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The relation between VR services and employment outcomes of individuals with traumatic brain injury

Journal of Rehabilitation, July-Sept, 2003 by David Gamble, Corey L. Moore

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Counseling and college services were also significant predictors of competitive closure, although these service variables had lower odds ratios of 3.03 and 5.21 respectively. In a cross-disability study of VR consumers, those closed successfully were more likely to have received counseling (Wheaton et al., 1996). In addition, Moore (2001b) found counseling and guidance to be significantly associated with closure success for VR consumers with hearing loss. The collective findings of this and previous studies provide evidence that the provision of counseling and guidance services is related to positive employment outcomes. This study's findings for college services on closure status are consistent with results from previous research. For instance, Moore (2001a) found that college training was a significant predictor of successful work status at closure for VR consumers who were deaf, late-deafened, and hard-of-hearing.

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In order to control for possible confounding effects of disability severity on employment status, we examined the relationship between college services and employment status for only those consumers reporting a severe primary disability. Chi-square analysis revealed that college services were significantly related to employment status, [chi square] (1, n = 953) = 42.22, [PHI] = .21, 11 < .001. That is, consumers with severe TBI who were provided with college services were significantly more likely to be closed into competitive jobs (74 of 90 or 82.2%) when compared to those individuals with severe TBI who were not provided with such services (399 of 863 or 46.2%). This suggests significant variation in functioning of persons classified as having severe TBI.

The significant inverse relationship between work adjustment services and closure status in this study is of particular interest. The low odds ratio (i.e., .61) indicated a possible spurious association. Therefore, we analyzed the relationship between work adjustment training and employment status while controlling for disability severity. In short, we excluded those cases from the analysis representing consumers with non-severe TBI. Chi-square analysis refuted the previous finding: work adjustment training was not significantly or inversely related to employment status, [chi square] (1, n = 953) = 1.21, [theta] = .04, p = .27. This finding suggests that severity of disability could have contributed to differences found on employment status along with work adjustment services. Deficits in behavioral functioning are common following TBI (Cicerone & Fraser, 2000). Perhaps clients who received adjustment services had greater difficulty inhibiting impulsive or inappropriate interpersonal responses than clients who did not. Interpersonal skills are critical to vocational success (Kosciulek, 1991). It is conceivable that clients with pronounced deficits in this area were more likely to have their cases closed unsuccessfully. Alternatively, counselors may have either referred clients with greater deficits to this program or expected less from clients who received these services (i.e., Pygmalion effect). As such, we urge readers to refrain from perceiving or interpreting the inverse relationship between work adjustment training and closure status as valid.

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The relation between VR services and employment outcomes of individuals with traumatic brain injury

Journal of Rehabilitation, July-Sept, 2003 by David Gamble, Corey L. Moore

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