title: Persons with brain injury and employment supports: Long-term employment outcomes and use of community-based services.
abstract: OBJECTIVE
  To understand how employment services (ES) are provided to persons with brain injuries (PWBIs) in Ontario, Canada, and the impact service delivery has on competitive-employment outcomes.
  
  
  METHODS
  A mixed-method case study of one community-based agency that provides specialized services to PWBIs. Relationships between demographic, service-related variables and employment outcomes (2009-2014) were analysed using chi-squares and analyses of variance. In addition, 14 interviews were conducted and analysed using thematic analysis.
  
  
  RESULTS
  PWBIs accessed services on average of 16 years post injury; 64% secured at least one competitive-employment job, which was how employment success was defined in this study. Average job tenure was 368 days, and average job intensity was 3.8 hours/day. Employment success was significantly associated (p < 0.05) with use of job development, job coaching, case management and job retention services. Interviews revealed that PWBIs were provided five services: job goal(s) identification, assessment of work-related abilities/skills, job development, on-the-job supports and job retention assistance. Challenges to ES delivery included lack of suitable jobs and hiring incentives, and difficulties in establishing natural supports at the workplace.
  
  
  CONCLUSIONS
  PWBIs' employment outcomes may be supported through provision of ES to assist with: the development of realistic job goals and job-finding skills, securing work, on-the-job coaching and advocacy with employers.
authors.affiliation: a Toronto Rehabilitation Institute , University Health Network , Toronto , ON , Canada.|b Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada.
authors.forename: Alisa
authors.initials: A
authors.lastname: Grigorovich
authors.affiliation: a Toronto Rehabilitation Institute , University Health Network , Toronto , ON , Canada.|c Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada.|d Institute of Work & Health , Toronto , ON , Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Stergiou-Kita
authors.affiliation: e School of Social Work, University of Windsor , Windsor , ON , Canada.
authors.forename: Thecla
authors.initials: T
authors.lastname: Damianakis
authors.affiliation: c Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada.|f School of Speech-Language Pathology and Audiology, Faculty of Medicine , Université de Montréal , Montreal , QC , Canada.|g Centre for Interdisciplinary Research in Rehabilitation of Montreal , Montreal , QC , Canada.
authors.forename: Guylaine
authors.initials: G
authors.lastname: Le Dorze
authors.affiliation: h Community Head Injury Resources , Toronto , ON , Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lemsky
authors.affiliation: a Toronto Rehabilitation Institute , University Health Network , Toronto , ON , Canada.|c Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada.
authors.forename: Debbie
authors.initials: D
authors.lastname: Hebert
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000523:psychology* / Q000534:rehabilitation*; D018672:Community Health Planning / Q000379:methods / Q000706:statistics & numerical data*; D004651:Employment; D016832:Employment, Supported / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012050:Rehabilitation, Vocational / Q000379:methods; D012189:Retrospective Studies; D055815:Young Adult
keywords: Acquired brain injury; community integration; community-based rehabilitation; mixed method; work