Frameworks describing the transition to open labour employment for persons with mild and moderate intellectual disability: a scoping review protocol.

INTRODUCTION: Persons with mild and moderate intellectual disability (MMID) have the right to participate in all aspects of society and be afforded equal opportunities to realise their full potential. However, it is a challenge for persons with MMID to find and maintain employment due to many different barriers. Currently, there is no contextually relevant framework in South Africa that considers the unique employment support needs and accommodation of persons with MMID, which can guide and inform the transition to employment interventions, strategies and national policy directives. METHODS AND ANALYSIS: The proposed scoping review will be guided by the methodological framework developed by a working group from the Joanna Briggs Institute (JBI) and the JBI Collaboration. The search for relevant studies will be conducted across 12 research databases. Reference mining of review studies will be conducted. A three-step search strategy will be used, including the use of information management software to manage the search results. Three independent reviewers will screen the full-text studies to finalise the list of included and excluded studies. Included studies will be assessed for methodological quality using a critical appraisal tool. Data will be charted by one independent reviewer and assessed by two independent reviewers, using a data charting instrument. The data chart will be presented using tables and charts describing the demographic features of the reviewed studies, with an explanation of the thematically analysed results. ETHICS AND DISSEMINATION: This scoping review has received ethical approval (BM22/10/11). A summary of the findings of the study will be published in a peer-reviewed journal. This scoping review will contribute to a better understanding of the key characteristics or factors underpinning the components of a multilevel transition to employment framework that will result in open labour market employment for persons with MMID.

A human resource professional perspective of strategies to accommodate employees with mental health conditions in the workplace in South Africa.

BACKGROUND: The South African Labour Relations Act, specifically the Code of Good Practice (CGP) advocates against the discrimination and unfair dismissal of individuals with mental health conditions in the workplace. However, little is known about the implementation of these national policies within the workplace, especially from the perspective of the employer rather than the employee. OBJECTIVE: The aim of this study was to explore the experiences and perceptions of how human resource practitioners accommodate and support individuals with mental health conditions in the workplace. METHOD: Eleven participants (Human Resource Professionals) participated in the study. The researchers utilized semi-structured interviews where the data was analysed by means of thematic analysis to formulate themes. RESULTS: Three themes emerged depicting the participants' experiences and perceptions of barriers and facilitators which influenced their return to work: The themes that emerged through thematic analysis consisted of 1) Challenges perceived by Human Resource personnel that influences work participation; 2) The influence that workplace accommodations and support structures have on the work participation; 3) The prevalence of policies and laws that are available in theworkplace. CONCLUSION: The study highlighted that Human Resource Professionals struggle to interpret and implement labor related polices that aid in employing individuals with mental health conditions in the workplace. It is important to implement strategies that will assist Human Resource practitioners in understanding how to implement such policies to successfully accommodate individuals with mental health conditions in the workplace.

Exploring the experiences of women with acquired brain injury on return to work and entrepreneurial skills development in the Western Cape Metropolitan, South Africa.

BACKGROUND: Acquired brain injury (ABI) is an important public health problem. Individuals with ABI experience greater challenges with community reintegration and successful return to work (RTW) due to both personal and environmental factors. Empirical evidence has shown that women with brain injury are vulnerable to poorer functional outcomes and have demonstrated lower RTW rates post-injury. Therefore, further research is needed to gain greater insight on women with acquired brain injury's functional and work abilities as well as their experiences of RTW and entrepreneurial skills development. OBJECTIVE: This study aimed to explore and describe women with acquired brain injury's experiences during their rehabilitation process, their resumption of their worker role, and entrepreneurial skills development. This qualitative exploration formed part of a study that resulted in an occupational therapy practice model to enhance the entrepreneurial skills of women with acquired brain injury living in the Cape Metropolitan, Western Cape, South Africa. METHODS: Semi-structured interviews were conducted with ten females with acquired brain injury. A qualitative approach was employed to thematically analyse the data. RESULTS: Three themes emerged from the study: (1) Barriers within the rehabilitation process, 2) ABI causes loss of a sense of self and financial strain, 3) Entrepreneurship and education as a strategy to empowerment. CONCLUSION: Unmet individual needs related to occupational engagement results in RTW challenges for women with ABI. ABI sequelae cause activity limitations and hinder gainful occupational participation. A holistic client-centred entrepreneurial skills development approach is a viable and needed strategy to facilitate economic empowerment for women with ABI.

A qualitative enquiry regarding the factors influencing return to work after a cardiac incident in the Western Cape, South Africa.

BACKGROUND: Cardiovascular disease is amongst the top three leading causes of mortality in South Africa and the world. The effects of cardiovascular disease can be seen in limitations of function within all spheres of life, including work function. Cardiac rehabilitation programs have been documented to improve functional abilities, however further research is required with regard to activity limitation, participation restrictions, facilitators, and barriers of return to work, after cardiac rehabilitation. OBJECTIVE: This qualitative study aimed to determine and explore the barriers and enablers of return to work for individuals with cardiovascular disease who completed a cardiac rehabilitation program in the Western Cape, South Africa. The qualitative exploration was part of a study that resulted in a return-to-work program for individuals with cardiac disease. METHODS: Qualitative methodology was employed for this study. Semi-structured interviews were used with 10 participants that attended a cardiac rehabilitation program. Thematic analysis of the qualitative data was completed. RESULTS: The participants described the barriers and facilitators of their return-to-work process and the factors that were of critical importance in the resumption of the worker role or the result of unemployment. The four major themes were 1) Cardiac conditions negatively affect function, 2) Being unemployed, 3) Participation in ADLs and lifestyle modification enhances one's activity levels, and 4) Return to work. CONCLUSION: Lifestyle modification, vocational rehabilitation and reasonable accommodation were viewed as helpful in enabling a successful return to work after a cardiac incident.

Healthcare professionals' perceptions and experiences of the influence of the COVID-19 pandemic on their personal and work performance.

BACKGROUND: Healthcare workers are known to experience higher stress levels compared to other industry workers due to challenges presented in their work environment. The global pandemic of COVID-19 has seen many countries' healthcare systems struggle to meet the demands of healthcare seekers. OBJECTIVE: The aim of the article is to explore healthcare professionals' perceptions and experiences of the influence of the COVID-19 pandemic on their personal and work performance. METHODS: Twelve individuals working in the health sector participated in this study. The researchers used a qualitative exploratory and descriptive research design. Semi-structured interviews were used to collect data. RESULTS: Theme one "A feeling of ambivalence", describes the positive and negative influence that the COVID-19 pandemic has had on HCWs. Theme two "Unfortunately, the support from the government is not as much as it's said to be in the news", describes the support required from government services during the pandemic. Theme three "Changes experienced by the individual related to his or her personal and work routine", describes the changes experienced by healthcare professionals in their daily tasks during the pandemic. CONCLUSION: The study found that the work environment contributed to experiences of burnout and anxiety due to staff shortages, lack of personal protective equipment (PPE) and an increase in work pressure. More research needs to be conducted to inform policies and organizations on how to best support healthcare workers to prevent burnout and anxiety.

Towards occupational resilience: A model to facilitate high school participation post traumatic brain injury.

BACKGROUND: This article describes the model components of a study that applied a two-phased approach towards the development of an occupational resilience model. OBJECTIVE: The occupational therapy practice model that is proposed seeks to facilitate high school re-entry and school participation post traumatic brain injury (TBI). The study's first phase generated results on participants' experiences of high school re-entry and school participation post TBI. These findings contributed to the second phase of developing a practice model to improve upon school transition practice for learners post TBI. METHODS: The study's first phase comprised a qualitative multi-case study of eight cases. Data collection involved semi-structured interviews, participant and contextual observation, and document analysis. Data analysis was performed via an inductive process combined with cross-case synthesis. Phase 2 employed theory generation, suggesting an occupational therapy practice model for facilitating high school participation post TBI. RESULTS: Participant responses revealed, following the onset of the TBI, a need for adolescents to display resilience in order to re-participate in school. This was displayed by adolescents adapting through drawing upon personal and environmental resources as well as preparing for and engaging in occupation. CONCLUSION: A deeper understanding of the experiences of key role players involved in the school transition post TBI, combined with theory generation, formed the basis of developing the proposed model of occupational resilience. Occupational resilience, through a series of resilience-promoting tasks, is offered as a mechanism to increase learners' capacity to adapt to occupational challenges and meaningfully participate in school post TBI.

Worker roles in the open labor market: The challenges faced by people with intellectual disabilities in the Western Cape, South Africa.

BACKGROUND: Work holds great meaning and benefits beyond just monetary gain for people with intellectual disabilities. It gives these individuals the opportunity to engage in meaningful occupation. OBJECTIVE: The purpose of the study was to explore challenges that people with intellectual disabilities (PWID) experience when adapting to their worker roles in the open labor market. METHODS: The study used grounded theory as the research design. Five male participants and two key informants participated in the study. Two semi structured interviews were conducted with each one of the seven participants (five PWID and two key informants). RESULTS: Three core concepts emerged: 1) Unforeseen challenges of change; 2) A well-planned work preparation program enables success and 3) Crossing the bridge into the workplace: "Do I belong here?" CONCLUSIONS: This indicated that with sufficient external support, PWID are able to gain a sense of social belonging and develop the necessary skills to cope with challenges that arise in the workplace when PWID transition from protective/sheltered workshops to the open labor market. The findings of the study also indicated that work preparation programs and supportive employment approaches helped PWID transition to the open labor market.

The value of occupational therapy intervention for the worker roles of forensic mental healthcare users in Cape Town, South Africa.

BACKGROUND: There is a void in research that focuses on how OT programs facilitate self-esteem in forensic mental healthcare users' return-to-work in the open labor market, particularly in South Africa. OBJECTIVE: To explore the experiences and perceptions of forensic mental healthcare users, transitioning from an OT program to the open labor market. METHODS: Five individuals, diagnosed with Schizophrenia, and two key informants participated in this study that was positioned in a qualitative paradigm, with an exploratory and descriptive design. Semi-structured interviews were used to collect data. RESULTS: Theme one reflects on the challenges experienced by forensic mental healthcare users, when returning to work. Theme two describes various OT programs, as well as how they facilitate the reintegration of forensic mental healthcare users into the worker role. Theme three describes the positive support for forensic mental healthcare users, in the mental healthcare setting, workplace, and the greater community. Theme four describes how participation in occupation installs hope in forensic mental healthcare users, reinforcing the value of work, while positively influencing their work identity. CONCLUSION: The results revealed that stigma, residual symptoms, relapse due to substance abuse/mental health, and the lack of family support, were not be conducive to work skills development. However, the support of family and friends, workplace occupational therapy support, assembly line work, and therapeutic groups in an OT program, ensured positive workplace reintegration.

A descriptive, qualitative study of the challenges that individuals with Autism Spectrum Disorder experience when transitioning from skills training programs into the open labor market in Cape Town, South Africa.

BACKGROUND: There is limited existence of qualitative research on adults with Autism Spectrum Disorder (ASD), who are transitioning between skills training programs and finding employment in the open labor market, in South Africa. OBJECTIVE: The aim of this current study was to explore the experiences and perceptions of individuals living with ASD, regarding transitioning from a skills training program to working in the open labor market. PARTICIPANTS: The data were collected through semi-structured interviews with ten participants, who were diagnosed with ASD, and working in the open labor market, as well as five key informants, who have worked with autistic individuals in a skills training program. METHODS: The data collected, using an explorative, descriptive, qualitative method, were analyzed using thematic analysis, and resulted in three emerging themes. RESULTS: Theme one: The 'disorder' in the workplace -The individual and collective barriers that individuals experience in the workplace are described, including social, emotional, and communication difficulties, as well as the stigmatization experienced by persons with a disability. Theme two: Making the workplace work -The facilitative support that individuals are exposed to, in the form of intervention from occupational therapists, sensory psychologists, and other forms of skills training programs, are described. In addition to supportive intervention, the relationships and networking within, and outside of the workplace, are discussed in theme two. Theme three: What works for me -The individual adaptations made by the participants, in the form of unique coping mechanisms in the workplace, as well as in the home environment, are discussed. CONCLUSION: It was observed that, while there are barriers to the transitioning of autistic individuals into the open labor market, there are enablers that facilitate a less challenging transitioning process, in the form of family and workplace support, as well as skills training, and self-identified coping mechanisms.

The Use of the Model of Occupational Self-Efficacy for Work Retraining: A Multiple Case Study.

The South African labour law serves as a guide for employers to accommodate injured individuals in the work place. The aim of the study was to explore and describe the experiences of individuals with traumatic brain injury regarding returning to work through the use of the Model of Occupational Self-Efficacy (MOOSE). The study utilized a multiple case study research design, and 10 participants participated in the study. An analytical strategy of explanation building was used to analyse the data. Three themes emerged from the study, i.e., Theme 1: the model has its limitations (barriers), Theme 2: the model helps facilitate work integration (facilitators), and Theme 3: further enhancements to improve the model. The findings of this study indicated that the participant experiences of the MOOSE are a useful model to facilitate the return of individuals living with a TBI back to work. Coping skills and support groups were also viewed as being an important part of the vocational rehabilitation program.

The experiences of women with traumatic brain injury about the barriers and facilitators experienced after vocational rehabilitation in the Western Cape Metropole, South Africa.

BACKGROUND: Traumatic Brain Injury (TBI) is a serious global public health problem. Globally and annually, at least 10 million individuals live with TBI that is serious enough to result in death or hospitalisationOBJECTIVE:This study aimed to explore and describe the experiences of women with traumatic brain injury, in their work environments utilising the Model of Occupational Self-efficacy as a vocational rehabilitation approachMETHOD:Ten females with mild to moderate traumatic brain injury participated in the study. Semi-structured interviews were conducted and data were analysed utilising a qualitative approach to elucidate themes. Semi-structured interviews were also conducted with two occupational therapists who served as key informants. RESULTS: Two themes emerged depicting the participants' experiences and perceptions of barriers and facilitators which influenced their return to work: (1) Barriers to work participation for women with TBI, 2) Re-establishing a worker identity by means of vocational rehabilitation. CONCLUSION: Both personal and environmental factors emerged as hindrances to returning to work for women with traumatic brain injury. Vocational rehabilitation proved successful in establishing a worker identity amongst participants; however, particular focus should be placed on the function-dysfunction continuum of the process of work place integration to further develop and enhance sustainable return to work programmes for women with traumatic brain injury.

The experiences and perceptions of employers and caregivers of individuals with mild-moderate traumatic brain injury in returning to work.

BACKGROUND: Traumatic brain injury (TBI) has contributed significantly to the burden of health care in many countries. The scarcity of resources in the public sector available for rehabilitation has caused many families to take responsibility for the care and rehabilitation of their family members who sustain a TBI. The roles of employers and caregivers in facilitating the return to work (RTW) process of individuals who sustained a TBI, is now commonly acknowledged. OBJECTIVE: The aim of this study was to explore the perceptions and experiences of employers and caregivers of individuals with mild to moderate traumatic brain injury who are returning to work after completing a vocational rehabilitation program (VR), using the Model of Occupational Self-Efficacy (MOOSE). METHODS: A qualitative research design was used to explore the experiences and perceptions of caregivers and employers of ten individuals who sustained a mild to moderate brain injury. Semi-structured interviews were completed and data analyzed according to thematic analysis. RESULTS: Five themes emerged: Themes one and two describe the employers' and caregivers' experiences and perceptions that hinder the RTW process. Theme three relates to the enabling aspects that the employers and caregivers, as well as the TBI individuals concerned, derive from engaging in the VR process. Themes four and five present the coping strategies that aid the employers and caregivers in playing an ongoing role in the RTW process. All ethical principles with regard to confidentiality, anonymity and informed consent were adhered to in the study. CONCLUSIONS: Occupational therapists (OT) using the MOOSE should regard employers and caregivers as key role players during therapy. Employers should have a better understanding of TBI and allow for sick leave to be granted to individuals with TBI during the rehabilitation process. Caregivers would benefit from establishing a support network for themselves, and by connecting with employers of the individuals with TBI in order to understand the their work environment.

A Service User Perspective Informing the Role of Occupational Therapy in School Transition Practice for High School Learners with TBI: An African Perspective.

BACKGROUND: In the South African context, there are no specific guidelines regarding how to prepare and support adolescents for the transition from a health care to a high school setting post TBI. This raises questions about the relevance and responsiveness of the current transition practices in occupational therapy in terms of adequately preparing and supporting these adolescents to participate in school and hence exercise their right to a quality education. METHOD: This study explored adolescents and other key role players' perspectives on and experiences of the high school transition (i.e., school reentry and continued school participation) post TBI. It was anticipated that this would provide an increased understanding of the enablers and barriers to high school reentry and participation post TBI. This served as a basis to explore the main aim of this study which was to help occupational therapists identify where efforts in terms of service delivery are needed. This study was situated in the interpretivist qualitative paradigm and used a multicase study design, which included semistructured interviews with eight adolescent learners with TBI, their primary caregivers, teachers, and principals as well as observations and documentation review. RESULTS: This paper will focus on a central theme in the research, namely, the nature and extent of support needed to facilitate the high school transition of adolescents with TBI within a developing context. Similar to the findings of studies conducted in developed contexts, participants highlighted that they felt that adolescents need support at various stages of the school transition. Participants further alluded to support that should be collaborative, coordinated, flexible, and monitored to ensure it is relevant and responsive to these adolescents' changing needs. CONCLUSION: The study findings conclude that occupational therapists have a crucial role in fostering an enabling environment (directly and indirectly) through fulfilling various roles including that of a facilitator, intermediary, coach, collaborator, supporter, and advocator.

The experiences and perceptions of individuals diagnosed with schizophrenia regarding the challenges they experience to employment and coping strategies used in the open labor market in Cape Town, South Africa.

BACKGROUND: There is limited research available regarding the coping skills of individuals living with schizophrenia and the strategies used in the open labor market, particularly from a South African context. OBJECTIVE: The aim of the study was to explore and describe the barriers, facilitators and coping strategies that individuals with schizophrenia use when returning to the open labor market after participating in a vocational rehabilitation program to improve work skills. PARTICIPANTS: Four individuals diagnosed with schizophrenia and two key informants (occupational therapists) participated in the study. METHODS: The research study was positioned within the interpretive paradigm, specifically utilizing an exploratory and descriptive design. Semi-structured interviews were used in order to gather data from the participants. RESULTS: Theme one reflects the barriers related to returning to work (i.e. society's acceptance of an individual's work potential). The second theme relates to the enabling factors related to returning to work (i.e. the usefulness of work preparation programs to enhance open labor market employability). Theme three relates to the coping skills that individuals with schizophrenia utilize (i.e. holistic support enhances participation in the worker role). CONCLUSION: In conclusion, the findings indicate individuals with schizophrenia experience barriers that prevent them from being able to adapt to their work environments. However, with the support of the occupational therapist, family, and employer, together with improvements to the vocational rehabilitation program, these barriers may be alleviated, and there could be an improvement in the reintegration of individuals with schizophrenia into the open labor market. The findings suggest that the disclosure of an individual's medical diagnosis, in order to facilitate the return to work of an individual diagnosed with schizophrenia, could be viewed as a barrier and a facilitator.

Exploring the experiences of rehabilitated stroke survivors and stakeholders with regard to returning to work in South- West Nigeria.

BACKGROUND: Stroke has been identified as a global cause of neurological disability with a resultant burden shared not only by the survivor but also by society. The resumption of an individual's role as a worker after having a stroke, is an important rehabilitation goal. South-West Nigeria has experienced a high incidence and prevalence of stroke, leaving a quarter of survivors with severe disabilities and difficulties in community integration after rehabilitation. OBJECTIVE: The study was aimed at exploring and describing the experiences of rehabilitated stroke survivors and perceptions of stakeholders about stroke survivors returning to work in South-West Nigeria. METHODS: A qualitative research design was used to explore these experiences and perceptions from 19 participants, comprising nine stroke survivors, two key informants, who were rehabilitation specialists, and eight caregivers of the respective stroke survivors. The researcher made use of focus groups with the caregivers and semi-structured interviews with the stroke survivors and rehabilitation specialists. The data from the study were analysed using thematic analysis. RESULTS: Three themes emerged: Themes one and two described the barriers experienced by the stroke survivors on returning to work. Theme three described the factors that facilitated the resumption of the worker role. CONCLUSIONS: The study findings clearly depicted the many barriers experienced by stroke survivors and how these negatively impact their worker roles. Limited facilitatory factors exist to assist stroke survivors in regard to adapting to their worker roles. Promoting participation of stroke survivors in work emanating from government policies was deemed to be a necessary recommendation for the study. These policies were seen to be achievable if rehabilitation resources were improved.

The experiences of occupational therapists regarding the use of the Model of Occupational Self Efficacy.

BACKGROUND: Studies exploring the views of occupational therapists about the vocational rehabilitation models of practice related to individuals with brain injury are limited. The views of occupational therapists regarding the use of vocational rehabilitation are important in the development of successful vocational rehabilitation programmes. OBJECTIVE: The aim of the study was to explore and describe the experiences of occupational therapists regarding the use of the model of occupational self-efficacy. PARTICIPANTS: Five occupational therapists participated in the study. METHODS: The research study was positioned within the qualitative paradigm specifically utilizing an exploratory and descriptive research design. In order to gather data, semi-structured interviews were conducted with each participant. RESULTS: Two themes emerged from the findings of the study. One theme reflected the barriers related to the use of the model, i.e. Theme one: Challenges related to the use of the model. The second theme related to the enabling factors related to the use of the model, i.e. Theme two: The model as an enabler of work skills. CONCLUSION: The findings of this study indicated that the Model of Occupational Self Efficacy (MoOS) is a useful model to use in retraining the work skills of an individual with brain injury. The participants in this study could maintain employment in the open labour market for a period of at least 12 months and it improved their ability to accept their brain injury as well as adapt to their worker roles. The MoOS also provides a  framework for facilitating work integration.

Breaking into the world of employment: the vocational experience of South African male ex-offenders.

OBJECTIVE: The study is aimed at exploring, describing and understanding the experiences and perceptions of male ex-offenders with regards to their participation in skills development and/or training programmes. METHODS: The research methodology utilised the qualitative research paradigm, specifically using the tradition of phenomenology. To gather data from the participants, focus groups and face to face interviews were conducted, consisting of broad questions followed by probes to gain an in-depth description of participants' experiences and perceptions. PARTICIPANTS: Five males who were classified as being ex-offenders and one female (key informant) participated in the study. RESULTS: Three themes emerged that reflected the vocational experience of ex offenders: 1) A sense of distrust, 2) A sense of support: Giving back to the community through learning and doing, 3) Working towards change through capacity building. CONCLUSIONS: The findings of the study suggest that occupational therapy practitioners as well as correctional service personnel should identify and eliminate the barriers that impacts on return to work intervention programmes. Professionals working with offenders and ex-offenders should incorporate the enablers identified in this study when designing return to work programmes.

The development of the Model of Occupational Self Efficacy: an occupational therapy practice model to facilitate returning to work after a brain injury.

OBJECTIVE: The purpose of this article is to describe the methodology used in order to develop the Model of Occupational Self Efficacy: An occupational therapy practice model to facilitate returning to work after a brain injury. PARTICIPANTS: Nine males and one female participated in the study. METHODS: Face to face, semi structured individual interviews were conducted and data were analyzed using a qualitative approach to explicate patterns and themes. The study was conducted in two phases, namely, Phase one described the lived experience of individuals with brain injury who had returned to work and Phase two described the development of the model by means of theory generation methodology. RESULTS: Four themes emerged that reflected the lived experiences for people returning to work after a brain injury. (1) A sense of loss of former self; (2) Uncertainty about the future; (3) The road to acceptance and believing in yourself; and (4) Participation in occupation enables growth. The above themes contributed to the central concept called Occupational Self Efficacy that resulted in the development of the occupational therapy practice model. CONCLUSIONS: The findings of the study suggest that theory generation methodology is adequate for the conceptual development of an occupational therapy practice model.

Are rehabilitation programmes enabling clients to return to work? Return to work perspectives of individuals with mild to moderate brain injury in South Africa.

OBJECTIVE: To describe the perceptions and experiences of individuals with brain injury with regard to return to work rehabilitation programmes. PARTICIPANTS: Nine males and one female who were diagnosed with a moderate to mild brain injury participated in the study. METHODS: In-depth interviews were conducted and data were analyzed using a qualitative approach to explicate patterns and themes. RESULTS: Two themes emerged that reflected the lived experiences of individuals with brain injury regarding intervention programmes that influenced their ability to return to work after the brain injury: 1) Enablers of return to work programmes, 2) Barriers related to return to work programmes. CONCLUSIONS: Occupational therapy practitioners as well as rehabilitation personnel should identify and eliminate the barriers that impact on return to work intervention programmes, incorporate the enablers identified in this study when designing return to work programmes.

Individuals with traumatic brain injuries perceptions and experiences of returning to work in South Africa.

OBJECTIVE: The aim of this study was to identify the central concepts of a model that would facilitate the return to work process of individuals with brain injury. However for the purpose of this paper there will be a focus only on the barriers and facilitators that influence the return to work process. PARTICIPANTS: Ten individuals who were diagnosed with a mild to moderate brain injury participated in this study. METHODS: Qualitative research methods were used in order to explore the research question. The participants were selected by means of purposive sampling and the data was collected by means of in depth interviews. RESULTS: The results of the study revealed that the participants experienced a sense of loss of function after the brain injury, a fear of the future and loss of confidence in their worker roles. The participants also indicated that by means of adapting occupational routines an actively engaging in rehabilitation they developed confidence in their worker roles. CONCLUSION: Occupational therapists have to use a client centred holistic work integrative approach in order to successfully rehabilitate as well as facilitate the return to work process with people who have suffered a traumatic brain injury.