Community-Based Employment Following Traumatic Brain Injury.

The preface of Community-Based Employment Following Traumatic Brain Injury, sounds a watch cry that forms the theme for the book: "Deficiencies in the quality of existing evidence regarding the effectiveness and efficiency of community-based services to persons with traumatic brain injury have emerged as a problem in rehabilitation," The editors have congregated an impressive host of professionals in research, education, policy development and analysis, and rehabilitation who strive to meet the changing needs of traumatic brain-injured populations. Extensive and tested research has identified solutions to the difficulties of workplace integration, and employment stabilization. The purpose of the book is to present community-based strategies for improved services and policy development to enhance the quality of life for those effected by traumatic brain injury.

The book is divided into three sections, each consisting of chapters that intertwine in their analysis and recommendations. Section I, Assessment and Clinical Applications in Community-Based Employment, presents training methods, assessment techniques for vocational placement, and diagnostic procedures for diagnosis, and future prognosis of individuals with brain injuries. Chapter 1 promotes computer training utilizing domain specific learning approaches, to be applied in work settings. The author states that for persons considered untrainable, that "demonstration of successful laboratory training of complex skills, such as word-processing, data-entry, and database management, increase the likelihood of securing community assistance and involvement in finding appropriate jobs for persons with brain injuries." Chapter 2 presents a critical evaluation into brain injury rehabilitation. Return to work data, including processes of recovery and intervention, are covered by review of relevant research; the question of ,"successful outcome" is examined clinically including injury-related (i.e., behavior control), and non-injury variables (i.e., environmental) and their impact on individual potential; and the overall effectiveness of flexible approaches to rehabilitation.

Chapter 3 offers useful information on selected assessment techniques of a neuropsychological evaluation to appraise successful rehabilitation outcomes based on level of injury. The author discusses types of neuropsychological and cognitive disorders resulting from brain injury, including clinical and cerebral functions examined through testing (i.e., perceptual and language), types of tests utilized, and methods of interpretation. New practices in assessment, including identification of pre-injury/post-injury variables and relationships to work, compensatory strategies, and appropriate job analyses before job development and placement are also reviewed.

Section II, Models and Approaches in Community-Based Employment incorporates topics ranging from rural-based programs, behavior management techniques and long-term case management, to a proposed model of community-based employment, and work maintenance issues. Chapter 4 considers the challenges of rural rehabilitation by describing two research programs, the Mayo Clinic Traumatic Brain Injury Care Management Model, and the University of Wisconsin-Stout Head Injury Re-entry Project. Characteristics of rural rehabilitation including service barriers are presented. Suggested strategies are then offered to increase policy development and planning for programs currently inaccessible to individuals and their families,

Chapter 5 is a summary of a project conducted by the Research and Training Center at Wisconsin-Stout. A complete review of "Project HIRE" follows, from intake assessment and vocational evaluation, through job placement, training and job-coaching. Each phase of the process is outlined, with emphasis on support services following placement and job-coaching services. General characteristics of individuals used in the project are described as well (e.g., demographics). The summary of findings that concludes the chapter is the refreshing summit of a "Mt. Everest-like" project that broadens the horizon and scope of community-specific employment of individuals with brain injuries.

Chapter 6 discusses intervention approaches to dealing with clients with behavioral problems. A functional analysis strategy consisting of five steps allows for improved placement and successful transition into the work place. The author closes with a list of questions for professionals regarding behavior management and placement, and intervention procedures to remediate problem behaviors. Chapter 7 relates observations made of two neuropsychological programs, and a list of propositions helpful in maintaining employment after traumatic brain injury, thereby increasing productivity and quality of life. Chapter 8 describes the case management process, and prevention of later crises. Long-term rehabilitation program formulation, trained case managers, work challenges and related barriers, and future trends are discussed.

In the final Section of the book, the development of effective public policy, funding and supported employment are featured, Chapter 9 focuses on the role of supported employment and intervention for persons with traumatic brain injuries. A complete review of a 30-month project at the Medical College of Virginia is described, including methods, results, statistical information, rehabilitation outcomes and costs of the program, Chapter 10 treats the issue of funding and economic hardship caused by traumatic brain injury on families. A comparison study of twelve families including types of impairments, services sought, and emotional/fiscal costs is described. Suggestions for funding through legislation is covered, with an analysis of several states, their successes and failures, and cost/benefit analyses with regards to brain injury rehabilitation.

The final chapter is an editorial summary of the efforts of the President's Council on Employment of the Handicapped, and the National Head Injury Foundation. It is a fitting chapter "intended to represent a blueprint for facilitating changes in public policy and the practice of rehabilitation and community integration of persons who have sustained a brain trauma injury.

Community Employment Following Traumatic Brain Injury is edited by three notable researchers from the Research and Training Center at the University of Wisconsin-Stout. The intent of the book is straightforward, and complimented with ,"heady" articles by established contributors. The editors are to be commended on the choice of subject matter, and the format of the materials used. This book should be included in the resource libraries of professionals, educators, rehabilitation counseling programs, and head injury survivors and their families alike. It offers viable alternatives for community employment, and transition to work following the trauma of brain injury.