title: The Program Without Walls: innovative approach to state agency vocational rehabilitation of persons with traumatic brain injury.
abstract: OBJECTIVE
  To describe the Program Without Walls (PWW), a person-centered, community-based approach for state rehabilitation counselors to provide vocational rehabilitation (VR) services to people with traumatic brain injury (TBI).
  
  
  METHODS
  Nonrandomized posttest only matched control group design using existing state VR data.
  
  
  METHODS
  Community-based within 2 district offices of the state-federal VR program in New York State.
  
  
  METHODS
  VR consumers with TBI (N=42); 21 received PWW services, and 21 matched controls received traditional VR services.
  
  
  METHODS
  All participants experienced the initial VR process: eligibility determination and the development of an individualized employment plan. Participants receiving the traditional approach were referred to various organizations for services and monitored by their state VR counselor. Those receiving PWW services were never "handed off" to outside agencies. Instead, they received person-centered, community-based services from a team of freelance consultants who were recruited, trained, and supervised by the state VR counselor overseeing the PWW team.
  
  
  METHODS
  Data were gathered from VR central files for all consumers with a primary or secondary disability of TBI. Outcome variables were case status at closure, weekly earnings at closure, hours working at closure, and cost of case services.
  
  
  RESULTS
  The PWW successfully placed more consumers who worked a greater number of hours per week and earned more per week than those who received traditional VR services without increasing the cost of case services.
  
  
  CONCLUSIONS
  The PWW showed promise as a systems change effort to improve VR services for people with TBI.
authors.affiliation: Department of Educational Foundation and Counseling Programs, Hunter College, City University of New York, New York, NY 10021, USA. joneil@hunter.cuny.edu
authors.forename: John H
authors.initials: JH
authors.lastname: O'Neill
authors.forename: Rosalind R
authors.initials: RR
authors.lastname: Zuger
authors.forename: Audrey
authors.initials: A
authors.lastname: Fields
authors.forename: Robert
authors.initials: R
authors.lastname: Fraser
authors.forename: Timothy
authors.initials: T
authors.lastname: Pruce
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D009518:New York; D019982:Organizational Case Studies; D018802:Patient-Centered Care; D012050:Rehabilitation, Vocational / Q000379:methods*; D013221:State Health Plans / Q000458:organization & administration*; D014481:United States