Using framework analysis to understand multiple stakeholders’ views of vocational rehabilitation following acquired brain injury

Venerina Johnston; Charlotte Brakenridge; Donna Valiant; Charmaine Leow Kai Ling; Nicole Andrews; Elise M. Gane; Ben Turner; Melissa Kendall; Ray Quinn

doi:10.1071/IB23018

RESEARCH ARTICLE (Open Access)

Using framework analysis to understand multiple stakeholders’ views of vocational rehabilitation following acquired brain injury

Venerina Johnston ^A ^B ^C ^* , Charlotte Brakenridge ^A , Donna Valiant ^A , Charmaine Leow Kai Ling ^B , Nicole Andrews ^A ^D , Elise M. Gane ^B ^E ^F , Ben Turner ^G , Melissa Kendall ^G and Ray Quinn ^G

+ Author Affiliations

- Author Affiliations

^A RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia

^B School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia

^C School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD 4310, Australia

^D Occupational Therapy Department, The Royal Brisbane and Womenâ€™s Hospital, Metro North Hospital and Health Services, Brisbane, QLD 4029, Australia

^E Physiotherapy Department, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia

^F Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD 4102, Australia

^G The Hopkins Centre, Acquired Brain Injury Outreach Service, Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health, QLD, Australia

^* Correspondence to: v.johnston@uq.edu.au

Brain Impairment 24(2) 347-370 https://doi.org/10.1017/BrImp.2022.27

Submitted: 7 January 2022 Accepted: 9 October 2022 Published: 23 November 2022

© The Author(s), 2022. Published by Cambridge University Press on behalf of Australasian Society for the Study of Brain Impairment. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To explore how vocational rehabilitation (VR) is currently delivered for individuals with acquired brain injury (ABI) across multiple stakeholder groups and identify areas for improvement in service delivery using the Consolidated Framework for Implementation Research (CFIR).

Methods:

Seven focus groups were conducted with rehabilitation clinicians; outreach providers, insurers/regulators, VR providers and disability employment service providers (n = 44) experienced in VR of individuals with ABI. All groups were audio-recorded and transcribed verbatim. Data analysis was guided by the CFIR constructs.

Results:

All stakeholder groups believed they offered quality VR interventions given available resources and legislation, but many clients fell through the ‘cracks’. Themes that were identified included: a) number and complexity of systems supporting VR; b) fractured communication across systems, c) lack of knowledge by both stakeholders and clients in navigating systems, d) lack of expertise in supporting the vocational needs of clients with ABI and e) perceived limited awareness of ABI by employers.

Conclusion:

Stakeholders and clients need support to navigate Australia’s complex VR pathways. Limited specialist ABI clinicians, VR providers and disability employment services were identified as barriers for effective VR. Domains of the CFIR were appropriate for organising and understanding how VR is delivered.

Keywords: Brain injury, vocational rehabilitation, return to work, qualitative research, Consolidated Framework for Implementation Research.

References

Access Economics (2009). The economic cost of spinal cord injury and traumatic brain injury in Australia. Retrieved from https://books.google.com.au/books?id=qJa1AQAACAAJ.

Agency for Clinical Innovation (2018). Vocational intervention program: implementation report. Retrieved from https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/415156/ACI18037_VIP_Report_v3_final-110418.pdf.

AIHW, Australian Institute of Health and Welfare (2007). Disability in Australia: Acquired brain injury (55). Retrieved from https://www.aihw.gov.au/reports/disability/people-with-disability-in-australia.

AIHW, Australian Institute of Health and Welfare (2014). National community services data dictionary, https://www.aihw.gov.au/reports/technical-report/national-community-services-data-dictionary-8.

Bond, G. R. (2004) Supported employment: evidence for an evidence-based practice. Psychiatric Rehabilitation Journal 27(4), 345-359.
| Crossref | Google Scholar |

Bond, G. R., Drake, R. E., Becker, D. R. (2012) Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US. World Psychiatry 11(1), 32-39.
| Crossref | Google Scholar |

Bould, E., Callaway, L. (2020) A co-design approach to examine and develop pathways to open employment for people with acquired brain. Brain Impairment 1-17.
| Crossref | Google Scholar |

Bradshaw, C., Atkinson, S., Doody, O. (2017) Employing a qualitative description approach in health care research. Global Quality Nursing Research 4, 233339361774228.
| Crossref | Google Scholar |

Brakenridge, C. L., Leow, C. K. L., Kendall, M., Turner, B., Valiant, D., Quinn, R., Johnston, V. (2021) Exploring the lived return-to-work experience of individuals with acquired brain injury: use of vocational services and environmental, personal and injury-related influences. Disability & Rehabilitation 44(16), 4332-4342.
| Crossref | Google Scholar |

Burns, T., Catty, J., Becker, T., Drake, R. E., Fioritti, A., Knapp, M., Wiersma, D. (2007) The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. The Lancet 370(9593), 1146-1152.
| Crossref | Google Scholar |

Carpenter, C., & Suto, M. (2008). Qualitative research for occupational and physical therapists: a practical guide. Blackwell Pub.

Cicerone, D. K. (2004) Participation as an outcome of traumatic brain injury rehabilitation. Journal of Head Trauma Rehabilitation 19(6), 494-501.
| Crossref | Google Scholar |

Colantonio, A., Salehi, S., Kristman, V., Cassidy, J. D., Carter, A., Vartanian, O., Vernich, L. (2016) Return to work after work-related traumatic brain injury. NeuroRehabilitation 39(3), 389-399.
| Crossref | Google Scholar |

Collie, A., Di Donato, M., Iles, R. (2019) Work disability in Australia: an overview of prevalence, expenditure, support systems and services. Journal of Occupational Rehabilitation 29(3), 526-539.
| Crossref | Google Scholar |

Coole, C., Radford, K., Grant, M., Terry, J. (2013) Returning to work after stroke: perspectives of employer stakeholders, a qualitative study. Journal of Occupational Rehabilitation 23(3), 406-418.
| Crossref | Google Scholar |

Culler, K. H., Wang, Y. C., Byers, K., Trierweiler, R. (2015) Barriers and facilitators of return to work for individuals with strokes: perspectives of the stroke survivor, vocational specialist, and employer. Topics in Stroke Rehabilitation 18(4), 325-340.
| Crossref | Google Scholar |

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., Lowery, J. C. (2009) Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science 4(1), 50.
| Crossref | Google Scholar |

Damschroder, L. J., Lowery, J. C. (2013) Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR). Implementation Science 8(1), 51.
| Crossref | Google Scholar |

Donker-Cools, B., Schouten, M. J. E., Wind, H., Frings-Dresen, M. H. W. (2018) Return to work following acquired brain injury: the views of patients and employers. Disability & Rehabilitation 40(2), 185-191.
| Crossref | Google Scholar |

Donker-Cools, B. H., Daams, J. G., Wind, H., Frings-Dresen, M. H. (2016) Effective return-to-work interventions after acquired brain injury: a systematic review. Brain Injury 30(2), 113-131.
| Crossref | Google Scholar |

Fadyl, K. J., McPherson, M. K. (2009) Approaches to vocational rehabilitation after traumatic brain injury: a review of the evidence. Journal of Head Trauma Rehabilitation 24(3), 195-212.
| Crossref | Google Scholar |

Fleming, J., Tooth, L., Hassell, M., Chan, W. (1999) Prediction of community integration and vocational outcome 2-5 years after traumatic brain injury rehabilitation in Australia. Brain Injury 13(6), 417-431.
| Google Scholar |

Hellman, T., Bergström, A., Eriksson, G., Hansen Falkdal, A., Johansson, U. (2016) Return to work after stroke: important aspects shared and contrasted by five stakeholder groups. Work - a Journal of Prevention Assessment & Rehabilitation 55(4), 901-911.
| Crossref | Google Scholar |

Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., Ladany, N. (2005) Consensual qualitative research: an update. Journal of Counselling Psychology 52(2), 196-205.
| Crossref | Google Scholar |

Hooson, J. M., Coetzer, R., Stew, G., Moore, A. (2013) Patients’ experience of return to work rehabilitation following traumatic brain injury: a phenomenological study. Neuropsychological Rehabilitation 23(1), 19-44.
| Crossref | Google Scholar |

Institute of Medicine. (2009). Gulf war and health, vol. 7. Long-Term Consequences of Traumatic Brain Injury.

Johansson, U., Tham, K. (2006) The meaning of work after acquired brain injury. European Journal of Public Health 16, 192.
| Google Scholar |

Kuluski, K., Dow, C., Locock, L., Lyons, R. F., Lasserson, D. (2014) Life interrupted and life regained? Coping with stroke at a young age. International Journal of Qualitative Studies on Health Well-being 9(1), 22252.
| Crossref | Google Scholar |

Lachapelle, D. L., Finlayson, M. A. J. (1998) An evaluation of subjective and objective measures of fatigue in patients with brain injury and healthy controls. Brain Injury 12(8), 649-659.
| Crossref | Google Scholar |

Lannin, N. A. (2016). Process-ABI: Evaluation of the processes of developing a statewide specialist severe ABI rehabilitation service (108-0716-R01). Institute of C. a. R. R. I. Institute for Safety Compensation and Recovery Research.

Libeson, L., Ross, P., Downing, M., Ponsford, J. (2021) The experience of employers of individuals with traumatic brain injury. Neuropsychological Rehabilitation 1-23.
| Crossref | Google Scholar |

Libeson, L., Ross, P., Downing, M., Ponsford, J. (2021) Exploring employment following traumatic brain injury in persons who completed an insurer funded vocational rehabilitation program in Australia. Disability & Rehabilitation 1-11.
| Crossref | Google Scholar |

Libeson, L., Ross, P., Downing, M., Ponsford, J. (2021) Factors associated with employment stability following traumatic brain injury, in a sample who have received comprehensive vocational rehabilitation. Disability & Rehabilitation 44(21), 1-8.
| Crossref | Google Scholar |

McRae, P., Hallab, L., Simpson, G. (2016) Navigating employment pathways and supports following brain injury in Australia: client perspectives. Australian Journal of Rehabilitation Counselling 22(2), 76-92.
| Crossref | Google Scholar |

Merriam, S. B., & Tisdell, E. J. (2015). Qualitative research: A guide to design and implementation (4th edition, John Wiley & Sons.

Millis, S. R., Rosenthal, M., Novack, T. A., Sherer, M., Nick, T. G., Kreutzer, J. S., Ricker, J. H. (2001) Long-term neuropsychological outcome after traumatic brain injury. Journal of Head Trauma Rehabilitation 16(4), 343-355.
| Crossref | Google Scholar |

Ntsiea, M. V., Van Aswegen, H., Lord, S., Olorunju, S. S. (2015) The effect of a workplace intervention programme on return to work after stroke: a randomised controlled trial. Clinical Rehabilitation 29(7), 663-673.
| Crossref | Google Scholar |

O’Neill, R. J., Hibbard, J. M., Broivn, M., Jaffe, J. M., Sliwinski, J. M., Vandergoot, J. D., Weiss, J. M. (1998) The effect of employment on quality of life and community integration after traumatic brain injury. Journal of Head Trauma Rehabilitation 13(4), 68-79.
| Google Scholar |

Patton, M. Q. (2015). Qualitative research & evaluation methods: integrating theory and practice (4th ed.). Thousand Oaks, California: SAGE Publications, Inc.

Queensland Health, Q. (2016). Statewide adult brain injury rehabilitation health service plan 2016-2026. Retrieved from www.health.qld.gov.au.

Ritchie, J., & Lewis, J. (2003). Qualitative research practice : a guide for social science students and researchers. London Thousand Oaks, California: SAGE.

Rødevand, L., Ljosaa, T. M., Granan, L. P., Knutzen, T., Jacobsen, H. B., Reme, S. E. (2017) A pilot study of the individual placement and support model for patients with chronic pain. BMC Musculoskeletal Disorders 18(1), 550.
| Crossref | Google Scholar |

Sands, R. G., Roer-Strier, D. (2006) Using data triangulation of mother and daughter interviews to enhance research about families. Qualitative Social Work 5(2), 237-260.
| Crossref | Google Scholar |

Silverberg, N. D., Panenka, W. J., Iverson, G. L. (2018) Work productivity loss after mild traumatic brain injury. Archives of Physical Medicine & Rehabilitation 99(2), 250-256.
| Crossref | Google Scholar |

Sinclair, E., Radford, K., Grant, M., Terry, J. (2014) Developing stroke-specific vocational rehabilitation: a soft systems analysis of current service provision. Disability & Rehabilitation 36(5), 409-417.
| Crossref | Google Scholar |

Singhal, B. A., Biller, S. J., Elkind, J. M., Fullerton, C. H., Jauch, J. E., Kittner, A. S., Levine, S. R. (2013) Recognition and management of stroke in young adults and adolescents. Neurology 81(12), 1089-1097.
| Crossref | Google Scholar |

Smith, J., Firth, J. (2011) Qualitative data analysis: the framework approach. Nursing Research 18(2), 52-62.
| Crossref | Google Scholar |

Soeker, S. (2017) The use of the Model of Occupational Self Efficacy in improving the cognitive functioning of individuals with brain injury: a pre- and post-intervention study. Work - a Journal of Prevention Assessment & Rehabilitation 58(1), 63-72.
| Crossref | Google Scholar |

Tatemichi, T. K., Desmond, D. W., Stern, Y., Paik, M., Sano, M., Bagiella, E. (1994) Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. Journal of Neurology, Neurosurgery & Psychiatry 57(2), 202-207.
| Crossref | Google Scholar |

Tong, A., Sainsbury, P., Craig, J. (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal of Qualitative Health Care 19(6), 349-357.
| Crossref | Google Scholar |

Waghorn, G., Childs, S., Hampton, E., Gladman, B., Greaves, A., Bowman, D. (2012) Enhancing community mental health services through formal partnerships with supported employment services. American Journal of Psychiatric Rehabilitation 15(2), 157-180.
| Crossref | Google Scholar |

Yasuda, S., Wehman, P., Targett, P., Cifu, D., West, M. (2001) Return to work for persons with traumatic brain injury. American Journal of Physical Medicine & Rehabilitation 80(11), 852-864.
| Crossref | Google Scholar |