Vocational services for traumatic brain injury: treatment definition and diversity within model systems of care.
OBJECTIVE
To examine characteristics and diversity among vocational treatment services in model programs for traumatic brain injury (TBI) rehabilitation.


METHODS
Vocational or postacute treatment components of 16 TBI Model System (TBIMS) centers.


METHODS
Vocational director/coordinator from each TBIMS surveyed in semistructured phone interview.


METHODS
Survey of vocational services for people with TBI, with about 100 closed and open-ended questions on vocational assessments; pre- and postjob placement treatments; program philosophies; funding; and integration of cognitive, behavioral, family, and medical rehabilitation interventions.


RESULTS
Great diversity was found among the vocational services of the 16 TBIMS. Programs fell into 3 clusters emphasizing medical rehabilitation services, supported employment, or a combination of these with an emphasis on case management. Job coaching was identified as a key intervention, but there was great variability in intensity, availability, and funding of coaching services.


CONCLUSIONS
Diversity in vocational services appears related to funding differences and "parallel evolution" rather than strong treatment philosophy or scientific evidence base. Multicenter research on effectiveness or establishment of best practices in vocational rehabilitation after TBI must deal with substantial existing variability in treatment models and specific interventions, and must examine the relationship of treatment variations to case-mix factors.
Hart
Tessa
T
Moss Rehabilitation Research Institute and Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19141, USA. thart@einstein.edu
Dijkers
Marcel
M
Fraser
Robert
R
Cicerone
Keith
K
Bogner
Jennifer A
JA
Whyte
John
J
Malec
James
J
Waldron
Brigid
B
D001930:Brain Injuries / Q000534:rehabilitation*; D019090:Case Management; D016832:Employment, Supported; D019538:Health Care Surveys; D006801:Humans; D009937:Organizational Objectives; D012050:Rehabilitation, Vocational / Q000379:methods