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Medical/Vocational Case Coordination System Appears Useful

Categories: Employment

The Question

Is the Medical/Vocational Case Coordination System useful to improve initial placement and 1-year employment outcomes for individuals with brain injury?

Past Studies

Past Studies show that brain injury frequently results in impairments that interfere with the return to work. Unemployment rates for individuals with brain injuries vary, from 60% to as high as 90% for individuals with severe injuries. Studies show that individuals with greater injury severity and other body injuries were less likely to be employed. Individuals with behavior and thinking process difficulties, particularly impaired self-awareness, were also less likely to be employed. Individuals with impaired self-awareness are unable to accurately rate their abilities and adjust their actions. Individuals with self-awareness problems tend to err on the side of overestimating their abilities, especially in the areas of thinking skills and behavior. Such people do not recognize the importance of adjusting their behaviors toward others. This can interfere with their interactions with others and cause them to be unsuccessful at what they set out to accomplish. Individuals that participate in community vocational rehabilitation early on and have the most accurate self-awareness report better employment outcomes. It appears that a case coordination system for employment would be helpful to channel individuals to the appropriate services at the appropriate time and optimize the opportunity for a return to work and employment. Research is lacking about such case coordination systems.

This Study

This study tested a Medical/Vocational Case Coordination System (MVCCS) designed for individuals with brain injury. The MVCCS emphasizes early intervention and coordinated service delivery through combined medical center-based and community-based services. The participants included 114 adults with brain injury in Minnesota. The researchers stressed early intervention to reduce the time between injury and community reintegration. They did this to prevent behavioral and socialization problems associated with lack of early intervention. The researchers expected the MVCCS to increase the participants’ employment and independent living abilities and to minimize the use of community and medical resources. With the MVCCS, the participants received early case management services, medical and vocational rehabilitation services, work trials, and temporary or long-term supported employment when appropriate. Supported employment provides on-site supports, often with the direct help of a job coach who assists the individual to maintain satisfactory job performance.The researchers found that employment rates at the time of first job placement and at a 1-year follow-up approached or exceeded their expectations. Initially, eighty percent of the participants were placed in community work settings. Forty-six percent of the participants eventually progressed to independent work settings. At the one-year follow-up, 81% were working in the community and 53% worked independently. Individuals that achieved employment were most likely to have shorter lengths of time since injury and less severe disability and impairment. Most of those placed within three months of admission to vocational services returned to their pre-injury employment. Ten percent of the participants lost contact with the researchers or were unable to be placed in employment settings. This ten- percent also included participants who withdrew from the study because they felt employment earnings would affect the benefits they received. All of these people were counted in the unemployed group at follow-up. Individuals with severe disability and impairment, plus other bodily injuries besides to the brain, were less likely to obtain employment.

Who May Be Affected By These Findings

Individuals with brain injury, discharge planners, rehabilitation professionals, researchers


The best predictor of employment at one year from the injury date was the level of initial job placement. This finding is not what was found in studies that linked impaired self-awareness to employment. The results of this study suggest that impaired self-awareness may be a barrier to employment that can be overcome through rehabilitation, education, and supportive employers.

Bottom Line

The Medical/Vocational Case Coordination System appears useful to evaluate initial placement and 1-year employment outcomes for individuals with brain injury.

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Find This Study

Malec, J. F., Buffington, A. L. H., Moessner, A. M., & Degiorio, L. (2000). A medical/vocational case coordination system for persons with brain injury: An evaluation of employment outcomes. Archives of Physical Medicine and Rehabilitation, 81, 1007-1015.