Predictors of success for state vocational rehabilitation clients with traumatic brain injury

Objectives: To determine the characteristics of individuals with traumatic brain injury (TBI) who request state vocational rehabilitation services and to determine the best predictors of their successful vocational outcomes. Design: Observational study. Setting: Vocational services data from the Missouri Division of Vocational Rehabilitation (DVR). Participants: Seventy-eight individuals with TBI who requested services from the Missouri DVR. Interventions: Not applicable. Main Outcome Measures: Demographic, injury severity, neuropsychologic variables, vocational services offered, and vocational status at time of case closure (successful, unsuccessful, services interrupted, no services provided). Results: Individuals requesting DVR services were primarily men (71%), white (82%), single (47%), of low average intelligence (Wechsler Adult Intelligence Scales-III full scale IQ score, 84.8), and of limited education (11.8y). The majority experienced a significant TBI (ie, 66% were hospitalized after their TBI; 56% reported loss of consciousness; 37% reported posttraumatic amnesia; 32% reported multiple TBIs; avg time since injury, 9.2y). At DVR case closure, 17% were rated as being successfully employed, with nearly all working in industrial, service, or clerical positions (2 in a sheltered workshop, 1 in a professional position). Stepwise logistic regressions indicated that delivery of DVR services (ie, vocational guidance and counseling, on-the-job training) predicted vocational outcome and demographic, injury severity, and neuropsychologic variables did not. Conclusions: DVR clients have multiple impairments that affect them several years postinjury; the provision of DVR services may be more important in determining vocational outcomes than traditional medical, psychologic, and demographic variables.