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HIRE – Return to Work from Brain Injury

HIREThe HIRE – Return to Work from Brain Injury program at the Miami Valley Hospital (MVH) Rehabilitation Institute of Ohio is a multi-disciplinary treatment program for individuals with acquired brain injuries who want to return to a job or to school. Founded in 1989, HIRE is the only program in the Dayton area to offer people recovering from brain injuries a complete continuum of return to work or school services.

The HIRE program provides comprehensive cognitive and vocational evaluation, treatment and placement services. Your treatment team will confer regularly as a group, with you and with your family and caregiver, to develop and refine your rehabilitation goals. Most clients participate in treatment six hours a day, five days a week, and are generally in the program for four to six months. Following discharge from the program, HIRE will refer you to community services that help maintain the optimal level of function gained from treatment.

Referrals usually come from a vocational funding source such as the Bureau of Vocational Rehabilitation Off Site Icon, the Bureau of Services for the Visually Impaired Off Site Icon or Bureau of Worker’s Compensation Off Site Icon. Your HIRE admissions coordinator can assist with the referral process.

Certified by the Commission on Accreditation of Rehabilitation Facilities (CARF)

HIRE services provided by the Rehabilitation Institute of Ohio to both adolescents and adults are accredited by the Commission on Accreditation of Rehabilitation Facilities Off Site Icon (CARF), the most prominent certifying organization for rehab.

The HIRE Team

HIRE services are provided by a team of professionals from multiple disciplines, including:

Your HIRE team includes a group of specialized staff to address the many aspects of brain injury rehabilitation:

  • Physiatrist – a doctor who specializes in physical medicine and rehabilitation for both diagnosis and treatment.
  • Admissions coordinator – works with patient and referral source to obtain information required for HIRE to provide services; handles billing, scheduling and documentation questions.
  • Neuropsychologist – evaluates cognitive problems and developmental difficulties caused by injury or illness, then develops a treatment strategy to address those issues.
  • Psychometrist – administers and scores cognitive evaluation testing.
  • Vocational rehabilitation counselor/case manager – coordinates and compiles all evaluations and testing results, monitors patient through treatment and work clinic, and meets regularly with patients, families and referral sources to discuss progress.
  • Occupational therapist – tests abilities in three areas: daily functional skills, fine motor coordination and new learning.
  • Physical therapist – evaluates physical skills, including flexibility, strength, endurance, coordination, balance, mobility and ability to perform a job.
  • Speech therapist – evaluates and treats communication and swallowing disorders.
  • Work skills supervisor – oversees and evaluates patients in the work skills clinic by providing orientation to simulated work tasks, grading and recording work, and giving feedback on work behaviors.
  • Work skills coordinator – occupational, physical or speech therapist who works on specific tasks to target key areas of improvement observed during work skills evaluation.
  • Placement specialist – works with patients at the conclusion of the HIRE program to help them secure employment.
  • Job coach – provides one-on-one training on the job to improve work quality, productivity, coworker and supervisor interactions in a daily work environment.

HIRE Admission Criteria

To qualify for the HIRE program, you must meet the following referral criteria:

  • Have experienced brain injury (such as from trauma, stroke, surgery or debilitating illness) or other learning disorder and continue to experience problems resulting in an inability to return to work or school
  • Demonstrate desire for return to work or school
  • Be able to tolerate a minimum of three hours per day of evaluation or treatment
  • Be independent in feeding, toileting, mobility and dispensing medications, or be accompanied by an attendant who can administer care during your evaluation or treatment
  • Have a means of functional communication
  • Be free of behavior which is dangerous to yourself or others
  • Be free of any active substance abuse
  • Be at least 18 years old
  • Have achieved maximum benefit from traditional rehabilitation services
  • Be medically stable and not require any acute medical management (to be verified by the HIRE Program’s medical director)

Should your primary challenges relate to personal or living independence, physical, psychological or social issues, or leisure activities you will be referred to other programs for those services prior to being admitted to HIRE treatment.

Conditions Treated

HIRE helps people who need instruction, supervision or assistance in at least three of the following areas:

  • Basic or specific work skills
  • Cognition
  • Communication
  • Emotional/behavioral management
  • Endurance
  • Memory
  • Physical conditioning
  • Social skills
  • Vocational exploration


Because every patient is different, every HIRE treatment plan is custom-coordinated from with an interdisciplinary team approach, including evaluation, treatment and job placement:

  • Comprehensive evaluation – this intensive, one-week process examines your strengths and weaknesses from a variety of perspectives, including physical, neuropsychological, vocational, occupational, speech and language. Treatment recommendations are based upon the results of this evaluation, including treatment through the HIRE program or community agencies.
  • Work skills – to prepare you for a job, HIRE creates work simulation tasks to provide experience and training, both as an individual and in a team. Performance and behavioral expectations are clearly defined and consistently reinforced through use of compensatory strategies. One-to-one psychology is available as needed.
  • Job try out – a unique component of HIRE, you will be placed in a modified job at MVH for a skills assessment by a job coach to determine work readiness. Areas for evaluation include work quality, productivity, supervisor and coworker interaction and physical tolerances.
  • Job placement – HIRE job development and placement staff will work with you to find employment that matches your skill set.
  • Job site analysis – an assessment of a job, work environment and your ability to perform the tasks required by the position.
  • Community job coaching - one-on-one training on the job after placement, with 90-day follow along services designed to help you maintain employment.
  • Support – a support group for HIRE clients and their families provides a forum for sharing job search tips, successes and employment-related concerns.

HIRE Discharge Criteria

Upon completion of the HIRE program you must meet the following criteria for discharge:

  • Achievement of vocational/educational goals
  • Obtainment of employment prior to completion of program

Discontinuation of the HIRE program can occur due to:

  • Lack of progress
  • Change in medical status
  • Determination that goals or objectives cannot be obtained through the HIRE program
  • Determination that goals and objectives can be better achieved in an alternative program
  • Display of behaviors that violate terms of the HIRE commitment or behavioral contract
  • Client/family choice

HIRE Patient Outcomes

To ensure that HIRE clients receive the most comprehensive level of care as they pursue their goals of returning to work or school, we follow-up with them by telephone three, six, nine, 12 and 24 months after the conclusion of their job coaching services. Referrals and outcomes in 2009 include:

  • 35 referrals for comprehensive evaluation
  • 30 comprehensive evaluations completed
  • 11 clients admitted to the program
  • At the conclusion of their program clients rated their level of satisfaction with HIRE at an average of 4.26 on a scale of 1 to 5
  • 112 referrals for neuropsychological evaluation
  • 108 neuropsychological evaluations completed
  • 7 job placements at an average salary of $13.84 per hour (salary range of $7.60 to $15.70 per hour) for an average of 37 work hours per week
  • 71 percent of placed clients received benefits with their job offer
  • At three month follow-up after completion of job coaching services, 100 percent of clients remained employed
  • At 12 and 24 month follow-ups after completion of job coaching services, more than 50 percent of clients remained employed

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