Ask Kathy M. Archives
A Collection of Questions and Answers from TBI Advice Expert - Kathy Moeller

Topic: Vocational Services - Vocational Evaluation and Reintegration

Question:

Dear Kathy M.,

I have some questions about Vocational Evaluation and reintegration to employment after a TBI.

From the small amount I have been able to read so far, it seems that some of the most commonly used work samples and paper/pencil tests have no normative data for people with a TBI. Doesn't this make it difficult to make decisions based upon these instruments?

Additionally, it seems that behavioral problems are the most common reason that a person with a TBI might loose his or her employment.

Finally, would it not be beneficial to include a qualified Behavior Analyst in the Vocational Evaluation process?

Scott


Kathy's Response:

Dear Scott,

Thanks for writing to "Ask Kathy M." I'll do the best I can with your questions, being mindful of the fact that I am not a professonal vocational evaluator. In fact, I have no formal education in vocational counseling, whatsoever. I have some practical experience, though, and the areas you address are ones in which I have given much thought. I'm curious what your background is to ask such insightful questions.

Scott wrote: I have some questions about Vocational Evaluation and reintegration to employment after a TBI.

The term "reintegration" is used a great deal in the world of rehab., and I'm curious to know what you mean when you use the term. May I assume you are simply asking about the role vocational evaluation has on the practical task of helping persons with brain injury successfully return to work?

Scott wrote: From the small amount I have been able to read so far, it seems that some of the most commonly used work samples and paper/pencil tests have no normative data for people with a TBI. Doesn't this make it difficult to make decisions based upon these instruments?

I don't know if data exists or not. You may well be right. That aside, the core problem with these instruments, as I see it, is that they do not measure a person's ability to use compensatory skills -- which is often the most relevant factor for predicting success on the job. Nor do these instruments evaluate a persons ability to learn compensatory skills (it is not necessary based on memory, IQ, reasoning, or other things that are typically measured). And lastly, neither these instruments nor the evaluations that generally accompany them, offer much that is useful (use-able) by the consumer, his or her counselor or any clinicians with whom they may be working!!! It is a multi-faceted, multi-layered problem, and professionals (including leaders) in the vocational field have bared scratched the surface!!

Truth be told, BRAIN BOOK System developed our own instrument, called a "Skills in Action" assessment because we could not find a commercially available product that measured what we wanted to measure. You see, we often need to screen persons with brain injury before they start our program -- to ensure they are able to benefit from learning what we have to teach. After that, we evaluate critical areas (weaknesses and strengths) so we can help teach compensations.

For more information on this assessment tool, see: http://brainbook.com/brainbook/skills_ws.shtml

We can send you more detailed information at a later date, as well.

Scott wrote: Additionally, it seems that behavioral problems are the most common reason that a person with a TBI might loose his or her employment.

This may *appear* to be the case (it is certainly routinely stated). My experience confirms that the straw that breaks the camel's back is often viewed as an emotional discontrol issue. When we dig deeper, however, I think a case can be made for linking incidents of discontrol (or other behavioral issues) to the general lack of compensatory skills and tools (which result in horrendous frustration, brain-breaking stress, confusion, disorientation, and a host of other things that would crack a non-brain-injured individual at the workplace). Also, lack of awareness about how to to alter one's environment (related to noise, light and motion, among others).

Yet, I don't see any formal mechanism for doing behavioral observation included in many of these traditional vocational evaluation methods.

You may be looking in the wrong place for a solution to the problem of both evaluating persons with brain injury for work readiness and helping them return to work successfully. Let's talk by phone sometime. I'm in the office 9am to 3pm, Monday through Friday, as a rule, West Coast time. 541-779-5646.

Finally, would it not be beneficial to include a qualified Behavior Analyst in the Vocational Evaluation process?

Yes. As long as they have a track record of working successfully with persons with brain injury -- being mindful that professionals with a track record *in this area* are few and far between! I know a few of them.

If nothing else, the Behavioral Analyst could work with the consumer and the CVE to develop compensatory strategies for problems that emerge as part of the vocational evaluation process. Thanks! Scott

But they would be re-inventing the wheel, in my view (though this is attempted all the time). Also, I don't know if "the behavioral analyst" has the right background for developing strategies for persons with brain injury -- particularly what I call "cognitive compensations" (writing use-able Memory Notes, learning strategies for scheduling and altering routines comfortably,learning strategies for effective communication, planning one's time, etc., etc., etc. (there are about 150 areas we have identified). Compensatory skills trainers (and some SLP's and some OT's too) have the most to bring to the party, in my view (or at least, in my experience).

Since I do not have formal education in the vocational area (though I work with vocational counselors and consumers all the time), I do not feel comfortable touting myself as an expert on this topic on this site, so let's keep talking via phone or personal e-mail.

You raise exellent questions I would *love* to discuss further. There is so little useful (practical) help "out there." Let's keep talking.

Hope this helps.

Kathy M.

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