title: A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes.
abstract: 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.
  
  
  METHODS
  One hundred fourteen Minnesota residents, ages 18 to 65 years, with acquired BI.
  
  
  METHODS
  
  
  
  RESULTS
  Five levels of Vocational Independence Scale (VIS).
  
  
  METHODS
  Preinjury employment status (VIS) and years of education, severity of initial injury, time since injury, current impairment/disability 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 employment; 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 1-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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Medical Center, Rochester, MN 55905, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Malec
authors.forename: A L
authors.initials: AL
authors.lastname: Buffington
authors.forename: A M
authors.initials: AM
authors.lastname: Moessner
authors.forename: L
authors.initials: L
authors.lastname: Degiorgio
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D012050:Rehabilitation, Vocational / Q000379:methods*