Paul Wehman

Psychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations

The psychosocial problems of decreased social contact, depression, and loneliness that occur for many with traumatic brain injury (TBI) create a major challenge for enhancing efforts at community re-entry. Despite dramatic physical progress within the first six months after injury, these psychosocial problems remain a persistent long-term problem for the majority of individuals with severe TBI. Researchers have consistently suggested that the psychosocial problems associated with TBI may actually be the major challenge facing rehabilitation. The majority of individuals who sustain TBI are young males between the ages of 19 and 25, who are in the early stages of establishing their independence in areas including friendships, leisure activities, intimate relationships, residence, and employment. The problems of social isolation and decreased leisure activities create a renewed dependence of the survivor on his/her family to meet these needs. In this article we review a large number of papers which examine t...

Substance abuse and crime patterns among persons with traumatic brain injury referred for supported employment

The present investigation examined the incidence of alcohol use, drug use and criminal behaviour among persons with traumatic brain injury referred for supported employment services. Primary caretakers of 74 consecutive referrals completed the General Health and History Questionnaire, the brief version of the Michigan Alcohol Screening Test, and the Quantity-Frequency-Variability Index. Pre-injury, a fifth of the sample were abstinent from alcohol and 66% were labelled as moderate or heavy drinkers. Post-injury alcohol use declined. Half of the sample were abstinent and 28% were moderate or heavy drinkers. Thirty-six percent reported illicit drug use pre-injury. Reportedly, post-injury drug use declined to an incidence of 4%. Nearly 20% of the sample had been arrested pre-injury and 10% were arrested post-injury. Implications for further research and programme development are discussed.

Critical factors associated with the successful supported employment placement of patients with severe traumatic brain injury

A number of investigations have recently demonstrated the effectiveness of supported employment programmes in improving the vocational status of clients with traumatic brain injuries. The present study investigated a sample of 39 individuals participating in a return to work programme emphasizing a supported employment approach to identify key functional characteristics which differentiated successful and unsuccessful clients. Clinical ratings of employment specialists were used to identify two groups of individuals rated least and most difficult to place and maintain. Results indicated that the two groups differed markedly on key employment outcomes. Individuals rated most difficult tended to be younger, possess functional limitations such as visual and fine motor impairments, and display significant deficits in numerous work-related skills. Recommendations are made for applying these findings to assessment, placement, and training activities within vocational rehabilitation programmes for persons with traumatic brain injuries.

Employment outcomes of persons following traumatic brain injury: pre-injury, post-injury, and supported employment

This paper provides a prospective analysis of the pre-injury, post-injury and supported employment work histories of 20 persons who survived a severe head injury. All persons had a very limited or inconsistent work history post-injury, due to the severity of the injury. Data are presented on the placement outcomes and include factors such as wages, hours worked, months of employment and type of occupation. The supported employment model is described and the job coach approach is presented in some detail. The most significant finding of this preliminary report is that, as an aggregate group, supported employment was able to facilitate restoration of vocational capacity from pre-injury levels based on total months worked.

Return to Work After Traumatic Brain Injury: A Supported Employment Approach

Traumatic brain injury (TBI) is one of the most prevalent disabilities in the United States. Of the estimated 1.4 million who sustain a TBI annually, about 1.1 million are treated and released from the emergency room (Langlois et al. 2006). Another 235,000 are hospitalized, and 80,000 to 90,000 experience permanent disabilities (Langlois et al. 2006) TBI is three times more common in men than in women, with the most common causes for injury being motor vehicle accidents, falls, and violence (Greenwald et al. 2003).

Supported Competitive Employment for Individuals with Autism and Severe Retardation Two Case Studies

A o r o e o PUBLICATION Supported employment involves paid work in integrated work settings. Unlike other rehabilitation models, permanent, long-term follow-along staff support is provided to workers in order to enhance job retention. The target population that supported employment programs are designed for are those individuals who are severely handicapped and who traditionally have been excluded from competitive employment. The Rehabilitation Act Amendments of 1986 provide for a discretionary supported employment grant program, through which 27 states are currently funded to convert their adult service systems from center-based programs emphasizing preparatory activities to industry-based employment. In addition, the Amendments of 1986 also provide for Title VI-C, which is a formula-based program for all states with the purpose of stimulating new supported employment programs.

Improving Access to Competitive Employment for Persons with Disabilities as a Means of Reducing Social Security Expenditures.

The Social Security Administration (SSA) disability programs have experienced tremendous growth in both beneficiaries and expenditures, threatening the viability of this safety net for individuals with disabilities. This article suggests that one means of assisting SSA beneficiaries to reduce dependence, thereby slowing program growth, is for the SSA to directly or indirectly fund competitive employment initiatives focusing on individuals who are currently served in nonremunerative day support programs. These initiatives require coordination of SSA trust funds with vocational rehabilitation and mental retardation/developmental disability funding streams.

Educational and Vocational Issues in Traumatic Brain Injury

This article describes some of the current issues related to return to school and employment for individuals with traumatic brain injury. A strong, collaborative partnership between an individuals health care providers and key stake holders is essential to a smooth transition back to school or work. Ways to improve current practices and ensure more timely and appropriate educational and employment services and supports for individuals with traumatic brain injury are described. Some recommendations on areas for future research are also offered.

Critical Issues in Planning Vocational Services in the 1990s

Efforts to predict the future are always difficult, even under the best of circumstances. In trying to assess what vocational opportunities will be available to people with mental retardation as this century closes, several difficulties come to mind. First, vocational programs depend heavily on the overall labor market and economy. As Stark and Goldsbury (1988) point out, one cannot analyze future trends for persons with disabilities out of the context of society as a whole. There is not a clear picture as of yet about how inflation, interest rates, or automation and mechanization will affect the labor force. We do know that there will probably continue for sometime to be a labor shortage in entry-level service occupations. Persons with mental retardation should be able to expand their growth into these positions.