Place, Train and Sustain

Addressing physical and neuropsychological difficulties in the workplace

 This project was funded by The Department of Health Section 64 and was completed in March 2011.

The overall objective of the project was to investigate whether vocational outcomes for brain injured adults can be improved by the Momentum’s Brain Injury Vocational Rehabilitation Service adopting a ‘Place and Train’ approach to vocational rehabilitation instead of the ‘Train and Place’ model which has dominated service delivery to date. The ‘Train and Place’ model is characterised by a primary emphasis on assessing and intervening with the physical and neuropsychological effects of the person’s brain injury within the vocational rehabilitation centre. However within the ‘Place and Train’ approach the focus is upon directly assessing how any residual physical and neuropsychological effects of brain injury disable the individual within the workplace and, in particular, in regard to their specific work duties.

In 2006 Rehab UK carried out a vocational outcome study based on a traditional approach to vocational rehabilitation. This involved Job Coaches sourcing, overseeing and monitoring client’s work placements in real world employment settings. The Job Coach’s role also extended to encouraging client’s to use compensatory strategies to overcome physical and neuropsychological difficulties impacting upon their work as well as liaising with employers/colleagues to implement ‘reasonable adjustments’ (Disability Discrimination Act 1995) to the work place environment and duties to enable the client to competently fulfil their job role. At the time of the 2006 study however the vast majority of the assessment of the client’s physical and neuropsychological difficulties post injury was undertaken within the then Rehab UK vocational rehabilitation centres. There was limited assessment of the impact of these effects upon the client’s job performance from direct observation in the work place.  

The primary aim of the Place, Train, Sustain project was to investigate whether the vocational outcomes attained in the 2006 Rehab UK study could be improved upon by adopting a ‘Place and Train’ approach within Momentum’s vocational rehabilitation practice. Here, the primary emphasis is on assessing the impact of any physical, cognitive, emotional and behavioural sequelae of the brain injury ‘on the job’. The aim is to achieve this through the use of a new observational measure specifically developed for this purpose. It is anticipated that the results of the workplace based observational measure will then be used to identify the main potential barriers to successful work placement completion. Moreover it is expected that it will also inform the focus of the Momentum intervention within the work placement

Thirty-nine clients of the Momentum Vocational Rehabilitation Services in Newcastle and Birmingham were entered into the project during its three year duration. 47% of the project participants had sustained a traumatic brain injury (TBI). Of the 18 traumatic brain injury participants 14 sustained their brain injury from a road traffic accident; 1 from a fall; 1 from an assault; 1 from a work accident and 1 from a penetrating head injury.  A stroke was the cause of the brain injury for a third of participants (33%) and of these thirteen participants three had experienced a haemorrhagic stroke. The remaining participants had sustained their brain injury through either encephalitis or brain tumour. All four brain tumour participants had had their tumour surgically removed, been medically stable for a minimum of three years and had a prognosis of medical stability prior to their entry to the project.

58% of participants achieved a positive vocational outcome from the ‘Place, Train and Sustain’ project. Paid competitive work (full time) accounted for nearly half of the positive outcomes achieved. Voluntary work (part time) made up nearly a quarter of the projects positive vocational outcomes. Interestingly educational outcomes, whether full or part time, only accounted for 6% of total outcomes. (27%) had not been able to attain a vocational outcome by the project end date of 31.01.11 and were continuing in vocational rehabilitation with the Momentum service.

A Client Satisfaction Survey  was completed by 28 of the 39 participants, a response rate of 71.8%. Of these 28 respondents 27 (96. 4%) answered positively to the yes or no question ‘Do you feel overall that you received sufficient support from Momentum regarding your work placement?’

An Employer Satisfaction Survey was completed by 25 of the 39 employers / work placement providers involved in the project, a response rate of 64.1%. To the yes or no question ‘Do you feel overall that you and your staff received sufficient support from Momentum regarding this client’s work placement?’ all 25 of the employers / work placement providers responded positively.

The level and nature of the vocational outcomes achieved are considered very encouraging given both the assessed severity of brain injury within the participant sample as well as the range and frequency of neurophysical and neuropsychological disabilities presenting. The overall positive outcome rate of 78.6% is likewise judged to be a pleasing finding, particularly given that 64 % of participants entering the project did so when more than 2 years post injury. Earlier studies of return to work after traumatic brain injury have found that if employment has not been re-established within 2 years of injury it is unlikely to be achieved thereafter (Oddy et al,1985; Brooks et al, 1987; Johnson, 1987a). The proportion of the sample attaining and sustaining a positive outcome strongly suggests that the ‘Place and Train’ approach to brain injury vocational rehabilitation which was used in this project is clinically and cost effective. This analysis is strengthened when it is considered that the project has been conducted in the aftermath of the October 2008 economic crisis with UK unemployment reaching 2.5 million towards the end of the project period. In the July to September quarter the unemployment rates in regions served by the project were as follows: East Midlands 8.0%; West Midlands 8.7% and the North East of England 9.0% (Office for National Statistics. www.statistics.gov.uk).   Although the sample size of this project is relatively limited at 39 participants the positive findings suggest that the Momentum vocational service can further increase its general effectiveness by more fully adopting a ‘Place and Train’ approach (see 4.1 above). It will therefore be a priority within the organisation that the findings of this project are considered in full and that appropriate recommendations concerning the further development of the ‘Place and Train’ approach within the Momentum vocational service are specified and implemented.

You can read the full report by clicking on this link