Toolkit D: Return to Work

Return to Work Toolkit

This toolkit is designed to help people with Traumatic Brain Injury (TBI), their families, support workers, rehabilitation professionals, vocational providers and employers to work together to support people with TBI to return to work. Contained within this toolkit is the background research and some practical information about supporting clients to RTW.   

The Toolkit also contains resources developed for the Vocational Intervention Program (VIP). VIP is a NSW-wide specialist vocational rehabilitation program. Access to the VIP resources on this website is restricted to the clinicians and vocational providers engaged in VIP.

Return to Work after TBI

Return to work (RTW) is a key measure of community reintegration and forms a central rehabilitation goal following TBI. Although an array of service systems exist in Australia to assist people with injury or disability to participate in employment, people with TBI, their families and clinicians within the sector encounter a range of barriers in accessing appropriate and effective supports to achieve RTW.

In NSW, an outcome study was undertaken by the Agency for Clinical Innovation, in partnership with icare (Insurance & Care, NSW) to measure the RTW rate for the community population of the NSW Brain Injury Rehabilitation Program (BIRP) and investigate the experiences of clients and clinicians in navigating the support systems. This study was entitled the Vocational Participation Project (VPP) and was finalised in 2014. 

The VPP is the largest Australian study and one of the largest international studies to address this issue. Data was collected on all 900 active community-dwelling clients of the BIRPs, of whom 721 sustained TBI. Presented below is a summary of findings. Further information is also available in publications:

McRae, P., Hallab, L. & Simpson, G.K. (2016). Navigating Employment Pathways and Supports Following Brain Injury in Australia: Client Perspectives. Australian Journal of Rehabilitation Counselling, 22(2),1–17.

Simpson, G.K., McRae, P., Hallab, L., Daher, M & Strettles, B. (2018). Participation in competitive employment after severe traumatic brain injury: New employment versus return to previous (pre-injury) employment. Neuropsychological Rehabilitation. DOI: 10.1080/09602011.2018.1531769.

 Key Findings about the rate of RTW following TBI

  • Employment participation fell from 78% (pre-injury) to 29% (207/721) post-injury.

  • This decline is comparable to previous Australian and international studies reporting on samples with severe TBI (range 30% to 35%).

  • There was a marked shift from full-time to part-time employment

  • The best outcomes were associated with return to pre-injury employment

  • Over half the clients (54%) were not engaged in any work-related activity.

Service and client-related facilitators and barriers to RTW

In-depth case study interviews were conducted with 33 clients and focus groups held with each of the 12 adult BIRP teams.

Facilitators:
  • The work role is vitally important in client’s lives, promoting health, shaping their self-identity and signifying achievement of normality.

  • Central to the success of all case studies was a high degree of motivation and resilience.

  • The continuous support available through the BIRP was highly valued.

  • Positive relationships with local vocational providers and specific interventions: work trial and voluntary work placements, access to wage subsidies, on-job training and assistance with written documents (e.g. resume).

Barriers:
  • The number and severity of impairments (particularly fatigue), interaction of multiple impairments and the length of recovery time were all identified as central issues.

  • Lack of understanding about ABI within the employment sector

  • Clients living in rural locations face additional barriers of limited job vacancies and poor public transport options.

  • Lack of opportunities to develop work readiness

Project recommendations

  • Implement an early intervention RTW program for people with opportunity to resume their pre-injury employer.

  • Implement a work trial program of 12-week placements to circumvent formal recruitment processes and promotes the development of vocational skills and opportunities for achieving paid work outcomes.

  • Implement a trial of a group-based ‘place and train’ model that provides work crews specifically for people with extremely severe TBI who are not suited to a work trial placement in open employment.

  • Address the vocational rehabilitation gap for adolescents by developing and trialling a vocational transition program for school-leavers

  • Engage with Commonwealth government agencies and VR providers to advocate for improved access to the right employment program at the right time so that sustainable employment programs more suited to people with complex, acquired conditions are available and funded.

Subsequent to this study, ACI was funded by icare to implement the first 2 recommendations via a ‘proof of concept’ trial (Vocational Intervention Program; 2014-17), involving 6 of the 12 BIRP sites. This program is currently being expanded (2018-21) to all 12 NSW sites to establish a statewide network of specialist TBI employment services.

 

The Vocational Intervention Program (VIP)

The VIP is an initiative of the Agency for Clinical Innovation (ACI) and icare (Insurance & Care, NSW) involving implementation of a NSW–wide specialist employment program for people with TBI.
The VIP operates under a model of service integration where each Brain Injury Rehabilitation Program (BIRP) site is partnered with a number of vocational rehabilitation / employment service providers to co-ordinate a RTW program for each client.

Services are funded through existing channels: the Commonwealth Disability Employment Service (DES), insurance schemes (icare, CTP, income protection) and the National Disability Insurance Scheme (NDIS)

The Icare Foundation is the sponsor of the VIP, funding the ACI to manage the implementation and evaluation of the program (2018-21).

Further information related to the VIP can be found in Section 5 of this toolkit.

 

 

 

Glossary

ABI

Acquired Brain Injury (refers to any damage to the brain that occurs after birth)

ACI

NSW Agency for Clinical Innovation

ADE

Australian Disability Enterprise – organisations funded within the NDIS to provide supported employment

Aphasia/ dysphasia

Difficulty understanding or expressing language as result of damage to the brain

Apraxia/
dyspraxia

An inability to coordinate movements that is not due to damage to the muscles needed for the movement

Ataxia

Abnormal uncontrolled movements due to loss of muscle co-ordination.

BIRD

Brain Injury Rehabilitation Directorate, ACI

Brain stem

The bottom part of the brain that sits on top of the spinal cord and controls basic life support systems. Sometimes damaged in severe brain injury

CANS

Care and Needs Scale

Cerebellum

Part of the brain that controls coordination

Cerebral

To do with the brain

Cerebrovascular

Relating to blood vessels of the brain. A stroke is a cerebrovascular accident (CVA)

Coma

The deepest level of unconsciousness

Contusions

Bruising

Cranioplasty

Repair of damage to the bone in the skull

Craniotomy

Removal of part of the bone in skull

CTP

Compulsory Third Party insurance scheme (in NSW)

CT scan

Computerised Tomography – an X-ray of the brain shown in slices

DES

Disability Employment Services

Diplopia

Double vision

Disinhibition

Loss of control of emotions and or actions

DSP

Disability Support Pension

Dysarthria

Difficulty speaking because of weakness and lack of coordination of the muscles of speech

Dysphagia

Difficulty swallowing

Epilepsy

Seizures resulting from abnormal electrical activity in the brain

GCS

Glasgow Coma Scale – a measure of severity of brain injury

Haematoma

Blood clot

Haemorrhage

Bleeding from a blood vessel

Hemianopia

An inability to see things from the left or right side of both visual fields

Hemiplegia

Paralysis on one side of the body

Hemispheres

The two major halves of the brain, which have largely different functions

icare

Insurance & Care, NSW. State government insurance body, comprising six schemes providing cover, treatment and care to the people of NSW

icare Lifetime Care

Scheme of icare, providing treatment, rehabilitation and care to people severely injured in motor vehicle accidents or at the workplace in NSW

Initiation

The ability to start an activity

JCA

Job Capacity Assessment (conducted by Centrelink)

Lobes

Sections of each cerebral hemisphere: frontal, temporal, parietal and occipital

Memory

The storage and recollection of information

NDIA

National Disability Insurance Agency

NDIS

National Disability Insurance Scheme

Neglect

Decreased awareness of one half of the body and the objects placed to that side of the body

OSI

Occupational Search Inventory

PTA

Post traumatic amnesia – the period of confusion and inability to consistently remember recent events after brain injury

Problem solving

The process of getting all the information, thinking about it and picking the best solution

QoL

Quality of life

RTW

Return to work

Rigidity of thinking

Decreased ability to consider alternative points of view

Self monitoring

The ability to judge and control your own actions and emotional reactions

SIRA

State Insurance Regulatory Authority – the government regulator of motor accidents, CTP insurance, workers compensation insurance and the home building compensation scheme in NSW

Spasticity

Abnormally high muscle tone, with increased resistance to passive movement

TBI

Traumatic brain injury (acquired Brain Injury incurred through trauma)

Tracheostomy

An opening made in the neck for breathing purposes. A tube may be inserted

Tinnitus

A ringing or buzzing noise in the ears

Verbosity

Excessive talking

VIP

Vocational Intervention Program

VPP

Vocational Participation Project

VR

Vocational rehabilitation

Workers Care

Program within the icare Lifetime Care scheme for people severely injured at work, following the same injury criteria and approach to treatment, rehabilitation and care

Workers Insurance

icare scheme covering people injured at work

Work Options Plan (WOP)

A New Track report form completed by VIP providers