Family News and Views, A Monthly Publication of the Brain Injury Association
Vol. 5, No. 4 June 1998
By Carolyn Rocchio

Returning to work or finding that first job upon completion of school can be very challenging for individuals with brain injuries. Having a job is not only important for economic stability, but being employed increases self-worth and fulfillment. Russian artist Marc Chagall wrote, "Work isn’t to make money; you work to justify life."

Persons with brain injuries are faced with unimaginable challenges to regain their places in society. Not only must they learn to cope with the loss of the person they were before the injury and its impact on their self-esteem, but they must also adjust to a new and changing personality with limitations that are poorly understood by those around them. This alone is enough to create depression and lack of motivation to get out and keep trying; however, everyone needs a reason to get out of bed and contribute to society in one way or another.

There are a variety of reasons people have difficulty re-entering the work force after a brain injury. The general public, as well as employers, have little understanding about how the brain is negatively affected by traumatic brain injury, particularly when appearance is unaffected. As a result, expectations by both the employee and the employer may be unreasonably high. Cognitive impairment that impacts on memory, alertness, attention, problem solving skills, organization skills, judgment, visual perception and language processing present major barriers to employment. Prior to the injury, these important capabilities were taken for granted and the employee could easily accommodate distractions, new job responsibilities and disruptions that often occur in any job setting. However, when a brain injury affects the way information is processed, even the smallest interruption can create a difficulty in the individual’s ability to quickly return to the task and even impossible for some to continue without the assistance of a job coach.

Cognitive deficits are by far the most persistent and troublesome consequence of brain injury, and often prevent individuals from returning to gainful employment. Without adequate cognitive rehabilitation to develop strategies to compensate for deficits, many will find returning to their previous job out of the question and preparing for new employment equally challenging. The cognitive deficits are further eroded by fatigue, and in competitive employment, people are expected to put in an eight-hour-day. Even when working part-time, there may be no provision for rest periods and thus people are unable to compete in the job market.

In a job setting, workers are expected to "get along with" co-workers and many individuals with brain injury have lifelong problems with interpersonal skills and difficulty relating to co-workers in an acceptable manner. Inappropriate behavior, particularly inappropriate sexual behavior, can be a problem, and in general decreased social judgment cannot be tolerated in a work setting. The emotional instability that contributes to mood swings creates a hardship for co-workers, particularly ones that knew the employee before the injury and are puzzled about the changes.

Individuals with motor impairment may experience less difficulty in seeking employment due to the public’s better understanding of physical disabilities. Again, though, the unseen cognitive deficits may result in higher than attainable expectations.

How then can the family assist an individual regain a fulfilling life that includes productive work activity? Family involvement in the rehabilitation process is critical to understanding ways the injury affects cognition and behavior. It is particularly important that the family and individual with brain injury confer with the neuropsychologist regarding the preserved abilities, and fully understand how residual deficits may limit choices in the future. Many rehabilitation facilities, particularly transitional or community re-entry programs, focus on pre-employment assessment and preparation for re-entering the work force and/or planning for the first job in the case of students leaving the school system. Youngsters in the public school system nationwide, being served under the Individuals with Disabilities Education Act (IDEA), should have a transitional plan under development starting at age 14. This plan is designed to prepare for life once schooling is completed. For some this may mean higher education, while for others, there may be a focus on training and interfacing with vocational rehabilitation services to enter the work force.

Vocational Rehabilitation (VR) services are provided by the Rehabilitation Act in every state. Although the names may differ depending on the state in which a person resides, the services offered are the same. To be eligible for VR services, an individual must have a disability that impedes employment, and it is expected that from rehabilitation intervention there is a reasonable chance for successful re-entry into the work force.

When seeking assistance from VR, it is important that you take a family member or friend with you to assist through the process of intake interviews, appointments for evaluations and development of the Individual Written Rehabilitation Plan (IWRP), a plan which outlines the goals mutually determined that may lead to employment. Some services provided by VR may include:

• training, such as training for a trade, technical or business school, college or on-the-job training;
  
• physical aids such as hearing aids, braces or medical services;
  
• assistive technology, such as computers or other devices and accommodations to help you perform a job;
  
• tools or equipment to perform your job, and transportation or personal assistance; and
  
• job placement assistance with leads, as well as help with filling out applications and interviewing.
  
  

The VR counselor may schedule appointments for evaluations and assessments to determine preserved abilities that may support employment. It is vital that all appointments be kept and all responsibilities be carried out. If the client does not cooperate with the planning, VR will terminate the case. That is why it is so important to have a responsible individual accompany the client to all appointments and help with scheduling to ensure compliance of the client.

Many other state agencies and non-profit organizations provide services that enhance quality of life for individuals with brain injury. The federally mandated Centers for Independent Living provide a menu of services, i.e., independent living skills training, case management, counseling and peer support. Goodwill Industries, Easter Seals, Catholic Community Charities and Jewish Family Services, as well as many sheltered workshops throughout the country, offer opportunities for individuals with disabilities use their skills in a productive manner.

Some people are concerned about loss of Social Security benefits if they return to work; however, there is a plan whereby an individual can work for a period of nine consecutive months (a trail period) without loss of benefits. Arrangements can also be made to continue Medicare coverage even when Social Security disability benefits are terminated.

For some, return to work or entering the work force may not be an option due to the severity of the injury. However, even when presented with these barriers to employment, many families have creatively developed cottage industries, incorporated individuals into family businesses, and/or arranged for satisfying volunteer opportunities to ensure the individual is a productive member of society.

Work is an achievable goal for most after brain injury, but it takes some time and effort to find the right niche into which the individual can feel needed and proud of a job well done.