Traumatic Brain Injury and Work Re-entry
Guest Editor: Paul Wehman, PhD
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Message from the Guest Editor
Work is a critical part of adult life. Employment brings financial independence, socialization, a sense of purpose, and opportunity for personal growth. Therefore, disruption to employment following a traumatic brain injury (TBI) negatively impacts many life areas beyond simply employment status. Unfortunately, individuals with TBI experience substantially higher rates of unemployment than individuals without disabilities and are faced with difficult decisions about how, when, and where to return to work. While some individuals with TBI will resume employment at a previous position, others will need to consider pursuing work in different departments within the same company or in another industry altogether. The return to work process is different for each individual as some may be ready soon after injury while others may have a longer term, chronic disability and thus require more medical intervention before work becomes a possibility. The take-away message from this special “return to work issue” is that employment is possible and desirable for most patients with TBI. Approximately 30 years ago it was next to impossible to find articles documenting meaningful competitive employment outcomes for individuals with long term TBI, yet, over time this has changed. We increasingly know that patients with TBI can successfully return to work through use of vocational supports and services.
This issue of Brain Injury Professional focuses on detailing the scope of the issue of unemployment for individuals with TBI along with presenting employment interventions that promote successful return to work for both military and civilian populations. The first article by Dr. Dillahunt-Aspillaga and colleagues presents an overview of current research on the status of employment for Veterans with TBI. She includes important descriptions of services such as vocational case management, cognitive rehabilitation, vocational rehabilitation counseling engagement, and supported employment all with or without increased utilization of assistive technology, which show promise as effective interventions.
Next, my colleagues and I present a complimentary article to Dr. Dillahunt-Aspillaga’s article by describing how Service Members and Veterans who have extensive polytrauma injuries are able to receive employment supports through the U.S. Department of Veterans Affairs polytrauma network.
The remaining two papers by Dr. Koch and colleagues, and Dr. Whittenburg and colleague focus on an array of interventions available to both civilian and military populations through state Vocational Rehabilitation agencies. These include services focused on assessment, on the-job support, and intervention models such as supported and customized employment.
In particular, customized employment is an emerging practice with wide implications for individuals with TBI because it focuses on working with employers to create positions that mutually benefit the employer and the individual with TBI.
Finally, an interview from the perspective of a Vocational Rehabilitation Counselor who has worked to return Veterans with TBI to employment is included. In the interview, Cynthia Young offers insight into some of the struggles and successes Veterans with TBI experience during the process of regaining employment.
Work offers a variety of benefits. Moving forward, there needs to be more research on the therapeutic impact of return to work on TBI. It is absolutely essential that such studies be conducted in the years ahead in order for physicians, psychologists, parents, patients and policymakers to understand the full benefits of work and to make return to work a priority.
About the Editor
Paul Wehman, PhD, is a VCU Professor in the School of Education’s Counseling and Special Education Department with a longtime appointment in the VCU Health System’s Physical Medicine and Rehabilitation. He is Director of both the VCU Rehabilitation Research and Training Center and the Autism Center for Excellence and Editor-in-Chief of the Journal of Vocational Rehabilitation. Recognized as one of the 50 Most Influential People in Special Education for the millennium by Remedial and Special Education, his highly interdisciplinary background has made him a nationally recognized expert in transition, supported employment, brain injury, physical and developmental disabilities and autism.
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