Hiring Individuals with Traumatic Brain Injuries (TBI) Education Employees About TBI Michelle...

Hiring Individuals with Traumatic Brain Injuries

(TBI)Education Employees About TBI

Michelle Maultsby, PhD, CRCAssociate Professor of Rehabilitation

Counseling - South Carolina State University

May 14, 2012

Throughout this webinar, attendees will be allowed to ask questions. Note that presenters will provide a response based on limited and unverified information. These responses should not be construed as direct advice regarding the issue raised, nor should they be construed as a formal opinion issued by CRCC or South Carolina State University.

TACE Center: Region IV, a project of the Burton Blatt Institute.Funded by RSA Grant # H264A080021. © 2012

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GOAL FOR TODAY

To obtain a general understanding of traumatic brain injury, its signs, symptoms and affects in employment settings.


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• Have an understanding of traumatic brain injury (TBI)

• Be able to identify characteristics and symptoms

• Gain knowledge about other disabilities commonly associated with TBI

• Gain factual information related to hiring individuals with TBI

• Understand some predictors of employment for individuals with TBI

• Be able to identify resources available to employees with TBI

LEARNING OBJECTIVES


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• An injury to the brain from external forces, such as vehicular accidents, falls, violence, or sports or recreational injury, or penetration of the skull by a foreign object.

• Not degenerative

• Not a result of a disease

• Not congenital in origin

TRAUMATIC BRAIN INJURY (TBI)


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• Can result in various forms of impairment

• Cognitive

• Emotional/Behavioral changes

• Physical manifestations

• Social

• Vocational

• Other areas of person’s life

TRAUMATIC BRAIN INJURY Cont.


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• 1.4 million persons in the US with TBI (yearly) 50,000 die 235,000 are hospitalized 1.1 million treated and released

• Highest Risk group Infants -4 Adolescents 15-19

• Approximately 80,000-90,000 experience the onset of a long term disability due to a TBI

• Langlois, J. A., Rutland-Brown, W., & Thomas, K. E (2006). Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths.Atlanta, Ga: Centers for Disease Control and Prevention.

TBI STATS


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• 37.8 Billion total

• 4.5 billion in direct expenditures for medical purposes

• 20.6 billion in work related losses & disability

• 12.7 billion in lost income from premature death

Pangilinan, P.H., & Campagnolo, D. (2011). Classification and Complications of Traumatic Brain Injury. J Head

Trauma.

Yearly Economics statuses for TBI


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TYPES OF TBI

• Open Head Injury (Penetrating)

• Injuries as a result of the skull being fractured

• Impairments are related to specific areas of brain affected

• Closed Head Injury

• Skull is not fractured

• Results from blow to the head or violent shaking of the head


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Mild

• Approximately 70% of TBI

• Experience more subtle but disruptive symptoms headaches, dizziness ringing in the ears, sleep disturbances depression, irritability reduced attention span memory impairment

• May have credibility questioned

LEVELS OF TBI


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Moderate

• Loss of consciousness for few minutes or several hours Confusion, disorientation Physical Impairments Cognitive Impairments Psychosocial Impairments

• Symptoms may be permanent

LEVELS OF TBI


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Severe

•Remain in a coma for extended periods of time

•Permanent and more severe deficits

LEVELS OF TBI


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• Loss of response to sounds, light or touch• Response to stimuli is affected

Responding to loud noises Eyes have difficulty focusing Movement is not consistent

• Confusion and agitation

Falvo, D. (2009) Medical and Psychosocial Aspects of Chronic Illiness and Disability. 4th ed. Sudbury, Ma:

Jones and Bartlett Publishers.

CHARACTERISTICS AND SYMPTOMS OF TBI


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• Impaired Communication Difficulty with speech (slurred) Difficulty using and understanding words Misarticulation Laborious speech Hesitancy Reduced vocabulary and grammar



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CHARACTERISTICS AND SYMPTOMS OF TBI• Impaired motor skills (movement, coordination and

balance) walking unsteady balance, walk with a gait, lurch from side to

side Muscle coordination abnormal movements, abnormal muscle tone which

decreases ability to move, too much muscle tone which heightens reflexes or exacerbates abnormal movement

• Impaired motor skills will affect areas such as dressing, eating, driving, typing etc.

Falvo, D. (2009) Medical and Psychosocial Aspects of Chronic Illness and Disability. 4th ed. Sudbury, Ma: Jones and Bartlett Publishers.


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• Impaired Vision Visual-Spatial deficits affects judgment of

distance, size, position, rate of movement, form and the relation of parts to wholes.

May experience difficulty navigating movement through environment and judgment of space

May appear clumsy, knocking items off tables, dropping things when attempting to put them on tables because of perception, unable to read some signs

Falvo, D. (2009) Medical and Psychosocial Aspects of Chronic Illiness and Disability. 4th ed. Sudbury, Ma: Jones and Bartlett Publishers.



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• Hearing Impairments Difficulty interpreting sound Acquired hearing loss Ringing in the ear



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• Memory Affects individuals ability to recognize and

recall Difficulty problem solving Difficulty organizing and planning



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• Touch, taste or smell May experience numbness in various body

parts Inability to feel pain Inability to sense movement of body parts Decrease sense of smell which affects taste

• Eating/ swallowing Difficulty swallowing, chewing Increased chances of choking Saliva build up (causing drooling)



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• Endurance Physical fatigue Mental fatigue Altered sleep patterns



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• Bladder and Bowel function Incontinence Embarrassment


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• Epilepsy Post traumatic epilepsy Experience seizures which results in a loss of

control over body functions Prevoked seizures- caused by extrinsic factors

such as alcohol ,drugs or withdrawals Unprovoked seizure- a symptom of an

underlying neurological condition

Mayfield, J. & Homack, S. (2005). Behavioral considerations associated with traumatic brain injury. Preventing Social Failure, 49(4), 17-22.


TBI - ASSOCIATED DISABILITIES


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• Major Depression

• Anxiety Disorder

• Substance Abuse

• Other associated conditions (usually for more severe TBI) Pneumonia Septicemia Digestive conditions

Mayfield, J. & Homack, S. (2005). Behavioral considerations associated with traumatic brain injury. Preventing Social

Failure,49(4), 17-22.

TBI - ASSOCIATED DISABILITIES


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• Persons with TBI don’t want to work• Persons with TBI are not able to return to work• TBI is immediate and recognizable• Hiring an individual with a TBI will be expensive• Organizations have to hire individuals with TBI

regardless of experience in order to prevent issues of discrimination

Shames, J. Treger, I. Ring, H. & Giaquinto, S. (2007). Return to work following traumatic brain injury: Trends and

challenges. Disability and Rehabilitation, 29(17), 1387-1395.

MYTHS RELATED TO HIRING INDIVIDUALS WITH TBI


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MYTHS RELATED TO HIRING INDIVIDUALS WITH TBI

• Individuals with TBI won’t be able to work long• Individuals with TBI don’t have an earning

capacity• Earning capacity is an individuals ability or

power to earn money

Gamboa, A. M., Holland, G. H., Tierney, J. P., & Gibson, D. S. (2006). American community survey: Earnings and

employment for persons with traumatic brain injury, NeuroRehabilitation, 21, 327-333.


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• Assessment• Counseling/guidance• Job Placement• Job Search• Diagnosis and treatment

Schonbrun, St. L. & Kampfe, C. M. (2007). RSA services and employment outcome in consumers with traumatic

brain injury. Journal of Rehabilitation , 73(2), 26-31.

PREDICTORS OF EMPLOYMENT


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• Level of Severity

• Level of functioning/Improvement

• Receiving vocational rehabilitation services early on

• Knowing what services are available

• Knowing what to say to employers



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PREDICTORS OF EMPLOYMENTKnowing what accommodations are necessary

• Shorten hours• Modified equipment• Modification of duties• Job restructuring• Rest breaks• Reassignment to different person• Modification of workplace• Training materials• Provision of readers


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Employer accommodation and discrimination can powerfully affect successful job acquisition and maintenance. Research shows that employers who exhibit tolerance of difficulties and disruption provided a supportive work environment and assisted in the outcome of successful employment.

Barton, B., Brouwers, L., Ruoff, J., Trudel, T., Valnes, B., Elias, E., & Pines, H. (2010). Child, adolescent, and young adult community integration after a traumatic brain injury.

EP Magazine.



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• Interest in Job

• On the job training

• Counseling and guidance

• Supportive work environment



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• Age

• Personality

• Family Functioning

• Injury Characteristics

Simpson, A. & Schmitter-Edgecombe, M. (2002). Prediction of employment status following traumatic brain injury

using a behavioural measure of frontal lobe functioning. Brain Injury, 16(12), 1075-1091.


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RESOURCES FOR EMPLOYEES• State/federal Vocational Rehabilitation Agencies

• American with Disabilities Act Technical Assistance Program

• Job Accommodations Networks 800-562-7234

• Brain Injury Association of Americahttp://www.biausa.org/

• The Center on Outcome Measurement in Brain Injuryhttp://www.tbims.org/combi/

• Injury Prevention and Control: Traumatic Brain Injury (CDC)http://www.cdc.gov/TraumaticBrainInjury/index.html


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Comments & Questions


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Thank You


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Contact InformationMichelle Maultsby

Associate Professor of Rehabilitation Counseling - South Carolina State University

Email: [email protected]


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Education CreditsCRCC Credit - (1.5)Approved by Commission on Rehabilitation Counselor

Certification (CRCC) • By May 24, 2012, participants must score 80% or

better on a online Post Test and submit an online CRCC Request Form via the MyTACE Portal.

My TACE Portal: TACEsoutheast.org/myportal


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Southeast TACE Region IVToll-free: (866) 518-7750 [voice/tty]

Fax: (404) 541-9002

Web: TACEsoutheast.org

My TACE Portal: TACEsoutheast.org/myportal

Email: [email protected]


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Disclaimer

This presentation was developed by the TACE Center: Region IV ©2012 with funds from the U.S. Department of Education, Rehabilitation Services Administration (RSA) under the priority of Technical Assistance and Continuing Education Projects (TACE) – Grant #H264A080021. However, the contents of this presentation do not necessarily represent the policy of the RSA and you should not assume endorsement by the Federal Government [34 CFR 75.620 (b)].

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