Vocational Rehabilitation Outcomes for individuals with brain injury – per the RSA

A number of people who attended my presentations in Salem last week (annual Oregon Voc Rehab In-service Conference) asked me to post the “Vocational Rehabilitation Outcomes” tables used in my PowerPoint. The Tables and Summaries were provided by Frank A. Smith, who can be contacted at Frank.Smith@UMB.edu.

Voc Rehab Outcomes for consumers with TBI per the RSA.

  • Table 1: Total VR exiters in 1012
  • Table 2: Percentage of individuals with TBI that successfully returned to the workplace for at least 90 days after placement
  • Table 3: What percentage of the time do people work (hours per week)
  • Tables 4 & 5: Average length of time a case is open (months or range of months)
  • Tables 6 & 7: Average cost and or range of costs to the VR agency

Summary of Table #1:

Individuals with TBI were approximately 2% of all people who exited state VR programs in 2012. Most individuals with TBI who exited (95%) were marked has having a significant disability. Comparatively, 92% of other cognitively impaired individuals and 89% of all others with no TBI or cognitive impairment had a significant disability.

Summary of Table #2:

When an individual exits their VR program, a VR counselor assigns a “closure status” to each individual. The ideal outcome is that a person exits with an employment outcome. As Table 2 shows, about 35% of all individuals who exited VR in 2012 exited with an employment outcome. Looking at the four disability groups in Table 2 we see that when compared to the other groups, individuals with TBI have a lower rate of exiting into employment than individuals from other disability groups. This is true for people with TBI who do or do not have a significant disability.

Summary of Table #3:

Looking at the four disability groups in Table 3, we see individuals with TBI who exit their VR program with a job work fewer hours per week on average than individuals from other disability groups. For all disability groups in Table 3, individuals with a significant disability work fewer hours per week on average than those without a significant disability.

Summary of Table #4:

The number of days an individual is in the VR system, from the day they apply until the day they exit, can be an indicator of how well the VR system is equipped to serve individuals and can also be an indicator of how challenging it is for certain groups to complete a VR program. Looking at the columns for mean in Table 4, we see that individuals with TBI are typically in the VR system for longer than individuals from other disability groups. Not surprisingly, having a significant disability increases the amount of time and individual is in the VR system.

Summary of Table #5:

Not everyone is Table 4 is someone who exited with a job. When looking at the amount of time an individual is in the VR system, it is interesting to look at the subgroup of individuals who exited with a job. This is the group shown in Table 5. Looking at the columns for mean in Table 5, we see that individuals with TBI who exit with a job are typically in the VR system for longer than individuals from other disability groups. Not surprisingly, having a significant disability increases the amount of time and individual is in the VR system. Typically, individuals with TBI who exit with employment are in the VR system for over 2 years before exiting with a job.

Summary of Table #6:

Table 6 summary: Another metric that is interesting to look at is the total cost of services provided an individual while they were in their VR program. Compared to individuals with other disabilities, the mean cost of services purchased for individuals with TBI is typically higher. It should be noted that VR programs provide a wide range of services. Unfortunately, the RSA 911 does not allow us to know specifically how much was spent on the different services provided. It is also important to note that the cost of providing VR services may be miniscule when compared to the reduction in costs for public program transfers if a person gains sustainable employment.

Summary of Table #7:

Not everyone is Table 6 is someone who exited with a job. When looking at the cost of services purchased for an individual while they were in the VR system, it is interesting to look at the subgroup of individuals who exited with a job. This is the group shown in Table 7. Compared to individuals with other disabilities, the mean cost of services purchased for individuals with TBI is typically higher. It should be noted however that these are individuals who exited VR with employment, a very positive economic outcome.

Comments and questions are welcome.

“Clarify and Verify”

“Clarify and Verify” is perhaps one of the most POWERFUL compensatory skills (habits) an individual with cognitive inconveniences can practice.  It’s a common communication technique, but for anyone who is challenged with “mis-hearing,” “mis-remembering,” or other mis’s brain injury can cause this simple phrase often saves the day:

“Let me see if I heard you correctly.  You said (or asked me to) ___________________.  Is that right?”

Then write down the results (or speak the results into you iPad or other recording device). Not only is this good for you (the person asking for verification), it’s good for the person you are talking to.  It’s good for the relationship too.  The two-way communication “street” will be clear of clutter and misunderstanding.  And when others see you writing down the results, they will start to gain confidence that they are heard and you will know, if not remember, what was said and agreed upon. Employers are especially appreciative of this communication practice.  Don’t be surprised if they start using it, and asking others they work with to use it too!

Thank you Francis, for this valuable phrase.

Compensatory Strategies and Employment

NIH banner    Most of my functional gains are because I learned early that I got the most bang for my buck cognitively, by compensating for the gaps and glitches my brain injury caused.  See this article from 1999. See the attached with highlighting added where I was quoted (page 7): “Many of my peers would be working too, if they had been given the opportunity to learn how to compensate.”   NIH article quoting Moeller from 1994 – emphasis added

The entire article is still on the internet at: http://www.nichd.nih.gov/publications/pubs/TBI_1999/Pages/Appendix_A.aspx

Fast forward to 2014:

If I were being quoted today, instead of saying “learn how to compensate” (which is difficult without the kind of cognitive rehabilitation I was fortunate to have), I would say it this way:

“Many of my peers would be working too if they had the specialized tools and work-focused skills training they need to be able to compensate.”

For those of us with cognitive disabilities, our strengths often lie in being visually cueable.  This, coupled with the residual strength of muscle memory (AKA “procedural memory”), as long as we have accessible visual cues we can reach for, we can level the playing field at home, at work and in our involvement in the community.

After working with hundreds of individuals over 20 years’ time, my research and experience has resulted in a commitment to producing a state-of-the art compensatory system — a cognitive prosthetic, if you will — complete with self-help skills training support and 24/7 support. “Knowing how to compensate” continues to be the key, in my view, to empowerment, cognitive mobility, and sustainable, long-term functional recovery from brain injury and other “cognitive inconveniences.” For a printable copy of the image below: TRI-FOLD brochure

Everything in One Place

 

Newsletter – Cognitive Breaks

Newsletter Cognitive Breaks  Many of us have learned to take one-minute cognitive breaks during our work shift — perhaps one every hour.  If done throughout the work day — before we are so exhausted that we “crash and burn” — many of us can extend our productive hours at work longer and longer every day.  These breaks are in the category of “reasonable accommodations.”  For anyone who wants or needs to be able to work full-time, this strategy can be invaluable.

For details on how this works, download the newsletter from this link:  Newsletter – Cognitive Breaks

Cue Don’t Rescue

cue card

“Cue Don’t Rescue” is one of my mantras. I share it whenever the discussion focuses on empowerment.  Many of us can do a lot more than we ever imagined – attain or at least come within striking distance of our pre-injury level of function – when we train ourselves to use external memory cues. The trick is getting into the new habit of NOT looking in our heads for all the stuff that used to be accessible there.  Instead, we can learn to look for our external memory cues and tools.

The next trick is teaching those around us to cue us to use our external cues and tools, rather than jumping in to do for us, what we can do for ourselves. We don’t need other people to rescue us when we learn to cue ourselves. And others can stop trying to rescue when they start to see that we can do things on our own.

When we go back to work, “Cue Don’t Rescue” is particularly important for us to focus on – and to remind those we work with. See PowerPoint for examples.

CUE DONT RESCUE FOR EMPLOYERS – not updated 2014-07-25