Vocational services for traumatic brain injury: treatment definition and diversity within model systems of care

To examine characteristics and diversity among vocational treatment services in model programs for traumatic brain injury (TBI) rehabilitation.

Vocational or postacute treatment components of 16 TBI Model System (TBIMS) centers.

Vocational director/coordinator from each TBIMS surveyed in semistructured phone interview.

Survey of vocational services for people with TBI, with about 100 closed and open-ended questions on vocational assessments; pre- and postjob placement treatments; program philosophies; funding; and integration of cognitive, behavioral, family, and medical rehabilitation interventions.

Great diversity was found among the vocational services of the 16 TBIMS. Programs fell into 3 clusters emphasizing medical rehabilitation services, supported employment, or a combination of these with an emphasis on case management. Job coaching was identified as a key intervention, but there was great variability in intensity, availability, and funding of coaching services.

Diversity in vocational services appears related to funding differences and "parallel evolution" rather than strong treatment philosophy or scientific evidence base. Multicenter research on effectiveness or establishment of best practices in vocational rehabilitation after TBI must deal with substantial existing variability in treatment models and specific interventions, and must examine the relationship of treatment variations to case-mix factors.