The Relation between VR Services and Employment Outcomes of Individuals with Traumatic Brain Injury. (VR Services and TBI)

Abstract

There is a substantial incidence of traumatic brain 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 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 (TBI) is a non-degenerative, non-developmental 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TBI attempt to to work (Wehman et al., 1989) as they are likely to encounter environmental and attitudinal barriers, outdated or limited vocational assistance, and social separation (West, 1996).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 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 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 (Chandler, 1993; Fabiano, 1991), demographic characteristics (Chandler, 1993), length of time between and 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? …