the “perfect job”: resources and tools for finding meaningful work after brain injury hollee...

The “Perfect Job”: Resources and Tools for Finding

Meaningful Work after Brain Injury

Hollee Stamper, MSW, LSW Jeff Noonan, M.Ed.Cognitive Therapists

Today’s Objectives:

• Understand the significance of volunteer and employment positions as related to quality of life

• List challenges encountered when helping individuals with acquired brain injuries find their “Perfect Job”

Today’s Objectives:

•List Community resources and services available to support the vocational process

•Understand how to utilize brain injury outcome measures (the MPAI-4) as an effective assessment tool to determine job compatibility

Outline

• Today’s Objectives

• Vocational Planning and Quality of Life

• Job Coaching Challenges

• Cognitive Challenges and Strategies

• Unrelated to Cognitive Challenges

• MPAI- What is it?

• How the MPAI Can Assess Job Compatibility

• Types of Employment

• Vocational Resources

• Quality of Life

Vocation and Quality of LifePerceived Quality of Life has a strong relationship with Employment“The Effect of Employment on Quality of Life and Community Integration after Traumatic Brain Injury” Authors: John O’Neil,PhD and others

337 Adult participants, ages 18 to 65

Participants sustained brain injury a minimum of one year prior to interviews

Vocation and Quality of Life

Measures: The Craig Handicap Assessment Capacity Technique, Bigelow Quality of Life Questionnaire, Flanagin Scale of Needs, and Global QOL measure

Part-time or full-time employment contributes to community community inclusion inclusion and sense of well-being sense of well-being

Outline










• Quality of Life

Specific struggles of job coaching working with individuals affected by brain injury

Premorbid educational and vocational history

– Specialized training

– Certification and Degrees

– Prior work experience

– Metacognition

Job Coaching and Challenges

Metacognition

• Metacognition: Metacognition: Knowing about cognitive processes; knowing about one’s own cognitive strengths and weaknesses; knowing procedures (strategies) to improve cognitive functioning (learnet)

• Self-AwarenessSelf-Awareness

• Sense of IdentifySense of Identify

Case Example

• Volunteer Opportunity at New Jersey Tree Foundation

• Matched interest and experience with volunteer opportunity

ABMale, 55 years oldTree logging accidentManual Laborer

Strengths

-High level of initiation

-No impairments with

mobilityStruggles

-Episodes of irritability

- processing speed

New Jersey Tree Foundation

Outline










• Quality of Life

Job Coaching and ChallengesCognitive changes

• Attention• Memory

• Initiation

• Problem-solving

• Mood

• Processing-Speed

Physical changes • Mobility• Use of hands• Fatigue• Pain

• Others…

Attention Strategies

Schedule TasksUtilize Alarms

Complete a single task at a timeLimit Distractors if possible

Incorporate breaks

Sustained Attention

Divided Attention

Selective Attention

Case Example• Volunteer Opportunity

at Operation BackPack

• Completed Single Task

• Structured Environment

• Frequent Breaks

• Social engagement

CDMale, 54 years oldVictim of Assault

Strengths

-Selective Attention

-Meticulous Struggles

-Difficulty w/ divided

attention

-Poor Alertness

Operation Backpack

Memory Strategies

Review job responsibilitiesDevelop checklist of tasksIdentify steps of tasks Onsite trainingCollaborate with volunteer/job site

Encoding

Storage

Retrieval

Case Example • Volunteer Opportunity

at

• Reviewed steps of routine prior to entering food bank

• Completed Alterative Tasks

• Assembly Line Format

• Peer Feedback

EFFemale, Early 20’sMotor Vehicle Accident

Strengths

-Extroverted

-CreativeStruggles

-Labile

-Memory Deficit

-Poor stability

Physical Functioning

Consider accessibility of site

Match task with level of mobility

Consider impact of cognitive fatigue

Mobility

Use of hands

Fatigue

Pain

Case Example• Volunteer Opportunity

presented by

• Structured Environment• Completed assigned

task• Format was tailored for

success

•

GH Female, Early 20’s Motor Vehicle Accident

Strengths

-Initiation to learn new

information

-Strong family involvement

Struggles

-Poor Stability

-Memory Deficit

Job Coaching and Challenges

Other challenges to consider: Funding source for rehabilitation servicesSocial Security Income (SSI)Social Security Disability (SSD-I)Family Support and Input

Outline










• Quality of Life

Mayo-Portland Adaptability Inventory Mayo-Portland Adaptability Inventory (MPAI-4)

and Job Compatibility Job Compatibility

The Mayo-Portland Adaptability Inventory (MPAI) was primarily designed:

To assist in the clinical evaluation of people during the post-acute period following acquired brain injury (ABI)

To assist in the evaluation of rehabilitation programs designed to serve these people

To better understand the long-term outcomes of

acquired brain injury (ABI) (Malec, J. (2005). The Mayo-Portland Adaptability

Inventory.The Center for Outcome Measurement in Brain Injury.)

The MPAI-4 provides the rehabilitation professional or other clinicians with a brief and reliable means of assessing functioning in each of three major domains to help target areas for intervention and assess progress (Malec, J. (2005). The Mayo-Portland Adaptability Inventory.The Center for Outcome Measurement in Brain Injury.)

Mayo-Portland Adaptability Inventory Mayo-Portland Adaptability Inventory (MPAI-4)

and Job Compatibility Job Compatibility

Mayo-Portland Adaptability Inventory Mayo-Portland Adaptability Inventory (MPAI-4) and Job Compatibility Job Compatibility

Table 1: MPAI-4 Items by subscales

Ability Index Adjustment Index Participation IndexMobility Use of Hands Vision Audition Motor Speech Communication Attention/Concentration Memory Fund of Information Novel problem-solving Visuospatial Abilities Dizziness

Anxiety Depression Irritability, anger, aggression Pain and headache Fatigue Sensitivity to mild symptoms Inappropriate social interaction Impaired self-awareness Family/significant relationships Initiation Social contact Leisure/recreation

Initiation Social contact Leisure/recreational activities Self-care Residence Transportation Work/school Money management

Outline










• Quality of Life

MPAI-4 Tool to Assess Job Compatibility

Job compatibility tool specifically assesses: Executive FunctioningMemoryAttentionSocial CommunicationVisuospatial Physical Ability

MPAI Tool to Assess Job Compatibility

Person Served: Date:Job Title:

Organization: Hours:

LOS: Assessor:

Executive Functioning

Functional Area/Correlating MPAI Rating PS Rating Job With Aid?

11. Novel problem-solving Y/N

20. Impaired self-awareness Y/N

22. Initiation Y/N

Total

MPAI Scoring Rubric

0 None 1 Mild problem but does not interfere with activities; may use assistive device or medication

2 Mild problem; interferes with activities 5-24% of the time

3 Moderate problem; interferes with activities 25-75% of the time

4 Severe problem; interferes with activities more than 75% of the time


MemoryFunctional Area Requirement9. Memory: Problems learning and recalling new information 0 1 2 3 410. Fund of Information: Problems remembering information learned in school or on the job; difficulty remembering information about self and family from years ago

0 1 2 3 4

Total Comments:

Attention

Functional Area Requirement8. Attention/Concentration: Problems ignoring distractions, shifting attention, keeping more than one thing in mind at a time

0 1 2 3 4

Total Comments:


Social Communication

Functional Area Requirement6. Motor speech: Abnormal clearness or rate of speech; stuttering 0 1 2 3 47A. Verbal communication: Problems expressing or understanding language 0 1 2 3 47B. Nonverbal communication: Restricted or unusual gestures or facial expressions; talking too much or not enough; missing nonverbal cues from others

0 1 2 3 4

15. Irritability, anger, aggression: Verbal or physical expressions of anger 0 1 2 3 419. Inappropriate social interaction: Acting childish, silly, rude, behavior not fitting for time and place

0 1 2 3 4

25. Self-care: Eating, dressing, bathing, hygiene 0 1 2 3 4Total

Comments:

VisuospatialFunctional Area Requirement3. Vision: Problems seeing; double vision; eye, brain, or nerve injuries that interfere with seeing 0 1 2 3 412. Visuospatial abilities: Problems drawing, assembling things, route-finding, being visually aware on both the left and right sides

0 1 2 3 4

Total Comments:


Physical

Functional Area/Correlating MPAI Rating PS Rating Job With Aid?

1. Mobility Y/N

2. Use of hands Y/N

4. Audition Y/N

16. Pain and headache Y/N

17. Fatigue Y/N

Total

MPAI-4 Job Compatibility Tool in Practice

Volunteer Opportunity: Habitat for Humanity Restore

IJ Male 37 years old Sustained injury

from work related accident

MPAI-4 Score:17


IJ’s MPAI-4 Score:

Review: Total Score of Ability

Executive Functioning 4

Memory 4

Attention 3

Social Communication 5

Visual spatial 1

Physical 0

Total score of all abilities 17

MPAI-4 Job Compatibility Tool in PracticeRestore Program Description

Cashier responsibilities

Pricing and shelving of items

Evaluate condition of donations

Assist with item repairs

Evaluate condition of donation

Assist with item repair




Memory 6

Attention 2


Visual spatial 6

Physical 9

Total Score of all abilities 45

Restore MPAI-4 Score:

Outline










• Quality of Life

Types of Employment• Competitive and Supported Employment

• Transitional Supported Employment (TSE)

• Contract Employment

• Internships/Volunteer Positions

37

Community Prevocational ResourcesVolunteer Opportunities

-Utilize local non profits which require varied physical and cognitive skills

e.g., Animal Shelters, Food Bank, thrift stores, Meals-on-Wheels, Garden Centers, Local Churches

-Craigslist, Indeed, other search engines

38

Outline

Today’s Objectives

Vocational Planning and Quality of Life

Job Coaching Challenges

Cognitive Challenges and Strategies

Unrelated to Cognitive Challenges

MPAI- What is it?

How the MPAI Can Assess Job Compatibility

Types of Employment

Vocational Resources

Quality of Life

40

Community Vocational Resources

1.State/County Funded-Resources that use federal or state money to

provide vocational assistance for persons with disabilities

Example: Ticket to Work

http://www.ssa.gov/work/overview.html#a0=0

http://www.ssa.gov/work/overview.html#a0=0

State/County Funded

• Division of Vocational Rehabilitation Services (DVRS)

41

42

2.Internal programs that support vocational planning-Volunteer opportunities within the department-Volunteer opportunities in the community-Transitional or therapeutic employment opportunities


Employment Opportunity: Transitional Supported Employment

KL Male 28 years old Sustained anoxic

brain injury MPAI-4 Score: 35

Paid Employment OpportunityTransitional Employment Services (TES)Job duties include:

-Environmental Services:•Care of lawn and lots •Office Maintainence

44

Physical and Cognitive AbilitiesPhysical abilities:

-must be independently ambulatory-must be able to lift 10lbs. Independently

Cognitive Abilities:-must be able to communicate clearly-must be able to follow directions-sustained attention

Target MPAI-4 Score: 43

45



Executive Functioning 6Memory 7Attention 2Social Communication 14Visual spatial 4Physical 10


TSE MPAI-4 Score:


KL’s MPAI-4 Score:



Memory 7

Attention 3


Visual spatial 0

Physical 1



Volunteer Opportunity: Animal Adoption Center

MNMale55 years oldTBI Secondary to Motor Vehicle Accident MPAI-4 Score: 33

Animal Orphanage

Job Duties:Volunteer will be able to work for a maximum duration of 2 hoursVolunteer will perform activities needed by the shelter including but

not limited to:• making animal enrichment toys• pet care• cleaning cages• walking animals.• socializing animals• safety awareness, known allergies

49

Physical and Cognitive AbilitiesPhysical abilities• Use of fine motor skills

Cognitive Abilities• Maintain attention

50



Executive Functioning 8Memory 6Attention 2Social Communication 15Visual spatial 6Physical 15


Animal Adoption Center MPAI-4 Score:


MN’s MPAI-4 Score:



Memory 4

Attention 2


Visual spatial 2

Physical 6


Outline

Today’s Objectives

Vocational Planning and Quality of Life

Job Coaching Challenges

Cognitive Challenges and Strategies

Unrelated to Cognitive Challenges

MPAI- What is it?

How the MPAI Can Assess Job Compatibility

Types of Employment

Vocational Resources

Quality of Life

Vocation and Quality of LifeEmployment may be related to:Employment may be related to:

-Higher rates of energy

-An indicator of rehabilitation success

--Associated with lower levels of depression

-Overall psychological well-being-

”“The Psychological Effects of Employment After TBI: Objective and Subjective, Theodire Tsaousides,Teresa Ashman, and Colette Seter-Mount Sinai School of Medicine

Our MissionBancroft’s mission is to ensure that every person is given opportunities for lifelong learning and fulfillment.

We do this by altering perceptions, and by supporting those with intellectual and developmental challenges and acquired brain injuries in achieving their life goals as valued and respected members of our world.

Respect is our clearly defined core value that helps unify the organization and provide a framework for services, decision-making and working together.

It is important that we demonstrate Respect…

In everything we do.

With everyone with whom we interact.

Always.

Respect begins with ME. Right now.

Our Core Value - RESPECT

Questions and Contact Information

• [email protected]• [email protected]

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the “perfect job”: resources and tools for finding meaningful work after brain injury hollee...

Documents

quality of lifemeasures

cognitive challengesmpai

quality of lifelist

cognitive strengths

cognitive processes

brain injury outcome

traumatic brain injury

brain injuryhollee stamper