A framework to support early team-based provision of vocational rehabilitation for adults with acquired brain injury

Figures & data

Table 1. Phases of research activity underpinning the ABI VR framework.

Research phase	Activity/study	Study findings
Phase 1	Systematic scoping review to identify models, processes and components of ABI VR. 57 studies met the criteria for review. See [18].	Study identified: 16 models of ABI VR 9 process steps; 8 components; 4 service delivery components of ABI VR Key findings identified to include in framework – see Results and Appendix 1
Phase 2	Qualitative study investigating the experiences of consumers (Queensland adults with ABI) regarding ABI VR and RTW (n = 8), analysed using thematic analysis. See [33].	Study identified: Positive and negative experiences with ABI VR and RTW across 5 experiential themes: Addressing VR in rehabilitation; Facilitators of recovery and RTW; Importance and experience of working again; ABI and identity; Services, systems and policies. 5 key areas for early ABI VR services Key findings identified to include in the framework – see Results and Appendix 1
Phase 3	Qualitative study investigating the experiences of expert clinicians (ABI clinicians and VR providers) regarding the provision of ABI VR and RTW in Queensland (n = 34), analysed using content analysis. See [31].	Study identified: 5 themes regarding ABI VR service provision in Queensland: Factors influencing RTW; Service provision, service delivery and pathways; ABI VR processes; Gaps in ABI VR; Ideal services Key findings identified to include in framework – see Results and Appendix 1
Phase 4	Qualitative study investigating significant others’ views of their partner’s experience with ABI VR and RTW in Queensland (n = 2); analysed using thematic analysis. See Appendix 2.	Study findings and key components identified to include in framework are reported in this manuscript - see Results and Appendices 1–3.
Phase 5	Synthesis of findings (from phases 1-4 above) to develop a framework for transitional community ABI VR.	Reported in this manuscript - see Results and Appendix 1

Figure 1. Framework for interdisciplinary vocational rehabilitation in transitional ABI rehabilitation.

Table

Framework Component & Features	Evidence base + Recommendations
	Phase 1 Scoping Review	Phase 2 pwABI	Phase 3 HP Study	Phase 4 SO
Vocational coordinator role
● Coordinates IDT approach and leads Stream A client activities	●	●	●	●
● Leads communication with client around VR goals, vocational roles, treatment and progress + coordinates consents (e.g., employer contact)	●	●	●
● Leads employer and stakeholder contact (funders, external RTW providers, educational institutions)	●	●	●	●
● Leads in-team medical liaison			●
● Coordinates completion of documentation - Vocational Profile, medical records and GP correspondence	●		●
Assessment
Initial interviews and IDT assessments	●		●
IDT ‘Vocational Profile’ commenced to gather information from a variety of sources- client, employer, role descriptions, significant others, colleagues, etc. to identify:	●	●	●	●
● Role tasks (task analysis)	●	●	●
● Personal factors and abilities	●	●	●
● Work / study environment	●	●	●
Outcome measures:		●	●
● AQ and RRTW			●
● IDT measures as indicated			●
Identify other partners for RTW	●	●	●
Goal setting and rehabilitation planning
Formalise vocational goals during collaborative IDT goal setting	●	●	●
Considerations for RTW:  Employment type (e.g., professional registration, self-employed), Neuropsychology assessment, Health and medical considerations	●	●	●
Determine VR Stream & program focus:   A. RTW predicted within 3 months (typically to previous employer) → VR   B. RTW predicted 3-12 months (to previous or new employer) → VR + Pre-vocational Rehabilitation   C. RTW predicted >12 months (to previous or new employer) → Pre-vocational Rehabilitation	●	●	●
Intervention
Education to client, significant others, employer, other support agencies.	●	●	●	●
Explore and identify vocational role	●	●	●	●
IDT therapy targeting skills and strategies required for vocational role	●	●	●	●
Individual +/– group therapy	●	●	●	●
Stream A clients (predicted RTW in 3 m):
● Work site visit	●	●	●	●
● Develop RTW / study plan	●	●	●	●
● Liaison with medical team and employer / educational institution to arrange clearance	●	●	●	●
● Review and progress RTW / study plan	●	●	●	●
● Ongoing therapy during RTW	●	●	●	●
Active liaison with employers or other service providers to support RTW or job placement	●	●	●	●
Monitoring and evaluation
● Review goals and progress	●		●
● Re-assessment as required	●		●
● Ongoing IDT therapy planning	●	●	●	●
● Planning next steps	●		●	●
Discharge
Discharge planning	●	●	●	●
Onward referrals	●	●	●	●
Repeat Outcome measures	●
Documentation completed:		●	●
● Service discharge summary			●
● Individualised Vocational Profile to onward providers/agencies			●
Service delivery features
Timing & Access to ABI VR:	●	●	●	●
● During early rehabilitation	●	●	●	●
● Long-term services with monitoring, advice and support	●	●	●	●
Coordinated IDT approach to VR:	●	●	●	●
● Involving a range of team members + VR coordinator	●	●	●	●
● Involve external team members	●	●	●	●
● Knowledgeable clinicians	●	●	●	●
● Positive therapeutic relationships	●	●	●	●
● Positive culture of hope and belief regarding RTW		●		●
Family factors for review (± intervention):		●		●
● Family dynamics and relationships		●		●
● Significant other wellbeing and adjustment		●		●

ABI: acquired brain injury; HP: health professional; GP: general practitioner; IDT: interdisciplinary team; pwABI: people with ABI; RTW: return to work; SO: significant other; VR: vocational rehabilitation.

Table 2. Significant other demographics.

	S/O1	S/O2
Gender, Age, Employment	Female, 29 years, employed	Male, 54 years, employed
Relationship to person with ABI	Partner of male with ABI (injury sustained ∼3 years prior)	Partner of a female with ABI (injury sustained ∼12 years prior)
Demographics of partner with ABI	Employed at time of injury; goals of RTW; has returned to full-time work.	Employed at time of injury; goals of RTW; has returned to full-time work.

Key: ABI: acquired brain injury; RTW: return to work; S/O: significant other.

Table

1	Demographic data (information about you) Name; Contact email; Date of birth; Gender; Relationship to person with ABI Were you employed (including voluntary work and supported employment) or studying at the time of the person’s injury? If yes, what was your role? Are you currently employed (including voluntary work, supported employment or study)? If so, what is your role?
2	Your significant other with ABI Name; Date of birth; Gender; Date of injury; Type of injury (e.g., traumatic, stroke, tumour); Rehabilitation person with ABI Received (e.g., hospital, outpatients) Was the person with ABI employed (including volunteering/supported employment) or studying at the time of injury? If yes - what was their role, type of employment (casual/permanent), and hours worked (e.g., full-time). Is the person with ABI in current employment (including volunteering/supported employment) or study? If yes - what is their role, type of employment (casual/permanent), and hours worked (e.g., full time).
3	Tell us about your family member/friend / significant other - their vocational goals and rehabilitation. Has your family member/friend had rehabilitation for their ABI? Where and when did this occur? After the ABI, when did they first express vocational goals (e.g., returning to work)? When your family member/friend left the hospital, did they have vocational goals? What were they? Did they have vocational goals when they did their rehab? Did their rehab work on these vocational goals?
4	Describe your experiences with their rehabilitation for vocational goals. How and when did this happen? (e.g., outpatient vs inpatient therapy, coordinated program vs single therapist, who did you work with?) How important is/was that goal to the person with ABI? How important is/was that goal to you / your relationship with them? At that time of rehab, did anyone talk to their employer / help you to talk to their employer? Did you feel that rehabilitation addressed their vocational goals?
5	Tell us about your expectations and satisfaction with rehabilitation and vocational rehabilitation. How satisfied were you with this rehab? How satisfied was your family member/friend? How satisfied were you with their rehab outcomes? What was positive about the intervention? What was missing / what were the challenges? What would you have liked your family member/friend to receive help/support with? What would you have liked to receive help/support with regarding vocational rehabilitation? If these goals were not addressed, how would you have wanted this to happen?
6	How is your family member/friend / significant other going today? Do they have current goals around vocation/work? Is your family member/friend / significant other working now? If not, are they involved in other productive activities (e.g., volunteering)? Do they still have vocational goals? What are the barriers you see to them achieving these?
7	Early on in your friend/family member/significant other’s recovery … What should have you both been told about returning to work after a brain injury? What advice or information would you have liked to get?
8	In an early rehabilitation service (e.g., just after getting home from hospital) … What should be provided for adults with vocational goals? How should this happen?
9	In your journey as a family member/friend of an adult with ABI, how has your role changed? Were you working at the time of their injury? Did you need to change your work/vocation following your injury? If yes, Why? Are you working/involved in productive activities / work now? Any other comments on changes to your role following the person’s ABI?
10	Is there anything else you would like to say about vocational rehabilitation with people with ABI that you haven’t had the opportunity to say?

Murray A, Watter K, McLennan V, et al. Identifying models, processes and components of vocational rehabilitation following acquired brain injury: a systematic scoping review. Disabil Rehabil. 2022;44(24):7641–7654. doi: 10.1080/09638288.2021.1980622.

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Watter K, Kennedy A, McLennan V, et al. Consumer perspectives of vocational rehabilitation and return to work following acquired brain injury. Brain Impairment. 2022;23(2):164–184. doi: 10.1017/BrImp.2021.4.

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Watter K, Murray A, McLennan V, et al. Clinician perspectives of ABI vocational rehabilitation in Queensland. Brain Impairment. 2023;1–24. doi: 10.1017/BrImp.2023.6.

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