Vocational interventions and supports following job placement for persons with traumatic brain injury

Previous research on vocational rehabilitation after traumatic brain injury (TBI) has suggested that coaching and other services provided following job placement are particularly important for successful work re-entry in this population. Methods of defining and measuring these services are needed to estimate more precisely their effects on vocational outcomes. In this study we developed a measure of the type, amount, and location of post-placement interventions that could be completed by treaters in "real time". Treatment was measured prospectively for 6 months after job placement for 65 people with moderate to severe TBI treated at 5 TBI Model System centers. Centers were found to differ substantially in the amount and location of treatment provided following job placement; centers providing more intensive treatment and treatment at the workplace also served more severely impaired clients at a longer interval after injury. Within centers, participants' cognitive speed and emotional distress predicted certain aspects of amount and type of treatment provided. Three-fourths of the sample were still working at the placement job after 6 months. Due to the confounding between case mix and treatment variables, unique effects of treatments on outcomes could not be determined.