Research and Training Center on Community Integration of Individuals with Traumatic Brain Injury

1. Department of Rehabilitation Medicine Mount Sinai School of Medicine New York City Research and Training Center on Community Integration of Individuals with Traumatic Brain Injury Supported by Grant No. H133B980013, from the National Institute on Disability and Rehabilitation Research, United States Department of Education.

2. Program Without Walls:Evaluation of an Innovative Approach to State Agency Vocational Rehabilitation

3. Overview of Presentation • History and background of the Program Without Walls (PWW) • PWW Model • Evaluation data • Case studies

4. History and Background of PWW • Model was developed in Rochester New York by two State VR Counselors • PWW services are consistent with the services provided by high performing VR offices • The Research and Training Center and the New York State VR agency (VESID) implemented the PWW model in two lower performing VR offices: New York City and White Plains

5. The Effectiveness of Vocational Rehabilitation (VR) Services for People with TBI in New York State • In New York State there are high performing and low performing State VR offices • High performing offices have rehabilitation rates greater than 50% • Low performing offices have rehabilitation rates of less than 50%

6. Differential Service Patterns for People with TBI in High Performing and Low Performing VR Offices Services used more frequently by high performing VR Offices Community based evaluation and training Higher education Psychosocial services

7. Differential Service Patterns for People with TBI in High Performing and Low Performing VR Offices Services used more frequently by low performing Offices Facility based evaluation and training Neuropsychological services Medical evaluation and treatment Psychological evaluation and treatment

8. The PWW Model • State VR counselor remains fully accountable-counselors do not transfer responsibility to agencies • State VR counselor recruits, trains and supervises a team of independent contractors or vendors

9. The PWW Model • Vendors provide person-centered services in the community • Some vendors are individuals with brain injury

10. PWW Services • Functional cognitive remediation at work, school, or in the home • Situational assessment • Work based learning: internship, job tryouts • Service coordination (e.g. housing, benefits, medical/psychiatric services)

11. PWW Services • Individual and family counseling • Job coaching • Job development and placement • Tutoring

12. Evaluation Design • A total of 42 VR participants whose cases had been closed took part in the study. • Twenty-one participants received PWW services. • Twenty-one participants who received traditional VR services were matched with the PWW participants on gender, age, ethnicity and education.

13. Participants Characteristics • Ethnicity White 42% (N=18) Diverse 58% (N=24) (I.e., Black, Asian) • Gender Men 81% (N=34) Women 19% (N=9) • Education Finished High School 14% (N=6) Did not Finish High School 48% (N=20) Some Postsecondary Education 38% (N=16)

14. Outcomes in New York City and White Plains • Higher rates of rehabilitation for consumers served by the PWW versus the matched consumers with brain injuries who received traditional services. • Higher weekly earnings and hours worked per week for PWW consumers versus matched consumers with brain injuries who received traditional services. • Cost of the PWW is not significantly different from standard services provided to brain injured consumers.

15. Out Comes for Consumers with Traumatic Brain Injury in New York City and White Plains PWW Matched Controls Rehabilitation Rates 57% 24% Weekly Earnings $328.70 $124.00 Hours Worked 32.02 17.80 Average Cost $3586.10 $3326.00 of Services

16. First Case Example Introduction • A 36 year old Latino who was shot in the head in 1990 • Language : Spanish/English bilingual • Consequences of TBI: memory, cognitive processing and speech deficits; right side hemiparesis, hemisensory loss and hemianopsia; chronic pain in left arm • Former employment: owned and operated two small businesses • High school diploma plus one year of college • Vocational goals: Self employment, security guard • Participated in two facility based diagnostic vocational evaluations (DVE) prior to receiving PWW services • DVEs found consumer unemployable or unable to benefit from further training

17. First Case Example PWW Services Functional cognitive remediation and service coordination provided by a rehabilitation counselor PWW Vendor • Pursued training as a Kiosk operator through Commission for the Blind but visual impairment was not severe enough • Coordinated remedial reading evaluation to determine reading levels because consumer wanted to return to college • Coordinated services with community based clinical counselor throughout

18. First Case Example PWW Services Functional cognitive remediation and service coordination provided by a rehabilitation counselor PWW Vendor • Pursued vocational placement options by working directly with many employment programs • Tutored consumer for security guard pre-employment and post-employment tests Outcome Working full-time as a security guard and has received one raise

19. Implications • The PWW is one way of serving a challenging, underserved population and improve bottom-line VR outcomes • The PWW can improve the effectiveness of lower performing VR offices • Best practices can be infused into low performing VR offices via the PWW