| Gamble & Moore (2003)
USA
Cohort
N=1073 |
Population: TBI; Mean Age=35.4yr; Gender: Male=800, Female=345.
Intervention: Patients from a public vocational rehabilitation service provider were compared: those with supported employment services (treatment) and those without (control).
Outcome Measure: Vocational status. |
1. There was a significant difference between the number of individuals who were competitively employed at time of case closure between those who were and those who were not provided with support (67.9% vs. 47%, respectively, p<0.003).
2. Controls had significantly higher earnings per week (p<0.05), worked more hours per week (p<0.001) and had fewer rehabilitation expenditures (p<0.001) than those who had employment services. |
| Klonoff et al. (2001)
USA
Case Series
N=164 |
Population: TBI=113, Stroke=38, Other=13; Mean Age=33.6yr; Gender: Male=108, Female=56; Mean Time Post Injury=13.9 mo.
Intervention: Follow up of participants in a work/school re-entry program at the Adult Day Hospital for Neurological Rehabilitation (ADHNR).
Outcome Measure: Rates of productivity depending on return to work/school. |
1. Of the participants who were productive pre-injury, 25.3% were engaged in the same line of work/school at the same capacity at follow up.
2. Eleven percent returned to the same job as pre-injury with modifications and 38.3% returned to a different job or school level (mostly lower) or in volunteer or homemaker positions.
3. Those working/in school at follow up were significantly younger than the non-productive group (p=0.009). |
| Malec & Moessner (2000)
USA
Post-Test
N=62 |
Population: TBI=48, ABI=14; Mean Age=34.8yr; Gender: Male=48, Female=14; Severity: Mild=2, Moderate=1, Severe=37, Undetermined=22; Median Time Post Injury=679 days.
Intervention: Patients completed a brain injury comprehensive day treatment program. Outcomes were evaluated at the end of the program and at 1yr follow-up.
Outcome Measure: Mayo-Portland Adaptability Inventory (MPAI), Vocational Independence Scale (VIS), Independent Living Scale (ILS), Goal Attainment Scaling (GAS). |
1. Those with mild impaired self-awareness (ISA) showed a decline in ISA on the MPAI from 37% to 29%, and those with moderate to severe ISA declined from 58% to 29%. Overall change after 1 yr was found to be significant (p<0.001).
2. ISA accounted for 23.7% of the variance in GAS scores (p<0.00).
3. ISA contributed significantly to the prediction of ILS (p<0.01).
4. There was no significant difference in VIS outcome at 1 yr. |
| Klonoff et al. (1998)
USA
Pre-Post
N=64 |
Population: TBI=37, Stroke=19, Other=8; Mean Age=35yr; Gender: Male=44, Female=20.
Intervention: Patients attended a work/school re-entry program (6hr/d, 5d/wk).
Outcome Measure: Adjusted outcome scores (productivity at discharge vs impairment at admission), Working alliance ratings, Work eagerness, Work readiness. |
1. At discharge, 89.5% showed a fair or good adjusted outcome, 62% were gainfully employed or full-time students, with 15.6% returning to the same level of work or school as before the injury.
2. Patient and family working alliance during treatment correlated with level of successful adjusted outcome (p<0.01).
3. Work eagerness was found to be significantly related to productivity (p<0.001).
4. Patients seeking compensation had lower work eagerness (p<0.01) but not lower work readiness.
5. Those with more severe injuries had better adjusted outcomes than those with less severe injuries. |
| Wall et al. (1998)
USA
Post-Test
N=38 |
Population: TBI=31, Stroke=3, Other=4; Mean Age=35.38yr; Gender: Male=28, Female=10; Mean Time Post Injury=8.91yr; Severity: Severe=90%.
Intervention: Patients attended a 16 wk Community Based Training Program (CBTP) that combined work adjustment and supported employment concepts. Outcomes were assessed after treatment and at follow-up.
Outcome Measure: Employment status, Modified Job Diagnostic Survey (mJDS). |
1. Fifty-eight percent of patients completed the program. Those who completed the program had a longer length of disability and longer pre-injury work histories than those who did not complete it (p<0.05).
2. Mean time from program completion to follow-up was 18.67mo, at which point 38% were employed.
3. More than one placement was required by 14% of the sample to secure employment and 14% were still in the placement process.
4. Of those who completed the program, 59% were competitively employed, 24% were unemployed, and 18% were still in the placement process.
5. For those employed, the mean mJDS score was 25.18 (i.e. they were satisfied with their positions as persons without disabilities). |
| Buffington & Malec (1997)
USA
Pre-Post
N=80 |
Population: TBI=52, ABI=27; Median Age=37yr; Gender: Males=50, Females=30; Mean Time Post Injury=64mo; Severity: Mild=10, Moderate-Severe=35, Unknown=7.
Intervention: Patients received vocational services and assistance through inpatient or outpatient rehabilitation with follow-up 90 days after occupational placement.
Outcome Measure: Vocational Outcome Scale (VOS). |
1. At 3mo, almost 40% were placed, with the majority placed in independent competitive work (VOS level 5).
2. At 1yr, about 70% of all participants were placed.
3. Of those placed by 1yr, 74% were in community-based employment (VOS levels 3-5), of which 41% were placed into independent work (VOS level 5).
4. Of all placements made, 37% were returning to work with the same employer as pre injury, but not necessarily the same job.
5. Those entering the program at <12mo post injury had significantly faster (3.68 vs. 6.0mo) and better (VOS score of 4.48 vs. 3.74) job placements than those entering the program >12mo post injury (p<0.05). |
| Wehman, Kreutzer, et al. (1989)
USA
Pre-Post
NInitial=20, NFinal=20
|
Population: TBI=20; Age Range=18-64yr; Gender: Male=18, Female=2; Mean Time Post Injury=Not reported; Severity: Mild=0, Moderate=0, Severe=20
Intervention: Participants received supported employment intervention, which involved job development, job placement, job site training, and job retention services provided by job coaches. The intervention was provided over a number of weeks or months until the participants’ job performance was stabilized.
Outcome Measures: Job placement outcomes (wages, hr worked, length of employment and type of occupation, direct behavioral observation of work performance, a 5-point Likert scale form on the participants’ work habits completed by employers, monthly employment ratio (dividing the # of months the client was employed during an employment phase by the total possible months that he/she would have had an opportunity to be employed) |
1. The mean number of hr worked per person for supported employment intervention was 278hr.
2. Employment ratios improved significantly after the intervention (p<.001) |
| Wehman et al. (1988)
Post-Test
USA
NInitial=32, NFinal=15
|
Population: TBI=32; Mean Age=29yr; Gender: Male=90.6%, Female=9.4%; Mean Time Post Injury=Not reported; Severity: Mild=0, Moderate=0, Severe=32
Intervention: Participants were clients who received supported employment intervention over the course of 5yr. The intervention involved job development, job placement, job site training, and job retention services provided by job coaches. Participants had received an average of 266h of intervention at the time of the program evaluation. The intervention was still ongoing as of the writing of the article.
Outcome Measures: hours worked, type of occupation, job retention, length of employment, staff intervention hours required |
1. Fifteen of the participants had been placed in competitive employment as of the writing of the article.
2. Participants gained employment in warehouse (31.5%), clerical (31.5%), and human service-related occupations (19%).
3. Mean hr worked per wk was approx. 31h.
4. Eleven of 15 participants were still working as of the writing of the article, making up a job retention rate of 73.4%.
5. The mean length of employment was 9mo as of the writing of the article.
6. The percentage of the intervention hours that required assistance from job coaches saw a steady decline, from an initial percentage level of approx. 90% over the first 7wk of placement to less than 10% at 28wk. |
| Wehman et al. (1993)
Pre-Post
USA
NInitial=80, NFinal=80
|
Population: TBI=80; Mean Age=30.9yr; Gender: Male=82.5%, Female=17.5%; Severity: Mild=0, Moderate=0, Severe=80; Mean Time Post Injury=6.1yr
Intervention: Participants received supported employment intervention, which involved job development, job placement, job site training, and job retention services provided by job coaches. The intervention was provided over a number of weeks or months until the participants’ job performance was stabilized.
Outcome Measures: Hr worked, type of occupation, earnings, job retention, monthly employment ratio, intervention hr required from job coaches |
1. Participants’ monthly employment ratio increased from 13% after injury with no supported employment to 67% with supported employment services (a ratio of 100% indicates continuous employment).
2. The majority of participants were employed in warehouse (23.7%), clerical (19.5%), and food service-related occupations (16.9%).
3. An average of 249.1h was required from job coaches to train and provide follow-up services to program participants. |
| Wehman, West, et al. (1989)
USA
Case Series
NInitial=5, NFinal=5 |
Population: TBI=5; Mean Age=30yr; Gender: Male=5; Severity: Mild=0, Moderate=0, Severe=5
Intervention: Participants received supported employment intervention, which involved job development, job placement, job site training, and job retention services provided by job coaches. The intervention was provided over a number of weeks or months until the participants’ job performance is stabilized.
Outcome Measures: Wages earned per week, hr worked per week, Staff intervention hr and costs of the program, supervisors’ levels of satisfaction with participants’ job performance rated on a 5-point scale, with 1 indicating extreme dissatisfaction and 5 indicating extreme satisfaction |
1. The range of hours worked per week varied from 15 to 40.
2. Participants required 339hr of job coach intervention time on average.
3. Employers were generally satisfied to very satisfied with participants’ job performance, with the mean supervisor ratings ranging from 3.1 to 4.3 on a scale of 1-5. |
