title: Vocational services for traumatic brain injury: treatment definition and diversity within model systems of care.
abstract: 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.
authors.affiliation: Moss Rehabilitation Research Institute and Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19141, USA. thart@einstein.edu
authors.forename: Tessa
authors.initials: T
authors.lastname: Hart
authors.forename: Marcel
authors.initials: M
authors.lastname: Dijkers
authors.forename: Robert
authors.initials: R
authors.lastname: Fraser
authors.forename: Keith
authors.initials: K
authors.lastname: Cicerone
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Bogner
authors.forename: John
authors.initials: J
authors.lastname: Whyte
authors.forename: James
authors.initials: J
authors.lastname: Malec
authors.forename: Brigid
authors.initials: B
authors.lastname: Waldron
mesh_terms: 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