Return to Work After Brain Injury

1. Return to Work After Brain Injury Jeffrey S. Kreutzer, Ph.D. Virginia Commonwealth University Medical Center

2. Pre- and Postinjury Work Statusof Patients Working Postinjury Brooks, Glasgow

3. Proportion of Employed Patientsat Varying Times Postinjury Brooks, Glasgow Months Postinjury

4. Return to Work and Job Stability after TBIA TBI Model System Multicenter Analysis J. Kreutzer, J. Marwitz, W. Walker,et al. Virginia Commonwealth University Medical Center Job Stability after TBI

5. Job Stability after TBIPrimary Outcome Measure • Job Stability –operational definition • Stably Employed - employed at all three follow-up intervals (n=44) • Unstably Employed - employed at 1 or 2 of 3 follow-up intervals (n=35) • Unemployed - unemployed at all 3 follow-up intervals (n=50)

6. Employment and Productivity Status Job Stability after TBI

7. Employment and Productivity Status Job Stability after TBI

8. TBIMS Employment Rates 1996 and 2002Comparisons

9. no transportation bad temper no motivation can’t walk or climb stairs depression poor vision trouble using limbs can’t speak properly can't understand speech memory problems seizures medical illness thinking problems Perception of Problems Impeding Return to Work n=443

10. Perceived Employment Impediments

11. Key PointSuccessful Return to Work holistic approaches work best

12. 1. Bored 2. Moves slowly 3. Frustrated 4. Difficulty lifting 5. Writes slowly 6. Reads slowly 7. Poor concentration 8. Trouble making decisions Neurobehavioral ProblemsMost Commonly Reported 5 - 10 Years Postinjury 9. Tired 10. Thinks slowly 11. Loses train of thought 12. Easily distracted 13. Impatient 14. Loses balance 15. Misunderstood by others Witol, Sander, Seel, & Kreutzer

13. 1. Frustrated 2. Forgets reading 3. Impatient 4. Misunderstood 5. Bored 6. Loses train of thought 7. Reads slowly 8. Writes slowly 9. Moves slowly Neurobehavioral ProblemsMost Commonly Reported More Than 10 Years Postinjury 10. Tired 11. Thinks slowly 12. Thinking of the right word 13. Restless 14. Trouble making decisions 15. Trouble following directions 16. Learns slowly Witol, Sander, Seel, & Kreutzer

14. Symptom 5- 10 yrs10+ yrs bored 2.57 2.28 frustrated 2.40 2.44 impatient 2.20 2.33 misunderstood 2.14 2.33 Most Commonly Reported Mood Problems* n=97 *among 15 most commonly reported

15. Symptom5-10 yrs10+ yrs moving 2.54 2.22 writing 2.30 2.24 reading 2.34 2.27 thinking 2.27 2.19 learning 2.11 Most Commonly Reported Slowness Problems* *among 15 most commonly reported

16. Employee EvaluationSupervision Issues Rating 1. Performs routine tasks with little or always no guidance 2. Requires little supervision to always complete complex tasks 3. Willingly accepts and carries out always assignments Position Title: Executive Secretary I

17. Employee EvaluationTime Utilization Issues Rating 1. Able to work effectively against always tight deadlines 2. Performs effectively in pressured always and tense situations 3. Uses time in an efficient and always productive manner 4. Uses the organization’s resources always effectively to meet deadlines Position Title: Executive Secretary I

18. Employee EvaluationTime Utilization Issues Rating 5. Sets priorities and revises work always plans to meet deadlines 6. Works overtime to make certain always that deadlines are met 7. Punctual always 8. Coordinates time away from the always office in accordance with guidelines Possible Ratings: Always, Usually, Rarely

19. Employee EvaluationKnowledge and Creativity Rating 1. Demonstrates thorough knowledge always and applies to assignments 2. Maintains conscientious effort usually to enhance knowledge 3. Provides and applies creative usually solutions to assignments Position Title: Executive Secretary I

20. Employee EvaluationPerformance Quality Issues Rating 1. Thorough and accurate in usually completing assignments 2. Attentive to detail usually 3. Maintains acceptable production usually rate without sacrificing quality 4. Reliable always Possible Ratings: Always, Usually, Rarely

21. Employee EvaluationPerformance Quality Issues Rating 5. Answers calls promptly and takes always accurate messages 6. Demonstrates good follow-through always on assignments 7. Adapts and copes well with always changing situations 8. Written communication is organized, always grammatical, and accurate Position Title: Executive Secretary I

22. Performance EvaluationProfessionalism Rating 1. Active in providing phone coverage always to the team 2. Offers assistance to team members always and supports “team concept” 3. Resolves conflict in a professional usually manner Position Title: Executive Secretary I

23. Key PointSuccessful Return to Work Recognize that employee evaluations often emphasize performance speed

24. Key PointSuccessful Return to Work Some jobs and work environments are more disability-friendly than others

25. Key Point Vocational Demands and Outcome Success in higher status occupations is more difficult because of lower error tolerances

26. Typing & word processing Computer data entry Photocopying Phone answering Collating & stapling Mail preparation Filing Packaging & unpacking Pricing Delivery Light assembly Light cleaning Microfilming Food preparation Vocational Tasks for Personswith Severe Disabilities

27. Experience tells us that people with even the most severe disabilities can succeed at working - • The personal qualities of successful workers are well known. • Personal qualities are different than work skills. • You have the ability to change the kind of person you are, and to succeed at work. How so?

28. “Am I Ready To Work ?” TestTrue or False? • I know my strengths and limitations. • I have clear goals and focus on making things better. • I keep trying even when things seem difficult. • I try to learn from my mistakes.

29. “Am I Ready To Work ?” TestTrue or False? • I am willing to admit when I make a mistake. • I am willing to ask for help. • When people ask if I need help, I respond politely. • When people talk, I make sure to listen.

30. “Am I Ready To Work ?” Test True or False? • When I’m not sure how to do something, I ask. • I look for the positive in other people and situations. • I’m polite and respectful to others. • I can learn a lot from other people. • I’m thankful when people offer me constructive feedback.

31. “Am I Ready To Work ?” Test True or False? • I do my best to be patient with myself, my goals, and other people. • I pay attention to how I’m feeling. • I work hard to control my discouragement and anger. • I think about other people’s feeling.

32. “Am I Ready To Work ?” Test True or False? • I can clearly see the benefits of work. • Outside of work, I try to do things that are good for me. • I choose to spend time with people who can help me reach my goals.

33. “Am I Ready To Work ?” Test True or False? • I am an important and responsible member of my treatment team. • I communicate my feelings, needs, concerns, and ideas. • I understand that success at work means more than just doing my job.

34. Vocational Planning and Counseling Jeffrey S. Kreutzer, Ph.D., ABPP VCU Health System

35. Case Planning Issues • Should I choose to help this person find and keep a job? • What goals and time frames are practical? • What do I need to be concerned about or sensitive to?

36. Client FactorsCharacter, Personality, Intellect, Skills, and Health • Work ethic, attitude, desire for success • Stamina, sleep, pain, and health • Transportation independence • Stress and frustration tolerance • Control of sexual and aggressive impulses • Ability to accept diminished skills and potential

37. Client FactorsCharacter, Personality, Intellect, Skills, and Health • Interpersonal and negotiation skills • Responsiveness to feedback • Neuropsychological functioning • Adaptability • Loyalty to employer

38. Client FactorsSituational • Immediate and long-term financial needs • Expense of working • Accumulated benefits and other pressures to remain • Consistency between career plans, hopes, and available options • Retirement plans

39. Work Responsibilities and Environmental Factors • Dangers • Cost of making mistakes • Job complexity and demand on workers • Flexibility in scheduling and assigning responsibilities • Organizational stability • Noise, distractions, and ambience

40. Colleague and Supervisor Factors • Presence and level of supervision • Morale • Attitude toward people with disabilities and willingness to be supportive • Employee evaluation and feedback system • Competitiveness • Tolerance of individual differences

41. Community Factors • Demand for workers • Accessibility • Presence and types of local businesses • Availability of medical and rehabilitation resources • Cost of living and average wages

42. Return to WorkAssessment Jeffrey S. Kreutzer, Ph.D., ABPP VCU Health System

43. Assessment ComponentsInterview or Questionnaire Format • conditions for return to work • responsibilities • schedule • safety issues • work environment • relationship with your supervisor • goals and job security

44. Conditions for Return to Work • Has your doctor or employer set any conditions for your return to work? • If yes, describe conditions……. • How long do you feel that you need before you can return to work part-time? • How long do you feel that you need before you can return to work full-time?

45. Responsibilities • What is your job title? Do you have a written job description? If yes, please provide a copy. • Is driving required for you to perform your job? Will transportation be an issue if you return to work? How will you get to work? • Describe job responsibilities and indicate most important.

46. Responsibilities • Do you have contact with customers? If yes, please describe. • Do you have contact with other workers? If yes, please describe. • Do you supervise other workers? If yes, please describe? • What equipment do you use on your job? Describe any training or qualifications to use equipment.

47. Schedule • How many hour per week are you required to work? • Are you required to work overtime? • Would you be allowed to work part-time? • Are you required to work swing-shifts? • How much flexibility would you be allowed in your schedule to accommodate breaks, doctors appointments, not feeling well?

48. Safety Concerns • Is your job dangerous? If yes, how? • Do you use dangerous equipment on the job? If yes, describe. • Do other employees use dangerous equipment? If yes, describe. • Have you or others been injury at work? If yes, please explain (e.g., how often).

49. Work Environment • Are there other people in the workplace who have had serious injuries and return to work? If yes, how have they been treated? • Do you have concerns about how you would be received by co-workers if you returned to your previous position? If yes, explain.

50. Relationship with Your Supervisor • How frequently have you had contact with your supervisor since your injury? • What does your supervisor know about the injury? • What was your relationship with your supervisor like before the injury?