In Oregon, a Turning Point for People with Traumatic Brain Injuries

Turning Point specializes in vocational and community re-entry rehabilitation for people who have experienced a traumatic brain injury (TBI). This program, a division of Southern Oregon Goodwill Industries, gets maximum results by building the skills that will give each client as much autonomy and independence as he or she is capable of achieving. Increased autonomy and independence enhances each client’s quality of life.

Turning Point was developed through an establishment grant awarded to Southern Oregon Goodwill Industries in 1990 by the state of Oregon’s vocational rehabilitation division. The original purpose was to provide supported employment services to people with TBI. With naive enthusiasm, we developed assessment tools and identified community work sites. It wasn’t long, however, before we realized there were many missing links within the traditional model. Barriers to job placements and retention soon emerged that revealed issues related to cognitive deficits. Individuals were missing appointments, disorganized, frustrated and overwhelmed by daily challenges, unable to manage money, not following through, getting lost, misinterpreting information and unaware of many of their deficits. Our frustration as service providers was the unavailability of adequate training to teach clients compensatory skills and strategies.

Such traditional services as situational assessments, work adjustment and even job coaching were not proving successful. Turning Point became actively involved in the refinement of traditional memory tools, daily planners and cognitive training.

The Turning Point program has concluded that the most-valuable service we can offer is to teach individuals specific skills that can compensate for their cognitive deficits. Such innovative and affordable new services as compensatory skill-building workshops, support groups and group counseling are offered, as well as traditional vocational services. Turning Point recognizes that long-term success depends on the quality of compensatory skills training received. People with a head injury have issues exceeding the normal range of services offered to people with disabilities. They must learn how to follow an employer’s instructions, handle interruptions and changed priorities, cope with background noise and work distractions, set priorities, schedule tasks, check work, control stress and keep their emotions in check. Moreover, this is a population of newly disabled individuals who have no resources, face major role changes and – of equal significance – lose friends, jobs and self-identity.

The challenge for Turning Point as a vocational provider is to determine the degree to which compensatory skills training has or has not been part of the person’s rehabilitation, and then to develop ways to provide the practical skills training the person needs in order to be successful. Turning Point has determined the importance of measuring outcomes, through clients who report on Turning Point strategies they have used consistently and successfully.

Turning Point currently uses the BRAIN BOOK® Life Management System to teach cognitive skills. This customized day planner/life manager developed by Kathy Moeller, herself a TBI survivor and a Turning Point job coach is designed for people with TBI or other neurological deficits.

The day planner compensates for memory deficits. The life manager portion compensates for such executive-function challenges as scheduling, setting priorities, initiation, following through, keeping from getting lost, solving problems, making decisions and avoiding the feeling of being overwhelmed. Once mastered, BRAIN BOOK® strategies are applied to work settings.

The BRAIN BOOK® system’s new dimension of providing compensatory skills-training services allows people with limited funding to access materials at home, on a daily basis, in much the same manner that people living in expensive, private rehabilitation programs benefit from daily cognitive rehabilitation. The system includes audiotape guides for friends and family, and memory cueing tapes to enhance learning. Turning Point provides cost-effective services with positive outcomes. (Goodwill officials deem outcomes “positive” if the client’s quality of life is considered to have improved, or if a job placement lasts longer than 60 days.)

More than 40 clients have been served during Turning Point’s five-year history, and many of those individuals have been placed in jobs. One man who had been a mechanic prior to his injury now works at a service station. Other positions have included receptionist work, stocking and freight-handling.

Turning Point has become a regional resource for health care and other nonprofit agencies in southern Oregon. National recognition has included an article about the program in TBI Challenge!, the magazine of the National Head Injury Foundation; recognition of Turning Point’s program director as the Oregon Head Injury Foundation’s 1994 Clinician of The Year; and an article about Moeller in the newsletter Traumatic Brain Injury Update, published by the University of Washington.

Moeller also has conducted a training workshop on use of the BRAIN BOOK® for the Washington State Head Injury Foundation. In addition, Turning Point sponsors a monthly support group as a member organization of the Oregon Head Injury Foundation.

A major component not now available to people with cognitive deficits in southern Oregon is a residential program — specifically, a transitional living program that could provide a holistic milieu in which daily activities and skills training would be fully integrated. It is critical that an alternative to long-term supervision for TBI survivors in Oregon’s Rogue Valley becomes available.

Turning Point is in a position to provide the specialized staff needed to operate cost-effective housing for those whose physical, intellectual or behavioral limitations are temporary barriers to living independently. The goal of such a residential staff would reflect the overall goal at Turning Point to set in motion a process of development the individual could continue and build on after completing the program.

Southern Oregon Goodwill Industries’ Turning Point program can be replicated by agencies regardless of their population or region. For more information regarding staff training or how to access The BRAIN BOOK® Life Management System, contact Turning Point Director Lorraine Linder at (541) 772-3300.