Improving Employment Outcomes After Traumatic Brain Injury Through Resource Facilitation

Traumatic brain injury (TBI) is associated with decreased community participation (CP) after injury in key roles, including employment. Approximately 60% of individuals hospitalized with TBI remain unable to return to work at one year post-injury,¹ resulting in estimated total lifetime productivity losses of $51.2 billion.² Resource facilitation (RF) has been shown to be effective toward improving CP following TBI. RF is a “partnership that helps people and communities choose, get and keep information, services and supports to make informed choices and meet their goals.”³ RF can also be referred to as case management, case coordination, service coordination or resource coordination. RF seeks to improve outcomes by eliminating barriers to accessing resources and services. Participation in RF programs results in improved ability to make informed choices when accessing community and state resources.³

Empirical studies have demonstrated the effectiveness of RF for improving CP.^4,5 In a prospective randomized controlled trial of RF in Indiana, Trexler and colleagues5 found a greater rate of return to work and a higher level of CP in the group of participants with brain injury who received RF for six months as compared to a control group. In a related report, the provision of RF in Indiana yielded an estimated $22.5 - $31 million in recaptured earnings.⁶ The need for mechanisms to provide long-term proactive RF for persons with TBI was highlighted by the 2012 Galveston Brain Injury Conference Psychosocial Work Group, consistent with recent emphasis on the perspective of TBI as a chronic condition requiring individualized services throughout the lifespan.⁷

Researchers at the TIRR Memorial Hermann Brain Injury Research Center (BIRC) have recognized the importance of RF through implementation of a randomized controlled trial aimed at improving employment outcomes after TBI. This study is part of BIRC’s Rehabilitation Research and Training Center on Developing Strategies to Foster Community Integration and Participation for Individuals with Traumatic Brain Injury, funded by the National Institute on Disability and Rehabilitation Research. The trial involves comparison of employment outcomes between two randomly assigned groups of individuals with medically documented TBI who wish to return to work. Recruitment is based on consecutive admissions of adults hospitalized for TBI at Memorial Hermann-Texas Medical Center, which operates the Texas Trauma Institute, a Level I trauma center. After successful completion of an evaluation to verify eligibility and readiness to participate in the trial, participants are assigned to either the RF group or to the standard-of-care control group.

Participants in the RF group are referred to the Texas Department of Assistive and Rehabilitative Services (DARS) for possible vocational rehabilitation services. They are also followed for up to one year by one of the study’s case coordinators. Case coordinators facilitate the identification of needed resources (e.g., psychiatric care, therapy services, financial services), accessing of resources and successful utilization of DARS vocational rehabilitation services. Members of the standard-of-care control group receive a referral to DARS, but do not work with case coordinators. Participants in both groups undergo outcome assessments by an examiner who is blinded to group assignment at six, nine, 12 and 18 months following study enrollment to determine employment status, level of CP and life satisfaction. The research team hypothesizes that participants in the RF group will demonstrate higher rates of employment, greater rates of utilization of DARS vocational rehabilitation services, and will obtain higher scores on measures of CP as compared to participants in the standard-of-care control group.

To date, over 90 participants have been enrolled in the study. Although statistical analyses of group differences cannot be conducted until data collection is complete, preliminary participant feedback suggests a benefit of this RF intervention, as participants are frequently unaware of the existence of many services or their need thereof, often lack centralized sources of information about resources and commonly encounter difficulty in navigating the service provision process. After data collection is complete, several peer-reviewed publications are planned to complement our prior presentations on RF and preliminary data from this line of research at regional and national conferences.

¹Malec, J.F. Vocational rehabilitation. In: High WM, Sander AM, Struchen MA, Hart KA, eds. Rehabilitation for Traumatic Brain Injury. New York, NY: Oxford University Press; 2005:176-201.

²Finkelstein EA, Corso PC, Miller TR et al. Incidence and economic burden of injuries in the United States, 2000. New York, NY: Oxford University Press, 2006.

³Connors SH. Resource facilitation: A consensus of principles and best practices to guide program development and operation in brain injury. McLean, VA: Brain Injury Association of America, 2001.

⁴Reid-Arndt SA, Schopp L, Brenneke L et al. Evaluation of the traumatic brain injury early referral programme in Missouri. Brain Inj. 2007;21:1295-1302.

⁵Trexler LE, Trexler LC, Malec JF et al. Prospective randomized controlled trial of resource facilitation on community participation and vocational outcome following brain injury. J Head Trauma Rehabil. 2010;25:440-446.

⁶Reid I, McGreary KA, Hicks MJ. Potential economic impact of resource facilitation for post-traumatic brain injury workforce re-assimilation: Ball State University, January 2011:1-3.

⁷Trexler L, Anders D, Braden C et al. Brain injury as a chronic condition: Implications for psychosocial interventions. From the 2012 Galveston Brain Injury Conference Psychosocial Work Group. Brain Injury Professional. 2013;10:26-28.

Lynne Davis, PhD, is a neuropsychologist at the TIRR Memorial Hermann Brain Injury Research Center and a clinical assistant professor in the department of Physical Medicine and Rehabilitation at Baylor College of Medicine. She is principal investigator of a randomized controlled trial aimed at improving employment outcomes after TBI, funded by the National Institute on Disability and Rehabilitation Research, as part of the Brain Injury Research Center’s Rehabilitation Research and Training Center on Developing Strategies to Foster Community Integration and Participation for Individuals with Traumatic Brain Injury.