Once a patient with ABI has returned to competitive employment they are at a high risk for failure because of the lingering effects of their brain injury. Available evidence for assisting patients who are with coping with work-related stress due to their disability is reviewed in this section.
Supported employment has a good track record of improving the chances of patients with ABI finding employment. In a study by Gamble and Moore (2003), 78 patients with TBI received supported employment (treatment group), while 995 patients with TBI did not receive supported employment (control group) during vocational rehabilitation. Overall, supported employment significantly improved the level of competitive employment (67.9%) compared to those who did not receive supported employment (47%). Gamble and Moore (2003) found that the provision of supported employment services contributed to competitive employment outcomes particularly for clients who had 12 or more years of education, prior work experience and severe TBI, and were over 35 years of age and male. For those that do return to work, Wehman et al. (1990) found that most individuals reached a point of stability and independence on the job within 20 weeks of working.
Despite the prominence of supported employment, other approaches have been tested to compete with such programs by focusing on additional functional aspects that further the patients’ abilities in the workplace. Twamley et al. (2014) compared enhanced supported employment with CogSMART, a cognitive symptom management and rehabilitation therapy plus supported employment with veterans. It was found that although there were no statistically significant differences between the two groups on psychological issues, more participants in the CogSMART group obtained employment in the first 14 weeks of treatment (50% versus 28%). CogSMART participants also demonstrated significantly greater improvements in memory (Twamley et al. 2014). Despite such programs being effective in helping individuals obtain employment, the evidence favoring the utilization of supported employment programs in order to maximize the earning potential of these individuals post ABI is limited. There is a clear need for more data in this area to delineate the most appropriate strategies to facilitate job retention, maximize earnings, and achieve vocational success.
There is Level 2 evidence that cognitive symptom management and rehabilitation with standard supported employment results in greater employment rates, improved memory and a reduction in psychiatric and post-concussive symptoms.
There is Level 3 evidence that supported employment improves competitive employment outcomes particularly for ABI survivors who are older, have more education, have no prior work experience or who have suffered more severe injuries.
Supported employment results in patients being competitively employed more often than if they had not received supported employment.