Family caregiving and support are perhaps the most essential elements in their disabled loved ones’ adjustment for response to disability. This chapter first explores the prevalence of caregiving in America, including demographic information about who the typical caregiver is and what the situational circumstances are for these individuals. It is followed by providing a definition of the types of caregiving support generally provided by loved ones, as well as the nuanced differences between unpaid family care versus paid formal care. This segues into a brief exploration into the significant family role caregiving entails and its impact on each member. The chapter then discusses caregiver abuse as well as the often painful decision to place a loved one in a long-term care facility. Finally, it explores strategies for counselors to be able to support family caregivers in caring for their loved one while maintaining their own mental and physical health needs.

Community-based rehabilitation (CBR) originated in 1978 as a strategy for improving rehabilitation services and outcomes for people with disabilities living in low-and middle-income countries who were not well served by traditional medical-model rehabilitation. CBR enlists and empowers the person’s social network from family to community to provide and sustain a network of care and support, create opportunities for participation, and remove physical and attitudinal barriers to inclusion. Guidelines for CBR practice are ensconced in the five key components of the CBR matrix: health, education, livelihood, social, and empowerment. Poverty and its consequences are a particularly central concern to CBR planning as a prerequisite to robust community health and health care. Empowerment is the starting point for CBR planning, acting as an organizing feature of the plan, and the source of its motivation for success.

Counseling people with disabilities has evolved in its constructs from medical models that focus on pathology within the individual, to functional models that focus on economic viability of the individual, to sociopolitical models that focus on the handicapping dynamics of the external environment. We have evolved science and practice sufficiently to understand that disability is a social construction. The meaning of disability emerges from the interaction between the person and the society; it varies across groups and changes over time. The sociopolitical lens highlights the issue of power, its use, and its abuse; the minority experience under a dominant culture; and the role of culture as a context for empowerment, research, and the development of more effective practice. This chapter considers the changeable nature of disability from this postmodern, multicultural perspective and explores its implications for serving diverse populations in diverse cultural settings.

Rehabilitation counseling (RC) recognized family impact on service outcomes decades ago (Power & Hershenson, 2003; Westin & Reiss, 1979), but failed to develop substantive research (Bryan, 2009), practice, or policy (Kneipp & Bender, 1981) on their behalf. The cursory overview of family counseling approaches presented in this chapter is informative as a gestalt of theories and as a collection of unique tools. From the Community-based Rehabilitation Counseling (CRC) perspective, the therapeutic tools of family counseling can be repurposed for inclusive community development outcomes through community processes in all of the nested and networked communities that populate our lives. Thinking about counseling in systems and inclusive community development provides the backdrop for a CRC consideration of the models and tools of family counseling. The chapter describes models that align with social justice and integrated author’s own thinking in the hypothetical discipline of the CRC.

The identity of rehabilitation counseling is rooted in the constructs of counseling psychology and is expressed through current best practice. This chapter provides a brief description on which counseling theories and techniques work best with different disability populations and why. It traces the emerging threads of rehabilitation counseling through counseling theories and techniques. Next, it focuses on the relevance of theory and an accounting of successful applications of theory to practice. It then moves outward from the roots of counseling, from common factors to schools of thought, to describe how counseling fits into our community-based world. Career counseling is a signature venue for rehabilitation counseling. The chapter describes three of the most popular and useful approaches (Minnesota Theory of Work Adjustment, Holland’s Theory, and Super’s Life Span, Life- Space Theory) to providing a sense of the spectrum of service possibilities.

Family members have been recognized for their influence on rehabilitation process and outcomes. The specialized knowledge of family counseling has become part of the qualified rehabilitation counselor identity. This chapter discusses the emergence of the family ethos in rehabilitation counseling from values, to theory, to its model implications. The special identity of rehabilitation counseling is negotiated in the lived community experience of disability. Rehabilitation counseling’s science and practice is predicated on the values of human rights. The social construction of rehabilitation counseling requires a social psychology that embraces liberation. Rehabilitation counseling for families is cast as community counseling, with family as first community. The chapter explores the discipline’s identity in this new context through the applied values of the fundamental mission. It argues that rehabilitation counseling in the family has three distinct transactional expressions in identity, power, and capital.

Identity gives people a sense of constancy and centeredness across the sometimes-turbulent change that comes with living. This chapter presents the developmental concept of identity through its manifestations at different levels of community, revealing a complex and systemic context for rehabilitation counseling. Each level of identity such as personal, social, and collective, denotes a potential point of counseling exchange with the family. The chapter describes how the experience of disability challenges the family system and how that experience is inculcated at each level of identity for each participating member. It is important for a family-inclusive profession to contemplate the meaning of rehabilitation counseling in the context of family identity. The working alliance between the counselor and the family eschews the clinical for an intentional community of purpose that emerges from a joint common cause: full community inclusion for the person with a disability, and support for the participating family.

This chapter discusses the concept of care as the medium through which all community grows. It examines care as a term of art for community use and describes the relationship between family and rehabilitation counseling within the context of care. The chapter defines care in terms of the family ethos and a preliminary model emerges. Family roles are subject to change and shift in their interrelationships as the group adapts to the reality of care and support for the person with a disability. By building from the values that link care to community, the chapter explains a new understanding of how rehabilitation counseling enters into the caring relationship as a value-driven profession and to provide support for the caring family. Facilitating family care is justified by the assumed connection between family participation in rehabilitation efforts and optimal client outcomes.

Trade in family capital builds on the family identity. The interdependence of family members is defined in their transactions. Disability changes the dynamics of trade, and the nature of relationships within the family and between the family and other groups. Society provides for citizens who are politically, economically, socially, or otherwise at risk so they may ideally trade as equals in community. Although an agent of the client, the rehabilitation counselor is also working on behalf of the funding source in compliance with policy and law and in cooperation with a constellation of stakeholders with potentially competing interests. The profession advocates for the client through the context of trade and does so in two approaches to family capital: Community development (CD) and case management. Case management effectiveness depends on the strength, depth, and span of the case managers’ knowledge of how to strengthen and build formal and informal support networks.

“Families in community-based rehabilitation counseling” is a work in progress. The rationale is strong for its development. It has resonance with the great trends of the social movement. It appears to reflect the aspirations of policy. It is admittedly an armchair social construct that has emerged from a conversation among experts. The rehabilitation counseling practice reflected in family experience does not amount to a unified family theory. Indeed, the community-based approach was never meant to be the resolution of professional family practice, just the remit for the bridge-building work ahead. This chapter discusses a final reflection on people’s own personal experience and parting thoughts on the major themes of practice and science such as family impact on rehabilitation counseling identity and practice, research issues and ideas, and considerations for research design.

The disability rights movement is the quintessential case study for empowerment and a window into rehabilitation counseling’s challenges in conceptualizing family practice. The political discourse between social power and disability exemplified in the disability rights movement is the space within which empowerment resides. Rehabilitation counseling must enter this politicized space to fully understand what empowerment means. The consumer-directed theory of empowerment (CDTE) provides an essential point of departure for clarifying empowerment in the context of families and community-based rehabilitation counseling. Psychological empowerment has affective, cognitive, behavioral, and relational dimensions that constitute people’s sense of empowerment. Empowerment in community development ranges from issues of self-advocacy and civic engagement in the most proximal of environments to mobilizing citizenry in community change at municipal, state, and global levels. The empowered client remains at the center of all service and maximally in control of planning, implementation, coordination, and evaluation.

Identity arises out of the sum of our experiences. This chapter traces the developmental concept of identity through its manifestations at different levels of community, revealing a complex and systemic context for rehabilitation counseling. Each level of identity (personal, social, and collective) denotes a potential point of counseling exchange with the family. The authors of this chapter consider family identity in relation to disability and interaction with the community. They discuss personal identity versus family identity and social identity within a social movement. The McMaster model of family functioning and the three dominant tasks of family are explored as are the International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) domains of health conditions, activities and participation, and functions affected. Finally, the chapter presents methods of family coping (both negative and positive strategies), family resiliency, and strategies that counselors can use to effectively assist families.

The authors of this chapter are tasked with reviewing the dos and don’ts of interacting with people with disabilities as human beings. A collection of suggested behaviors, a disability etiquette, has emerged from the collective experience of people with disabilities and is widely available in brochures and on the Internet. Although disability etiquette is an important read for anyone in the field, it is not a sufficient guide for the rehabilitation counselor. The authors are a value-driven profession. They share allegiance to the fundamental mission of full community inclusion for people with disabilities. They act with their clients and on their behalf to help individuals achieve standing in their communities and to advance a more inclusive world for all people with disabilities. Disability etiquette is only the superficial expression of professional values that have much deeper roots and higher aspirations.