Adults with acquired and traumatic brain injury often struggle to access specialized vocational rehabilitation to support their goals of returning to work. Identified barriers include limitations in service delivery, timing of services and access to knowledgeable and skilled staff. Solutions to improve access and availability of vocational rehabilitation include services delivering vocational rehabilitation as a component of a rehabilitation program. Further, using a clinical framework for service delivery should improve the consistency, quality and overall provision of vocational rehabilitation; positively impacting client experiences and outcomes. This study aimed to develop an evidence-based framework for the delivery of vocational rehabilitation during early community rehabilitation for adults with acquired and traumatic brain injury. This occurred within a specific service context, i.e., a state-wide transitional community rehabilitation service for adults with brain injury, in Queensland, Australia.

Methods: The evidence-based framework for vocational rehabilitation was developed using an emergent multi-phase design. Four study phases were undertaken to identify and generate the contextual knowledge and evidence-base, guided by evidence-based practice models. These findings informed development of the vocational rehabilitation framework (phase five). The framework was also informed by the implementing service’s model of care, national rehabilitation standards, guidelines for complex intervention development, guidelines for model of care and framework development, and the knowledge to action framework.

Results: An evidence-based framework was developed, providing a structure for delivering vocational rehabilitation as a component of interdisciplinary community rehabilitation. It uses a hybrid model of vocational rehabilitation, involving aspects of case-coordination and program-based vocational rehabilitation, delivered across 5 phases of clinical activity (assessment, goal setting and rehabilitation planning, intervention, monitoring and evaluation, discharge). The framework details the specific roles and activities to be undertaken by a case coordinator and the treating team, and also includes key service delivery features (access and timing, a coordinated interdisciplinary approach, supporting families).

Conclusions: The developed framework has been implemented in clinical practice, increasing the delivery and consistency of vocational rehabilitation service provision as a component of community rehabilitation. Translation and implementation to other services/contexts is possible, which should improve access to vocational rehabilitation for adults with brain injury.