the “perfect job”: resources and tools for finding meaningful work after brain injury hollee...
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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
• 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
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
• 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
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
• 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
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
• 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
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
MPAI-4 Tool to Assess Job Compatibility
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:
MPAI-4 Tool to Assess Job Compatibility
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:
MPAI-4 Tool to Assess Job Compatibility
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
MPAI-4 Job Compatibility Tool in Practice
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
MPAI-4 Job Compatibility Tool in Practice
Review: Total Score of Ability
Executive Functioning 8
Memory 6
Attention 2
Social Communication 14
Visual spatial 6
Physical 9
Total Score of all abilities 45
Restore MPAI-4 Score:
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
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
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
MPAI-4 Job Compatibility Tool in Practice
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
MPAI-4 Job Compatibility Tool in Practice
Review: Total Score of Ability
Executive Functioning 6Memory 7Attention 2Social Communication 14Visual spatial 4Physical 10
Total Score of all abilities 43
TSE MPAI-4 Score:
MPAI-4 Job Compatibility Tool in Practice
KL’s MPAI-4 Score:
Review: Total Score of Ability
Executive Functioning 12
Memory 7
Attention 3
Social Communication 12
Visual spatial 0
Physical 1
Total score of all abilities 35
MPAI-4 Job Compatibility Tool in Practice
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
MPAI-4 Job Compatibility Tool in Practice
Review: Total Score of Ability
Executive Functioning 8Memory 6Attention 2Social Communication 15Visual spatial 6Physical 15
Total Score of all abilities 52
Animal Adoption Center MPAI-4 Score:
MPAI-4 Job Compatibility Tool in Practice
MN’s MPAI-4 Score:
Review: Total Score of Ability
Executive Functioning 10
Memory 4
Attention 2
Social Communication 9
Visual spatial 2
Physical 6
Total score of all abilities 33
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