Sustaining employment after vocational rehabilitation in acquired brain injury

To explore factors affecting sustaining employment in people with acquired brain injury (ABI).A multiple case study approach using semi-structured interviews in eight cases (29 individuals). Each case included an individual with ABI, a family member, a job coach and a co-worker (triangulation). The eight individuals with ABI had completed vocational rehabilitation and were purposely selected based on whether they had sustained employment (4) or not (4).Similarity between pre-injury work or leisure interest and post-injury work, unconditional motivation, insight and the ability to cope with cognitive and behavioural sequelae were beneficial in sustaining employment. Post-injury instances of poor cognitive or behavioural function did not necessarily affect sustained employment. The vocational rehabilitation programme was beneficial in building up confidence, providing continued follow up and providing co-worker 'twins' in the work place. Employers with a personal experience of disability helped individuals with ABI to sustain employment.Similarities between pre-injury work or leisure interests and post-injury work improved motivation. Factors associated with sustained employment were insightful, unconditional, internal motivation providing an ability to cope, confidence provided by ongoing vocational rehabilitation support through job coaches, supportive co-workers and employers with a personal experience of disability. People with ABI can be outstanding employees.