The effects of Brain Injury on employment
Annalisa Stoddart
Manager
Brain Injury Vocational Rehabilitation Services
Glasgow
The effects of Brain Injury on employment
Rehab Scotland – Brain Injury Vocational Rehabilitation Services
Aim:
To enable people with acquired brain injury to participate in
further education/further training and/or employment
opportunities.
This is achieved by working with clients using a multidisciplinary team approach in order to enable clients to address
brain injury related problems which might present barriers and
to clarify and test out training/employment goals.
The effects of Brain Injury on employment
Introduction
Brain Injury – the facts
Brain Injury – the effects
Case study 1
Vocational rehabilitation and supported employment
Case study 2
Conclusion
The effects of Brain Injury on employment
Brain Injury – the facts
Approximately 1 million in Britain each year
Per year, per 100,000 of the population
*10 – 15 severe
*15 – 20 moderate
*250 – 300 mild
One family in every 300 will be affected by the long term effects
The effects of Brain Injury on employment
Brain Injury – the causes
Road traffic accidents (including bicycles)
Assaults
Falls
Sports/industrial accidents
Alcohol
The effects of Brain Injury on employment
Brain Injury – prevalence
3:1 male/female ratio
2/3 of head injuries are aged under 30 years old
Residence in urban areas where social inclusion predominates
Income poverty
Unemployment
Lack of educational attainment
High levels of crime
Substance misuse
The effects of Brain Injury on employment
Brain Injury – types of injury
Primary injury occurs at the moment of impact, being caused by
the blow
Secondary injury occurs as a result of systemic complications,
which are potentially treatable
Primary: skull fracture, cerebral contusions, diffuse axonal
injury
Secondary: intracranial haematoma, brain swelling, infection,
raised intracranial pressure, respiratory failure, hypotension,
ischaemic brain damage
The effects of Brain Injury on employment
Brain Injury – delayed complications
Post traumatic epilepsy
Hydrocephalus
The effects of Brain Injury on employment
Brain Injury – severity
Mild head injury (75%): loss consciousness <15 minutes/no loss
of consciousness
Moderate head injury: loss of consciousness between 15 minutes
and 6 hours/post traumatic amnesia up to 24 hours
Severe head injury: loss of consciousness >48 hours/post
traumatic amnesia>24 hours
The effects of Brain Injury on employment
Brain Injury- disability
Thornhill and Teasdale – 2000
Study of 3000 people admitted to hospital with head injury
Follow up of 1000 at one year post injury
78% of severe head injuries experienced disability
54% of moderate head injuries experienced disability
51% of mild head injuries experienced disability
The effects of Brain Injury on employment
Brain Injury – lack of follow up
Most head injured receive no follow up after discharge
Less than 50% were seen in hospital after discharge
Only 28% received any form of rehabilitation
Only 15% had contact with Social Work
Most common service was physiotherapy
The effects of Brain Injury on employment
Brain Injury – physical effects
Headaches
Paralysis/mobility problems
Balance problems
Dizziness
Epilepsy
Reduced stamina
Problems with co-ordination
Ataxia (shakiness)
Dyspraxia (message from brain to limb is blocked)
Problems with continence
Reduced/increased libido
The effects of Brain Injury on employment
Brain Injury: physical effects
Visual impairment
Loss of sense of smell
Loss of sense of taste
Impaired hearing
Swallowing problems
Dysarthria ( difficulties forming words )
The effects of Brain Injury on employment
Brain Injury – cognitive/executive/communication effects
Impaired memory
Impaired concentration
Increased sensitivity to noise/stimuli
Reduced speed of information processing
Perseveration
Confusion/disorientation
Lack of insight
Difficulties with visual - spatial judgment
The effects of Brain Injury on employment
Rigidity of thought
Problems with initiation/motivation
Problems with planning/organising
Difficulties with problem solving and decision making
Word finding problems
Difficulties understanding language
Dyslexia and literacy problems
The effects of Brain Injury on employment
Brain Injury – emotional effects
Agitation
Anger and frustration
Anxiety
Depression
Mood swings
Reduced tolerance/increased irritability
Loss of feeling/empathy
Loss of confidence
The effects of Brain Injury on employment
Brain Injury – behavioural effects
Agitation/aggression
Impulsivity
Disinhibition
Withdrawal
The effects of Brain Injury on employment
Brain Injury – social effects
Reduced ability to understand and cope with social interactions
Interpersonal/relationship difficulties
Impaired communication/social skills
Family/relationship breakdown
Social isolation
Reduced work/educational performance
Loss of role/identity
Loss of employment/loss of income
(less than 30%of head injured people will return to work without specialist rehabilitation and support)
The effects of Brain Injury on employment
Case Study 1 - Injury Details
Injury sustained in 1996
Male aged 28 years
Fall ( 70 Feet )
Alcohol
Orthopaedic injuries/respiratory and renal complications
Diffuse head injury
PTA: approximately 6 weeks
Length of hospitalisation: 8 weeks
The effects of Brain Injury on employment
CASE STUDY 1 – EFFECTS OF BRAIN INJURY
Sleep disturbance and low levels of stamina
Visuospatial impairment
Word finding problems
Disorientation
Memory impairment
Poor Concentration
Executive Dysfunction
Slowed information processing
Emotional and behavioural problems
The effects of Brain Injury on employment
CASE STUDY 1 –REINTEGRATION
Effects of trauma
Effects of head injury
No information or support
Stress of adjustment
Stress of reintegration into family,social life, education and work
The effects of Brain Injury on employment
CASE STUDY 1: SECONDARY PROBLEMS
Reduced ability to self monitor
Impaired social skills and relationship difficulties
Increased stress and and loss of self confidence
Difficulties balancing work and leisure
Impaired work performance
Reduction in earnings
Housing problems
Anger/frustration
Loss of social/work identity/status
Alcohol dependency
The effects of Brain Injury on employment
CASE STUDY 1: OUTCOME
Exhaustion
Psychiatric admission
Loss of employment/income
Loss of home/independence
Loss of role and achievement
Family and relationship breakdown
Alcohol dependency
Increasingly chaotic lifestyle
Academic failure
The effects of Brain Injury on employment
CASE STUDY 1: Implications for Vocational Rehabilitation
Loss of confidence in services and lack of trust
Programme had to be reactive rather than proactive initially
Vocational re-evaluation rather than retention
Need to address secondary psycho-social problems before
vocational rehabilitation was possible
Lack of insight
Family denial
The effects of Brain Injury on employment
Case Study 1 – vocational rehabilitation: a multi disciplinary team
approach
Manager
Clinical Neuropsychologist
Assistant Psychologist
Work Related Social Skills Tutor
Employment Liaison Officer
Job Coach
Occupational Therapist/Job Coach
The effects of Brain Injury on employment
CASE STUDY 1: INDIVIDUAL PROGRAMME
PLANNING
Assessment
Induction
Introduction to structured environment and activity
Brain Injury Awareness Training
Training cognitive and executive skills
Stress, anxiety and relaxation training
Social reintegration and leisure activities
Work Related Social Skills Training
Individual psychological support and Liaison with Community
Psychologist
Family information and support
Referral to Housing Department
Welfare rights advice
The effects of Brain Injury on employment
CASE STUDY 1: INDIVIDUAL PROGRAMME
PLANNING
Vocational profiling
Vocational exploration
Job Seeking Skills Training
Liaison with university
Liaison with an architects’ business
Setting educational/vocational goals
Supported study for diploma thesis in Architecture
Study Skills Training
Work Placement in an architects’ office, supported by a specialist
job coach
The effects of Brain Injury on employment
CASE STUDY 1: OUTCOME
Passed Diploma Thesis in Architecture: June 2001
Employed by Architects Office: September 2001
The effects of Brain Injury on employment
Vocational rehabilitation and supported employment – ideal model
Information, advice and support to client and family
Early intervention
Employer liaison
Community integration
Holistic assessment with other agencies, family and client input
Neuropsychological/occupational therapy assessment as
required
Individual programme planning (multi disciplinary approach)
The effects of Brain Injury on employment
Vocational rehabilitation and supported employment – ideal model
Psychosocial rehabilitation
Training in compensatory strategies for physical problems/
stamina building
Flexible and realistic vocational profiling and exploration
Information technology training
Graded work experience placements with job coaches as
transitional specialists
(place and train model)
The effects of Brain Injury on employment
Vocational rehabilitation and supported employment
Regular review of work goals
Specific vocational training as required/study skills training
Job seeking skills training and intensive job search
Marketing to employers
Ideal job match
Back to work benefits advice
Transitional/through care support in employment
Optimal use of natural supports in the workplace
Independence in the workplace/supported employment
The effects of Brain Injury on employment
CASE STUDY 2 - INJURY DETAILS
Injury sustained in May 1998
Male aged 34 years old
Fall down stairs, circumstances unclear
Admitted to Glasgow Royal Infirmary.
CT brain scan: left subdural haemorrhage with significant mass
effect and oedema
2 small intracerebral haematomas in the right and left frontal lobes
Transferred to The Southern General Hospital( no surgery –
conservative treatment
Returned to GRI
PTA 2-3 days. Length of hospitalisation, 2 weeks
The effects of Brain Injury on employment
CASE STUDY 2: EFFECTS OF HEAD INJURY
Headaches
Sleep disturbance and low levels of stamina
Dizziness and positional vertigo
Impaired memory and poor concentration
Slowed information processing
Difficulties in initiating, planning and organising tasks
Word finding problems
Low mood and irritability
Increased sensitivity to noise
Low levels of motivation
High levels of anxiety/panic attacks
Low confidence and social isolation
The effects of Brain Injury on employment
CASE STUDY 2: SUPPORT PROVIDED PRIOR TO
REFERRAL TO VRP
Information regarding head injury and its effects
Regular home support visits
Allocation of a support worker to assist community integration
activities, including travel management
Liaison with employer/negotiation of medical retirement
Benefits advice and assistance
Anxiety management
Information about/support to implement compensatory strategies
for memory impairment
Carer support/information
Referral to and assistance to attend The Head Injuries Trust for
Scotland
Referral to Rehab Scotland, Brain Injury Vocational Rehabilitation
Programme
The effects of Brain Injury on employment
CASE STUDY 2: Assessment of needs at referral
Dizziness/balance problems
Headaches
Poor stamina
Memory impairment
Difficulties with concentration( especially divided attention)
Difficulties initiating, planning and organising tasks
Anxiety
Low mood
Low levels of motivation
Lack of hope/goals in relation to returning to work
The effects of Brain Injury on employment
CASE STUDY 2: INDIVIDUAL PROGRAMME
PLANNING
Induction
Gradual introduction to a structured, simulated work
routine/environment
Neuropsychological assessment
Brain Injury Awareness Training
Cognitive training for memory/concentration problems
Rehabilitation strategies for executive problems
Stress,anxiety and relaxation training
Individual psychology support re anxiety and low mood
Work Related Social Skills Training
The effects of Brain Injury on employment
CASE STUDY 2: INDIVIDUAL PROGRAMME
PLANNING
Social Re-integration and leisure activities
Individual Resource Project: Teaching others to play guitar
Family information and support (e.g childcare)
Client representative training
Information Technology Training ( Certificate)
Vocational profiling and exploration
Specific vocational training in Lifting and Handling
2 Work Experience Placements ( Support Worker)
Review of work goal and Job Seeking Skills Training. (Cert)
Intensive Job search
Outcome: Employment, August 2000 as a concierge with Glasgow
City Council, Housing Department
The effects of Brain Injury on employment
The benefits of early intervention, facilitated by an integrated
pathway approach which promotes joint working:
Case Study 1: Significant gap between brain injury and return to
employment (5 years)
Case Study 2: Reduced gap between brain injury and employment
(2 years)
Case Study 1: Significant secondary problems affecting mental
health, family relationships and readiness/willingness of
client/family for specialist intervention
Case Study 2 : Information and support at an early stage facilitated
effective intervention, trust in service providers and family
involvement/commitment
The effects of Brain Injury on employment
Range of employment outcomes
Architect – City centre practice
Concierge – Glasgow City Council
Support worker – Turning Point
Support worker – Care Line
Warehouse assistant – Index
Project Co-ordinator – Glasgow Play Scheme Association
Support worker – Key Housing
Warehouse assistant – Clothing factory
Sports centre assistant – National Sports Centre - Largs
The effects of Brain Injury on employment
Vocational rehabilitation – benefits
Cost effective (80% employment/15% further
education/training)
Addresses specialist problems
Empowers
Feedback mechanism which captures performance targets
Promotes personal/professional development
Reduces psychosocial problems
Promotes social and economic inclusion