We have developed this fact sheet to provide information and direction on supporting people with acquired brain injury. It is a starting point for a range of matters you may wish to consider when offering employment related support to this group of job seekers.
Understanding acquired brain injury and its impact on job performance
People with disability are usually experts in their own needs. They will understand the impact of their disability on work performance and any workplace adjustments they may need at interviews, while training or on the job. However some people with acquired brain injury may not necessarily have a great level of self awareness in these areas and may need additional assistance in finding and keeping a job.
Acquired brain injury (commonly abbreviated as ABI) is an umbrella term for any brain damage that occurs at any time after birth. The causes of such damage are many and varied and include:
- illness such as strokes or tumours
- infection
- accident
- assault
- drug or alcohol abuse.
It is not the cause of the acquired brain injury that is relevant when looking at employment. Rather it is necessary to focus on each person’s capabilities as acquired brain injury affects every person differently depending on the severity of the original trauma and which part of the brain was damaged.
People with acquired brain injury may experience long term changes and difficulties in five major areas, all of which may impact upon work performance. These possible changes include:
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cognitive functioning, in areas such as memory, concentration levels, initiative, problem solving, self insight (the awareness to monitor your own behaviour or performance) and flexibility
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neurological functioning, such as epilepsy of various forms, usually requiring medication
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physical and sensory abilities, such as hemiplegia (inability or reduced ability to move one side of the body), vision changes or hearing impairment
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psychological wellbeing, including behavioural issues (for example, loss of inhibition which often presents as temper outbursts, swearing or irritability) or reactive depression relating to awareness of the changes to the person's ‘pre-injury self’
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communication difficulties, such as word slurring, speech impairment, word finding problems or at the other extreme, excessive talking.
Acquired brain injury can be a complex disability. It is therefore important to be aware of the uniqueness of every job seeker with acquired brain injury. It is unlikely that they will exhibit all of the previously described characteristics and they will each have vastly different life and work experiences, skills and limitations.
Acquired brain injury is often a hidden disability, not readily apparent to others. So the job seeker’s decision to disclose information about their disability is an issue that you should be aware of and have strategies in place to accommodate.
Acquired brain injury is not the same as intellectual disability. A person’s intelligence remains but their ability to use it may be reduced. Consequently disability adjustment counselling is often crucial to assist people with acquired brain injury confront any limitations in their post-injury work capabilities.
Some people with acquired brain injury live independently in the community but many live with family or in supported accommodation facilities. It is therefore very important to establish contact with family, carers or significant others. Gaining permission to talk to these people can assist in building an accurate picture of the work related abilities and limitations of any job seeker with acquired brain injury on your caseload. The support of family and others is a very important element in gaining a successful employment outcome for the job seeker.
The Workplace Adjustment Tool contains further information on acquired brain injury. The Workplace Adjustment Tool is a searchable database that allows you to search for ideas for workplace adjustments and solutions based on a particular disability and the type of job being undertaken.
Put the person first
When developing a job search plan or offering post-employment support, it is necessary to be flexible and treat each person with acquired brain injury individually. Tailor your approach to individual needs and capacities and focus clearly on each person’s goals and abilities. This should also entail reassessing and adapting plans and support as necessary and linking individuals with relevant specialist services.
Tapping into existing support networks may also help job seekers achieve vocational goals. Use current and valid assessments and reports (school, medical, rehabilitation or work capacity) to help you gain a full understanding of the person’s strengths, barriers and any assistance they will require along the road to employment.
Pre-employment strategies
You can assist job seekers with acquired brain injury to find suitable and durable employment by developing an individualised pre-employment plan that incorporates a discussion of the following:
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an exploration of realistic job options
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a job development strategy covering resumes, interviews and job search techniques, including the job seekers role and your role in these activities
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consideration of disability disclosure
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requirements for workplace adjustments or modifications
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consideration on post-placement support needs.
An exploration of realistic job options could include use of the Employability Skills Profiler to assist in the discussion and generation of areas of employment. Most job seekers with acquired brain injury may need your support to go through this tool however it can be useful for gaining information about job preferences. See our Related Links for more information on the Employability Skills profiler.
Job search
Sometimes people with acquired brain injury may have unrealistic ideas about jobs in which they could succeed. This may occur more often in instances where the person had a strong pre-injury work history. Unrealistic work ideas may be a result of the person not yet coming to terms with any post-injury changes to their capabilities or to a lack of awareness of the changes to their abilities.
Whatever the cause, it is crucial to carefully explore each job seeker’s work skills and interests through personal discussion, checking any post-injury employment referees or talking frankly to rehabilitation case managers. Some people may need adjustment to disability counselling to assist them to come to terms with their changed abilities.
For job seekers with limited or no recent work experience, it may be beneficial to arrange work experience or voluntary work to assist in determining future job choices. A work experience placement may also assist those job seekers with pre-injury work skills to assess their own capabilities and assist to identify training requirements or transferable skills into other job types.
This process of exploration may also help determine whether a person will be able to work for full wages or be paid productivity-based ‘sub-minimum’ wages through access to the Supported Wage System.
Most job seekers will benefit from personal involvement in preparing suitable resumes and using a range of job search methods. However, due to cognitive or communication difficulties, many people with acquired brain injury may need considerable encouragement or even direct assistance with contacting employers and setting up interviews. Reverse marketing, consisting of job creation or redesign approaches prior to employer advertising, may be the best method to use with many in this client group. A good rule of thumb is to involve a person to the maximum level of their abilities in the whole job search experience.
Job interviews—support and interview tips
When it comes to actual job interviews or face to face meetings with employers, many people with acquired brain injury will often struggle to compete for jobs with other candidates. Consequently they may benefit from advocacy support at interviews or meetings to fully understand the job requirements and sell themselves to a prospective employer. This may include help with explaining individual training and support needs and what employer incentives may be available, for example, wage subsidies and supported wages.
Importantly, as an interview support you can encourage an employer to compensate for possible information processing or speech difficulties by speaking clearly and simply while also allowing enough time for responses to interview questions.
All job candidates, whatever their interview skills, can benefit from interview practice opportunities and from understanding what job interviews entail from start to finish. Also make sure the job seeker has a good understanding of what are acceptable and legally permissible interview questions in relation to their disability.
Disclosure issues
There is no single answer to the question of disability disclosure for people with acquired brain injury.
For some this may not be a critical issue as their disability, due to appearance or speech, will be apparent. In this case it may be a matter of working out a way of discussing a job seeker’s disability with prospective employers in a manner with which they are comfortable.
For others whose acquired brain injury is hidden, disclosure can become a real issue that warrants careful consideration. Often the disability will not be readily apparent in an interview but may become apparent later on the job. In this case appropriate disclosure strategies may be vital to ensure that the employee receives the training and support they need to make the job placement succeed.
Post-placement strategies
Job commencement—on site training techniques and tips
Starting a job can be a testing time for any new employee but for many with acquired brain injury, given possible cognitive and behavioral difficulties, there may be the initial need for extra training assistance and support in addition to any employer incentives you may arrange. This will vary depending on the person, the severity of the disability, the complexity of the job and the nature of the workplace. Such training and support could include:
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proactive education of the employer and co-workers on the impact of acquired brain injury with the aim of avoiding misunderstandings on the job—this may involve full or partial disclosure
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if relevant, first aid training for staff on responding to epilepsy related seizures in the workplace.
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if relevant, travel training to familiarise the worker to new public transport routes
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implementation or introduction of any necessary modifications or equipment into the workplace to reduce the impact of any physical or sensory disability
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job analysis and systematic practical ‘show and tell’ instruction by an external or internal job coach to achieve task competence
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ensuring the employee has a clear understanding of the requirements of their position, and associated responsibilities
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performance monitoring and the introduction of aids to foster independence and productivity such as:
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exploration of work culture with a view to social competence and inclusion such as:
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discussion of strategies to deal with occurrence of unacceptable workplace behaviours (private counselling, disciplinary procedures)
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a train the trainer approach involving:
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a more formal process of instructing a designated co-worker or supervisor in more appropriate specialist training and performance monitoring techniques
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the development of an informal buddy system where a co-worker is willing to keep an eye on the employee’s progress and assist with learning new tasks and dealing with work related problems as required
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encouragement through relevant and appropriate positive praise.
The ideal situation is when the employer takes ownership of employee induction and training, but for new employees with acquired brain injury they may need your advice and assistance to do the right things. The following is a series of tips on effective training for such employees, though keep in mind that every person is unique with their own capabilities, limitations and learning styles:
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teach new tasks by practical demonstration (the show and tell method):
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break down more complex tasks and show the person step by step, especially for tasks with which a person is having trouble mastering
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be open to different ways of completing tasks as long as the end result is the same
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concentrate first on quality rather than quantity, ensuring a person is undertaking the task correctly before focusing on speed or productivity
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give lots of positive feedback though never neglect to correct mistakes, unacceptable behaviours or unsafe working methods and stress why this is important
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avoid immediate job rotation or introducing too much variety from day one, though remember that many people with acquired brain injury will be able to multi-skill and it often helps the learning process (repetition being the key) if they can master one, two or a few tasks before moving on to learn new duties
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be clear in your instructions and don’t flood the person with a lot of new information at once
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avoid difficult language or complex directions
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give one instruction at a time
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if memory is an issue make up a list of jobs for the day
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make it clear that it is OK to ask questions if unsure about a task or what to do next, though also encourage and praise initiative.
Ongoing support
Once an employee with acquired brain injury has commenced work and been given all the necessary initial assistance and training, you can increase their chances of maintaining this employment by providing ongoing support as it is required.
Ongoing support requirements and the way this support is delivered should be discussed with the employee. Ongoing support may include:
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visits, emails or phone calls to monitor performance
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assistance with resolution of work related problems including conflict resolution
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if required, assistance to apply for mobility allowance if the worker is unable to use public transport
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ongoing coaching of employers and co-workers on relevant disability issues (for example epilepsy, memory loss, behavioural irregularities) or training techniques
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advice on job-redesign (tasks, processes, hours) or workplace adjustments (structural modifications, special aids/equipment, communication strategies)
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provision or arrangement of ergonomic or workplace assessments
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assistance with memory aides and time management., for example, use of diaries, calendars, electronic organisers, written checklists or flow charts
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off or on site counselling or performance feedback
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referral to community services or linkage into work related support mechanisms
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negotiation of work based personal assistance, for eligible workers, if required for feeding, toileting or medication support and assistance
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assistance with training and expansion of duties, including regular performance reviews/appraisals
More information
For information and step by step instructions on the financial help available to employers of people with disability, including the application process, visit:
The following fact sheets, developed for service providers, are also a useful resource: