Karen's Story

Personal History

 O.K. I was 14 and I was with my family in Arkansas on vacation when I fell off a horse. That was nine years ago. I was knocked unconscious and it was a couple of hours before anyone found me. At the hospital, the doctors and nurses told my parents that I would be dead by the next morning. I didn't die apparently, but I was in a coma for over a month.

Let's see, what was I going to say? I forget sometimes. I remember things that happened a long time ago great, but I guess my short-term memory isn't so good. I use a memory notebook to help me. Everything I've got to remember each day I write it down in the book.

Adjusting to Life With TBI

 Anyway, after I "recovered" from the accident and came home, it took a while for me to realize that I was different. I would get angry real easy. If someone bumped me or ran into me, I'd get so mad. I didn't know what was wrong with me. I couldn't control my feelings. Imagine! Imagine your feelings magnified by 50. Nobody warned my Mom about this. It was really, really difficult. I became very violent, very violent. Hit things and people.

I also developed a seizure disorder a year after my injury and I wasn't walking well either. I went to school the following fall, had problems, but I graduated from high school on time with my class. so... oh gosh, where was I?...

 I just want to say now: you cannot feel sorry for people with head injuries. You just can't do it. It's the worst thing you can do. You feel sorry for us and we end up feeling sorry for us. It's not unfair, it's the way it is, and you have to start over. Work from where you are - don't feel sorry, that just gives you excuses to fail.

I graduated from high school in 1994 down in Texas. I went to some community rehabilitation programs down there for training, and worked at some fast food restaurants for a while, but it didn't always work out. About a year ago I decided I wanted to move to Missouri, so I've been working here in Clayton at Hardee's and living with my aunt.

Community Rehabilitation Program - a program that provides (or helps provide) rehabilitation services. A CRP is not necessarily housed in a specific building or place; it may be distributed through several coordinated offices. In the past, these were called "rehabilitation facilities", but the name was changed to include more distributed programs that aren't located in one central building. Goodwill, EasterSeals, and McJobs are CRPs with an emphasis on job training.

Now I can do more things on my own. I am independent. No one hands me anything. I structure my day, doing a routine every day. I get up at the same time, clean, bathe, eat, go for my walk, and do my cross-stitch. But in general things are pretty good.

I still sometimes have problems dealing with people, but I'm trying to work on that. I don't drive, because of my seizures, so I walk everywhere, which sometimes also helps me deal with things when I get angry. It also helps keep me healthy.

 The VR Process

When I moved here last year, I needed some more training, so I applied for Vocational Rehabilitation. The vocational rehabilitation process was created to help people with disabilities find jobs and live independently. It's run under a federal law, the Rehabilitation Act, which spells out rules for the State VR Agencies. They have VR in Texas, and everywhere else, I guess, but I hadn't used it in Missouri before, so I had to apply again.

VR - Vocational Rehabilitation - Help for persons with disabilities so that they can find paying, meaningful jobs that match their abilities and goals in life. The goal, says the Rehab Act, is to maximize empowerment, independence, and productivity of persons with disabilities. See the Rehab Act's discussion.

VR Process - According to the Rehabilitation Act, the purpose of vocational rehabilitation (VR) is to maximize empowerment, independence, and productivity of persons with disabilities. More specifically, vocational rehabilitation is supposed to help persons with disabilities "Pursue meaningful careers by securing gainful employment commensurate with their abilities and capabilities." Each state officially designates one agency to accomplish this for all its citizens with disabilities, and carefully outlines the process through which it will be accomplished (as required by the Rehab Act).

This process must include the client as an active partner in decision making, must be done by qualified vocational rehabilitation counselors, must include an accountability system, and must start from the assumption that everyone can hold a job.

 Referral, Application, and Eligibility

You start the process with a referral of the person with a disability to the local VR office. That referral can come from the person's parents, teachers, doctors - but also from the person themselves. So I called up and asked for an appointment. I got a VR Counselor, Jackie, and we established my eligibility for VR services. That's not too big a deal - it includes a review of your medical and psychological records so they know more about your disability, and lets the counselor get to know you better. Then they generally try to figure out if VR services can help you get a job - which they call your "employment outcome."

Person with a Disability - Anyone with a physical or mental impairment that makes it difficult ("substantial impediment") to find a job.

Eligibility for VR Services - To be eligible for VR services, a person must have a disability that limits their ability to find a job, and limits it in a way that could be helped through vocational rehabilitation. A person's VR counselor is usually the one who decides if they are eligible. The Rehab Act says this assessment should include a review of all information about the person's condition. Often this includes medical, psychological, and financial records. If additional information is needed, tests can be ordered to determine skills, limitations, intelligence, social adjustments, or anything else relevant to the assessment. See the Rehab Act's description. See the Rehab Act's description. (Title 1, sec 102, a) (Sec. 7, 22)

Vocational Rehabilitation Counselor - A vocational rehabilitation counselor (VR Counselor) works for state government vocational rehabilitation agencies. He or she helps individuals who have mental and/or physical disabilities (clients) to find, get, and keep jobs. The counselor plans, organizes, and implements individualized rehabilitation services for the client. Usually, a VR counselor has a Master's Degree in Rehabilitation Counseling or a related field.

After my counselor determined I was eligible, we wrote up an IWRP outlining my goals. Then I was able to go to the McJobs community rehab training program last year, and VR paid for it.

Closing the First Case File

When I got through, I worked for McDonalds, and at that point I didn't think I needed any more VR help, so we closed my file. But a few months later I had trouble with one of the managers - we didn't get along. So I went to work for Hardee's, which has been fine. It gives me a job that's orderly, with no big surprises, which I need. I'm so happy in routines. Anyway...

My parents also moved to Missouri last year, and my mom heard about Medallion Services in University City. She convinced me to give it a try. They help you with job seeking skills, resume writing, interviewing, and job leads. So I'm hoping I can get my case reopened and maybe find a career I like a little better.

People with head injuries are confused a lot and people don't realize it. For instance, sometimes we don't know why we feel mad, but we do. There's no control. I tend to be real self-centered.

 Reopening the Case File

In the Rehab Act that I was talking about, it says the goal of VR is to help a person with a disability - one that matches their abilities and needs. So I'm hoping they will help me look for a new one, since I don't think this one does that for me. I called up the VR office and made an appointment.

Consistent with the Person's Interests, Abilities, and Needs - this type of language occurs many times in the Rehab Act and in other rehabilitation documents such as state VR manuals. It refers to the underlying philosophy of the Rehab Act, spelled out in its preamble - that a disability does not remove a person's right to (among other things) be part of society and pursue a meaningful career. The Rehab Act is intended to give people with disabilities a chance to make the same choices everyone else in U.S. society makes, based on their interests, strengths, abilities, and preferences. See the Rehab Act discussion of this (Sec. 2)

Once we reopen my case - or "change my case status" as they call it - my counselor will help me review my options in VR services, like arranging job supports and stuff. Then we will write a revised employment goal.

Change Case Status - According to the Policy and Procedure Manual (PPM) for Missouri's Division of Vocational Rehabilitation, a person's rehabilitation process is recorded using a set of 17 case status codes based on their progress towards getting a job. Codes range from 00 to 32, and the person's VR counselor fills out forms documenting every move from one "code" to another.

Job Supports - Any help needed by a person with a disability so they can stay employed. It can include help from other people, specialized equipment, modification of the job, or anything else.

Before we had just put "working at McDonalds" as my goal on the IWRP (Individualized Written Rehabilitation Plan), but I'd like to try for something more, I think. I was thinking maybe bookkeeping or something.

 Gather Information / Develop IWRP

The VR counselor has to really get to know her client when writing the IWRP. For instance, she might call local community rehabilitation programs like Goodwill, rehabilitation centers, or anyone else who knows the person, to help her develop theIWRP.

After we create a new IWRP, which is kind of like "The Plan" for your training and services, we will get me started. Then we will meet periodically to review things and deal with any problems that come up.

So I'm hoping I can get some help in finding... something. Something more than fast food. And Medallion sounds like they can help, but I'll need VR to help me afford it. And then maybe I can get a job, get a real apartment, and live on my own.

The Rehab Act says the job should be in an "integrated setting" - which means, like, a REAL job, with benefits and stuff, and one that fits better with what I am able to do. Because I just feel like I could be doing more. So we will look at that, and what sort of supports VR can offer.

Below is some more information on Traumatic Brain Injuries such as Karen's. As you will see, Karen has some, but not all, of the possible symptoms. Different people with TBI can show very different symptoms.

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