Do current vocational evaluation practices in traumatic brain injury align with best practices? Strengths, challenges and recommendations

Introduction: To support implementation of the Inter-professional Guideline for Vocational Evaluation Following Traumatic Brain Injury we compared current practices to best practices as outlined in the guideline. Method: We recruited health/vocational professionals who do vocational evaluation of traumatic brain injury survivors to participate in qualitative semi-structured interviews. We also conducted a document review of internal clinical and provincial workers' compensation insurance documents. All data were analyzed using directed content analysis. Results: Thirteen individuals participated and three types of documents were reviewed. Practices that were found to be frequently aligned with the Inter-professional Guideline for Vocational Evaluation Following Traumatic Brain Injury included: (a) identification of evaluation purpose; (b) obtaining informed consent; (c) gathering background information; (d) assessing persistent symptoms and abilities; (e) analyzing and synthesizing results; and (f) developing return to work recommendations. Practices partially aligned included: (a) incorporating the worker's perspectives into the evaluation; (b) observing work behaviors in naturalistic settings (c) assessing available supports; and (d) assessing occupational/job demands in context. Practices that did not align with the guideline included: (a) evaluation of the workplace environment and workplace supports; (b) accommodation potential; and (c) assessment of workplace safety. Conclusion: To support implementation of the guideline and enhance successful vocational outcomes, additional attention and resources should be dedicated to evaluating workplace-based factors and assessing workplace-based risks.