By:Nicole Korbecki, MS, OTR/L, CBIS
Rainbow Rehabilitation Centers
Physical abilities, cognitive abilities, and behavioral control are all necessary for success in the workplace and can make rehabilitation following a traumatic brain injury (TBI) challenging, depending on the level and severity of the injury.
A TBI can have a devastating effect on almost all areas of an individual’s life and can affect the ability to contribute in a meaningful way to family and community:
Physical impairments or weaknesses can limit one’s strength, endurance, or ability to use both sides of the body.
Cognitive skills are often impaired, which may limit one’s memory, concentration, or ability to problem solve.
Behavioral changes may limit one’s ability to follow directions, accept feedback, or obey rules.
Individuals who were injured early in life face an additional challenge—they may not have yet held their first competitive job. These teens, who are ready to transition out of high school, truly require more guidance where vocational goal setting is concerned. In these cases, services take on a habilitation approach. Habilitation is learning a new skill in order to achieve maximum independence. Conversely, rehabilitation is relearning a skill previously present to improve maximum independence with daily life.
Rainbow offers a Young Adult Program-—with various pre-vocational and supported occupational opportunities—that is structured to be a stepping stone to competitive employment.
Upon entering the program, each potential candidate goes through a 90-day evaluation period in a community rehabilitation setting with job coach assistance. The focus here is solely on skill building. A grading system provides a concrete number and percentage to the employee as a baseline that is used to track performance and performance changes. It is based on a 100-point scale, similar to a school report card. Attention is given to basic skills. The following are just a few:
- Use of a time clock
- Taking appropriate breaks and break lengths
- The number of hours one can work in a day
- Accepting feedback
- Quality/productivity while working
Following the evaluation period, an individual has the opportunity to work in an occupational site with full supports on a four-days-a-week schedule. After evaluating scores, behaviors, and participation, the individual could be offered a “part-time” two-days-a-week schedule.
Opportunities within the young adult program include recycling materials, shredding documents, copying and assembling manuals, completing mailings and labeling, landscaping, auto detailing, and assembling various products to sell. Much of the mailing and labeling work the young adults complete assists local community charities such as Hospice.
With the successful management of a four-day schedule and successful maintenance of a daily points reward system, an individual may move into a community enclave, or small group, with job coach assistance.
The community enclaves have provided opportunities for work at locations such as Villa Marie Assisted Living Facility, Sanctuary of Marian Assisted Living Facility, The Salvation Army Thrift Shop, and The Gap and other retail locations. Work tasks include meal preparation, customer service, general cleaning, stocking, and maintenance of store standards.
Pre-competitive employment and competitive employment
The young adult team then coordinates, as appropriate, stepwise progression from the community enclave in the following way:
- A Rainbow-based pre-competitive employment site with a job coach
- A pre-competitive employment site without a job coach consistently present
- And then if possible, into competitive employment
- Feedback is provided along the way via the job coach, site supervisors, occupational therapy, and the use of a point system.
Additional support is provided as needed by the therapy team, with opportunity for a full therapy schedule designed to compliment the workday. Mental health services are also available as needed to assist with managing the challenges faced in work adjustment. For those who wish to continue with community college work or the completion of a GED, support is provided through occupational therapy and speech & language pathology.
Opportunities in pre-competitive employment include work in Rainbow’s Central Supply Room. The centralized shipping and receiving team focuses on training in logistics and warehouse-based work. Tasks include receiving shipments, order packaging, and order delivery. Other pre-competitive employment opportunities include kitchen and dining room assistance at Rainbow’s NeuroRehab Campus® and training with a janitorial service.
In addition to the vocational opportunities within the Young Adult Program, Rainbow’s Oakland Treatment Center also offers an optional Saturday work skill building program for the high school group. A variety of prevocational opportunities are also offered for those in middle school and high school in combination with group and individual therapies during Rainbow’s Summer Fun! Program.
Working toward independence
Vocational rehabilitation is a challenge for anyone who has sustained a brain injury. For young adults who have never had a work experience, the path to employment can be even more complex. That’s why evaluation, basic skills training, support and careful placement are the necessary ingredients of a young adult vocational program. The goal of increasing one’s independence and competitive employment opportunities has become the recipe for success at Rainbow Rehabilitation Centers.