Article Details

Research Database: Article Details

Citation:  Catalano,D., Pereira,A.,P., Wu, M.,Y.,Ho,H., & Chan, F. (2006). Service patterns related to successful employment outcomes of persons with traumatic brain injury in vocational rehabilitation. NeuroRehabilitation, 21 (4), 279-293.
Title:  Service patterns related to successful employment outcomes of persons with traumatic brain injury in vocational rehabilitation
Authors:  Catalano,D., Pereira,A.,P., Wu, M.,Y.,Ho,H., & Chan, F.
Year:  2006
Journal/Publication:  NeuroRehabilitation
Publisher:  IOS Press
Full text:  https://www.ncbi.nlm.nih.gov/pubmed/17361045   
Peer-reviewed?  Yes
NIDILRR-funded?  Yes
Research design:  Database mining

Structured abstract:

Background:  A number of cognitive, physical, and psychosocial impairments can occur following a TBI. These deficits can have a profound effect on daily functioning including an individual’s ability to work. This may raise significant challenges for vocational rehabilitation professionals when helping individuals with TBI to prepare, obtain, and maintain competitive employment. Given the prevalence of TBI and the young age of many survivors, vocational rehabilitation will be needed. Professionals serving these individuals need to be prepared to develop appropriate rehabilitation plans. To be effective, they need to be familiar with TBI and the current research that looks at what impacts successful vocational outcomes. This may help facilitate the best use of limited funds for the vocational rehabilitation of persons with TBI. There are limitations in the research to date and more research is needed.
Purpose:  This purpose of this study was to examine effects of demographic characteristics, work disincentives, and vocational rehabilitation services patterns through an analysis of the Rehabilitation Services Administration (RSA) case service report (RSA-911) data on employment outcomes of persons with traumatic brain injuries (TBI) for fisical year 2004.
Setting:  This study included individuals with TBI served by multiple vocational rehabilitation agencies in various settings.
Study sample:  The sample included 7,366 individuals with TBI whose cases were closed by state vocational rehabilitation agencies as employed or not employed in the fiscal year (FY) 2004. This included 4,862 men (66%) and 2,504 women (34%). The majority or 78% were European Americans. The average age of participants was 37 years. Thirteen percent had co-committant disabilties (psychiatric or substance abuse). Seventy six percent had a high school degree or more education. The average time between applying to eligible for VR services was a month and a half. The average time between eligibility and case closure was 30 months. Case expenditures averaged $4,238.
Intervention:  The interventions included various vocational rehabilitation services. This included job search assistance, job placement assistance, and on-the-job support services for individuals with TBI.
Control or comparison condition:  There was no control or comparision condition.
Data collection and analysis:  A data mining technique, exhaustive chi-squared automatic interaction detector (CHAID), was used to analyzeIn the current study, exhaustive CHAID was used to build classification trees. This technique uses a systematic algorithm to detect the strongest association between predictors and the outcome variable (e.g., employment outcomes) through a comprehensive search of the predictors and the levels of predictors from the entire set that show the most differentiation on the employment outcome variable. The degree of differentiation is depicted sequentially in a decision tree format to show the optimally split predictors. Thus, homogeneous groups of vocational rehabilitation clients could be identified based on their demographic characteristics, work disincentives, and service patterns in terms of their observed levels on the outcome variable. The statistical software SPSS AnswerTree 2.0 was used to conduct the exhaustive CHAID analyses. The alpha level for all statistical tests was 0.01. This study corrected for the number of statistical tests within each predictor using a Bonferroni feature in the AnswerTree software. the data in this study.
Findings:  The employment success rate for the entire sample was 50%. The employment success rate for persons with TBI is somewhat lower than the 55% rate for the overall sample of vocational rehabilitation clients closed in FY 2004. European Americans had higher competitive employment rates than other groups. Clients with co-occurring psychiatric disabilities had a lower employment rate than those without psychiatric disabilities . Clients who had work disincentives also showed significantly poorer employment outcomes than those without disincentives. In terms of education, clients with a bachelor or higher educational degree had the highest competitive employment rate as compared to those with less education. Case expenditure was related to outcomes,with more money spent on clients who were closed as successfully rehabilitated. Clients who were successfully rehabilitated also required less time in the rehabilitation process than unsuccessfully rehabilitated clients. Clients who received the following vocational rehabilitation services on-the-job training, job readiness training, miscellaneous training (e.g., GED or high school training needing to diploma), job search assistance, job placement assistance, on-the-job supports, maintenance, rehabilitation technology, and/or other services (e.g., occupational licenses, tools and equipment, and initial stocks and supplies) had significantly higher competitive employment rates than those who did not receive such services. Overall, the results indicated that the TBI clients 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.
Conclusions:  Several vocational rehabilitation clinical practice guidelines came from the results of this study. First, the study underscore the importance of considering job placement and workplace support services in the vocational rehabilitation of persons with TBI. Unfortunately, job placement assistance and on-the job supports were found to be significantly underutilized by rehabilitation counselors in serving their TBI clients. Second, this study highlights the influence of disincentives on employment outcomes. Increased emphasis appears needed in the education of rehabilitation counseling students and practitioners on the importance of benefits counseling services and to encourage rehabilitation counselors to discuss this important service with consumers early in the rehabilitation planning process. Third, co-occurring psychiatric disabilities were found to significantly affect employment outcomes. This finding underscores the importance for rehabilitation counselors to (a) appropriately assess the emotional and psychological functioning of those served and and to provide mental health counseling (b) increase knowledge about evidence-based mental health practices, and (c) to utilize the various interventions that have been found successful in diminishing psychiatric symptoms in the rehabilitation process. Finally, the very low incidence of co-occurring substance abuse disorders identified in this study (3%) is unusual, given research has indicated that about 50% to 66% of TBI clients had a history of alcohol and other drug abuse. This may be under reported. Rehabilitation counselors, need better education and training in substance abuse assessment and treatment within the context co-occurring disabilities.

Disabilities served:  Traumatic brain injury (TBI)
Populations served:  Gender: Female and Male
Race: American Indian or Alaska Native
Race: Asian
Race: Black / African American
Race: White / Caucasian
Race: Native Hawaiian / other Pacific Islander
Ethnicity: Hispanic or Latino
Interventions:  Accommodations
Assistive technology
Job search and placement assistance
On-the-job training and support
Vocational rehabilitation
Outcomes:  Employment acquisition
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