A medical/vocational case coordination system for persons with brain injury: An evaluation of employment outcomes

Objective: To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. Participants: One hundred fourteen Minnesota residents, ages 18 to 65 years, with acquired BI. Main Outcome Measures: Outcome: Five levels of Vocational Independence Scale (VIS). Predictor: Preinjury employment status (VIS) and years of education, severity of initial injury, time since injury, current impairment/disaibility as measured by the Rasch-analyzed Staff Mayo-Portland Adaptability Inventory (MPAI), and impaired self-awareness measured by staff rating and the difference between Staff MPAI and Survivor MPAI. Results: At placement, 46% in independent work; 25% in transitional placements; 9% in long-term supported employ ment; 10% in sheltered work; and 10% not placed. At 1-year follow-up (n = 101), 53% in independent work; 19% in transitional placement; 9% in supported work; 6% in sheltered work; and 13% unemployed. Regression analyses showed time since injury and Rasch Staff MPAI predicted VIS at placement; only VIS at placement independently predicted VIS at I-year follow-up; Rasch Staff MPAI and preinjury education level predicted time to placement. Conclusions: The MVCCS optimized vocational outcome after BI. Time since injury and impairment/disability best predicted Vocational placement. Level of initial placement best predicted employment status at follow-up. Persons with greater disability required more extended time and more extensive rehabilitation services before placement.