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Employment After Brain Injury

Thursday, August 23rd, 2018 By

Every day in the U.S.153 people die from a traumatic brain injury (TBI). Of the nearly 300,000 who survive a TBI, some are injured so severely their lives will never be the same. They struggle to get back the physical and mental capabilities they had before their injury.

Most of those who experienced a brain injury (BI) of any kind long to be self-sufficient. They seek employment, but due to the residual effects of their injury, they find this difficult since they may be impaired either physically, cognitively, emotionally or all three.

Barriers to Employment for Those with a BI:

Those who suffer a BI often have cognitive, physical, or emotional impairments that affect their ability to find a job. Some disabilities which are barriers to employment are:

Cognitive disabilities.

This include things like a shortened attention span, difficulty remembering things, decreased communication skills and a lack of reasoning and problem-solving skills. Those with a cognitive disability may also have trouble remembering things, so directions may need to be given several times or provided in writing.

Physical disabilities.

Some people may suffer long-term or permanent paralysis. Others may have weakened limbs and suffer from lack of coordination, making it difficult for them to walk or to grasp with their hands. They may have impaired vision or hearing, and have difficulty sleeping. Many are unable to drive and must learn how to use alternative methods of transportation. Some may require the use of a wheelchair, which may affect the way they can move around in the workplace.

Emotional disabilities.  

Many have difficulty controlling their emotions and may cry or laugh improperly and at inappropriate times, or have difficulty controlling their anger. They may succumb to periods of depression, and may exhibit impulsive behavior.

Things may be changing for those with a BI.

Those who previously were believed to be unemployable due to their disability may be able to find employment if they work within a system where there are now advocates and services that can help them overcome previous barriers to their employment.

Vocational Rehabilitation Services

Every state has a Vocational Rehabilitation Services Agency (VR) which has as its mission to help those with disabilities find employment. Every year, they assist thousands of people with disabilities to obtain job skills and ultimately become successfully employed.

VRs were established primarily to help those with physical disabilities. Since people with BIs who are seeking employment often have disabilities that are not visible, the severity of their disability may be discounted. In order to obtain VR services, those with a BI that results in cognitive or emotional disabilities and not physical ones must prove that their injury, although not immediately visible, is severe enough for them to qualify for services.

Even after a person with a BI convinces the counselor that they qualify for services, the VRs are required by law to assist those with the most severe disabilities first. Evaluations by a rehabilitation physician and neuropsychologist are often necessary in order to prove the person with a BI is indeed entitled to prompt services.

VRs experienced in dealing with those with a BI can be extremely helpful. Unfortunately, in some areas of the country, it may be uncommon to find a counselor with BI experience. That puts the onus of helping the counselor understand the limitations a BI has caused on the shoulders of the person with the BI. The injured person may need to provide the VR counselor with educational materials about the impact of a BI, how it changes lives, and how employers can benefit from employing them.

Once the hurdle of qualifying for services is over, the VR helps prepare those who are disabled in any way due to their BI to gain the skills they need for a particular job, prepare them for job interviews, and help them to understand what accommodations to ask the employer about during the employment interview.

Some specific services provided by some VRs include:

  • Education.
  • Intensive job training.
  • Rehabilitation.
  • Career counseling.

The Maryland VR, operated under the state Division of Rehabilitation Services offers services to “people with physical, emotional, intellectual, developmental, sensory and learning disabilities.” In addition to career assessment and counseling, it also provides education, job training, technology assistance, and job placement services.

Applicants for services must prove they are eligible for services. Those who are receiving benefits under the Social Security Administration (SSA) are automatically eligible.

VRs generally are aware of the most important elements of successful VR experiences for people with BIs. This includes early intervention, employer education, work trials, supported employment, a “place then train” program, and long term follow-up.

Early intervention.

The earlier those with a BI begin rehabilitation, the better the outcome. This means including the prospect of returning to work as part of the rehabilitation plan. This is true even if it is clear that there will need to be a long period of rehabilitation time, which also means it will be a long time before returning to work will be a realistic option.

Employer education.

Some people want to hide their disability and not inform their employer or coworkers that they had a BI. For those who qualify for VR services, this is generally a mistake.

Employers are, or can be, educated about the value a person can bring to the workplace despite the disability. Also, if employers are aware of the disability, they can make the necessary legal accommodations. In some cases, an employer may be eligible for a financial incentive offered by the state or federal government for hiring someone with a certain disability.

Former employers of the person disabled by a BI are, for the most part, supportive of bringing the person back to work to their old job. If this is not possible, former employers are known to work diligently to find an alternate placement for the BI employee somewhere within the organization.

Work trials.

An employer, and even the brain-injured potential employee, may have reservations about the ability of the injured person to do the job. Convincing either or both of them to give it a trial has often been successful. It may then lead to permanent employment.

Supported employment.

Initially, a brain-injured person may need a job where they can have a job coach available as he or she learns how to do the job. The job coaching needs diminish as the employee becomes more comfortable at the job. Eventually, the coach will no longer be needed.

Place then train.

Traditionally, people are trained to do a job before they seek employment. Those with a BI have been found to do better if they have on-the-job training with the assistance of a job coach. That gives them the opportunity of learning what is specifically required of them, which is easier for them than transferring their general training to the specific job description.

Long term follow-up.

The most common reason people with BIs lose their jobs is that there was a change in the job requirements, or a change in the work environment that upsets them. This can range from having a new supervisor, or a change, even a simple change, to their job duties. If a counselor or job coach is involved and providing long term follow-up, the counselor can intercede with the employer and work with the employee in adjusting to the new situation.

Americans with Disability Act (ADA)

In 1990, the Americans with Disability Act (ADA) was made into law. It is a civil rights act designed to protect those with disabilities from discrimination in all areas of public life, including protection against discrimination by employers. This means that employers cannot refuse to hire someone who is otherwise qualified for a job simply because the person has a disability.

The ADA also prevents an employer from firing, or refusing to offer a person who is otherwise qualified a promotion or job training based solely on the employee’s disability. A qualified individual with a disability is defined as “a person with a disability who satisfies the requisite skill, experience, education and other job-related requirements of the employment position such individual holds or desires, and who, with or without reasonable accommodation, can perform the essential functions of such position.”

A reasonable accommodation is defined as, “any modification to a job or the work environment that will enable an applicant or employee with a disability to participate in the application process or to perform essential job functions.”

Some examples of reasonable accommodations are:

  • Installing a ramp for wheelchair access or modifying a rest room to make it accessible.
  • Allowing a service animal in the workplace.
  • More frequent breaks.
  • Allowing for part-time employment.
  • Modifying equipment or training manuals.
  • Allowing a generally timed test to be taken without a time limit.
  • Providing written instructions along with oral ones.

Employers are not required to pay for accommodations themselves, and there are federal funds available to compensate them for changes they make. Employers may avoid making accommodations if they can show that such an accommodation creates an “undue hardship” for them.  But, they cannot refuse to make accommodations, or refuse to hire someone with a disability, if the disability interferes with the person’s ability to perform minor duties that are not essential to the performance of the job.

Those with a BI who are seeking employment need to let the employer or prospective employer know about accommodations as soon as possible. Employers need advance notice in order to make many potential accommodations. They are not required to make any accommodation if they have not been notified of the need to make such an accommodation and the accommodation requested must be reasonable.

Social Security Administration (SSA) Benefits

The Social Security Administration (SSA) administers two programs designed to assist people who have a medically related disability:

  • Social Security Disability Insurance (SSDI), which is for those who have worked for a long enough period of time at a job where Social Security (SS) taxes were withheld from their wages.
  • Supplemental Security Income (SSI), which is for those who have a financial need.

The SSA has no provisions for paying benefits to those who are only partially disabled or disabled for only a short period of time. The qualifications that must be met in order to qualify for benefits under the SSA definition of disability are:

  • The injured person must not be able to return to their former work; and
  • The SSA decides that the person cannot adjust to any other work due to the medical condition; and
  • The disability has lasted a year, or is expected to last a year, or to end in death.

The SSA periodically reviews a case to determine if a person receiving benefits is still disabled. In turn, the disabled person is expected to keep SSA informed of any improvement in their medical condition.

The SSA offers assistance to those who receive benefits with a goal of helping them increase their self-sufficiency and return to work. The program helps then in preparing to reenter the work force and in maintaining that employment.

The Ticket to Work and Self-Sufficiency Program

When people begin receiving benefits under the SSA, most of them become eligible for the Ticket to Work Program which has as its goal to help those with disabilities to reenter the workforce. To help them meet that goal, under this program, the injured person can choose to use the services of an Employment Network (EN), a vocational rehabilitation services provider, or any other services provider that is designed to help them achieve the goal of returning to work.

Whichever service provider the disabled person chooses to work with, the idea is to put a plan together with a goal for the person receiving disability benefits to reenter the workforce.

Participating in the program does not affect the receipt of benefits. Benefits continue until the person actually begins earning wages or income from self-employment. The program is also designed so those who become self-sufficient by earning an income are still able to keep their Medicaid or Medicare.

There are many aspects to the Ticket to Work program. SSA has provided a FAQs section on its website to assist those who are receiving SSA benefits in understanding the Ticket to Work program.

In addition, for those who are receiving SSA benefits, every state has a program called Protection and Advocacy for Beneficiaries of Social Security (PABSS). PABSS staff assist people who are receiving SS disability benefits in “obtaining information and advice about receiving vocational rehabilitation and employment services.”

The Work Incentives Planning and Assistance (WIPA) program, formerly known as the Benefits Planning Assistance and Outreach (BPAO) program, is designed to help those with disabilities who want to work, but still face barriers in finding employment.

Vocational Rehabilitation and Employment Program for Veterans

The U.S. Department of Veterans Affairs provides vocational rehabilitation and employment services (VR & E) to those who have a service-related disability and find it difficult to work in their former occupations. The goal is to help the veterans find suitable employment. Suitable employment is defined as employment that is: 1) within a veteran’s physical and emotional capacity; and 2) matches his or her skills and interests.

All veterans who are on active service who expect to receive a discharge other than dishonorable, and have received a memorandum rating of 20 percent are eligible for VR & E services. Veterans who received a discharge other than dishonorable, and have a service-connected disability rating of 10 percent, are eligible for VR & E services.

After eligibility for services is established, the veteran will meet with a VR counselor (VRC). Together, they will put together a rehabilitation plan. In order to determine a realistic plan, the two will work together to, among other things:

  • Determine if the person has transferable skills, aptitudes, or interests.
  • Establish realistic employment and/or independent living goals.
  • Explore the labor market and obtain wage information.
  • Identify job characteristics, like what are the possible physical, cognitive, and emotional demands it will make.
  • Check out suitable employment options and training requirements.
  • Identify necessary resources that will help in achieving the goals.

The purpose of the plan is to assist the veteran to meet his or her goal of self-sufficiency and employment.

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