Getting Back To Work
As a survivor of a severe brain injury, Nicole
has a hard time with the word 'impossible'. Once told she would
never work full time, she is now finishing her degree in
Rehabilitation Counselling and works as a support worker with other
This topic has a somewhat personal note for me, because, as
someone who has sustained and survived a severe brain injury, I
have a phenomenally difficult time with the word 'impossible'. As
someone who was told they would never work full time, I am grateful
to now have the opportunity to be able to put something back into
the brain injury field.
I am currently in my last year of doing a degree in
Rehabilitation Counselling, and in between university and studying,
I work in the Lifestyle Support division of ABICIS in Brisbane.
This article is written with the intention of providing knowledge
for people with acquired brain injury (ABI) and their carers about
maximising your potential for employment.
ABI AND WORK
Too often people with ABI are given little hope of regaining or
gaining employment possibilities, sometimes due to the pessimism
and shortsightedness of the medical profession. Employment means
many things to many people. For people with ABI it may be seen as a
means of community integration, independence or a chance to return
to the type of life they may have been engaged in prior to the
occurrence of ABI.
People with ABI often have difficulty in executive functioning and
memory, which can result in impaired organisationand reasoning
skills. Further physical impairments frequently include fatigue,
headaches, epilepsy and speech difficulties. Furthermore, injury to
the frontal lobes may cause irritability, loss of emotional control
and socially inappropriate behaviour. ABI often encompasses
long-term physical, emotional and cognitive impairments, which can
make fruition of successful vocational outcomes a challenging
process; but nothing is impossible.
MAXIMISING YOUR CHANCES
You may think that you are limited in skills due to lack of
education or lack of work experience; however an effective
vocational evaluation process should enable you to look at many
skills you have in everyday life, and apply them to a potential
work context. For example, if you pay your bills you have the
ability to handle money, and this may also give you problem solving
skills and prioritising skills (haven't most of us had to juggle
our money at some stage?). If you have ever listened to a friend or
family member problems you may have developed effective listening
and empathy skills. The things we manage to do in everyday life can
give us skills that are often taken for granted, but are incredibly
useful in a work situation.
Key issues that will maximize a person's chance at gaining
- Having a rehabilitation counsellor who is knowledgeable in
- A flexible approach to vocational goals
- The use of empowering methods which promote inclusion
- The vocational evaluation process should give individuals a
better understanding of their
potential vocational functioning and interests.
- People with ABI will need to gain awareness of job
opportunities compatible with their skills and interests.
- Knowledge of rehabilitation services and supports which will
optimise vocational functioning and stability.
Typically, rehabilitation counsellors have used neuropsychological
assessments as a way of predicting vocational functioning. This is
considered a traditional form of assessment; however some feel that
such a singular structured approach is not adequate to address the
variety of functional impairments and environment needs of people
with ABI. Questions regarding how a person's disability may be
accommodated to enable employability are rarely asked.
Traditional methods almost always rely on reading and language
skills, which may exclude a significant sector of people with ABI
due to cognitive and communication changes. If, as someone with an
ABI, you have ever been subjected to these kinds of tests, you will
know how unrewarding the process can be.
In order to get the most advantage from a vocational evaluation,
it is imperative to be aware of what methods will work for you.
Contextual interviewing could be a preferable beginning to the
vocational evaluation process, rather than questionnaires.
Contextual interviewing considers both the environment in which the
interview is conducted, and the way the rehabilitation counsellor
physically relates to the client.
The environment for interviewing should be relaxing and calming
with minimal distractions. The initial interview provides an
opportunity to enhance information the rehabilitation counsellor
should have already gathered from your team of professionals.
During the initial interview, the rehabilitation counsellor should
gain the following insights about you:
- Your socio-vocational history
- Education level
- Involvement in activities prior to the ABI
- Personality tolerances
- Impact of disability on current life experiences
- Environmental supports and barriers
- Goals and interests
- Financial situation.
Once goals, interests, education skills, experience, interests and
barriers are determined, both you and the rehabilitation counsellor
should have a better idea of the agreed vocational direction to
take. The next step is to identify available jobs in your local
community, and this process should also involve you.
A situation assessment can provide effective insights regarding
employability behaviour, as it is the observation of a client
engaging in a work situation. People with ABI, particularly frontal
lobe injury, often perform significantly better or worse in
everyday contexts than predicted by standardised tests (Ylvisaker,
Hanks and Johnson-Greene, 2002). Situational assessment enables a
view of behaviours rather than just skills, and allows observation
of the interaction between the worker and the workplace. The
ability for an individual to participate in real-life work
experience can also avoid the stress associated with an artificial
A situational assessment is more empowering than traditional
methods, as it emphasises inclusion, and assumes everyone is
capable of working. This type of assessment shifts the focus from
functional limitations to workplace barriers, and develops the role
of co-worker supports. Situational assessment also accommodates
disabilities through resolving difficulties, and may be used as a
means to achieve employment goals, or develop further
rehabilitation plans such as supported employment.
ALTERNATIVE METHODS NEEDED FOR ABI
Traditional methods of vocational assessment may not be the most
appropriate choice for people with ABI, as they may be taxing on
concentration and require significant application of language
skills. Any attempt to simplify or modify traditional assessment
for adaptation to ABI impairments will impede the validity and
reliability of the results. Failure to encompass real world issues
through aspects such as environment consideration and practical
learning, may lead to greater potential for failure to reach
vocational goals for people with ABI. When considering the
implications of ABI impairment, it is necessary for assessment
tools to accommodate disability through more flexible and
empowering methods that promote inclusion. When a person feels a
part of the process, they are more likely to accept ownership of
the process, and therefore are more likely to achieve their desired