Predictors of success for state vocational rehabilitation clients with traumatic brain injury.

Abstract

To determine the characteristics of individuals with traumatic brain injury (TBI) who request state vocational rehabilitation services and to determine the best predictors of their successful vocational outcomes. Observational study. Vocational services data from the Missouri Division of Vocational Rehabilitation (DVR). Seventy-eight individuals with TBI who requested services from the Missouri DVR. Not applicable. Demographic, injury severity, neuropsychologic variables, vocational services offered, and vocational status at time of case closure (successful, unsuccessful, services interrupted, no services provided). Individuals requesting DVR services were primarily men (71%), white (82%), single (47%), of low average intelligence (Wechsler Adult Intelligence Scales-III full scale IQ score, 84.8), and of limited education (11.8 y). The majority experienced a significant TBI (ie, 66% were hospitalized after their TBI; 56% reported loss of consciousness; 37% reported posttraumatic amnesia; 32% reported multiple TBIs; avg time since injury, 9.2 y). At DVR case closure, 17% were rated as being successfully employed, with nearly all working in industrial, service, or clerical positions (2 in a sheltered workshop, 1 in a professional position). Stepwise logistic regressions indicated that delivery of DVR services (ie, vocational guidance and counseling, on-the-job training) predicted vocational outcome and demographic, injury severity, and neuropsychologic variables did not. DVR clients have multiple impairments that affect them several years postinjury; the provision of DVR services may be more important in determining vocational outcomes than traditional medical, psychologic, and demographic variables.