Job placement and training

In order to secure new employment, people with severe brain injury often require intensive assistance in job seeking, job placement, job-training and longer-term support. The level of support required is often underestimated by the client, new employer and vocational provider, contributing to lack of success with securing and maintaining employment. 

Some clients may benefit from intensive 1-1 support to prepare a resume, identify job goals, learn work related skills and approach employers to identify suitable employment opportunities.  A useful intervention for people with TBI preparing for work is a work trial placement.

Work trial

A work trial (also known as work experience or work training placement) is an unpaid placement with an employer, providing an opportunity for practical assessment, upgrading of work skills and capacity, updating work experience to include in a resume and improving prospects of achieving paid work.  The duration of work trial placements vary but often 12 weeks or more is required to allow sufficient time for the client to adjust to the workplace and reach their full capacity. The vocational rehabilitation provider can support the placement through providing additional on-site training, insurance coverage (if required) and employer negotiation.   Not all work trial placements will achieve a paid work outcome and multiple placements may be required to fine tune the job match and achieve paid work.

Training techniques commonly used in brain injury:

Errorless learning

The client is taught information in a way that does not allow them to make mistakes. Using this approach, the trainer demonstrates a task to be performed in the correct way and closely observes the client, preventing them from straying from the instructed technique in order to prevent errors.

Errorless learning is useful for those with more severe cognitive impairments impacting on memory and planning/problem solving abilities on the grounds that it prevents the inadvertent consolidation of the incorrect response.

Scaffold learning

Focuses on the core, underlying knowledge or skills prior to layering on a new task or step.

Cues and prompts

Visual cues are pictures that trigger learning (e.g., flowcharts) and can be used in conjunction with verbal prompts (e.g., single word reminders). The minimumamount of cues and prompts should be used to maximise independence, monitored and reduced over time where possible.

Chaining:

Step-by-step instruction following a task analysis, via either forward or backward task instruction.  With forward chaining, the client performs the first step of the task with gradual addition of further steps as each successive step is mastered. With backwards chaining, the trainer provides substantial assistance with the initial steps and allows the client to independently complete the final steps of the task

Repetition:

To assist the client learn the work role in the early stages, it is best to keep the routine consistent and avoid changes. Variables to be repeated can include: instructions, routines and work tasks. Using written instructions, checklists, phone reminders and other strategies can assist with repetition.

Make training specific:

Train in the actual task environment using the actual task resources wherever possible.

 

 

Disclosure of injury

Disclosure of injury is an issue that arises for clients seeking new employment. Brain injury is known as a “hidden” disability and for many people there may be no obvious physical impairments indicative of injury.  

There is no consistent approach to injury disclosure. Some clients may be reluctant to disclose their injury due to concerns that this information may jeopardise an employment opportunity.  Other clients prefer to disclose their injury from the outset, particularly if the injury will be apparent to the employer, or will impact their ability to perform some job tasks initially. Coaching the client through methods of injury disclosure is part of the job seeking process.

Some people have a high level of verbal ability, however underlying cognitive issues can impact greatly on task performance.  Upfront disclosure of injury in these circumstances may prevent the mis-understanding of performance issues (appearing ‘careless’ or ‘disinterested’) and allow strategies and support to prevent job loss.  

There is no requirement to disclose an injury to an employer if the injury doesn’t impact on completion of the job role.  However it is important to disclose an injury to an employer if it affects the client’s ability to do a particular job, or if it affects the ability to work safely and ensure the safety of others.