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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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The results of this research support an argument for increased access to postsecondary education services for VR clients with TBI. Several other authors have established a reasoned, positive relationship between the provision of college services to VR consumers and vocational outcomes as measured by employment rates and earnings (Moore, 2001a; Price-Ellingstad & Berry, 1999; Schmidt-Davis, Hayward, & Kay, 1999). The findings of this and prior studies suggest that enhanced access is necessary not only to increase rates of competitive employment for VR consumers, but also to improve their quality of employment (i.e., wages). It should be noted, however, that assignment to services was not random and may represent the practice of counselors recommending postsecondary training for higher functioning consumers.

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Implications for Practice

There are two primary implications for current practices. First, the findings reveal that the provision of college, counseling and job placement services are positively related to competitive jobs for clients with TBI. The current and previous studies support these services, especially the provision of job placement services, as invaluable resources in the vocational rehabilitation process. Two-way simple interaction effects also revealed that in the absence of job placement services, the combination of assessment and college services are significantly related to consumers with TBI achieving higher levels of weekly earnings. Rehabilitation practitioners should be educated on the importance of providing such services as this may lead to greater numbers of consumers with TBI achieving competitive jobs and higher levels of income.

Second, in light of the positive relationship of college, counseling, and job placement on competitive jobs and the combination of assessment and college, in the absence of job placement, on income, one might recommend that more consumers with TBI be provided with such services. Specifically, counselors should consider identifying additional consumers with TBI who might benefit from the provision of college, counseling, job placement and the combination of assessment and college in the absence of job placement services.

Implications for Future Research

From a research perspective, this study was limited in several ways. The findings have limited generalizability because the study was conducted using consumer records of general practices from only one state. Other researchers may wish to replicate this study to determine if the findings are consistent throughout the state-federal rehabilitation system. This study also did not account for differences in all employment outcome measures. Future authors are encouraged to describe occupational placements for competitively employed consumers who received these services and compare the groups on hours worked each week.

In addition, researchers who conducted prior longitudinal studies have found that employment was not durable for persons with TBI (Ashley, Persel, Clark, & Krych, 1997; Ellerd & Moore, 1992; Hillier, Sharpe, & Metzer, 1997; Kaitaro, Koskinen, & Kaipio, 1995; Olver, Ponsford, & Curran, 1996). Thus, the relatively short (i.e., 90 day) employment maintenance requirement for competitive closures in this study may have limited the findings. Future researchers are encouraged to implement an extension to the 90 day measure of maintenance of competitive jobs. Such an approach may provide more valid data to evaluate work status at closure. Last, there is potential for error in any RSA-911 database. VR counselors typically complete the service information to be included in this database upon case closure (Wheaton et al., 1996). Some counselors may rely exclusively on memory for this information (Wheaton et al., 1996). Information recorded by counselors may also be inaccurately typed into the database (Wheaton et al., 1996). Consequently, an unknown number of miscalculations may exist. It is assumed, however, that these unknown errors are indiscriminate and result in no methodical bias in the data (Wheaton et al., 1996).

Health Care Industry

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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