitation literature [59], supported employment was not a significant predictor of employment outcome for VR clients in this study. Primarily concerned with maintaining employment, supported employment programs have traditionally been defined as involving competitive employment, integrated work settings, and the provision of on-going job support [30]. "
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    ABSTRACT: This study analyzed the Rehabilitation Services Administration (RSA) case service report (RSA-911) data for fiscal year 2004 to examine effects of demographic characteristics, work disincentives, and vocational rehabilitation services patterns on employment outcomes of persons with traumatic brain injuries (TBI). The results indicated that European Americans (53%) had appreciably higher competitive employment rates than Native American (50%), Asian Americans (44%), African Americans (42%), and Hispanic/Latino Americans (41%). Clients without co-occurring psychiatric disabilities had a higher employment rate (51%) than those with psychiatric disabilities (45%). Clients without work disincentives showed better employment outcomes (58%) than those with disincentives (45%). An important finding from this analysis was the central role of job search assistance, job placement assistance, and on-the-job support services for persons with TBI in predicting employment outcomes. A data mining technique, the exhaustive CHAID analysis, was used to examine the interaction effects of race, gender, work disincentives and service variables on employment outcomes. The results indicated that the TBI clients in this study could be segmented into 29 homogeneous subgroups with employment rates ranging from a low of 11% to a high of 82%, and these differences can be explained by differences in work disincentives, race, and rehabilitation service patterns.
    Neurorehabilitation 02/2006; 21(4):279-93. · 1.74 Impact Factor
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    ABSTRACT: Prepared for: Dept. of Psychology . Thesis (M.S.)--Virginia Commonwealth University, 2006. Bibliography: leaves 88 - 102.
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    ABSTRACT: AIM The principle aim of this thesis was to develop a system to predict employment after Traumatic Brain Injury (TBI). METHODS This thesis consists of three studies; a systematic review of the predictors of employment following TBI; a descriptive qualitative study investigating the factors that individuals with TBI and professionals delivering rehabilitation perceived to be the influences of employment after TBI; and a quantitative study evaluating the association between fatigue, employment, and depression following TBI. FINDINGS 1. The systematic review found that the most consistent predictors of employment outcome following TBI were; age and education at time of injury, pre-injury employment status, and levels of impairments. The maximum variance in employment outcome explained by any study included in the systematic review was 42%. This review also identified that the majority of predictive research focused on factors intrinsic to the individual with TBI without sufficient attention to social influences or the individual‘s environment. 2. The descriptive study found participants considered it was how factors intrinsic to the individual with TBI interacted with both social and work related environmental factors that influenced employment outcome. As such, employment was reported to be the product of the individual with TBI‘s interaction with their environment. All stakeholder groups involved proposed fatigue to be a key influence of employment after TBI, a variable not identified in the systematic review. 3. The quantitative study of this thesis found that fatigue explained additional variance in employment outcome to predictors identified in the systematic review. This study also found that reports of fatigue and depression were highly associated. CONCLUSION Accurate prediction of employment for people after TBI based upon early functional indicators and demographic features remains problematic. Findings here suggest this could be because the interaction of factors intrinsic to the individual with TBI with their environment influences employment outcome. A case is made for a biopsychosocial model of disability, as opposed to an impairment only model, in considering employment issues following TBI. In keeping with a biopsychosocial approach, findings are then examined with reference to future research and clinical interventions to enable RTW following TBI.
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