The Importance of Being Earnest: Brain-Injury (BI) Informed Competencies for Employment Service Providers
Maria Crowley, MA, CRC, National Association of State Head Injury Administrators (NASHIA)
The Issue
An employee’s ability to be effective and efficient involves demonstrating knowledge, skills, and a certain set of aptitudes. Anyone would agree that being our best selves professionally requires ongoing skills development throughout our careers. Professional competency is a lifelong process, acquired through mentoring, exposure, and training. This is especially true when it comes to assisting individuals with cognitive challenges in beginning or returning to work. Vocational Rehabilitation (VR) and employment professionals require abilities and experience well beyond a formal education. It takes years to learn about community resources, the labor network, and the art of creating and implementing an individualized plan for employment that is person-centered. When layered with the medical, emotional, and physical consequences of brain injury (BI), additional expertise in these areas is required.
More than ever, employment services should be customized to meet the unique needs of individuals experiencing a new normal due to brain injury. Unlike many other disabilities, the related impact can create a sudden need for supports in order to obtain or maintain employment. Brain injury often necessitates a job search that happens in the middle of someone’s career trajectory rather than an entry-level position. Working with someone who has experienced a brain injury—especially when that person may have lost the ability to learn new skills, or transfer old skills learned into a new environment—demands a special set of skills.[1] Brain injury is a chronic condition: invisible, undiagnosed, or misdiagnosed, often even to the person applying for services, which requires the ability to identify suspected related but undocumented challenges.[2]
We teach individuals who have chronic challenges related to brain injury how to prepare for work, and all the hard and soft skills required for the job itself and the search process. But how do we develop the ability to help guide people in the right direction? How are we prepared to offer the best support possible to increase employment success? How do we instruct ourselves?
The Solution
The Administration for Community Living (ACL) is home to the Traumatic Brain Injury (TBI) State Partnership Program, supporting and coordinating grants to states for “building, enhancing, or expanding infrastructure to create and strengthen systems of services and supports that maximize the independence and overall health and well-being of all people with TBI across the lifespan.”[3] The TBI State Partnership Program seeks to enhance national impact through workgroups focused on specific topics related to individuals with brain injury. One of these workgroups is focused on transition and employment (T&E), as a critical part of the lifespan for most people includes work. The T&E workgroup set out to identify a set of core competencies, intended to serve as a general guide for the professional development of the knowledge, skills, and abilities needed by vocational rehabilitation counselors and other employment providers serving individuals who are working to enter or re-enter the workforce following a brain injury.
The Process
Step 1: The first goal of this workgroup was to review existing resources, current trends, and evidence-based practices to identify gaps in support across state systems related to employment and brain injury. This review included any existing research related to positive employment outcomes and current training needs. In the last funding cycle (2018-2021), the states participating in the T&E workgroup took a look at gaps in effective employment outcomes and conducted an extensive literature review to analyze current barriers, and new/relevant training materials. The resulting T&E Workgroup Literature Repository is extensive and the content is available for public review and dissemination. Resources include data on successful employment outcomes following brain injury; supported employment; brain injury sequelae; economic impact of employment on people living with brain injury; evidence-based training materials; and career development practices.
Step 2: Once the T&E workgroup completed the review, the participating states focused on drafting a comprehensive list of competencies that was distributed nationally. The workgroup identified VR subject matter experts to review and respond to the list of competencies via an online self-assessment survey that they developed. The purpose of the self-assessment survey was to gauge VR counselors’ self-perceptions of their level of expertise within each competency as it relates to serving individuals with brain injury. There is widespread interest among various partners in the brain injury field to learn what employment service providers perceive to be their own strengths, as well as areas where more training may be desired or needed. There were four domains in the survey involving self-perceived strengths related to brain injury in:
- Medical and rehabilitation areas;
- Employment;
- State and local systems, resources, and service coordination; and
- National systems, research, and best practice.
One additional open-ended item was included in the survey to collect information about the learning style of participants and how they apply what they learn.
The Results
From the survey results, The T&E workgroup created a national, culturally competent, person-centered professional development employment training infrastructure for professionals serving the TBI community, known as Vocational Rehabilitation Counselor Competencies. These competencies are focused on core knowledge, skills, and abilities needed for VR service professionals to help individuals with brain injury achieve and sustain successful employment. The areas of competency are centered around the four domains listed above. The T&E workgroup results are summarized in more detail in the 2022 Journal of Vocational Rehabilitation (JVR): Traumatic Brain Injury Vocational Rehabilitation Counselor Competencies: Implications for Training and Practice. State Brain Injury programs have encouraged their employment partners to integrate use of the competencies for staff training and skills building.[4]
The Applications
These competencies can be used as a best practice guide in a number of ways:
- States can include the competencies in hiring or in training requirements for VR counselors, as well as other workforce re-entry professionals and employment specialists (including counselors working in substance use treatment, mental health and homelessness settings, or other areas such as these where there is a high co-occurrence of brain injury).
- States have used BI competency and expertise development to create a cadre of specialty counselors, leading to better employment outcomes and more job satisfaction for individuals with brain injury as well as higher wage levels at closure.
- Programs offering supported employment long-term supports can also benefit. Consider recommending some or all of these competencies when working with community service providers.
- Additionally, supervisors and program directors in state VR programs often provide consult on brain injury-related cases or manage caseloads from time to time or when there are staff vacancies. As primary trainers for new employment service provider staff, they can utilize this resource as well.
Key takeaways from the JVR article and grantee insights
In 2014, the Workforce Innovation and Opportunity Act (WIOA) removed the requirement that VR counselors hold an advanced degree in rehabilitation counseling, but knowledge specific to rehabilitation and disability management remains essential.[5] The competencies discussed in the JVR article are helpful in identifying knowledge specific to rehabilitation and brain injury-informed disability supports. The T&E workgroup outlined how tiered training for best practices in effectively applying the competencies when working with individuals with brain injury is beneficial. Providing training on screening is also important, as cognitive disabilities might be hidden or unknown when providing services. As the demand for competitive, integrated employment increases, so should the skills and practices of professionals supporting individuals with cognitive challenges.
Being earnest about being brain-injury informed as an employment service provider or vocational rehabilitation counselor just makes the most sense. Wouldn’t you agree?
For more information about this project or employment and brain injury, contact the National Association of State Head Injury Administrators.
Maria Crowley serves as NASHIA’s Director of Professional Development and as a primary consultant for the TBI Technical Assistance and Resource Center, funded by ACL, supporting State TBI grantees and other stakeholders. Maria started working in the rehabilitation field as a job coach, then as a Business Relations Consultant with ADRS, facilitating the job placement of individuals with a wide variety of disabilities and providing customized employment training and consulting for businesses statewide. She has specifically focused on brain injury since 2000 to help individuals in home, community, and employment. She has led a number of initiatives and provided technical assistance related to behavioral health, juvenile justice, advocacy, concussion management, intimate partner violence, employment, trust funds, advisory boards, service coordination and trauma/ surveillance registries within business, state government, nonprofits, and partner organizations.
References
- Leahy, M. J., Chan, F., & Saunders, J. L. (2003). Job functions and knowledge requirements of certified rehabilitation counselors.
in the 21st century. Rehabilitation Counseling Bulletin, 46(2), 66-81. https://doi.org/10.1177/00343552030460020101 - Corrigan, J. D., & Hammond, F. M. (2013). Traumatic brain injury as a chronic health condition. Archives of Physical Medicine and Rehabilitation, 94(6), 1199-1201. https://doi.org/10.1016/j.apmr.2013.01.023
- Administration for Community Living Administration on Disabilities. (2021). Traumatic Brain Injury State Partnership Program (SPP). https://apply07.grants.gov/apply/opportunities/instructions/PKG00266188-instructions.pdf
- Bennett, K., Dillahunt-Aspillaga, C., Lasley, C., Trexler, L. C., Schmeeckle, W., Walker-Egea, C., Gonzalez, C. M., & Trexler, L. E. (2022). Traumatic brain injury vocational rehabilitation counselor competencies: Implications for training and practice. Journal of Vocational Rehabilitation, 57(1), 53–64. https://doi.org/10.3233/JVR-221198
- Mackay, M. M., Dunn, J. P., Suedmeyer, E., Schiro-Geist, C., Strohmer, D. C., & West, S. L. (2020). Rehabilitation counselor degree type as a predictor of client outcomes: A comparison of quantity versus quality in closure rates. Rehabilitation Counseling Bulletin, 63(2), 91-101. https://doi.org/10.1177/0034355218806378
