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Article Excerpt
It is estimated that 1.5 million Americans sustain a traumatic brain injury (TBI), annually, and that an estimated 5.3 million .individuals live with permanent disabilities as a result of their injuries (Centers for Disease Control, 2004). TBI occurs most frequently in three populations: young children, young adults, and older adults (Centers for Disease Control, 2004). The majority of individuals with TBI that vocational rehabilitation counselors see are in their early adulthood, less than 30 years of age (Ashley, Persel, Clark, & Krych, 1997). Return to work following TBI is critical because individuals typically have the majority of their work life remaining. The inability to gain and maintain employment not only affects individuals' self-esteem and self-identity, but also has larger social and economic consequences. Failure to return to work can result in poverty and long-term dependence on public assistance (Abrams, Barker, Haffrey, & Nelson, 1993; Dikman et al., 1994).
Disability sequelae following TBI often involve physical, behavioral, and cognitive problems that either alone, or in combination, cause a substantial impediment to employment (Centers for Disease Control, 2004; Golden, Smith, & Golden, 1993; Van Baalen et al., 2003). Employment rates within this population vary by study; however, the majority of researchers indicate high rates of unemployment that become even higher over time (Cattelani, Tanzi, Lombardi, & Mazzucchi, 2002; Isaki & Turkstra, 2000; Kosciulek, 1994; Kruetzer et al., 2003). Those who do return to work rarely do so at the same pre-injury level and pay scale (Gollaher, et al., 1998; Uomoto, 2000). In a recent analysis, Johnstone, Mount, and Schopp (2003) found that 31% of their participants with TBI were employed at one-year post injury with a 51% reduction in earnings and an estimated 275% increase in the amount of public assistance received. Given the large population, high cost, and poor employment outcome associated with consumers with TBI, numerous researchers have identified variables related to or predicting employment outcomes. Several researchers have indicated the need for more accurate prediction studies to improve consumer services and employment outcome (Leahy & Lam, 1998; Ponsford, Olver, Curran, & Ng, 1995, Schonbrun & Kampfe, 2004).
Using Rehabilitation Services Administration (RSA) data for a Southeastern state, Gamble and Moore (2003) examined the relationship of six services received by consumers with TBI (i.e., assessment, college, counseling/guidance, job placement, restoration, and work adjustment) to employment outcome. Their findings indicated that college, counseling/guidance, and job placement were significantly related to a competitive employment outcome for consumers with TBI. Of these three services, job placement most significantly predicted successful employment. This is consistent with findings of previous literature, that regardless of disability type, job placement services are frequently a significant predictor of employment outcome (Bolton et al., 2000). Gamble and Moore (2003) indicated that they did not find any similar studies that examined the relationship between specific services provided by RSA and employment outcome in consumers with TBI. They recommended that future research replicate their efforts to determine the consistency of their findings throughout the RSA system.
The purpose of the current research was to evaluate the relationship between specific services and employment outcome of clients with TBI using national data available through the RSA database for fiscal year 2002. The research questions were: 1) What specific services are related to competitive employment outcome in consumers with TBI? and 2) What is the relationship between the provision of specific services and consumers' earnings at case closure.
Methodology
Participants
The data analyzed in the current study were drawn from and represent a sample of RSA consumers whose cases were closed and recorded in the RSA 911 database for fiscal year 2002. The National RSA 911 database sample of consumers with TBI listed as the primary disability consisted of 14,311 consumers whose cases were closed. Similar to the general population of individuals with TBI, men comprised the majority of consumers (i.e., 64.9 %) and women, the minority (i.e.,...
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