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Vocational Rehabilitation in the Veterans Health Administration Polytrauma System of Care: Current Practices, Unique
Lisa Ottomanelli1, Shana Bakken, Christina Dillahunt-Aspillaga
1Rehabilitation Outcomes Research Section, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, and Rehabilitation and Mental Health Counseling Program, Department of Child & Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa (Drs Ottomanelli and Dillahunt-Aspillaga); Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, District of Columbia (Dr Bakken); Michael E. DeBakey VA Medical Center, and Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas (Dr Pastorek); and Service Member Transitional Advanced Rehabilitation (STAR) Program, Department of Physical Medicine and Rehabilitation, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia (Ms Young).
Objective/Purpose:
Veterans and service members (V/SMs) with traumatic brain injury (TBI) and comorbid conditions are treated in the Veterans Health Administration (VHA) Polytrauma System of Care (PSC). These V/SMs comprise a unique population with distinct needs for restoring community reintegration, including participation in meaningful employment. Low employment rates after TBI vary and are influenced by many factors. Employment is a central aspect of the VHA priority of facilitating adjustment, and addressing vocational needs alongside healthcare is critical to community reintegration. The purpose of this article is to outline current practices of addressing vocational rehabilitation in the PSC, discuss the unique challenges in serving Veterans with polytrauma, and outline future directions to improve vocational services and outcomes.
Methods:
Briefly review literature on V/SM with TBI and employment, describe the PSC and VHA vocational programs for V/SM with polytrauma, and synthesize proceedings on vocational rehabilitation from the 2017 VHA "Community Reintegration in the Polytrauma System of Care" meeting.
Conclusions:
To advance and expand vocational services the following guidelines were recommended: (1) designing flexible services based on individualized needs, (2) increasing access to vocational services through communication and collaboration, (3) promoting cross-disciplinary education and engagement in vocational care, and (4) systematically tracking employment outcomes.
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