Persons with brain injury and employment supports: Long-term employment outcomes and use of community-based services.

OBJECTIVES: To understand how employment services (ES) are provided to persons with brain injuries (PWBIs) in Ontario, Canada, and the impact service delivery has on competitive-employment outcomes. DESIGN AND METHODS: A mixed-method case study of one community-based agency that provides specialized services to PWBIs. Relationships between demographic, service-related variables and employment outcomes (2009-2014) were analysed using chi-squares and analyses of variance. In addition, 14 interviews were conducted and analysed using thematic analysis. RESULTS: PWBIs accessed services on average of 16 years post injury; 64% secured at least one competitive-employment job, which was how employment success was defined in this study. Average job tenure was 368 days, and average job intensity was 3.8 hours/day. Employment success was significantly associated (p < 0.05) with use of job development, job coaching, case management and job retention services. Interviews revealed that PWBIs were provided five services: job goal(s) identification, assessment of work-related abilities/skills, job development, on-the-job supports and job retention assistance. Challenges to ES delivery included lack of suitable jobs and hiring incentives, and difficulties in establishing natural supports at the workplace. CONCLUSIONS: PWBIs' employment outcomes may be supported through provision of ES to assist with: the development of realistic job goals and job-finding skills, securing work, on-the-job coaching and advocacy with employers.

Gender Influences on Return to Work After Mild Traumatic Brain Injury.

OBJECTIVE: To examine the influence of gender on the return to work experience of workers who sustained a work-related mild traumatic brain injury (TBI). DESIGN: Qualitative study using in-depth telephone interviews. SETTING: Community. PARTICIPANTS: Purposive sampling was used to recruit participants. Participants were adults (N=12; males, n=6, females, n=6) with a diagnosis of mild TBI sustained through a workplace injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Our findings suggest that gender impacts return to work experiences in multiple ways. Occupational and breadwinner roles were significant for both men and women after work-related mild TBI. Women in this study were more proactive than men in seeking and requesting medical and rehabilitation services; however, the workplace culture may contribute to whether and how health issues are discussed. Among our participants, those who worked in supportive, nurturing (eg, feminine) workplaces reported more positive return to work (RTW) experiences than participants employed in traditionally masculine work environments. For all participants, employer and coworker relations were critical elements in RTW outcomes. CONCLUSIONS: The application of a gender analysis in this preliminary exploratory study revealed that gender is implicated in the RTW process on many levels for men and women alike. Further examination of the work reintegration processes that takes gender into account is necessary for the development of successful policy and practice for RTW after work-related MTBI.

Return-to-work challenges following a work-related mild TBI: The injured worker perspective.

PRIMARY OBJECTIVE: To explore how individuals with work-related mild traumatic brain injury (wrMTBI) experience return-to-work (RTW) processes when returning to the workplace where the injury occurred. DESIGN: RTW experiences were explored using in-depth interviews and an inductive analytic approach. Qualitative analysis guided by the research question moved through phases of line-by-line and thematic coding through which categories and the interaction between categories emerged. PARTICIPANTS: Twelve workers diagnosed with a wrMTBI reported on their RTW experiences following wrMTBIs that occurred 3-5 years prior to the time of the interview. MAIN OUTCOMES AND RESULTS: Participants perceived employer and workers' compensation factors as profoundly influencing their RTW experiences. Participants consistently reported that employers and workers' compensation representatives had an inadequate understanding of wrMTBI sequelae. Six of 12 participants were re-injured following their wrMTBI, with three of these injuries occurring at work. CONCLUSION: Employers, co-workers and workers' compensation representatives should be aware of wrMTBI sequelae so injured workers can receive appropriate supports and both stigmatization and re-injury can be mitigated. Greater attention to the structural and social elements of workplace and compensation environments could inform strategies to break down barriers to successful return-to-work following a wrMTBI.

INCOG recommendations for management of cognition following traumatic brain injury, part III: executive function and self-awareness.

INTRODUCTION: Traumatic brain injury (TBI) results in complex cognitive (and other) sequelae. Impairments in executive function and self-awareness are among the most characteristic neuropsychological sequelae and can exert a profound effect on resuming previous life roles. An international group of researchers and clinicians (known as INCOG) convened to develop recommendations for interventions to improve impairments in executive functioning and self-awareness after TBI. METHODS: The team reviewed the available literature and ensured the recommendations were current. To promote implementation, the team developed decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials. The team then prioritized the recommendations for implementation and developed audit criteria to evaluate the adherence to the best practice recommendations. RESULTS: Intervention programs incorporating metacognitive strategy instruction for planning, problem-solving, and other cognitive-executive impairments have a solid evidence base. New evidence supports the use of strategies to specifically improve reasoning skills. Substantial support exists for use of direct corrective feedback to improve self-awareness. CONCLUSIONS: An increasing number of scientifically well-designed studies are available that demonstrate the effectiveness of a variety of interventions for the remediation of impairments in executive function and self-awareness after TBI.

INCOG guidelines for cognitive rehabilitation following traumatic brain injury: methods and overview.

INTRODUCTION: Traumatic brain injury results in complex cognitive sequelae. However, clinicians have difficulty implementing the available evidence. An international group of researchers and clinicians (known as INCOG) convened to develop clinical practice guidelines for cognitive rehabilitation posttraumatic brain injury. METHODS: The Guidelines Adaptation and Development cycle was used to derive the recommendations. Previously published cognitive rehabilitation recommendations were identified and tabulated. An expert panel met to select appropriate recommendations. Afterward, the team enhanced the recommendations by reviewing available literature. To address shortfalls of previous guidelines, the team developed decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials and expert opinion. The team then prioritized the recommendations for implementation and developed audit criteria to evaluate adherence to best practice. RESULTS: The team recommends that individuals have detailed assessments of cognition after resolution of posttraumatic amnesia. Cognitive assessment and rehabilitation should be tailored to the patient's neuropsychological profile, premorbid cognitive characteristics, and goals for life activities and participation. Clinical algorithms and audit tools to evaluate current practice are provided. CONCLUSION: Cognitive rehabilitation should be offered to select individuals with traumatic brain injury. These guidelines provide assistance to clinicians who want to provide evidence-based care.

INCOG recommendations for management of cognition following traumatic brain injury, part IV: cognitive communication.

INTRODUCTION: Cognitive-communication disorders are common in individuals with traumatic brain injury (TBI) and can have a major impact on long-term outcome. Guidelines for evidence-informed rehabilitation are needed, thus an international group of researchers and clinicians (known as INCOG) convened to develop recommendations for assessment and intervention. METHODS: An expert panel met to select appropriate recommendations for assessment and treatment of cognitive-communication disorders based on available literature. To promote implementation, the team developed decision algorithms incorporating the recommendations, based on inclusion and exclusion criteria of published trials, and then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to best practice recommendations. RESULTS: Rehabilitation of individuals with cognitive-communication disorders should consider premorbid communication status; be individualized to the person's needs, goals, and skills; provide training in use of assistive technology where appropriate; include training of communication partners; and occur in context to minimize the need for generalization. Evidence supports treatment of social communication problems in a group format. CONCLUSION: There is strong evidence for person-centered treatment of cognitive-communication disorders and use of instructional strategies such as errorless learning, metacognitive strategy training, and group treatment. Future studies should include tests of alternative service delivery models and development of participation-level outcome measures.

Quality of guidelines for cognitive rehabilitation following traumatic brain injury.

INTRODUCTION: Cognitive rehabilitation following traumatic brain injury can aid in optimizing function, independence, and quality of life by addressing impairments in attention, executive function, cognitive communication, and memory. This study aimed to identify and evaluate the methodological quality of clinical practice guidelines for cognitive rehabilitation following traumatic brain injury. METHODS: Systematic searching of databases and Web sites was undertaken between January and March 2012 to identify freely available, English language clinical practice guidelines from 2002 onward. Eligible guidelines were evaluated using the validated Appraisal of Guidelines for Research and Evaluation II instrument. RESULTS: The 11 guidelines that met inclusion criteria were independently rated by 4 raters. Results of quality appraisal indicated that guidelines generally employed systematic search and appraisal methods and produced unambiguous, clearly identifiable recommendations. Conversely, only 1 guideline incorporated implementation and audit information, and there was poor reporting of processes for formulating, reviewing, and ensuring currency of recommendations and incorporating patient preferences. Intraclass correlation coefficients for agreement between raters showed high agreement (intraclass correlation coefficient > 0.80) for all guidelines except for 1 (moderate agreement; intraclass correlation coefficient = 0.76). CONCLUSION: Future guidelines should address identified limitations by providing implementation information and audit criteria, along with better reporting of guideline development processes and stakeholder engagement.

Injured workers' perspectives on how workplace accommodations are conceptualized and delivered following electrical injuries.

PURPOSE: Returning to work following an electrical injury can be challenging due to the confluence of physical, cognitive and emotional impairments. Workplace accommodations can facilitate return to work. However, while electrical injuries can have potentially devastating consequences, there is a dearth of understanding of how workplace accommodations are obtained following electrical injury. This paper explores workers' experiences of returning to work and accommodations following an occupation electrical injury. METHODS: Thirteen semi-structured qualitative telephone interviews were conducted with injured workers recruited from acute and rehabilitation burns programs in Ontario, Canada. Thematic analysis was employed to identify themes related to the request and provision of accommodations. FINDINGS: Findings reveal that accommodations are most frequently narrowly defined in relation to physical work restrictions, leading to the exclusion of cognitive and psychosocial concerns. Challenges within the accommodations process such as perceived legitimacy, a do-it-yourself approach to accommodations, and concerns regarding job security can also influence workers' decisions to request accommodations. Process elements that facilitate the effective provision of workplace accommodations include: (1) finding a "just right" fit between workers' abilities and assigned tasks and duties (2) establishing effective lines of communication between relevant stakeholders; (3) prompt response to needs; (4) having a knowledgeable individual in a position of power to advocate on workers' behalf. CONCLUSIONS: Further education regarding electrical injuries and workplace accommodations is warranted to increase workers', employers', health and insurance personnels' knowledge about electrical injury and best practices for providing workplace accommodations.

After the storm: the social relations of return to work following electrical injury.

In this study, we explored the experiences of 13 individuals who had suffered an electrical injury at work and had subsequently returned to work. In this article, we report on the social, institutional, and relational elements that workers perceived to influence return to work experiences and the provision of workplace accommodations. These elements included (a) worker resources, (b) job characteristics, (c) workplace setting, (d) injury elements, (e) workers' compensation context, and (f) supports and advocacy provided. We conclude that the availability and provision of supportive accommodations are influenced by a multiplicity of interrelated factors including the legitimacy of resulting impairments following electrical injury, institutional structures (e.g., compensation and health care systems), the social relations of work, and broader labor market and economic contexts. Those workers who were vulnerable because of factors such as employment circumstances or labor market conditions were often poorly supported when returning to work following electrical injury.

Guidelines for vocational evaluation following burns: integrated review of relevant process and factors.

PURPOSE: A systematic literature review was undertaken to gather evidence to develop a guideline for vocational evaluation following burn injuries (BI). This review aimed to identify the key processes evaluators should follow and the key factors they should consider when completing such evaluations. METHODS: Steps outlined in Cochrane Handbook of Systematic Review were followed including: development of review question; search strategies and selection criteria; quality appraisal; data extraction; analysis & synthesis; drawing conclusions. Four databases (Pubmed, Medline, CINHAL, PsycINFO) and 14 websites were searched for relevant articles and studies (quantitative, qualitative), reviews and guidelines. Two reviewers independently completed reviews, performed quality assessments and extracted data into evidence tables. Using the ICF model and directed content analysis, key processes and factors were analyzed and synthesized across the evidence. RESULTS: A total of 138 articles were identified using the key words (e.g. burns, work). Studies, reviews and guidelines were retrieved if they focused on adults and discussed the processes relevant to vocational evaluation and/or factors associated with successful return to work (RTW) following a BI. Items were excluded if they did not address adults who had suffered a burn, the process of work or RTW, or challenges related to work after a BI. Using the above criteria 76 items were retrieved for full review. Fifty-six items remained after the quality appraisal. Results were integrated to develop the Evidence-based Framework for Vocational Evaluation Following Burn Injury. CONCLUSIONS: This framework outlines 7 key processes relevant to vocational evaluation following burn injuries.

Inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury: a systematic and evidence-based approach.

INTRODUCTION: This paper introduces an inter-professional clinical practice guideline for vocational evaluation following traumatic brain injury. This guideline aims to explicate the processes and factors relevant to vocational evaluation to assist evaluators (i.e. health care teams, individuals and employers) in collaboratively determining if clients are able to work and to make recommendations for work entry, re-entry or vocational planning. METHODS: Methods in the Canadian Medical Association's (CMA) Handbook on Clinical Practice Guideline and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were utilized to ensure rigour. Steps in the CMA handbook were followed and included: (1) identifying the guideline's objective and questions; (2) systematic literature review; (3) study selection and quality appraisal; (4) development of clear recommendations by key stakeholders; (5) guideline pilot testing and endorsement. RESULTS: The resulting guideline includes 17 key recommendations within the seven domains: (1) evaluation purpose and rationale; (2) initial intake process; (3) assessment of the personal domain; (4) assessment of the environment; (5) assessment of occupational/job requirements; (6) analysis and synthesis; (7) evaluation recommendations. CONCLUSIONS: The guideline may be useful to individually practicing clinicians, health care teams, employers and individuals with TBI. Future research will formally examine the success of the guideline's implementation.

An integrated review of the processes and factors relevant to vocational evaluation following traumatic brain injury.

INTRODUCTION: In order to develop the evidence base for a clinical practice guideline (CPG) for vocational evaluation following traumatic brain injury (TBI), we undertook a review to identify the key processes evaluators should follow and the key factors they should consider when completing a vocational evaluation. METHODS: Processes outlined in the Cochrane Handbook of Systematic Review guided our processes and included: development of review questions, search strategies and selection criteria; quality appraisal; extraction, analysis and data synthesis; drawing conclusions. Four data bases (i.e. Medline; PsychInfo; Embase; The Cochrane Library of Systematic Reviews) were searched for descriptive articles, quantitative and qualitative studies, and nine websites were searched for CPGs (e.g. Scottish Intercollegiate Guideline Network; US National Guideline Clearinghouse; New Zealand Guideline Group). Two reviewers independently appraised methodological quality. Data were extracted into evidence tables which included: study purpose; location; participants; design/method; themes; findings; relevant processes and factors. Directed content analysis was utilized to analyze and synthesize the descriptive process evidence. A constant comparative method was employed to compare study findings in relation to factors associated with successful employment. RESULTS: Results from process and factors syntheses are integrated into the Evidence-based Framework for Vocational Evaluation Following TBI. This framework identifies seven key processes in a vocational evaluation, including: (1) identification of the evaluation purpose and rationale; (2) intake process; (3) assessment of the person; (4) assessment of the environment; (5) assessment of the occupation/job requirements; (6) analysis and synthesis of assessment results; (7) development of evaluation recommendations. Relevant factors are integrated into each key process. CONCLUSIONS: This framework outlines the key information evaluators should gather, the domains of the person, environment and occupation they should assess, and elements of rigour they should consider when completing a vocational evaluation and making recommendations for work re-entry following a TBI.

The personal and workplace factors relevant to work readiness evaluation following acquired brain injury: occupational therapists' perceptions.

OBJECTIVE: This study examined the personal and workplace/environmental factors perceived most relevant to work readiness evaluations following acquired brain injury. RESEARCH DESIGN: Using a qualitative secondary analysis design 'indicators of success' and 'risks of failure', identified as relevant in a primary study of occupational therapists' evaluation practices, were explored further. METHOD: Data collected in the primary study, e.g. interviews, practice surveys, evaluation protocols, were re-analysed. Surveys and protocols were used to define participant and practice context characteristics. Interviews were coded, by three investigators, using a constructivist grounded theory approach. RESULTS: Four themes emerged describing relevant personal client attributes: (1) motivation; (2) physical and functional independence; (3) cognitive abilities; and (4) use of compensatory strategies and feedback. Four themes emerged describing relevant workplace factors: (1) workplace demands; (2) employer risks and burden; (3) risks associated with information sharing; and (4) financial implications associated with return to work. CONCLUSIONS: Findings suggest that work readiness needs to be viewed as both a client and a workplace issue. Findings are translated into questions for rehabilitation professionals to guide evaluations of work readiness. Recommendations for future research include investigating how professionals weigh factors in their decision-making and exploring strategies relevant from a workplace perspective.

Implementing Clinical Practice Guidelines in occupational therapy practice: recommendations from the research evidence.

BACKGROUND: Clinical Practice Guidelines (CPGs) are prominent tools in evidence-based practice which integrate research evidence, clinical expertise and client input to develop recommendations for specific clinical circumstance. With the push to use research evidence in health care, it is anticipated that occupational therapists will become increasingly involved in implementing CPGs in practice. The research evidence has revealed several factors that can affect guideline uptake, and a variety of strategies that can facilitate implementation. METHODS: This narrative review examines the health-related literature in CPGs to answer the following questions. Based on the research evidence, (i) what are the factors that may influence guideline implementation? (ii) What implementation strategies may enhance guideline implementation? RESULTS: Factors within the guideline itself (e.g. quality, complexity and clarity), within the practitioner (e.g. experience, perceptions and beliefs), the patient (e.g. expectations and preferences) and the practice context (e.g. resource availability, organisational culture and opinion leaders) can all affect implementation success. Currently, there is no conclusive evidence to support the use of one implementation strategy over another, in all situations. The choice of implementation strategy must take into account the guideline to be implemented, the practice context and the anticipated challenges to implementation. CONCLUSIONS: By understanding the factors that can influence implementation and the strategies for successful implementation, occupational therapists will be better prepared to implement guidelines. Recommendations to assist with guideline uptake and implementation are provided.

Workplace accommodations following work-related mild traumatic brain injury: what works?

Background: Individuals who have experienced a work-related mild traumatic brain injury face a variety of challenges when returning to work. Research has demonstrated that the implementation of workplace accommodations can reduce the incidence of workplace disability. Few studies investigate work-related mild traumatic brain injury from injured workers' perspectives, and none examine workplace accommodations in detail.Purpose: This study explores the types of accommodations that individuals receive, and the factors that influence how they are provided and to whom.Materials and methods: This study is a qualitative secondary data analysis of 12 telephone interviews. ATLAS.ti software was used to facilitate coding and thematic analysis was used to analyze the data.Results: This study makes explicit various accommodations identified as being useful or required by individuals on return to work. Participants identified a gradual return to work, and modified duties, among other accommodations. Components of the workplace social and structural environment, and the occupational context influenced how accommodations were provided and to whom.Conclusions: Obtaining appropriate support is of great importance to injured employees, their employers, insurers, and healthcare providers. Stakeholders should be aware of how to successfully identify and access appropriate workplace accommodations to support injured workers on return to work.Implications for rehabilitation Return to Work Accommodations • Workplace accommodations reduce the incidence of workplace disability. • Workplace accommodations can be formal or informal. • Participants identified a gradual return to work, modified duties, self-directed compensatory strategies, and allowances for medical appointments, among other accommodations, as being useful or required. • Stakeholders, including healthcare providers involved in rehabilitation, should be aware of how to successfully identify and implement these accommodations to ensure injured workers are supported on return to work.

From margins to mainstream: what do we know about work integration for persons with brain injury, mental illness and intellectual disability?

Employment is a right of citizenship and a social determinant of health, but employment rates remain low for persons with disabilities. The purpose of this paper is to examine the principles and practices guiding work integration within the fields of intellectual disability (ID), brain injury, and mental illness and to identify best practices to support transitions to employment across these three groups. This integrative review drew upon an occupational perspective to analyze the current literature. Findings reveal that the need and benefits of working are recognized across disability groups but that philosophical perspectives guiding work integration differ. In the area of mental illness, recovery is seen as a process within which work plays an important role, in ID work is viewed as a planned outcome that is part of the developmental process, and in the field of brain injury, outcomes of employability and employment are emphasized. A common theme across the three disability groups is that in order to facilitate work integration, the person, the job and the work environment are important factors in need of examination. Evidence pointing to the effectiveness of the supported employment model is increasing across these three populations. A framework for guiding the development of further research and for promoting changes to support work integration is presented.

Evaluating work readiness following acquired brain injury: building a shared understanding.

BACKGROUND: Despite occupational therapists' role in work-related evaluations, there are no guidelines for evaluating clients' work readiness. PURPOSE: This study explored how occupational therapists evaluate work readiness following acquired brain injury in order to develop an integrated model of the factors, processes, stakeholders, and contextual elements relevant to this evaluation. METHODS: Ten occupational therapists with expertise in vocational and brain injury rehabilitation were interviewed. Data were analyzed using grounded theory methods to develop the work readiness evaluation model. FINDINGS: This model describes five processes formative to therapists' evaluation: (1) drawing upon diverse sources of information and perspectives; (2) assessing occupational capacity; (3) contextualizing occupational potential; (4) building a shared understanding of work readiness among stakeholders, including, clients, employers, insurers, and rehabilitation teams; and (5) transforming the work readiness question. IMPLICATIONS: The model highlights the importance of building a shared understanding amongst stakeholders and provides a provisional framework to guide practice.

Qualitative meta-synthesis: reflections on the utility and challenges in occupational therapy.

BACKGROUND: A qualitative meta-synthesis is an approach to synthesizing relevant findings from across qualitative studies on a particular topic using methods consistent with qualitative research. PURPOSE: Using examples of recently completed qualitative meta-synthesis projects, the purpose of this paper is to present the meta-synthesis approach; highlight the key steps, processes, and issues involved; and demonstrate its potential to advance knowledge about occupation and occupation-based practice. KEY ISSUES: The qualitative meta-synthesis approach allows us to take stock of the current state of knowledge in a given area in order to ensure that we have explored the phenomenon from different perspectives and to begin to push the field forward by allowing us to develop deeper insights and understandings. IMPLICATIONS: Despite certain limitations and challenges associated with the approach, qualitative meta-syntheses can provide new knowledge through critical analysis and interpretation to inform client, practitioner, and policy audiences.

Improving Transition to Employment for Youth With Physical Disabilities: Protocol for a Peer Electronic Mentoring Intervention.

BACKGROUND: Although youth with disabilities have much to gain from employment readiness programs, they are often excluded from or have limited access to vocational programs. One encouraging approach to address gaps in vocational programming is through peer electronic mentoring (e-mentoring), which may facilitate a smoother transition to adulthood by offering support to enhance coping skills. Despite the increase in online communities, little is known about their impact on vocational mentoring for youth with physical disabilities and their parents. OBJECTIVE: The aim of this paper is to develop, implement, and assess the feasibility of an online peer mentor employment readiness intervention for youth with physical disabilities and their parents to improve their self-determination, career maturity, and social support compared to controls. METHODS: A mixed-methods feasibility randomized controlled trial (RCT) design will be conducted to develop and assess the feasibility, acceptability, and initial efficacy of the "Empowering Youth Towards Employment" intervention. Youth (aged 15 to 25) with physical disabilities and their parents will be randomly assigned to a control or experimental group (4-week, interactive intervention, moderated by peer mentors). RESULTS: Data collection is in progress. Planned analyses include pre-post measures to determine the impact of the intervention on self-determination, career maturity, and social support. A qualitative thematic analysis of the discussion forums will complement the surveys to better understand why certain outcomes may have occurred. CONCLUSIONS: Our intervention includes evidence-informed content and was co-created by a multi-disciplinary group of researchers and knowledge users. It has the potential for widespread implications as a cost-effective resource to supplement educational and vocational programming for youth with disabilities. TRIAL REGISTRATION: Clinicaltrials.gov NCT02522507; https://clinicaltrials.gov/ct2/show/NCT02522507 (Archived by WebCite at http://www.webcitation.org/6uD58Pvjc).

Development of a return-to-work planning tool for cancer survivors: Élaboration d'un outil de planification du retour au travail pour les survivants du cancer.

BACKGROUND: The ability to return to work (RTW) after a cancer diagnosis can present significant challenges for survivors and can be an important predictor of their long-term quality of life. Survivors report concerns related to disclosing their cancer diagnosis, describing ongoing late effects of cancer, and negotiating workplace accommodations. PURPOSE: This paper outlines the development of an RTW planning template (RTW-PT) designed to improve communication with stakeholders involved in the RTW process. Lessons learned throughout the process of developing the RTW-PT and implications for clinical practice are presented. KEY ISSUES: The RTW-PT assists the survivor and his or her health care provider to prioritize job demands during a graded RTW and to identify potential accommodations. The RTW-PT also helps survivors plan how they will communicate their RTW needs, particularly with employers and insurance representatives. IMPLICATIONS: The RTW-PT offers a structured approach to support communication among stakeholders involved in the RTW process and to assist survivors in negotiating workplace accommodations.