3.6 Supported Employment

Once a patient with brain injury has returned to competitive employment they are at a high risk for failure because of the lingering effects of their brain injury.

What evidence is there for the benefit of supported employment following ABI?

  1. There is Level 3 evidence, from one case-control study and Level 4 evidence from one case series that supported employment improves the level of 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.

Gamble and Moore105seventy-eight patients with TBI received supported employment (treatment group), while 995 patients with TBI did not receive supported employment (control group) during vocational rehabilitation. Supported employment consisted of on-the-job training and support for as long as the client needed. Closure status (competitive employment versus not working), occupational placements, weekly earnings, and hours worked each week were used as some of the main outcome measures. Overall, the authors found supported employment significantly improved the level of competitive employment as 67.9% of those who received supported employment versus 47% of those who did not receive supported employment were competitively employed at the time of closure (p < 0.003). Both groups were equally employed in miscellaneous occupations at closure (43.4% of the treatment group versus 42.3% of the control group). The authors found thatthe provision of supported employment services contributed to competitive employment outcomes, particularly for clients with 12 or more years of education, clients over 35 years of age, male clients, clients without prior work experience, and clients with severe TBI.

Wehman et al. 106found that 41 of the 53 patients enrolled in the program were placed in competitive employment. They also noted that the average number of hours worked per week for the group was 31.2 hours. Wehman et al. 106also found that most of the patients had reached a point of stability and independence on the job within 20 weeks of working. Even though there were successes (although no statistically significant findings were reported) with this program, they did note that their findings did provide reason for cautious optimism.

Gamble D and Moore GL. Supported employment: Disparities in vocational rehabilitation outcomes, expenditures and service time for person with traumatic brain injury. Journal of Vocational Rehabilitation. 2003;47-57.

  • 78individuals with TBI who received supported employment (treatment group) were compared to 995 patients with TBI who did not receive supported employment (control group) during vocational rehabilitation.
  • The control group had significantly higher earnings per week than treatment group and the control group worked substantially more hours per week than treatment group.


The evidence favoring the utilization of supported employment programs in order to maximize the earning potential of these individuals is limited. There is a clear need for more data in this area to delineate the most appropriate strategies to facilitate job retention, maximizing earnings, and achieve vocational success.