In the therapeutic community (TC), recovery is viewed as a change in lifestyle and identity. It is a view that can be contrasted with the conventional concept of recovery in medicine, mental health, and other substance abuse treatment approaches. In the public health experience of treating opioid addiction and alcoholism, drug abuse is viewed as a chronic disease, which focuses treatment strategies and goals on improvement rather than recovery or cure. The TC view of recovery extends much beyond achieving or maintaining abstinence to encompass lifestyle and identity change. This chapter outlines this expanded view of recovery and details the goals and assumptions of the recovery process. It presents the TC view of right living, which summarizes the community teachings guiding recovery during and after treatment. The terms “habilitation” and “rehabilitation” distinguish between building or rebuilding lifestyles for different groups of substance abusers in TCs.
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Therapeutic communities (TCs) are designed to enhance the residents’ experience of community within the residence. This chapter explores how the physical environment of the TC, its setting, facilities, and inner environment, can contribute to this perception and affiliation with community. Its separateness from the outside community in addition to its living spaces, furnishings, and décor are all utilized to promote affiliation, a sense of order, safety, and right living. TCs for the treatment of addiction are located in a variety of settings, which may be determined by funding sources and the external resistance to or acceptance of rehabilitation programs. Within the context of the TC perspective, privacy is considered an earned privilege based on the individual’s social and psychological growth. There are four physical features of the inner environment that instantly identify what is unique about a TC program: the front desk, the structure board, wall signs, and decorative artifacts.
The multicultural movement in counseling and psychology has begun to provide scholars and practitioners with contextually relevant, systems-based ecological approaches to counseling as alternatives to the traditional theoretical models of human behavior and intervention that are based on Western dominant culture. This chapter provides awareness of the complexity of multicultural issues among individuals with disabilities and discusses culturally sensitive strategies to work with people with disabilities (PWDs). It reviews legislative mandates related to diversity and multiculturalism in rehabilitation and addresses the relationship between disability and culture in the scope of rehabilitation practice. The chapter introduces multiculturalism and multicultural counseling models as a therapeutic framework and provides guidelines to help psychologists increase their cultural sensitivity. It also provides strategies to work with individuals with disabilities from minority backgrounds.
This chapter describes spirituality, religiousness, and indigenous/folk belief systems in a multicultural context. The majority of religion and health research to date has primarily focused on persons with life-threatening diseases and conditions, as persons facing death may use religion to help them accept their condition, come to terms with unresolved life issues, and prepare for death. In contrast, rehabilitation patients who suffer acute injuries or chronic progressive disorders may live for decades after the onset of their condition and use religious and spiritual resources to help them cope with their disability, give new meaning to their lives based on their newly acquired disabilities, and help them to establish new goals. The chapter then explains the different ways rehabilitation psychologists can address religious and spiritual beliefs with individuals from different faith traditions.
Rehabilitation providers who work with service members and veterans face significant cultural challenges that may impact the rehabilitation process. Part of this challenge is maintaining an awareness that any individual engaged in rehabilitation could have had prior military service that could impact rehabilitation care. This chapter provides an overview of military culture, including specific aspects of this culture that may affect the rehabilitation process, the various co-occurring disorders that are common in military/veteran populations, and resources and programs that are particularly useful when working with service members and veterans. Service members and veterans face unique challenges and stressors that are over and above some of the routine sources of stress that others face in the workplace. Stress can come from participating in combat, including exposure to traumatic events, risk of injury, and fears about deployment.
- Go to chapter: The Effects of Acculturation on Neuropsychological Rehabilitation of Ethnically Diverse Persons
This chapter explores the impact of acculturation on three diverse U.S. populations: Hispanics, represented by a specific focus on Mexican immigrants; African Americans; and Native Hawaiians. It reviews relevant acculturation theories developed to explain cultural and psychological changes occurring in racial and ethnic populations in the United States as a result of interactions with the majority racial/ethnic population. The chapter presents Berry’s model of acculturation in particular, as a helpful theoretical model for clinicians working in neuropsychological rehabilitation to use for understanding psychological issues related to acculturation pressures. It also highlights the unique historical context of acculturation for each ethnic group and its effect on their acculturation experience as well as mental and physical health outcomes. The chapter provides rehabilitation psychologists and counselors with culturally relevant assessment and intervention recommendations for working with ethnically diverse clients.
Cognitive behavioral therapy (CBT) with children addresses four main aims: to decrease behavior, to increase behavior, to remove anxiety, and to facilitate development. Each of these aims targets one of the four main groups of children referred to treatment. This chapter suggests a route for applying effective interventions in the day-to-day work of social workers who are involved in direct interventions with children and their families. An effective intervention is one that links developmental components with evidence-based practice to help enable clients to live with, accept, cope with, resolve, and overcome their distress and to improve their subjective well-being. CBT offers a promising approach to address such needs for treatment efficacy, on the condition that social workers adapt basic CBT to the specific needs of children and design the intervention holistically to foster change in children. Adolescent therapy covers rehabilitative activities and reduces the disability arising from an established disorder.
The therapeutic community (TC) for addictions descends from historical prototypes found in all forms of communal healing. A hybrid, spawned from the union of self-help and public support, the TC is an experiment in progress, reconfiguring the vital healing and teaching ingredients of self-help communities into a systematic methodology for transforming lives. Part I of this book outlines the current issues in the evolution of the TC that compel the need for a comprehensive formulation of its perspective and approach. It traces the essential elements of the TC and organizes these into the social and psychological framework, detailed throughout the volume as theory, model, and method. Part II discusses the TC treatment approach, which is grounded in an explicit perspective that consists of four interrelated views: the drug use disorder, the person, recovery, and right living. The view of right living emphasizes explicit beliefs and values essential to recovery. Part III details how the physical, social organizational, and work components foster a culture of therapeutic change. It also outlines how the program stages convey the process of change in terms of individual movement within the organizational structure and planned activities of the model. Part IV talks about community enhancement activities, therapeutic-educational activities, privileges and sanctions, and surveillance. The groups that are TC-oriented, such as encounters, probes, and marathons, retain distinctive self-help elements of the TC approach. Part V depicts how individuals change through their interaction with the community, provides an integrative social and psychological framework of the TC treatment process, and outlines how the basic theory, method, and model can be adapted to retain the unique identity of contemporary TCs.
- Go to chapter: Cultural Variables and the Process of Neuropsychological Assessment in the Neurorehabilitation Setting After Brain Injury
Cultural Variables and the Process of Neuropsychological Assessment in the Neurorehabilitation Setting After Brain Injury
Neuropsychological assessment involves the administration of a battery of tests that assess a variety of cognitive domains to obtain a clinical picture of brain behavior relationships. Within the inpatient rehabilitation setting, neuropsychologists often perform various functions, including neuropsychological assessment, psychotherapy, and assistance with adjustment issues for patients and their families. This chapter discusses some of the common cultural issues that impact neuropsychology in an inpatient rehabilitation setting. It focuses on potential sources of bias that can threaten the validity of neuropsychological tests. The chapter also examines the process of the neuropsychological evaluation within the inpatient setting when working with individuals from diverse cultural backgrounds. It deals with a complex composite of sociodemographic factors that include education, socioeconomic status (SES), race, ethnicity, language, and worldview, all of which interact with one another to influence brain-behavior relationships.
This book focuses on the key issues surrounding multicultural neurorehabilitation for a wide range of health care professionals. The study of traumatic brain injury has seen a clear evolution in the sophistication, breadth, and depth of findings concerning neuroepidemiology as it affects racial and ethnic minorities. As large-scale epidemiological studies increasingly include and distinguish individuals of color and linguistic minorities together with religion, sexual orientation, physical disabilities, place of residence, and key socioeconomic variables that interact with race/ethnicity, more information will be available to make changes in policy, training, and clinical service delivery. Neuropsychological assessment involves the administration of a battery of tests that assess a variety of cognitive domains to obtain a clinical picture of brain behavior relationships. Within the inpatient rehabilitation setting, neuropsychologists often perform various functions, including neuropsychological assessment, psychotherapy, and assistance with adjustment issues for patients and their families. The book discusses some of the common cultural issues that impact neuropsychology in an inpatient rehabilitation setting. Considerations of race and ethnicity, disability culture, military and veteran culture, and cultural aspects of religiousness and spirituality are all considered in the book. The authors in the book wrote from their own perspectives as clinicians and researchers, representing diverse cultural backgrounds and neurorehabilitation contexts and roles. Hopefully, the book will generate more discussion, research, and literature on multicultural neurorehabilitation.
This chapter addresses the key principles of sport, exercise, and performance psychology. It reflects the broadening of sport psychology studies to encompass more widespread human performance research. The most well-established model explaining factors likely to increase the chance of injury is Williams and Andersen’s Stress-Injury Model. They proposed that a history of stress, insufficient coping resources, and personality characteristics, all of which increase the stress response, increase susceptibility to injury. Integrated model of response to sport injury is intended to demonstrate the dynamic and complicated nature of the injury and rehabilitation experience. Most athletic trainers are educated on the body, thus they know how to identify the injury, treat the body part, and create a rehabilitation program to initiate recovery and return to play; however, they also spend a great deal of time with injured athletes and are privy to their frustrations. This connection between injured athlete/performer and health care provider is significant as research has found better adherence to rehabilitation programs when athletes believe their health care professional cares about their well-being.
Residential placement is indicated when a youngster becomes unmanageable at home, when outpatient- or community-based treatment does not work, or when it is mandated by the court. In discussing the successful rehabilitation of juvenile delinquents, Romig emphasizes that the focus should be on teaching the delinquents skills “that have been documented as improving their subsequent community behavior”. Adolescents in general are often portrayed as being in a state of constant emotional upheaval and unwilling to communicate with adults in a socially appropriate manner. An effective residential program should provide opportunities for participating in special activities to enhance the self-esteem and skill development of its residents. Treatment at Ocean Tides is grounded in the belief that successful rehabilitation results from a combination of a good program and talented, committed people. At Ocean Tides, a positive orientation is used in a variety of specific ways in the program to rehabilitate the residents.
Psychiatric disability refers to a psychiatric disorder associated with functional limitations that prevent achievement of age-appropriate goals. The nomenclature and diagnostic criteria for psychiatric disabilities vary widely, however, across the mental health, rehabilitation, and social security disability systems. Common mental disorders refer to psychiatric disorders that are less disabling than serious mental illness but still impact role functioning. Depression is probably the widest-ranging psychiatric disorder in terms of severity and duration. Substance abuse disorder is among the most common co-occurring disorders in all psychiatric disabilities, affecting 50" of people with psychiatric disabilities at some point in their lifetime. Anxiety disorders are highly comorbid with other psychiatric diagnosevs, including other anxiety disorders, mood and eating disorders, and schizophrenia spectrum disorders. Victimization of people with psychiatric disabilities is a serious public health problem, as they are 11 times more likely to be victimized by violence and crime than the general population.
This chapter addresses the medical, physical, neurological, psychological, social, and vocational aspects of spinal cord injury (SCI) medicine. SCI is often associated with risk-taking behavior. The prevalence of alcohol abuse is high when compared with that of the general population. Injuries involving the cervical and thoracic spinal cord have a deleterious effect on the respiratory system. As ventilatory demand increases with activity, accessory muscles, innervated by segments of the thoracic and cervical cord, are recruited to aid in inhalation and exhalation. A spinal cord injury below the twelfth thoracic vertebrae may damage the defecation reflex and cause paralysis of the anal sphincter muscle. Through proper medical management, psychosocial support, and rehabilitation therapies as well as the patient’s motivation and family/caregiver’s participation, it is possible for a person with SCI to pursue a productive and satisfying life.
The goals of geriatric rehabilitation are to maximize function and minimize activity limitations and restrictions on participation in daily life for older adults. This is accomplished in a variety of settings including acute inpatient rehabilitation facilities, skilled nursing facilities, outpatient rehabilitation clinics, and the home of the older adult. It is common for older adults to have multiple co-morbid conditions such as diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease, pointing to the need for an individualized program with adequate precautions that minimizes the risk of injury to the person undergoing a rehabilitation program. This chapter sketches the description of the demographic changes facing the US population and the impact of these changes on the delivery of health care. A careful and comprehensive evaluation of the older adults is imperative to both identifying the clinical problems and subsequently determining the appropriate rehabilitation plan.
Neuromuscular disorders are a complex and heterogeneous group of disorders that ultimately impair the general function of the skeletal muscles. Neuromuscular disorders include disorders of the peripheral nerves, plexuses, spinal roots, motor neurons, neuromuscular junctions (NMJs), and muscles. The cornerstone of management for patients with neuromuscular disorders is rehabilitation. An effective rehabilitation program is critical not only for maintaining a patient’s quality of life but also for optimizing one’s physical and psychosocial function. Botulism is a presynaptic disorder of neuro-muscular transmission. There is a variety of therapeutic and cosmetic uses of botulinum toxin. In neuromuscular disorders it is frequently used to treat spasticity and sialorrhea. Neuromuscular electrical stimulation (NMES) is widely used in rehabilitation to prevent disuse atrophy and recover muscle mass and function in immobilized patients. There is growing evidence of safety and benefit of NMES use in many of the inherited myopathies.
Peripheral vascular disease (PVD) encompasses not only diseases of arteries and veins but also multiple underlying medical conditions such as coronary artery disease, diabetes, and renal insufficiency that are associated with, and are often the cause of, the vascular pathology. The brain, abdominal viscera, lungs, and upper and lower extremities are all end organs affected by vascular disease. After treatment of PVD, patients are often left with disabilities that require extensive rehabilitation. The broad scope of PVD may be separated into several areas. A practical organization may include lower extremity peripheral arterial occlusive disease, cerebrovascular disease, venous disease, and peripheral and abdominal arterial aneurysmal disease. Patients with PVD usually have multiple medical problems, and the nature of their disease may be chronic and involve multiple organ systems. The high incidence of limb surgery, limb loss, and stroke makes patients with PVD in particular need of rehabilitation medicine and services.
This chapter overviews social work services from public health and boundary spanning perspectives. Social workers work to prevent negative long-term outcomes for persons with disabilities and to optimize the habilitation of the person with residual disabilities. The chapter is based on biopsychosocial framework for understanding the broad range of needs of people with disabilities and will present the epidemiology of disability in American adults. It discusses the policies that underlie disabilities support and services. Using an ecological approach, a multilevel, problem-solving approach to social work services will be defined, with special attention to services that are delivered within a family-centered perspective, which optimize use of policies, benefits, and financial resources to promote optimal rehabilitation and inclusion of the disabled person, and that integrate physical and behavioral health issues in viewing the whole person in a person-centered care approach.
Chronic renal failure poses a singular challenge for health professionals who deal with illness-related disability and rehabilitation. The course of progressive chronic kidney disease (CKD) leading to renal failure often spans many years; during the period before dialysis or renal transplantation is undertaken, the patient may experience disabilities related to cardiovascular disease, anemia, malnutrition, metabolic bone disease, neuropathy, muscle wasting, and acid-base and electrolyte disturbances. Dialysis treatment and transplantation significantly prolong the lives of patients with renal failure. A better understanding of the pathophysiological basis for many of the disabling aspects of chronic renal failure has led to therapies that may reduce the frequency and/or severity of these aspects of the disease. Prevention of disability and rehabilitation has become increasingly important as the number of patients treated with dialysis therapy and renal transplantation has become more common.
Multicultural counseling literature has critiqued traditional counseling practices, and education for cultural bias toward individualism, middle-classness, and certainly ability. This chapter describes advocacy in rehabilitation counseling by attending to the contribution of multicultural counseling perspectives. It discusses the relevance of incorporating multicultural competency and advocacy in rehabilitation counseling. The chapter addresses the role of advocacy in professional practice and describes various models and definitions of advocacy. It focuses on education and practice implications, with particular attention to the professional responsibilities of rehabilitation counselors (RCs) and the challenges they face as they attempt to advocate for their clientele. Currently, a major challenge in rehabilitation counseling may be that training on the issue of being an advocate for clients may not be well integrated into curriculum or internship. Effective training could be enhanced with exercises such as developing skills in identifying problem situations and determining which type of advocacy might be appropriate.
Rehabilitation counselors (RCs) work with “persons with physical, mental, developmental, cognitive, and emotional disabilities to achieve their personal, career, and independent living goals in the most integrated setting possible”. In rehabilitation counseling practice, there are three models that construct disability from three different points of view: the medical or disease model, the functional limitations or economic model, and the sociopolitical or minority model, also known as the social model as posited by the Disability Rights community. This chapter discusses some of the complexities of the Disability Rights community, including the emergence of the independent living movement, disability studies, and disability culture, in order to prepare practitioners to locate rehabilitation within the broader experience of disability. It also talks about the services provided by centers for independent living (CILs). Individual advocacy supports the self- determination of individuals to obtain necessary support services from other community agencies, such as state-federal vocational rehabilitation.
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.
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.
This chapter reviews the current scope of practice in rehabilitation counseling and the impact that counselor licensure legislation has on the field concerning eligibility for counselor licensure and becoming an independent rehabilitation practitioner. It defines the foundational skills and scope of practice required for effective, competent, and ethical rehabilitation counseling practice. The chapter explains a psychosocial model for rehabilitation counselors (RCs) who want to structure therapeutic interactions with clients who have chronic illnesses and disabilities. The counselor uses the counseling relationship to help clients draw from their personal history, knowledge, coping abilities, resiliency skills, and overall life experiences to derive meaning. Counselors across a variety of work settings and theoretical orientations must be proficient, competent, and ethical in working with a range of people with disabilities who may be culturally different. There are both universal and specific counseling approaches, programs, and services used during therapeutic interactions for people with disabilities.
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.
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.
This chapter defines disability in an international context and compares global disability issues in high-resource and low-resource countries. It discusses the relevant disability demographics, constructs, and resources that relate to global perspectives of disability issues and the expanding role of rehabilitation counselors (RCs). According to the UN, comparative examinations of disability-related legislation indicated that “only 45 countries have anti-discrimination and other disability-specific laws” thereby highlighting the urgent need to advocate for disability-friendly policies worldwide. These important issues relate directly to theoretical perspectives on disability, definitions of disability, and the role of RCs. The chapter addresses the awareness of current global contextual factors and other issues affecting disability such as culture, poverty, trauma, crisis, large-scale disaster, HIV and AIDS, and psychosocial issues across the life span. The WHO has published guidelines for community-based rehabilitation (CBR), including a matrix that covers the five components of health, education, livelihood, social dimension, and empowerment.
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.
This chapter identifies the origins of forensic and indirect service provision at the very start of the rehabilitation counseling profession and traces its growth and trajectory to its continued spread and growth today. It discusses the settings, methods techniques, resources, and ethics of forensic rehabilitation counselor (FRC) practice. The history of forensic rehabilitation and indirect service provision in rehabilitation counseling has often been assumed to be a modern phenomenon emerging with the current generation of practitioners. Workers’ compensation cases are the first cases to be found in the literature where FRC involvement became evident. A subspecialty in forensic rehabilitation counseling is life care planning, which merits mention in any discussion of forensic rehabilitation practice. Clinical judgment in forensics is not a subjective distal inference, guess, or opinion. The Commission on Rehabilitation Counselor Certification (CRCC’s) treatment of forensic and indirect service ethics is the most comprehensive in any counseling specialty.
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 addresses the most significant areas of knowledge for rehabilitation counselor (RC) competencies-general scope of use of technology, counselor and client competencies, assistive technology, distance education, and the future role of technology in the field. Although high and low technology advances hold the potential of a better quality of life (QOL) for people with disabilities, technological access to those individuals with physical, mental, and cognitive functional differences continues to lag behind that of the general population. The first legal mention of assistive technology devices or services is found in the Individuals with Disabilities Education Act (IDEA, 1990). The individuals involved in the provision of assistive technology are considered to be from a multidisciplinary profession. There are a number of technologies holding promise for the future that may have profound effects on the field of assistive technology. Self-driving vehicles may be the most dramatic of these developments.
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.
This chapter explores how the transformation of the health care system in the United States has impacted service delivery of health care disciplines including rehabilitation counseling in providing the most effective clinical services. It provides a review of key evidence-based practice, knowledge translation, and research utilization concepts. It discusses how evidence-based practice can be utilized to improve the professional practice of clinical rehabilitation counseling. The chapter explains how the mechanisms of theory development, empirical evidence, and clinical application inform practice in vocational rehabilitation (VR) service delivery, improving evidence-based practice to enhance outcomes and quality of life (QOL) of people with disabilities. The development of a systematic research agenda and conducting meaningful theory-driven research and intervention research will generate new knowledge and accumulate high-quality evidence, enhancing the ability of rehabilitation counselors (RCs) to truly engage in evidence-based practice to improve employment outcomes and QOL of people with disabilities.
The practicum and internship experience is the backbone of any counseling program. Beginning a practicum/internship represents a major step in our development as a counselor. The goal of this book is to provide orientation and guidance to help us successfully navigate our field placements. This chapter first discusses various general issues regarding the counseling profession itself; then, it offers a brief overview of the practicum/internship process. It reviews some basics of the counseling profession. The chapter briefly describes some of the key organizations that one will likely encounter as a student or over the course of our professional career. It provides brief introduction to the counseling profession, professional counseling organizations, licensure and certification, theoretical approaches, and our practicum/internship experience. The counseling profession has experienced dramatic growth in the past two decades and the future suggests continued expansion, particularly for the areas of clinical mental health, addictions, and clinical rehabilitation counseling.
This chapter provides an introduction to the constructs, theories, and strategies that are relevant for practicing rehabilitation counselors (RCs) to assist individuals with disabilities to attain work, maximize productivity, and successfully adjust to the contemporary social, organizational, and personal dynamics in the work environment. It covers the topics that highlights the vocational focus of rehabilitation counseling: centrality of work in people’s lives, how work relates to individuals’ basic needs and how these needs can be used to develop multidimensional outcomes to measure the effectiveness of rehabilitation counseling, the Illinois Work and Well-Being Model, relevant theories of career development and work adjustment, and basic career and employment development interventions. In addition to the core value that work is central to people’s lives, the chapter is based on several assumptions that the authors believe are not only relevant, but also fundamental to the field and practice of rehabilitation counseling.
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.
Work is the primary organizing structure of life, and the significance of work in the lives of individuals with disabilities has been radically altered over the past half a century. This chapter introduces the centrality of work and discusses the role and importance of work in meeting basic human needs. It identifies specific outcome domains for the three human needs of survival and power, social connection, and self-determination and well-being. The chapter describes the Illinois Work and Well-Being Model and discusses how it can be used to guide rehabilitation counseling case conceptualization. When the centrality of work is the core value guiding vocational rehabilitation services for individuals with disabilities, the rehabilitation counselor is working to increase the individual’s power, social connection, and self-determination. These outcomes can be operationalized by multiple outcomes and cannot be measured by the traditional dichotomous outcomes of employed versus unemployed.
The topic of work analysis is frequently given very limited coverage in textbooks related to occupational development, vocational behavior, rehabilitation counseling, and other rehabilitation healthcare fields; this is truly unfortunate. A comprehensive understanding of the requirements of work is essential to the career development and employment of individuals with disabilities; work analysis provides the foundation for building organizational processes that are effective, inclusive, and legally defensible. This chapter provides the reader with a thorough understanding of work analysis through coverage of its definition, history, methodological considerations, and applications. The workplace of today is a very different entity from what existed just a decade ago. Work analysis is a systematic process used to understand the nature of work. Although there are many methodological considerations to be contemplated and numerous existing work analysis tools available to the practitioner, the methods chosen must be appropriate for the purposes at hand.
Career Development, Employment, and Disability in Rehabilitation, 2nd Edition:From Theory to Practice
This book attempts to provide a comprehensive review of the career development and employment issues, theories, and techniques that impact rehabilitation professionals in their work with people with disabilities. It starts out by introducing the reader to the centrality of work. The psychology-of-work framework provides the reader with a foundation for understanding how and why work is central to individuals’ lives. The centrality of work also provides significant meaning and value to the work that rehabilitation professionals undertake to enhance the career development and employment of individuals with disabilities. In addition to the centrality of work, the book introduces the Illinois Work and Well-Being Model (
IW2 M) as a framework to guide career and vocational development. Specifically, the IW2 Mprovides a structure that researchers and practitioners can use to examine the core factors that impact all phases of the career development process. The book continues to underscore the impact of poverty on the career development and employment prospects of individuals with disabilities. Although the awareness of poverty as a factor impacting career development has increased over the last 10 years, poverty is still undervalued as a career driver in the rehabilitation counseling literature. The issue of poverty will be extremely relevant in the post- COVID-19world. Finally, the book provides a comprehensive review of the major theories related to career development and employment, including job satisfaction, work analysis, labor market research, and transferable skills analysis. Given the uncertainty of our time, the book helps the reader to either find reinforcement or develop a new-found appreciation regarding the career development and employment of people with disabilities and chronic health conditions. The book serves to be an important resource that can help facilitate their own career development and the career development of people with disabilities with whom they work.
This chapter describes the impact that neurological disorders have on health, employment, and quality of life outcomes and presents strategies designed to aid people with neurological disorders in achieving their rehabilitation goals. It begins with an overview of neurological disorders in general, then presents a conceptual framework for understanding the impact of neurological disorders in people’s lives. Following a discussion of the construct quality of life, the chapter provide examples of three commonly occurring neurological disorders (multiple sclerosis, Parkinson’s disease, traumatic brain injury) and examines the quality of life implications of each condition. Rehabilitation professionals are likely to encounter growing numbers of individuals with chronic neurological conditions, many of whom will be facing multiple psychosocial barriers and issues, and have complicated rehabilitation needs. The chapter discusses several important considerations that rehabilitation professionals should attend to in order to more effectively serve this diverse population and promote quality of life.
Assistive technology (AT) has a profound impact on the everyday lives and employment opportunities of individuals with disabilities by providing them with greater independence and enabling them to perform activities not possible in the past. Self-esteem, self-efficacy, and motivation are described as central elements in increasing a consumer’s confidence and belief in self. Good outcomes and efficacy expectations, as well as strong motivation, help lead to successful adaptation to AT. This chapter presents the human component of technology, the relationship between consumers and technological devices/equipment, and the acceptance and use by consumers. It offers recommendations to assist rehabilitation professionals in helping consumers with accepting, utilizing, and benefiting from technology. There needs to be a close and appropriate fit between the technological device and consumer. Therefore, the need for the counselor to actively listen and engage the consumer in the process is essential to the effectiveness and outcome of AT success.
This chapter explores a range of topics related to obesity, including its prevalence, medical aspects, and associated complications. Other relevant areas include the psychosocial factors pertaining to societal attitudes and individual mental health issues, vocational implications concerning work/wage discrimination, Social Security regulations, and Americans with Disabilities Act (ADA) protections. The chapter also discusses the implications for rehabilitation counselors regarding vocational and mental health counseling. The implications of working with persons who are obese or overweight may be broken down into mental health counseling and/or vocational counseling. Obesity and related medical complications have soared to the forefront of medical conditions that lead to premature death, discrimination in employment, compromised quality of life, and negative psychosocial implications. Counselors who are aware of the medical, psychosocial, and vocational implications of obesity can assist clients in a variety of ways, keeping Olkin’s (1999) recommendations in mind regarding disability-affirmative therapy.
One of the historical pillars of rehabilitation counseling has been the use of assessment throughout the rehabilitation process. With this historical emphasis, it is not surprising that the focus on assessment and the methods and techniques used have changed and evolved. As a result, students, practitioners, and researchers are on a constant quest for updated and current information to guide and inform practice, policy, and research. This constant quest for updated and comprehensive information is directly relevant to the assessment of individuals typically served by rehabilitation and mental health practitioners and is the focus of this book. To date, there has not been a book that has been able to provide a comprehensive discussion of topics applicable to service delivery across both setting. This book attempts to fill this gap. One factor that guided the development of this book was the authors’ goal to provide both the foundational information necessary to understand and plan the assessment process and combine this material with information that is applicable to specific population and service delivery settings. To achieve this goal, each of the chapters is written by leaders in the field who have specialized knowledge regarding the chapter content. The chapters provide practical hands on information that allows for easy incorporation of the material to rehabilitation and mental health practice. To further strengthen practical application, case studies and templates have been incorporated where applicable to highlight specific key aspects to promote application to service delivery. Second, this is the first assessment book to be developed after the Council on Rehabilitation Counselor Education and Council on the Accreditation of Counseling and Related Programs merger. Finally, the authors hope that the readers of this book can apply this information to enhance the overall quality of life of the individuals they work with, especially individuals with disabilities.
Assessment interviewing often takes place during the early stages of helping, which includes obtaining information about the client related to the client’s problem or area of change desired. During this stage of helping, the counselor is involved in “conceptualization or formulation” of the problem within counseling sessions or specifically within the assessment interview. Interviewing to assess entails a focus on all aspects of clinical concern, including physiology, cognition, behavior, duration, severity, relationships, and context. A detailed and thorough assessment interview that clarifies the problem holistically leads not only to accurate assessment but also, in later stages of helping, to amelioration. Assessment interviewing is viewed as the foundation of the therapeutic, counseling, and/or rehabilitation process. This chapter is on the assessment interview. It covers types and formats of assessment interviews. This overview is intended to orient the reader to the importance of depth, detail, and thoroughness within the assessment interview.
Planning assessment as part of the rehabilitation counseling process is an important step in providing the individual with critical information that can be used to establish relevant goals, outcomes, and promote self-exploration. In this chapter, the important elements of the planning process are discussed with an underlying assumption that assessment is part of the overall rehabilitation counseling process. With this assumption as a basis, this chapter begins with a brief discussion on how the International Classification of Functioning, Disability and Health (
ICF) can be used to provide a structure to plan assessment and how process variables such as stages of change ( SOC), motivational interviewing ( MI), and working alliance ( WA) can be used to help individuals engage in the assessment process. After briefly outlining the theoretical orientation issues related to test selection, the chapter discusses evaluating tests, test administration, interpretation of findings, and communicating test results.
Rehabilitation counselors can begin to assist women with issues of abuse by acknowledging that advocacy and protection from abusive behavior are a priority for many women with disabilities. By routinely asking about abuse and addressing issues of safety and control during rehabilitation planning, counselors can provide valuable information, resources, and support that may help prevent abuse from occurring and assist women for whom abuse has occurred. To address abuse issues during rehabilitation, rehabilitation professionals have several responsibilities to (a) learn about violence by using available training related to abuse of people with disabilities; (b) employ universal screening as a routine client-intake procedure; (c) volunteer information, resources, and referrals to clients who are in danger or at risk of an abusive situation; (d) facilitate collaboration with domestic violence shelters to supply personal care services and replace medications and assistive devices left behind in an emergency situation.
There are essentially three sectors of private rehabilitation counseling: the public sector, the private nonprofit sector, and the private-for-profit sector. This chapter helps the reader to learn the differences between nonforensic versus forensic private-sector vocational assessment and to learn about forensic life care planning and types of assessment used in the development of such reports. It differentiates the nuances of private vocational rehabilitation, forensic vocational consulting, and forensic life care planning are differentiated. The chapter also describes about the types of vocational assessment measures in non—private-sector versus private-sector vocational rehabilitation. It then discusses the various assessment measures and resources used in private-sector rehabilitation, including transferable skills analysis, labor market analysis, and functional capacity evaluations. The chapter finally describes the various life care planning assessments, including activities of daily living, day-in-the-life videos, comprehensive intake interviews, and multidisciplinary expert consultant assessment.
Career development and work adjustment theories continue to evolve as researchers and practitioners explore what influences work integration and adjustment. These descriptions of career and work adjustment theories bring to light the complexity of career development and adjustment. This chapter provides an introduction to the relevant theories of career development and work adjustment that are pertinent to rehabilitation practitioners. It provides detailed descriptions of the historically important and foundational theories of John Holland and Donald Super that focus primarily on career development. The chapter then introduces the career construction theory, a metatheory aimed at modernizing career counseling to better meet the needs of a more fluid labor market. It describes the theories that focus on the process of work adjustment, a process that we feel is often overlooked and underdeveloped in both the rehabilitation and the vocational research and literature.
Work values, such as security, prestige, and feelings of accomplishment and belonging, are what people want and expect from work. Values are central to our understanding of the reasons why people work and the type of work people design for others to do. This chapter reviews the history of the construct of work values. It explores the usefulness of assessing work values in rehabilitation contexts. The chapter considers the challenges of assessing work values in rehabilitation contexts and reviews the relevant characteristics and basic psychometric properties of several popular measures of work values. Correspondence (or match) between employee work values and employer reinforcers can predict numerous vocational outcomes, including job satisfaction, occupational commitment, career choice, and career success. Understanding and assessing the motivation to work is an important priority for successfully guiding clients into satisfying work.
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Religion and Disability: Clinical, Research, and Training Considerations for Rehabilitation Professionals
It is clear that laypersons, health professionals, and researchers are interested in addressing the importance of religion in society and in health care. However, if we are to use religion effectively to improve the health of individuals, there is a need to better educate current rehabilitation professionals and students about religion, to critically evaluate the existing literature on disability and religion, and to develop practical suggestions for rehabilitation professionals to appropriately use religion to promote positive health outcomes. Rehabilitation professionals need to collaborate with faith-based organizations to improve the physical and mental health of persons with disabilities, as well as their ability to reintegrate back into their communities. Such collaborations are particularly important given the resources that are available in most community churches (e.g., church vans, counseling services) to assist persons with disabilities with transportation and provision of social support.