In 1996, a 17-yr-old man suffered gunshot wounds to the head, chest, abdomen, and lower left limbs. As a result of his injuries, he has right-side paralysis, multiple memory deficits, impaired executive functioning, low frustration tolerance, impulsivity, and mental inflexibility related to problem solving. During a follow-up visit with his physiatrist, he expressed a desire to work and was referred to the State’s vocational rehabilitation services for supported employment.
Supported employment services are provided by a vocational rehabilitation professional known as a job coach. A job coach offers an array of supports to assist a person with a significant disability with gaining and maintaining employment. As physiatrists coordinate the long-term rehabilitation process for patients, they may want to consider bringing a coach on board as part of their interdisciplinary team.
Just like a physiatrist’s role changes to meet a patient’s needs, so does the role of the job coach. Initially, the coach learns about the individual’s vocational abilities by spending time with him or her in community-based rather than clinical settings. Afterward, a job search is conducted, unless the person has a job to which to return. In this instance, the coach helps negotiate a return to work. Once at work, the coach arranges or provides a unique array of workplace supports that usually include: providing additional new employee training that extends beyond what the employer offers, performing some of the duties while the new hire is learning, and securing assistive technology, modeling social skills, and teaching problem solving strategies. The aim is to create the “right” supports, those that enable the new hire to meet expectations and become a valued member of the workforce. Overtime, the coach fades from the job but continues to return throughout the person’s employment to keep a pulse on how things are going. If needed, additional support is provided.
In 2001, a job coach assisted the man described earlier with employment. His obstacles to work included lack of awareness of deficits, resistance to using compensatory strategies, executive functioning deficits, and diminished motor skills. His abilities included good communication skills and functional reading and writing skills. With the coach’s assistance, he located work at a local retailer. His job duties include security, customer service, processing, and stocking. Figure 1 shows the coach teaching him a new job task. Today, he works 25 hrs/wk, earns $8.50 an hour, and has been employed for >3 yrs.
Physiatrists focus on restoring patients to maximum function; the difference they make can be dramatic. Similarly, a job coach can assist the team with optimizing a patient’s vocational potential and functioning at work through facilitating or providing an array of customized workplace supports. Difficult cases, such as a person who is perceived as “unemployable,” should immediately be recognized as someone who may very well benefit from a supported employment approach. The interdisciplinary team that includes a job coach can help make employment become a reality for patients who might not otherwise think work is possible.