An exciting new approach to vocational rehabilitation is being used successfully by Turning Point, a division of Southern Goodwill Industries that specializes in vocational programs for people with head injury. In addition to traditional vocational rehabilitation services like skills assessment and job development, innovative new services like compensatory skill-building workshops and skill-based job coaching are being offered that are tailored to meet the unique needs of those who have sustained head injuries. This functional skill-building focus makes Turning Point such a bright spot in the head injury rehabilitation scene.

People With Head Injury Have Special Vocational Needs

People with head injury have special needs that often exceed the normal range of services usually offered to persons with disabilities. Besides offering assistance in returning to work, the challenge for the vocational service provider is to determine the degree to which compensatory skills training has or has not been part of the person's rehabilitation, and then to develop ways to provide the practical skills training the person needs to be successfull.

Why Compensatory Skills Training Is So Important

Long-term success depends on the quality of compensatory skills training an individual with head injury receives. If the person did not receive functional skills training before entering the vocational rehabilitation process, it should be included as part of their return-to-work plan. Otherwise, failure is likely to occur in only a matter of time.

I understand this challenge firsthand. Besides working part-time at Turning Point as a job coach, I am a person with a head injury who has spent the last three years using compensatory strategies in an effort to return to frill-time employment. In my situation, I needed to learn how to follow my employer's instructions, how to handle interruptions and changed business priorities, how to cope with background noise and office distractions, how to set my own priorities, schedule tasks, check my work and control my stress and emotions.

I am passionate about the value of practical compensatory skills training because solid strategies are essential for people with head injury to succeed at work. Many of my peers could be working, too, if they were given the opportunity to learn how to compensate. My work at Turning Point has allowed me to pass on what I have learned to others who are just as capable as I am, but who still need to learn specialized strategies for success in competitive employment.

Experiences Vary -- As Do Success Stories

The main difference between my situation and the situations of many of my clients is that many of the individuals with whom I work enter the vocational rehabilitation process without receiving much in the way of compensatory skills training. Based on the so-called "medical model," many people with head injury are discharged from acute care, deemed medically stable and ready to return to their homes and families-with little or no cognitive rehabilitation therapy. My experience differs. In 1990 when I was injured, immediately after I was discharged from acute care, I entered the NeuroCare Residential Treatment Program in Concord, California. I lived there for five months, received therapy for six hours a day, relearned how to live independently and during nine more months of outpatient treatment, I learned how to apply my new life skills to a professional environment.

It saddens me to encounter people exactly like myself who receive little or no follow-up care for practical compensatory skills development. Often, they do not realize that they are lacking in this area. What they do know is that things are not working right, they are hurting, and they need "something," not quite knowing what that "something" is.

What Is Compensatory Skills Training?

The "something" that they need is often compensatory skills training-special training that focuses on teaching a wide range of coping strategies for dealing with short-term memory problems, difficulty following oral directions and scheduling tasks, difficulty setting priorities, controlling emotional episodes and others. Most people with head injury are capable of learning strategies for handling these situations, if they are given the opportunity and enough time to reinforce their new habits in different environments.

Short-term memory problems call for logbook (memory book or day planner) mastery. Scheduling challenges necessitate learning how to set priorities and writing down steps for executing them. Problem-solving requires learning how to brainstorm, evaluate alternatives, examine consequences and communicate assertively. Confusion can be dealt with by learning how to divide a situation into basic parts. Getting lost calls for creating special maps. Getting overwhelmed at the grocery store requires learning how to organize lists and shop differently. Getting overwhelmed emotionally can be overcome by learning how to take a break. Forgetting things like where you parked the car calls for learning when and where to write things down.

When mastered, the strategies that are learned to successfully execute these tasks can then be applied to the workplace. The goal of the job coach specializing in TBI is to creatively apply the principles that the individual has learned for living to the challenges of the workplace.

Is Turning Point's Approach Right for Your Community?

The exciting part of the Turning Point story is that most communities (even rural areas like southern Oregon) are capable of providing the same kinds of services Turning Point offers practical skill-building for the person with head injury who is trying to return to work. Turning Point is staffed by paraprofessionals who have received specialized training. They work with individuals such as myself who understand firsthand the cognitive and emotional issues that other people with head injury face. And they get to the heart of the vocational rehabilitation issue by teaching individuals how to apply practical compensatory skills to real-life work situations. They have learned that the same person who fails without compensatory skills can succeed with them. This understanding makes the difference between success and failure for many who are struggling with this complex and difficult disability.

For more information about how your community could beneflt from establishing services like those that Turning Point has developed, or to share ideas about how your community is meeting the special vocational needs of people with head injury, please contact Lorraine Linder, R.N., Director of Turning Point; or me, Kathy Moeller, Skills Trainer and Job Coach, at Turning Point, 150 Hawthorne Street, Medford, OR, 97504 (503) 776-3427.

Kathy Moeller sustained a closed head injury in 1990 following a collision with a commercial bus. Prior to her injury, she was a marketing executive with several New York corporations. She now works full-time as an administrative assistant and telemarketer for a specialty direct marketing firm in Medford, OR. Ms. Moeller has published several articles in national trade marketing publications. This is her first published article post-injury.