Participation in competitive employment after severe traumatic brain injury: New employment versus return to previous (pre-injury) employment.

There is limited literature comparing the clinical and employment characteristics of clients accessing new employment with those resuming previous employment. To address this gap, a multi-centre observational study was conducted of all active clients with severe TBI from the 11 community rehabilitation services (n = 588) of the New South Wales Brain Injury Rehabilitation Program. Demographic, injury, clinical and vocational data were collected by treating clinicians employing a purpose-designed protocol. New employment constituted almost 40% of competitive employment outcomes. Clients accessing new employment were significantly more likely to be younger, single, less educated, with more severe injuries and more likely to be displaying challenging behaviours than those resuming pre-injury work. Kaplan-Meier analyses found time to RTW was significantly longer for new employment. Stability of new employment was significantly poorer with jobs twice as likely to break down compared to previous employment. New employment positions were also more likely to be part-time and unskilled compared to previous employment. The results found that placement into new employment made a substantial contribution to employment outcomes after TBI but requires more intensive and tailored programmes to meet the multiple clinical and workplace challenges.

Investigating the Model of Community-Based Case Management in the New South Wales Brain Injury Rehabilitation Program: A Prospective Multicenter Study.

OBJECTIVE: To investigate a model of community-based case management (CM). SETTING: New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP). PARTICIPANTS: All clinicians (N = 72) providing CM within 14 BIRP community rehabilitation teams. DESIGN: A prospective, multicenter study. MAIN MEASURES: A purpose-designed survey. METHODS: Participants from the 12 adult and 2 pediatric services (8 located in metropolitan areas, 6 in rural areas) completed a 3-part survey investigating their organizational context, clinical approach, and CM interventions. Between-groups analyses explored differences among individual services, as well as differences based on age (adult vs pediatric) and location (metropolitan vs rural). RESULTS: All services provided a direct service model of CM. The underlying principles were uniform across services (more direct than indirect service provision; with more client-related than administrative-related tasks; more holistic than service-led in defining client needs; with decision making equally directed by staff and clients; and undertaking a more comprehensive than minimalist range of tasks). CM interventions included the provision of individual support, family support, advocacy, and community development alongside assessment, monitoring, referral, and liaison tasks. There were little differences in practice based on age or location. CONCLUSION: The NSW BIRP has drawn upon the results to produce a model of service for CM.

Comparing the Injury Profile, Service Use, Outcomes, and Comorbidities of People With Severe TBI Across Urban, Regional, and Remote Populations in New South Wales: A Multicentre Study.

OBJECTIVE: To compare the demographic/injury profile, outcomes, service utilization, and unmet service needs of individuals with severe traumatic brain injury across urban, regional, and remote areas of New South Wales. SETTING: The 11 community-based rehabilitation teams of the New South Wales Brain Injury Rehabilitation Program. PARTICIPANTS: Active clients (N = 503) with severe traumatic brain injury. DESIGN: A prospective cross-sectional multicenter study. MAIN MEASURES: Overt Behaviour Scale, Health of the Nation Outcome Scale-Acquired Brain Injury, Disability Rating Scale, Sydney Psychosocial Reintegration Scale-2, Care and Needs Scale, data protocol on service utilization, and unmet needs. RESULTS: There were no differences in injury severity or functional outcomes across the 3 locations. However, clients in regional and remote areas had significantly higher levels of premorbid and postinjury comorbidities and lower levels of participation in comparison to urban clients. Although accessing the same number of services as their urban counterparts, clients in regional and remote areas had significantly higher levels of unmet needs suggesting problems with under-servicing. CONCLUSIONS: Geographical location had a significant impact on service access and outcomes.

Prevalence, comorbidities, and correlates of challenging behavior among community-dwelling adults with severe traumatic brain injury: a multicenter study.

OBJECTIVE: Investigate the prevalence, comorbidities, and correlates of challenging behaviors among clients of the New South Wales Brain Injury Rehabilitation Program. SETTING: All community-based rehabilitation services of the statewide program. PARTICIPANTS: Five hundred seven active clients with severe traumatic brain injury. DESIGN: Prospective multicenter study. MAIN MEASURES: Eighty-eight clinicians from the 11 services rated clients on the Overt Behaviour Scale, Disability Rating Scale, Sydney Psychosocial Reintegration Scale-2, Care and Needs Scale, and Health of the Nation Outcome Scale-Acquired Brain Injury. RESULTS: Overall prevalence rate of challenging behaviors was 54%. Inappropriate social behavior (33.3%), aggression (31.9%), and adynamia (23.1%) were the 3 most common individual behaviors, with 35.5% of the sample displaying more than 1 challenging behavior. Significant associations were found between increasing levels of challenging behavior and longer duration of posttraumatic amnesia, increasing functional disability, greater restrictions in participation, increased support needs, and greater degrees of psychiatric disturbance, respectively (P < 0.004). Multivariate binomial logistic regression found that premorbid alcohol abuse, postinjury restrictions in participation, and higher levels of postinjury psychiatric disturbance were independent predictors of challenging behavior. CONCLUSIONS: Challenging behaviors are widespread among community-dwelling adults with severe traumatic brain injury. Services need to deliver integrated anger management, social skills, and motivational treatments.