Research and Training Center

on Community Integration

of Individuals with

Traumatic Brain Injury

Department of Rehabilitation Medicine Mount Sinai School of Medicine New York City

Supported by Grant No. H133B980013, from the National Institute on Disability and Rehabilitation Research, United States Department of Education.

Program Without Walls:Evaluation of an Innovative Approach to State Agency Vocational Rehabilitation

Overview of Presentation

History and background of the Program Without Walls (PWW)

PWW Model Evaluation data Case studies

History and Background of PWW

Model was developed in Rochester New York by two State VR Counselors

PWW services are consistent with the services provided by high performing VR offices

The Research and Training Center and the New York State VR agency (VESID) implemented the PWW model in two lower performing VR offices: New York City and White Plains

The Effectiveness of Vocational Rehabilitation (VR) Services for People with TBI in New York State In New York State there are high performing

and low performing State VR offices High performing offices have rehabilitation rates

greater than 50% Low performing offices have rehabilitation rates

of less than 50%

Differential Service Patterns for People with TBI in High Performing and Low Performing VR Offices

Services used more frequently by high performing VR Offices

Community based evaluation and trainingHigher educationPsychosocial services

Differential Service Patterns for People with TBI in High Performing and Low Performing VR Offices

Services used more frequently by low performing Offices

Facility based evaluation and trainingNeuropsychological servicesMedical evaluation and treatmentPsychological evaluation and treatment

The PWW Model

State VR counselor remains fully accountable-counselors do not transfer responsibility to agencies

State VR counselor recruits, trains and supervises a team of independent contractors or vendors

The PWW Model

Vendors provide person-centered services in the community

Some vendors are individuals with brain injury

PWW Services

Functional cognitive remediation at work, school, or in the home

Situational assessment Work based learning: internship, job tryouts Service coordination (e.g. housing, benefits,

medical/psychiatric services)

PWW Services

Individual and family counseling Job coaching Job development and placement Tutoring

Evaluation Design

A total of 42 VR participants whose cases had been closed took part in the study.

Twenty-one participants received PWW services.

Twenty-one participants who received traditional VR services were matched with the PWW participants on gender, age, ethnicity and education.

Participants Characteristics

EthnicityWhite 42% (N=18)Diverse 58% (N=24)(I.e., Black, Asian)

Gender Men 81% (N=34)Women 19% (N=9)

EducationFinished High School 14% (N=6)Did not Finish High School 48% (N=20)Some Postsecondary Education 38% (N=16)

Outcomes in New York City and White Plains

Higher rates of rehabilitation for consumers served by the PWW versus the matched consumers with brain injuries who received traditional services.

Higher weekly earnings and hours worked per week for PWW consumers versus matched consumers with brain injuries who received traditional services.

Cost of the PWW is not significantly different from standard services provided to brain injured consumers.

Out Comes for Consumers with Traumatic Brain Injury in New York City and White Plains

PWW Matched Controls

Rehabilitation Rates 57% 24%

Weekly Earnings $328.70 $124.00

Hours Worked 32.02 17.80

Average Cost $3586.10 $3326.00of Services

First Case Example

Introduction A 36 year old Latino who was shot in the head in 1990 Language : Spanish/English bilingual Consequences of TBI: memory, cognitive processing and speech

deficits; right side hemiparesis, hemisensory loss and hemianopsia; chronic pain in left arm

Former employment: owned and operated two small businesses High school diploma plus one year of college Vocational goals: Self employment, security guard Participated in two facility based diagnostic vocational evaluations

(DVE) prior to receiving PWW services DVEs found consumer unemployable or unable to benefit from further

training

First Case Example

PWW Services

Functional cognitive remediation and service coordination provided by a rehabilitation counselor PWW Vendor Pursued training as a Kiosk operator through Commission for the Blind but

visual impairment was not severe enough Coordinated remedial reading evaluation to determine reading levels because

consumer wanted to return to college Coordinated services with community based clinical counselor throughout

First Case Example

PWW ServicesFunctional cognitive remediation and service coordination provided by a rehabilitation counselor PWW Vendor

Pursued vocational placement options by working directly with many employment programs

Tutored consumer for security guard pre-employment and post-employment tests

OutcomeWorking full-time as a security guard and has received one raise

Implications

The PWW is one way of serving a challenging, underserved population and improve bottom-line VR outcomes

The PWW can improve the effectiveness of lower performing VR offices

Best practices can be infused into low performing VR offices via the PWW