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Accounting for employment outcomes following traumatic brain injury (TBI): The implications for delivering TBI vocational rehabilitation in the UK

Langman, P. C. (2007). Accounting for employment outcomes following traumatic brain injury (TBI): The implications for delivering TBI vocational rehabilitation in the UK. (Unpublished Doctoral thesis, City, University of London)


This thesis arises out of personal experience of the employment problems faced by people sustaining traumatic brain injury (TBI). Through tracking the post-injury experience of 54 subjects it aims to test the opinion that, generally, there is a lack of expert support to facilitate a return to work and, for young people, inadequate mechanisms to facilitate a transition from education into employment. In particular, it is maintained that generic vocational rehabilitation (VR) services provided by Jobcentre Plus fail to meet the needs of many TBI customers ( to use their terminology). In the circumstances it is contested that a return to work following TBI may follow a random pattern, but that an appropriate programme of VR, objectively identified within the thesis and based upon best practice and research based evidence, should improve resettlement rates.

Following a review of research methodologies commonly found in employment and disability studies the thesis relies upon a combined methodological strategy to test the above opinions. The literature review, and the experience of the study sample, are used to identify a) significant demographic and clinical variables to be taken into account when planning vocational intervention, b) difficulties in accessing appropriate VR programmes. A non-experimental survey research design relied on a fixed format questionnaire to collect study sample data, evaluated through the use of description and association statistics. Three case studies are further analysed through a realist approach identifying the circumstances in which measures taken to resume employment contributed to the final outcomes.

The thesis identifies an inaccurate recording of the brain-injured population within the DWP and a significant job retention problem amongst the study sample. It establishes why generic vocational rehabilitation services are failing this population and why many potentially employable people find themselves receiving long-term incapacity benefits.

The conclusion presents a theoretical model VR programme, deliverable within the context of current developments for joint NHS/Jobcentre Plus condition management (VR) programmes. It argues the case for TBI VR programmes in the UK moving away from a focus on pre-placement treatment and job-search activity towards one incorporating lengthy occupational trials and on-site support for both the employee and employer. It establishes the need for both ’joined-up’ services, from hospital to employment, and trained job coaches. Finally there are recommendations for enhancing future research in the employment and disability sector.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
Doctoral Theses
[thumbnail of Langman thesis 2007 PDF-A.pdf]
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