2. Describing Difference Comparison of employment service delivery methods for people who have Traumatic Brain Injury (TBI) versus people who have Developmental Disabilities (DD)

3. Introduction The process of securing and maintaining employment is multi-faceted. The process of securing and maintaining employment is multi-faceted. There are successful service models for other populations, including people who have developmental disabilities, spinal cord injuries, and physical disabilities. There are successful service models for other populations, including people who have developmental disabilities, spinal cord injuries, and physical disabilities. The many similarities between people who have TBI and members of these populations may lead one to believe that the same service delivery techniques can be utilized for members of all groups. The many similarities between people who have TBI and members of these populations may lead one to believe that the same service delivery techniques can be utilized for members of all groups.

4. Introduction, Continued The purpose of this presentation is to compare service delivery elements for people who have TBI and those who have DD. The purpose of this presentation is to compare service delivery elements for people who have TBI and those who have DD. Gaining an understanding of the differences in service delivery for these two groups of people may improve service delivery and, ultimately, the probability of long-term success. Gaining an understanding of the differences in service delivery for these two groups of people may improve service delivery and, ultimately, the probability of long-term success.

5. Referral Source TBIDD Vocational Rehabilitation  Agency for Persons with Disabilities  Support Coordinators  BIAF Family Support Specialist  Physicians and Psychologists  Neuropsychologists, Neurologists, Neurosurgeons  Veterans Administration 

6. Referral Source, Continued TBIDD Community Support Groups  Adult Day Training Facilities  JOBSPlus School System  Hospital Social Worker  Self, Family, Friends 

7. Funding Source TBIDD Vocational Rehabilitation  Grants Private Pay  Medicaid Waiver  Agency for Persons with Disabilities  Private Insurance  According to Dr. Paul Wehman, the cost of employment services is double the cost of a person with moderate mental retardation and four times that of a person with mild mental retardation. (Brown Bag Series, 2007)

8. TBI and DD Intake Process Similarities Disclosure Issues: medical, psychiatric, or physical barriers May have memory, concentration, behavior, or emotion issues May have unrealistic expectations of capacity to work Cognitive challenges If TBI was acquired prior to age 18, individual could be classified as DD. In other words, DD may have been caused by TBI.

9. Intake Differences May not have any family, natural, or paid support to participate in intake – need to develop support team May have difficulty with motor skills they had once mastered, such as reading and writing Family member, natural, or paid support will likely participate in intake – support team is intact May have never learned to read or write even at most elementary level TBIDD

10. Intake, Continued Differences TBI May have substance abuse problems or criminal record Financial situation may be overwhelming May appear angry, agitated, anxious, or depressed More independent – don’t want help even when need it Not familiar with entitlements and laws DD Substance abuse and/or criminal record is rare Finances are usually stable – SSI/SSDI May be excited about the prospect of going to work More dependent – relies on support systems Support Coordinators help with entitlements

11. The Pre-Work Work (TBI Only) Vocational Guidance will help client pursue an appropriate vocation Horizons’ Curriculum Learn to access available Supports, entitlements, benefits, etc. Disability Adjustment Counseling will help the person accept their limitations

12. Job Development TBI versus DD TBI: Resume difficult as it must differentiate between pre- and post-injury skills DD: Resume is fairly simple with few jobs and experiences TBI: May be able to read and write, but have poor motor skills making it difficult to complete application DD: Few people can read, write, or complete application independently TBI: May be reeling from grief and loss – e.g. can no longer drive or complete much of process independently DD: Few people even attempt process independently

13. Job Development, Continued TBI versus DD TBI TBI May have greater understanding of appropriate dress, behavior, responsibilities, work culture, and expectations in the workplace but less support and ability to comply May have greater understanding of appropriate dress, behavior, responsibilities, work culture, and expectations in the workplace but less support and ability to comply DD DD Many lack basic understanding of appropriate social skills, and must be trained in appropriate dress, hygiene, timeliness, and behavior

14. Job Development, Continued TBI versus DD TBI: Brain damage may result in the person’s inability to control behavior, even when they are motivated to do so DD: Behavior programs are available to assist person learn to control behavior, even when they may not be motivated to do so Job Development for people with TBI and DD have some similarities: Register at JobsPlus Develop their schedule of work availability Participate in mock interviews Engage in a job assessment

15. Job Placement Placement TBI Prefers independent decision making DD Steer into career TBI Better understanding of work culture DD Little understanding of work culture TBI Job placement despite behaviors DD Unlikely to be referred if having behaviors DD are not usually referred to employment programs unless behaviors are under control DD have little experience or understanding of work culture as often they are just entering work place for first time People with TBI are more likely to make their own decisions about job opportunities; people with DD are more likely to be guided by their support team

16. Job Training TBI May resent intensive training More likely to benefit from FAAST Assistive Technology Anger and aggression is often present. Person is likely to be younger, did not anticipate injury, and can remember a time when they had no difficulties. Training must be highly individualized and creative to address deficits caused by specific region of the brain that has been damaged Often left with little short term memory and concentration problems. Skill building is different because what a person learns today can be gone tomorrow. DD population tends to be more reliant on professionals. Most programs structure the fading process to extricate the professional support from the job site. DD population rarely use assistive technology. If a person with DD displays anger and aggression, they are unlikely to be referred to employment programs. While DD training is individualized, there are standardized industry techniques to be utilized. DD: learn slower or learn differently, but usually don’t forget what is learned.

17. Stabilization The goal is to attain stability on the job, using the resources available at the job site TBI VR funding lasts for only 90 days on the same job Pressure to succeed as paid support systems are temporary in nature Improvement is a fluid process as person becomes healthy DD Funding lasts for unlimited time, on unlimited jobs Failure is common but supports are permanent in nature People with DD do Not improve over time The long-term success rates of both populations on a single job are not very high; the difference is that the DD population is given the funding to pick back up and start over again where people who have TBI are often left without support systems due to funding constraints.

18. Summary TBIDD Referral Sources People who have TBI can be referred from a variety of government and private sources. People who have DD are referred from two primary sources: APD and VR. Funding Options People who have TBI can access VR, but otherwise must rely on private funding sources. People who have DD have two reliable government funding sources -- VR and Medicaid Waiver. Gathering Intake Information People who have TBI may not present with a packet of information or a support person who can easily fill in the blanks. Some have severe memory loss and have difficulty with even the most routine information. People who have DD are referred after they have been determined eligible for services and begun working with a Support Coordinator. Information is a phone call away.

19. Summary, Continued TBIDD Pre-Work Work People who have TBI want to make decisions about work, but must first come to terms with their own disability. They will likely benefit from Vocational Guidance and Disability Adjustment Counseling. People who have DD usually have a well-established support team who helps them make decisions. They have often had transition and vocational exploration through school. People with DD have had years to adjust to their disability – and do not often present with depression and anger surrounding their disability. Job Development Job development must relate to post-injury skills, but person who has TBI would like to return to pre- injury job and level of responsibility. People who have DD have fewer pre-conceived notions of type of job or level of responsibility.

20. Summary, Continued TBIDD Placement People who have TBI are more involved in the placement decision-making. People with DD are more likely to include support team in placement decision- making. Job Training People who have TBI are more likely to resent the need for intensive job training, instead preferring to learn without support. People who have DD are more likely to depend on intensive job training, and support professionals will use a fading process to reduce on-site supports. Stabilization People who have TBI are no more likely to succeed or fail; however, they have fewer resources to fall back on if they fail. People who have DD have cradle-to-grave resources for support when needed.