Rehabilitation counseling has evolved from its inception in federal legislation in the early 1900s to its current recognition as a specialization of the counseling profession. An initial focus on case management served a constructive purpose during the early years, given the historic link of rehabilitation counseling to the state-federal vocational rehabilitation (VR) system. A psychiatric disability is when an individual with a serious mental illness is unable to perform major life activities in particular life contexts, such as community participation, and independent living. Credentialing has defined and regulated the professional practice of rehabilitation counseling in recent years. The professional identity of a rehabilitation counselor (RC) as a counselor has had wide formal endorsement by the major professional organizations and leaders in the field. Counselor licensure laws emerged because of regulations by Medicare and Medicaid as well as private health insurance that required licensure for the reimbursement of mental health services.
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This chapter provides a foundation for deeper understanding of the nature of rehabilitation counseling practice. Job analysis, role and function, professional competency, critical incident, and knowledge validation research are all terms that describe a process whereby the professional practice of rehabilitation counseling has been systematically studied. Rehabilitation counseling has been described as a process in which the counselor works collaboratively with the client to understand existing problems, barriers and potentials in order to facilitate the effective use of personal and environmental resources for career, personal, social, and community adjustment following disability. A majority of rehabilitation counselors (RCs) still practice in the public, private, and not-for-profit rehabilitation sectors. However, more recently RCs have begun to practice in independent living centers, employee assistance programs, hospitals, clinics, mental health organizations, public school transition programs, and employer-based disability prevention and management programs.
This chapter discusses the difference between medical models of disability and psychosocial models of disability. It addresses the environmental and psychosocial influences on relationships of individuals with disabilities and explains how people with disabilities can achieve and maintain optical health and functioning. The chapter describes the current health care systems in the United States and reviews alternative ways to improve weaknesses of the health care system. There are two ways to access to health care in the United States. The first is by having private health insurance purchased from a for profit health insurance company by your employer, yourself, or a family member. The second is by being eligible for Medicare or government-funded programs, most commonly Medicaid, the Veterans Health Administration, or the Indian Health Service. An organization of activist people with disabilities called ADAPT is dedicated to creating a priority on home-based services over institutionalization for people with disabilities.
This chapter discusses the nature and significance of person-centric assessments to rehabilitation support interventions for people with disabilities. It defines person-centric assessments and positions them within the framework of the WHO’s International Classification of Functioning, Disability and Health (ICF). The ICF provides a universally accepted biosocial conceptual framework for understanding health and disability. The chapter discusses the ways in which the ICF can be used in conjunction with the Diagnostic and Statistical Manual of Mental Disorders (DSM) and other WHO classifications systems to provide person-centric data for rehabilitation support interventions with people with disabilities. Finally, the chapter proposes a conceptual model for applying ICF framework concepts to the design, selection, and use of person- centric rehabilitation assessments for life design with disability. Person-centric assessments for rehabilitation supports provide data on the appropriateness, intensity demands, and opportunity affordances for a satisfying life with disability.
The development of a strong professional identity rests on clear professional standards of practice. Clients need solution-focused, respectful, nonexploitative and empowering, and, therefore, ethical relationships with their counselors. This chapter deals with the ethical standards of rehabilitation counseling and three types of professional standards which includes the internal standards of the profession, clinical standards for the individual practitioners within a profession, and external regulatory standards. Colleges and universities provide professional education and research services, doing so under the review of credentialing bodies such as the Council for Accreditation of Counseling and Related Educational Programs (CACREP). The intent of a code of ethics is to provide rehabilitation counselors with guidance for specific situations they experience in their practices. The Tarvydas integrative decision-making model of ethical behavior builds on several well-known decision-making models widely used by professionals in the mental health and counseling communities.
Credentialing refers to the general process of establishing the minimum standards, qualifications, and/or requirements essential to professional counseling practice. The credentialing process serves two fundamental purposes, namely control of the profession and public recognition of the profession. This chapter talks about rehabilitation counselors (RCs) to understand professional credentialing and the factors influencing the practice of rehabilitation counseling. It discusses the elements of accreditation, certification, and licensure as well as the role of professional associations and legislative changes. The purpose of accreditation in rehabilitation counseling is to guarantee that practitioners have obtained fundamental counseling skill and knowledge requirements prior to applying for certification and licensure. The primary accredition body of rehabilitation counselor education (RCE) programs has been the Council on Rehabilitation Education (CORE). The merger of CORE and Council for Accreditation of Counseling and Related Educational Programs (CACREP) represents an example of professionalization of the counseling profession.
The relationship of rehabilitation counseling to the larger profession of counseling has evolved in response to ongoing changes in the legislative, social, and business arenas. This chapter reviews the parallel histories of the counseling profession and the counseling specialty of rehabilitation counseling, and explores the changes that have affected this evolution over time. It focuses on rehabilitation counseling, bringing the reader up to the current merger of Council for Accreditation of Counseling and Related Educational Programs (CACREP) and Council on Rehabilitation Education (CORE) and its implications for rehabilitation counseling and the larger profession moving forward, starting with the earliest history. The values and beliefs underscoring the practice of rehabilitation counseling had its roots in the turn-of-the-century movements that emphasized a humanistic approach to assisting individuals in need, such as poor, destitute, and mentally ill people, as well as those with physical disabilities.
Rehabilitation counseling concepts and models have evolved progressively over the last century. This chapter describes fundamental philosophical values that characterize rehabilitation counselors (RCs) and how they approach their work. It discusses four traditional models or conceptual frameworks of disability namely, moral model, medical model, labor market economic model and ecological model. The chapter also explains four newer models such as social model, disability culture model, technology model and consumer economic model that propose alternative interpretations and responses to the stimuli that disabilities represent. An asset-oriented approach or strengths-based orientation of uncovering and exploiting the positive aspects in both the person and the situation is the widely endorsed current expectation for RCs. The interdisciplinary team has been a primary model for the delivery of comprehensive rehabilitation services, especially in large clinical settings. RCs who work in vocational programs have an essential partner in employers, sometimes called the “second client”.
This chapter discusses the array of laws that govern and impact the provision of vocational rehabilitation (VR) services. It explains the specific provisions of laws related to improved employment outcomes for people with disabilities. The Americans with Disabilities Act (ADA) is the seminal piece of federal legislation addressing disability in the workplace. The greater impact of Health Insurance Portability and Accountability Act (HIPAA) on the practice of rehabilitation counseling, however, involves the situation in which an occupational health provider qualifies as a health care provider or business affiliate under HIPAA. The 2010 Patient Protection and Affordable Care Act (PPACA) refers to two pieces of legislation: the PPACA and the Health Care and Education Reconciliation Act. Genetic Information Nondiscrimination Act (GINA) prohibits employers from discharging, refusing to hire, or making other decisions related to the terms and privileges of employment based on an employee’s genetic information.
Rehabilitation counseling, based on trait-factor philosophy and grounded in the psychomedical paradigm, was a conglomeration of methods that were used to assess and to treat clients. Family relationships and family dynamics plays a major role in the rehabilitation process and rehabilitation outcomes. This chapter describes the influence of relational factors in the rehabilitation process, and focuses primarily on the effect of disability from the perspective of the family. Debilitating progressive diseases or serious permanent loss of function are some of the most difficult situations for families to face. A family practice model involves the counselor anticipating, planning, and participating in full family involvement in the rehabilitation process. Rehabilitation counselors (RCs) should be educated about social systems theory and family therapy. Although cross-training in family therapy would be ideal, RCs must at least be willing to obtain continuing education and appropriate training to identify relationship factors impinging the rehabilitation process.