The “Perfect Job”: Resources and Tools for Finding Meaningful Work after Brain Injury

1. The “Perfect Job”: Resources and Tools for Finding Meaningful Work after Brain Injury Hollee Stamper, MSW, LSW Jeff Noonan, M.Ed. Cognitive Therapists

2. Today’s Objectives: • Understand the significance of volunteer and employment positions as related to quality of life • List challenges encountered when helping individuals with acquired brain injuries find their “Perfect Job”

3. Today’s Objectives: • List Community resources and services available to support the vocational process • Understand how to utilize brain injury outcome measures (the MPAI-4) as an effective assessment tool to determine job compatibility

4. Outline • Today’s Objectives • Vocational Planning and Quality of Life • Job Coaching Challenges • Cognitive Challenges and Strategies • Unrelated to Cognitive Challenges • MPAI- What is it? • How the MPAI Can Assess Job Compatibility • Types of Employment • Vocational Resources • Quality of Life

5. Vocation and Quality of Life Perceived Quality of Life has a strong relationship with Employment “The Effect of Employment on Quality of Life and Community Integration after Traumatic Brain Injury” Authors: John O’Neil,PhD and others • 337 Adult participants, ages 18 to 65 • Participants sustained brain injury a minimum of one year prior to interviews

6. Vocation and Quality of Life • Measures: The Craig Handicap Assessment Capacity Technique, Bigelow Quality of Life Questionnaire, Flanagin Scale of Needs, and Global QOL measure • Part-time or full-time employment contributes to community inclusion and sense of well-being

7. Outline • Today’s Objectives • Vocational Planning and Quality of Life • Job Coaching Challenges • Cognitive Challenges and Strategies • Unrelated to Cognitive Challenges • MPAI- What is it? • How the MPAI Can Assess Job Compatibility • Types of Employment • Vocational Resources • Quality of Life

8. Job Coaching and Challenges Specific struggles of job coaching working with individuals affected by brain injury • Premorbid educational and vocational history • Specialized training • Certification and Degrees • Prior work experience • Metacognition

9. Metacognition • Metacognition: Knowing about cognitive processes; knowing about one’s own cognitive strengths and weaknesses; knowing procedures (strategies) to improve cognitive functioning (learnet) • Self-Awareness • Sense of Identify

10. Case Example • Volunteer Opportunity at New Jersey Tree Foundation • Matched interest and experience with volunteer opportunity AB Male, 55 years old Tree logging accident Manual Laborer Strengths -High level of initiation -No impairments with mobility Struggles -Episodes of irritability - processing speed

11. New Jersey Tree Foundation

12. Outline • Today’s Objectives • Vocational Planning and Quality of Life • Job Coaching Challenges • Cognitive Challenges and Strategies • Unrelated to Cognitive Challenges • MPAI- What is it? • How the MPAI Can Assess Job Compatibility • Types of Employment • Vocational Resources • Quality of Life

13. Job Coaching and Challenges Physical changes Mobility Use of hands Fatigue Pain Others… • Cognitive changes • Attention • Memory • Initiation • Problem-solving • Mood • Processing-Speed

14. Attention Strategies • Schedule Tasks • Utilize Alarms • Complete a single task at a time • Limit Distractors if possible • Incorporate breaks Sustained Attention Divided Attention Selective Attention

15. Case Example • Volunteer Opportunity at Operation BackPack • Completed Single Task • Structured Environment • Frequent Breaks • Social engagement CD Male, 54 years old Victim of Assault Strengths -Selective Attention -Meticulous Struggles -Difficulty w/ divided attention -Poor Alertness

16. Operation Backpack

17. Memory Strategies • Review job responsibilities • Develop checklist of tasks • Identify steps of tasks • Onsite training • Collaborate with volunteer/job site Encoding Storage Retrieval

18. Case Example • Volunteer Opportunity at • Reviewed steps of routine prior to entering food bank • Completed Alterative Tasks • Assembly Line Format • Peer Feedback EF Female, Early 20’s Motor Vehicle Accident Strengths -Extroverted -Creative Struggles -Labile -Memory Deficit -Poor stability

19. Physical Functioning • Consider accessibility of site • Match task with level of mobility • Consider impact of cognitive fatigue Mobility Use of hands Fatigue Pain

20. Case Example • Volunteer Opportunity presented by • Structured Environment • Completed assigned task • Format was tailored for success GH Female, Early 20’s Motor Vehicle Accident Strengths -Initiation to learn new information -Strong family involvement Struggles -Poor Stability -Memory Deficit

21. Job Coaching and Challenges Other challenges to consider: Funding source for rehabilitation services Social Security Income (SSI) Social Security Disability (SSD-I) Family Support and Input

22. Outline • Today’s Objectives • Vocational Planning and Quality of Life • Job Coaching Challenges • Cognitive Challenges and Strategies • Unrelated to Cognitive Challenges • MPAI- What is it? • How the MPAI Can Assess Job Compatibility • Types of Employment • Vocational Resources • Quality of Life

23. Mayo-Portland Adaptability Inventory (MPAI-4) and Job Compatibility The Mayo-Portland Adaptability Inventory (MPAI) was primarily designed: To assist in the clinical evaluation of people during the post-acute period following acquired brain injury (ABI) To assist in the evaluation of rehabilitation programs designed to serve these people To better understand the long-term outcomes of acquired brain injury (ABI)(Malec, J. (2005). The Mayo-Portland Adaptability Inventory.The Center for Outcome Measurement in Brain Injury.)

24. Mayo-Portland Adaptability Inventory (MPAI-4) and Job Compatibility The MPAI-4 provides the rehabilitation professional or other clinicians with a brief and reliable means of assessing functioning in each of three major domains to help target areas for intervention and assess progress (Malec, J. (2005). The Mayo-Portland Adaptability Inventory.The Center for Outcome Measurement in Brain Injury.)

25. Mayo-Portland Adaptability Inventory (MPAI-4) and Job Compatibility Table 1: MPAI-4 Items by subscales

26. Outline • Today’s Objectives • Vocational Planning and Quality of Life • Job Coaching Challenges • Cognitive Challenges and Strategies • Unrelated to Cognitive Challenges • MPAI- What is it? • How the MPAI Can Assess Job Compatibility • Types of Employment • Vocational Resources • Quality of Life

27. MPAI-4 Tool to Assess Job Compatibility Job compatibility tool specifically assesses: Executive Functioning Memory Attention Social Communication Visuospatial Physical Ability

28. MPAI Tool to Assess Job Compatibility

29. MPAI-4 Tool to Assess Job Compatibility

30. MPAI-4 Tool to Assess Job Compatibility

31. MPAI-4 Tool to Assess Job Compatibility

32. MPAI-4 Job Compatibility Tool in Practice • Volunteer Opportunity: Habitat for Humanity Restore IJ Male 37 years old Sustained injury from work related accident MPAI-4 Score:17

33. MPAI-4 Job Compatibility Tool in Practice • IJ’s MPAI-4 Score:

34. MPAI-4 Job Compatibility Tool in Practice Restore Program Description Cashier responsibilities Pricing and shelving of items Evaluate condition of donations Assist with item repairs • Evaluate condition of donation • Assist with item repair

35. MPAI-4 Job Compatibility Tool in Practice Restore MPAI-4 Score:

36. Outline • Today’s Objectives • Vocational Planning and Quality of Life • Job Coaching Challenges • Cognitive Challenges and Strategies • Unrelated to Cognitive Challenges • MPAI- What is it? • How the MPAI Can Assess Job Compatibility • Types of Employment • Vocational Resources • Quality of Life

37. Types of Employment • Competitive and Supported Employment • Transitional Supported Employment (TSE) • Contract Employment • Internships/Volunteer Positions

38. Community Prevocational Resources • Volunteer Opportunities • -Utilize local non profits which require varied physical and cognitive skills • e.g., Animal Shelters, Food Bank, thrift stores, Meals-on-Wheels, Garden Centers, Local Churches • -Craigslist, Indeed, other search engines

39. Outline • Today’s Objectives • Vocational Planning and Quality of Life • Job Coaching Challenges • Cognitive Challenges and Strategies • Unrelated to Cognitive Challenges • MPAI- What is it? • How the MPAI Can Assess Job Compatibility • Types of Employment • Vocational Resources • Quality of Life

40. Community Vocational Resources • State/County Funded -Resources that use federal or state money to provide vocational assistance for persons with disabilities Example: Ticket to Work http://www.ssa.gov/work/overview.html#a0=0

41. State/County Funded • Division of Vocational Rehabilitation Services (DVRS)

42. 2.Internal programs that support vocational planning -Volunteer opportunities within the department -Volunteer opportunities in the community -Transitional or therapeutic employment opportunities

43. MPAI-4 Job Compatibility Tool in Practice • Employment Opportunity: Transitional Supported Employment KL Male 28 years old Sustained anoxic brain injury MPAI-4 Score: 35

44. Paid Employment Opportunity Transitional Employment Services (TES) Job duties include: -Environmental Services: • Care of lawn and lots • Office Maintainence

45. Physical and Cognitive Abilities Physical abilities: -must be independently ambulatory -must be able to lift 10lbs. Independently Cognitive Abilities: -must be able to communicate clearly -must be able to follow directions -sustained attention Target MPAI-4 Score: 43

46. MPAI-4 Job Compatibility Tool in Practice TSE MPAI-4 Score:

47. MPAI-4 Job Compatibility Tool in Practice • KL’s MPAI-4 Score:

48. MPAI-4 Job Compatibility Tool in Practice • Volunteer Opportunity: Animal Adoption Center MN Male 55 years old TBI Secondary to Motor Vehicle Accident MPAI-4 Score: 33

49. Animal Orphanage • Job Duties: • Volunteer will be able to work for a maximum duration of 2 hours • Volunteer will perform activities needed by the shelter including but not limited to: • making animal enrichment toys • pet care • cleaning cages • walking animals. • socializing animals • safety awareness, known allergies

50. Physical and Cognitive Abilities Physical abilities • Use of fine motor skills Cognitive Abilities • Maintain attention