Background
A 32-year-old male sustained a traumatic brain injury (TBI) in a 2019 road traffic collision, alongside orthopaedic injuries, facial trauma, and partial hearing loss. He was later diagnosed with focal epilepsy, adding complexity to his condition. Before the accident, he struggled to maintain employment; post-injury, he engaged in voluntary work but was unable to secure paid roles.

Challenges
The client had been out of paid employment for over five years. Ongoing cognitive and emotional challenges included:

  • Executive dysfunction (e.g. impaired motivation and initiation)
  • Physical and cognitive fatigue
  • Working memory and attention impairments
  • Social communication difficulties
  • Impulsivity and anxiety in unfamiliar environments
  • Low mood and poor self-efficacy

Despite support from his neuro-occupational therapist, attempts to secure work were unsuccessful. A Vocational Rehabilitation Consultant (VRC) was instructed to assess employment barriers and support suitable return-to-work planning.

Vocational Rehabilitation Interventions
The VRC introduced a structured, collaborative approach, working alongside the neuropsychologist and speech and language therapist. Interventions included:

  • Psychoeducation around disclosing disability during job applications
  • Transferable skills assessment and CV tailoring
  • Job search support with a focus on quality over quantity
  • Advice on reasonable adjustments and applying to Disability Confident employers
  • Interview coaching and mock interviews, including practicing responses to anticipated questions
  • Interview preparation strategies, such as bullet-point notes and relaxation techniques

Within four weeks, the client secured an interview for an administrative post at a Disability Confident college. With VRC support, he requested and received appropriate adjustments:

  • Pre-shared interview questions
  • 50% additional interview time with breaks
  • Quiet room setting and panel biographies
  • Supervised in-interview support from the VRC
  • Advance access to computer-based test details

The employer was impressed by his performance and offered him a more suitable position: Learning Support Assistant, leveraging his strengths in maths and previous volunteer experience.

Workplace Integration and Adjustments
With ongoing input from the VRC, a comprehensive workplace support plan was implemented:

  • Access to Work funding for transport to manage fatigue
  • Reduced working hours (approx. 18/week) and rest breaks
  • Written instructions and memory aids for new tasks
  • Lighting adjustments to mitigate seizure risk
  • Assistive technology
  • Disability awareness training for staff
  • Creation of an “About Me” profile outlining his needs and strengths
  • Regular supervision and joint reviews with the VRC and line manager

Outcomes
Eighteen months on, the client remains in post with excellent feedback. He has taken on additional responsibilities, including exam invigilation. His confidence, mood, and work performance have significantly improved, and there have been no further issues with attendance or motivation. He is now exploring teacher training pathways. Ongoing support from the VRC continues via a light-touch basis through six-monthly reviews.

This case demonstrates the value of multi-disciplinary vocational rehabilitation and proactive employer engagement in facilitating sustainable employment following traumatic brain injury.