Article Details

Research Database: Article Details

Citation:  O'Neill, J. H. , Zuger, R.R., Fields, A.,Fraser, R., & Pruce, T. (2004). The program without walls: Innovative approach to state agency vocational rehabilitation of persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85 (2), 68-72.
Title:  The program without walls: Innovative approach to state agency vocational rehabilitation of persons with traumatic brain injury
Authors:  O'Neill, J. H. , Zuger, R.R., Fields, A.,Fraser, R., & Pruce, T.
Year:  2004
Journal/Publication:  Archives of Physical Medicine and Rehabilitation
Publisher:  Elsevier
Full text:   
Peer-reviewed?  Yes
NIDILRR-funded?  Yes

Structured abstract:

Background:  Employment is compromised for individuals with traumatic brain injury (TBI). Rates after TBI range from 10% to 70% .The literature reports on successful work outcomes for some with the use of specialized or intensive rehabilitation intervention. In spite of a number of intensive demonstration projects focusing on vocational rehabilitation (VR) and some research showing the effectiveness of certain program components, many persons with TBI remain unserved or underserved within the VR system. Individuals with TBI access VR services at rates that are much lower than other consumers relative to their prevalence in the general population. In addition to being underrepresented in counselor caseloads, people with TBI are less successful than other consumers in obtaining and maintaining competitive employment.
Purpose:  The purpose of the paper was to describe the Program Without Walls (PWW), a person-centered, community-based approach for state rehabilitation counselors to provide vocational rehabilitation (VR) services to individuals with traumatic brain injury (TBI). The PWW includes many of the best practices suggested by previous research such as: functional cognitive remediation, job coaching, psychosocial counseling, job development and placement services, and fostering a strong relationship with the counselor via person-centered planning.
Setting:  The setting included communities and two district vocational rehabilitation offices in the state of New York.
Study sample:  The study sample was made up of 42 individuals who had been accepted by New York State's VR program for services. The majority or (34)were men. Half of the group (21) received traditional services and the other half participated in the PWW. In terms of ethnicity, the majority of participants were nonwhite (ie. black and asian). Related to education, close to half (48%) had not completed high school.
Intervention:  All participants went through the initial VR procedures for eligibility determination and development of an indivdualized employment plan. Individuals in the receiving traditional services were referred to various outside organizations for services and followed by the vocational rehabilitation counselor. Individuals in the PWW group received person centered, community based services from consultants who were recruited, trained and supervised by a VR counselor.
Control or comparison condition:  Each PWW participant was matched to a VR client receiving traditional services on gender, age, ethnicity, and education at referral.
Data collection and analysis:  The following data were gathered from VESID central files for fiscal years 2001 (October 1, 2000–September 30, 2001) and 2002 (October 1, 2001–September 30, 2002): case status (26 successfully placed for 90 days, 28 closed after IPE-initiated, 30 closed before IPE initiated, 8 closed before IPE developed), weekly earnings at closure, hours worked per week at closure, cost of case services provided to each consumer, consumer demographic characteristics (gender, level of education, employment status at application, ethnicity, age), and name of the state VR counselor serving the consumer. By using case status, the proportion of successful closures (ie, case status 26) were compared with unsuccessful closures (ie, case status 8, 28, and 30) for the PWW counselors and other counselors in the catchment areas served by using Pearson chi-square analyses. One-tailed t tests were used to compare weekly earnings at closure, hours worked per week at closure, and cost of services for PWW consumers versus the matched consumers.
Findings:  Fifty-seven percent of the PWW consumers were successfully closed compared to only 24% of the matched consumers who received traditional services. The proportion of successful closures for PWW versus unsuccessful closures was significantly greater for this group. PWW participants earned 204 dollars more a week and worked an average of 14 hours more than the other group. The cost of services for the PWW participants was 260 dollars more than the group who received traditional services.
Conclusions:  The PWW approach seems promising. More research is needed to determine its utility in assisting individuals with TBI with employment.

Disabilities served:  Traumatic brain injury (TBI)
Populations served:  Gender: Female and Male
Race: Asian
Race: Black / African American
Race: White / Caucasian
Interventions:  Vocational rehabilitation
Outcomes:  Return to work