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Support Services

Getting Back To Work

Personal Stories

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 survivors.


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.

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.

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 employment include:

  • Having a rehabilitation counsellor who is knowledgeable in ABI
  • 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 test environment.
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.

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 vocational goals.


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