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 practical information about supporting clients to return to work.    

The Toolkit also contains Vocational Intervention Program (VIP) resources. VIP is a NSW wide specialist vocational rehabilitation program, established as ‘best practice’ to support a person with a brain injury through their return to work journey.

Return to Work after TBI

Return to work (RTW) is a key measure of community reintegration and is a rehabilitation goal for many people after their TBI. People with TBI may experience challenges accessing appropriate, timely and effective supports to return to work.

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 Vocational Intervention Program (VIP)

The Vocational Intervention Program (VIP), an initiative of the NSW Agency for Clinical Innovation (ACI) and icare (Insurance & Care NSW) was implemented as a NSW specialist employment program for people with brain injury. The VIP operates under a model of service integration where each Brain Injury Rehabilitation Program (BIRP) site partners with vocational rehabilitation providers to co-ordinate a RTW program for clients.

The program was implemented initially as a pilot project (VIP1, 2014-2017) and then scaled up as a state-wide project (VIP2, 2018-2021) involving all 12 BIRP sites partnered with vocational providers (private and Disability Employment Service (DES) providers).

Preceding the VIP was the Vocational Participation Project (VPP). This project analysed employment participation and vocational outcomes for people with brain injury in NSW. The project team also completed a literature review to determine RTW rates after brain injury.     

Further information is 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.

The projects established benefits of participating in the VIP for people with brain injury"

• Working together with brain injury clinicians and a vocational rehabilitation provider to identify strengths and potential barriers to employment.
• Assistance to identify vocational goals and source opportunities for employment. 
• Improved quality of life and health outcomes associated with employment.
•  For Same Employer (return to pre-injury employment): early contact with the workplace and dedicated time and expertise to plan returning to work
• For New Employer (locating new employment): an opportunity to explore work interests, identify job goals, gain new skills, and achieve paid work.

Benefits to the employer:

• A coordinated approach for planning and managing the return-to-work process
• Improved knowledge of supporting people with brain injury in the workplace
• Opportunity to employ a motivated job seeker with access to ongoing support from a vocational rehabilitation provider.
• Access to wage subsidies, equipment and workplace modifications, where eligible.

At a systems level, the VIP projects resulted in:

• Improved co-ordination of vocational supports for people with brain injury in NSW
• Increased employment participation for people with brain injury in NSW
• Established network of vocational rehabilitation providers working collaboratively with BIRP teams to improve employment experiences for people with brain injury.
• Improved knowledge, understanding & skills of vocational rehabilitation providers and brain injury clinicians to promote sustainable return to work outcomes.

Further information about the VIP is located on the ACI Brain Injury Rehabilitation Network
Vocational Intervention Program
Contact: Email: ACI-BrainInjuryRehab@health.nsw.gov.au

 

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  Lifetime Schemes of icare 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)	Icare tool completed by VR  providers to explore vocational options for people with returning to new employment.