Ask Kathy M. Archives
A Collection of Questions and Answers from TBI Advice Expert - Kathy Moeller

Topic: Vocational Services - Working with Vocational Rehabilitation

Question:

Dear Kathy M.,

We are from another state and are having a dickens of a time getting appropriate services for our son, John, who is a client of our state's Vocational Rehabilitation Department. We are his legal guardians and feel like we have done everything we can to get services for him, but we are frustrated (so is he)!

The process to get him signed up as a client in the first place was grueling. After all the tests and evaluations were completed, they FINALLY accepted him last September. He then went into what they called the "assessment phase," which was followed by the "work assessment" phase. This was supposed to last a month. It lasted nearly three. Then he was supposed to get job coaching. He has had several coaches (not to mention two different VR counselors and three different "jobs"), and each new player seems to have a different idea. We think that all the changes they have made has delayed things and has not given John any structure or consistency. But now it seems that he's running out of time and they are saying he needs to go into a sheltered workshop. He could have done THAT before going through all this! We thought they were going to help him get a real job. We feel that after seven months, he (and we) should have been given more options, or more training or something.

We are also his legal guardians but feel like we are not in the loop. We have difficulty getting reports, and have almost nothing in writing. It can be weeks before phone messages are returned. We're beginning to think that no one cares about helping him. Any suggestions?

Mary and Jim A.


Kathy's Response:

Dear Mary and Jim,

While I cannot say that I have never heard of situations such as yours, I honestly do not think it's the norm. Which means a change of counselors or a conversation with the counselor's supervisor may help.

I have worked with many vocational counselors in different states and have to say that the vast majority are caring and competent.

They are generally over-worked, though, and their case loads are often very large. This can result in less attention to your son's case and needs than you feel is warranted. If this is the case, bringing some of these things (like the phone calls) to the attention of a supervisor, may help. If this doesn't work, you can always look into something called the "Client Assistance Program" (CAP). This is an advocacy program all the states have to help clients get services that will benefit them. I would use it as a last resort, however.

Lack of expertise

It's important to keep in mind, though, that many well-meaning vocational counselors do not have special training in brain injury. This can present problems for clients with brain injury and their families. It can also make the plan they support less effective than it would otherwise be. Now, if the counselor does not have the right kind of experience (in your opinion), you may still want to pursue appropriate "channels" in order to work with someone who does. Counselors can be changed if there is a need or a reason (or even a personality conflict, in some cases).

Sheltered Workshops

Some counselors sometimes use what I call "old models" for assessing and placing persons with brain injury in employment (because they are the "norm," they may not see them as "old") Other counselors are at a loss (they do not know what to do), because placing persons with brain injury is notoriously difficult (recovery and returning to employment is filled with mine fields, and people generally step on one or more of them as they try to get their lives back on track).

Some vocational counselors still use what used to be called the "MRDD model," meaning, they model the way they train and place persons with brain injury after the models that were set up years ago to place persons with mental retardation. Sheltered workshops (and "work enclaves") were used to give people a safe, supervised environment where they were able to "work." Sometimes the work was productive; sometimes it was not. The supervisors would actually do the work themselves sometimes if the client could not work quickly enough or with enough accuracy (so the vendor could count on a quality product). This is not a popular model any longer.

I don't want to go into the pros and cons of "sheltered employment" vs."enclave employment," vs. "supported employment" vs. "competitive employment." Suffice it to say that each of these options can be appropriate, depending on the person, their level of cognitive functioning, their desire to work in each of these environments, and their level of compensatory skill.

Brain Function "in the raw"

The key is ensuring that John is not being recommended for a sheltered workshop situation solely because of his cognitive deficits (test scores that measure what I call "brain function in the raw"). Without knowing more about what his job coaching entailed, it is difficult to know if this is what has happened.

You see, persons with brain injury are often evaluated with the help of neuorpsychological assessments that generally do not meaure or predict how well someone can be expected to perform on the job after they have mastered certain basic compensatory skills. In fact, I have had such a hard time finding an appropriate assessment tool for predicting functional success after learning strategies, I had to develop my own (I don't think a commercially available tool exists). In my experience, compensatory skills training generally needs to be in place before any work assessment or work experience will be valuable to anyone. And assessing how a person currently does, or will do after learning compensations, is difficult.

Also, since specialized compensatory skills training is rare, counselors often rely on the results of these neuropsychological assessments and the recommendations the evaluators make. If they do, they may feel they have no choice but to place a person with relatively severe impairments in sheltered workshop or a work enclave. You have touched on a profound issue (and problem) that is very close to my heart because in my view, some of the neuropsychologists we all rely upon, do not fully understand the ins and outs of compensatory skills training. If they do not, the clients the serve run to risk of not being recommended for compensatory skills training, or what they get is not effective.

It appears that John may have been "tracked" on a path on which many persons with severe injury are placed. Withot talking further or meeting with you and your son, there is no way to know. Has he had compensatory skills training, to your knowledge?

Options

You have several options. I would start by gathering as much information about vocational rehabilitation following brain injury as possible. In particular, find out what successful workers with brain injury did to "get there." The Internet has some excellent resources.

Other e-mail discussion lists are available on the Internet too. Some are for families, some are general.

Ask the same questions you asked me and you will get lots of information. Some families and brain-injured workers on these lists probably live in your state and they may be able to shed some light for you.

I think it is true that more people with brain injury are in sheltered and enclave employment than need to be there! But again, without knowing your specific situation, it is impossible to know.

I would start to network with other families and see what you can learn from them.

Hope this helps.

Kathy M.

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