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Robert

Robert is a 50 year-old male who experienced a TBI in 1987, caused by a fall of unknown circumstances. Reportedly, there were three possible scenarios that led to Robert being in a coma for twenty-one days, as well as more than five months of hospitalization and rehabilitation. One account is that Robert fell down and hit his head on a cement floor when startled by a coworker, another was that he tripped over some electrical cords and fell down a flight of cement stairs and, finally, that he fell off of a ladder. There also was an indication that Robert had been drinking alcohol prior to arriving at work on that day. Robert and his family members confirmed a long history of alcohol abuse.

Robert is a high school graduate with some additional education from a trade school. His pre-injury work history was stable and included working for 11 years at a factory and four years as a maintenance supervisor at the place where he was employed at the time of his injury. Over the years, his pay averaged a little higher than minimum wage at that time or around $5.75 per hour.

A couple of month’s post-injury, Robert was referred by his state department of rehabilitative services counselor to a vendor who offered supported employment services. At the time of referral, a neuropsychological evaluation revealed cognitive strengths in the area of auditory comprehension and remote memory. Deficits were noted in arithmetic reasoning, immediate and delayed visual memory, common sense, judgment of safety, sequencing, visual construction skills, logical deductive reasoning, immediate and sustained concentration and reading comprehension. The evaluator recommended that Robert work in an environment that was free of distractions and allowed frequent breaks.

During a home visit, the employment specialist interviewed Robert and his wife to learn about his interests and skills. Robert stated that he wanted to work independently with little or no supervision, and to do something where he was using his hands and moving around the workplace. The employment specialist noted that he had good physical abilities with the exception of decreased hearing in his left ear and visual acuity in his left eye. It also was noted that-for the most part-Robert had a pleasant demeanor, except when he and his wife got into disagreements. This couple was in therapy for marital problems and substance abuse issues. The employment specialist also observed that Robert appeared to be very self-conscious and lacking in confidence.

After spending some time getting acquainted and identifying Robert’s strengths and desires, Robert and the employment specialist began to look for employment. A full-time job as a linen room attendant was located at a hotel. The employment specialist met with the employer to explain her role in assisting Robert on the job and performed a job analysis to better understand the position requirements. The employer was open to the concept and encouraged the employment specialist to follow up by scheduling an interview for Robert with the housekeeping manager.

Next, the employment specialist met with Robert and his wife to explain why she felt this would be a good opportunity for him. Her reasons included: the work was physical in nature, he worked with a few co-workers and minimal supervision, the pay offered was comparable to Robert’s pre-injury salary, a benefits package was included and there were opportunities for advancement.

Robert agreed that this sounded like a good opportunity for him, applied for the job and was hire. Initially, the job involved sorting used linens, as well as loading and unloading linens from the truck. The employment specialist and Robert both participated in the employer’s new employee training. Afterwards, the employment specialist continued to provide job skills training to use a number of teaching techniques, including the use of compensatory memory strategies, to assist Robert with learning the job duties and job-related tasks (i.e., signing in and out of work, locating break areas, understanding company policy and safety issues). The employment specialist also insured that the job was completed in a timely manner and maintained the employer’s production requirements while Robert was learning how to do the job in the specific time frame.

After three weeks, data collection by the employment specialist revealed that Robert had learned how to do the job to the employer’s standards so she began to fade her presence from the jobsite. However, a number of case management issues suddenly began to surface. Robert decided to divorce his wife and move out of his home into an adult home where he had resided when he was first discharged from the hospital. Soon, he was evicted because the rent was not paid. His wife had become his legal guardian and refused to pay this bill, although the money would be withdrawn from Robert’s personal account.

Robert was living on the street with nowhere to go so he moved back in with his ex-wife. This led to a number of problems. For example, the ex-wife, who was drinking heavily, called Robert at work constantly and made accusations of him having an affair with his employment specialist, stole his car and one day called the police charging that Robert had held a gun on her. The police arrived on the scene and recommended that Robert immediately move out and agreed to escort him off the premises. Once again, Robert found himself on the street with little money and nowhere to go.

The employment specialist got involved, primarily because no one else was willing or able to and because these events-if left unattended-would have an adverse effect on his job retention. A lawyer was contacted that agreed to assist Robert with removing his wife as his legal guardian free of charge. A church with a fund for those in need was contacted and agreed to provide three months rent for shelter at a local hotel. Additionally, the supported employment provider lent Robert the money to purchase his hypertension and anti-seizure medications.

Initially, a total of 220 hours of staff intervention time was expended during these activities, with the majority of time spent on resolving case management issues. Afterwards, the employment specialist began providing long-term follow-along services and reduced her intervention to two on the job site visits per month which continues today. Follow-along services require around three hours of intervention per month.

Robert has been employed for twelve years. He continues to work in housekeeping; however, he has many new responsibilities such as filling customer requests for linens to be brought to their rooms, keeping inventory of what linens are available and stocking the linen room. He also has received his employer’s award for Employee of the Year twice.

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