Traumatic brain injury (TBI) causes two injury types: primary and secondary. In infants and young children, nonaccidental TBI is an important etiology of brain injury and is commonly a repetitive insult. TBI is by far the most common cause of acquired brain injury (ABI) in children and is the most common cause of death in cases of childhood injury. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) issued validated prediction rules to identify children at very low risk of clinically important TBI, which is defined as TBI requiring neurosurgical intervention or leading to death. The range of outcomes in pediatric TBI is very broad, from full recovery to severe physical and/or intellectual disabilities. Children and adolescents who have suffered a TBI are at increased risk of social dysfunction. Studies show that these patients can have poor self-esteem, loneliness, maladjustment, reduced emotional control, and aggressive or antisocial behavior.
Your search for all content returned 251 results
- Go to chapter: Neurodevelopmental Disabilities: Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder
Neurodevelopmental Disabilities: Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder
This chapter defines neurodevelopmental disorders, and examines the medical, psychosocial, and vocational aspects of two neurodevelopmental disorders that are increasing in the U.S. population: autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). It provides populations at risk of being diagnosed with ASD or ADHD, and distinguishes key considerations for outreach, eligibility determination, and rehabilitation assessment and planning. The chapter considers services to be included in the rehabilitation plan to facilitate goal achievement for consumers with ASD or ADHD, and examines evidence-based practices in job development, placement, and retention. Both ASD and ADHD can be accompanied by co-occurring psychiatric disabilities. Counseling and guidance are always individualized to the unique characteristics, rehabilitation needs, and preferences of each rehabilitation consumer. Rehabilitation counselors must also take into consideration the importance of family involvement in the transition and rehabilitation of youths with ASD and ADHD.
This chapter describes changes in the age demographic of the American populace that will steadily increase the number of elderly people in the United States for the next 30 years, and examines the relationship among aging, health, and disability. It provides the characteristics and needs of people who have frequently occurring aging-related disabling conditions such as dementia, rheumatoid arthritis, and stroke. The most common chronic health conditions for people over the age of 65 include arthritis, hypertensive disease, heart disease, hearing impairments, musculoskeletal impairments, chronic sinusitis, diabetes, and visual impairments. It is important for rehabilitation counselors to understand the impact that population aging has had and will continue to have on family interaction and socialization, the American economy, and human health care and social service systems. In providing counseling and guidance services to individuals with age-related disabilities, the issue of chronicity is often of paramount concern.
This chapter examines the roles that lifestyle factors and climate change play in the onset and exacerbation of emerging disabilities, and provides examples of chronic illnesses and disabilities linked to lifestyle and climate change that are increasing in the population. It considers the medical, psychosocial, and vocational characteristics of emerging disabilities associated with lifestyle and climate change, and explores characteristics of populations at risk of acquiring disabilities and chronic illnesses associated with lifestyle and climate change. The respective incidences of diabetes, asthma, and heart disease have reached epidemic proportions in the United States. The chapter presents an overview of the health impacts of extreme heat, extreme weather events, air pollution, and vector-borne diseases. Temperature increases, changing precipitation patterns, and extreme weather events have resulted in the increased spread of vector-borne diseases. Health promotions services may be especially beneficial to individuals with lifestyle disabilities to assist them with changing health-related behaviors.
This chapter examines the medical, psychosocial, and vocational characteristics, challenges, and rehabilitation needs of emerging populations of individuals with psychiatric disabilities, and introduces a recovery-oriented approach to providing responsive services to individuals with psychiatric disabilities. It explores integrated, evidence-based, and emerging practices to facilitate better recovery and rehabilitation outcomes for these populations. The onset of psychiatric disabilities occurs during critical years when major changes are occurring in the areas of identity formation and cognitive, psychosocial, psychosexual, and career development. Many individuals with psychiatric disabilities receive their health care in emergency departments and intensive care units and not until their secondary conditions create medical crises. Substance use disorders (SUDs) often co-occur with psychiatric disabilities. The principles of recovery align with the core values and principles of rehabilitation counseling. Illness management and recovery (IMR) is an evidence-based practice for equipping individuals with the knowledge and skills they need to self-manage their disabilities.
This chapter defines emerging disabilities; explores medical, psychosocial, and vocational implications of emerging disabilities that distinguish them from traditional disabilities; and provides demographic characteristics of individuals who are most vulnerable to acquiring emerging disabilities. It examines some social and environmental trends that have contributed to the development of emerging patterns and types of disabilities including advances in medicine and assistive technology, globalization, climate change, poverty, violence and trauma, the aging American populace, and disability legislation. Psychological and physical trauma from warfare, violent crime, intimate partner violence, and youth violence can result in permanent physical, cognitive, and psychiatric disabilities. Diagnostic uncertainties, misdiagnoses, and skepticism on the part of medical providers are frequently associated with emerging disabilities. Women also represent a population that is at an increased risk of acquiring emerging disabilities and chronic illnesses. Rehabilitation systems are still not fully prepared to address the multifaceted needs of individuals with emerging disabilities.
This book provides a better understanding of emerging disabilities and their impact on all areas of life and explores implications for rehabilitation counseling practice, policy, and research. It first defines emerging disabilities and examines current societal trends that contribute to the onset and diagnoses of chronic illnesses and disabilities that are considered to be emerging in the United States. Then, the book provides an overview of medical, psychosocial, and vocational aspects that distinguish emerging disabilities from traditional disabilities. The first section of the book includes four chapters on emerging disabilities with organic causes or unknown etiologies. It examines disabilities and chronic illnesses that are characterized by chronic pain. The second section of the book examines the role of natural and sociocultural environments in creating new patterns and types of disabling conditions. It focuses on both lifestyle factors and climate change and how these contribute to the onset and/or exacerbation of chronic illness and disability and explains physical disabilities, chronic illnesses, and mental health conditions that result from violence. The final section of the book explores implications for rehabilitation practice, policy, and research to better respond to the unique concerns and needs of rehabilitation consumers with emerging disabilities. It suggests research topics, designs, and procedures for building upon our knowledge about the rehabilitation needs of emerging disability populations and developing evidence-based practices to facilitate successful rehabilitation outcomes for individuals in these populations.
This chapter discusses medical, psychosocial, and vocational issues across emerging disability populations that should be addressed in the rehabilitation process. It also discusses the application of the ecological model developed by Szymanski, Hershenson, Ettinger, and Enright as a framework for assessment and planning with consumers who have emerging disabilities. The chapter examines the role that rehabilitation counselors can play in responding to issues affecting the lives of people with emerging disabilities in each phase of the rehabilitation process. Outreach to administrators, school counselors, mental health counselors who provide school-based services, teachers, school psychologists, parents, and students may be necessary to ensure that these students are made aware of the availability of rehabilitation services. One of the primary goals of counseling and guidance is to facilitate psychosocial adaptation to disability. Rehabilitation counselors can play a pivotal role in assisting consumers with emerging disabilities to develop health literacy skills.
This chapter discusses various types of violence and their impact on human health, functioning, and onset of physical and psychiatric disabilities, and identifies approaches and programs for treating individuals who have sustained disabilities from violent acts. It examines populations that are most vulnerable to violence, and explores trauma-informed approaches to providing services to these clients in all phases of the rehabilitation counseling process. Military sexual trauma (MST) is heavily confounded by military culture, making the decision to report sexual trauma extremely difficult. The functional limitations associated with disabilities acquired through violence can substantially impair survivor’s ability to achieve and maintain competitive employment. Outreach may be particularly necessary to inform individuals with violence-related disabilities about rehabilitation services. Frain et al. emphasized the importance of training in self-management techniques for veterans because they tend to have poor self-management skills.
This chapter defines chronic pain, types, and causes; describes medical characteristics of two emerging chronic pain conditions namely chronic migraines and fibromyalgia; and discusses symptomology, diagnosis, and treatment issues associated with these conditions. It explores the medical, psychosocial, and vocational aspects of chronic pain, and examines the characteristics of populations most likely to experience chronic pain. The chapter presents recommendations for providing responsive rehabilitation counseling services to the growing numbers of individuals living with chronic pain who are served by rehabilitation counselors across all employment settings. As myths about chronic pain are so prevalent, rehabilitation counselors must carefully examine their own potential biases and misconceptions about chronic pain, its causes, and treatment. Complementary health approaches are often used by people with chronic pain and may include yoga, spinal manipulation, massage therapy, heat and cold applications, meditation, acupuncture, herbal medicines, vitamins, and minerals.
This chapter highlights topic areas in which research is needed to more fully understand the nature and needs of people with emerging disabilities, and examines current trends in rehabilitation counseling research and how investigations with people with emerging disabilities are compatible with these trends. It describes types of emerging disabilities for which health care, community living, and vocational experiences should be investigated more thoroughly in future research. The chapter addresses methodological and data analytic strategies that rehabilitation researchers can use to study the complex, multidimensional needs of people with emerging disabilities. Intervention studies that promote evidence-based practices will be increasingly important in future emerging disabilities research. Multivariate data analytic technique that provides opportunities to more effectively model the complexity of the real world in which people with emerging disabilities live is multilevel modeling (MLM), also known as hierarchical linear modeling (HLM).
Stroke is an enormous public health problem as it is one of the leading causes of both death and disability worldwide. A stroke syndrome involves the sudden onset of symptoms or signs that match a focal area of the central nervous system, without features suggesting a nonvascular cause. Preventive treatments for stroke became widespread, including an understanding of lifestyle risk factors, treatments for vascular risk factors, antithrombotic agents, and surgical treatments such as carotid endarterectomy. Stroke occurs because of a disruption of the brain’s blood supply. Stroke symptoms, with very few exceptions, begin with the sudden onset of focal neurological deficits, which are confined to a vascular territory. Treatment of stroke can generally be divided into three categories: acute stroke management, rehabilitation, and secondary stroke prevention. Prognosis after a stroke of any type depends greatly on the location and size of the stroke as well as patient comorbidities.
This chapter provides sufficient background information to recognize some unique challenges associated with diagnosis and treatment of mild traumatic brain injury (mTBI). There is a strong desire to pursue ’objective’ hallmark neurophysiological sequelae of mTBI using traditional and novel neuroimaging methods. As the majority of mTBIs are associated with various types of accidents, many factors can complicate recovery, including other orthopedic and neurological injuries, involvement in litigation, and premorbid psychiatric factors. TBI is most frequently attributed to blunt-force trauma or closed-head injury. The Glasgow Coma Scale (GCS) is a rapid assessment rating scale that quantifies TBI severity on the basis of neurological factors such as degree of consciousness or presence of posttraumatic amnesia (PTA). Notably, patients sustaining mTBI as a result of sports-related concussion (SRC) are less likely to develop postconcussion syndrome (PCS).
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.
Speech-language pathologists are professionals who specialize in understanding the science behind the process of human communication. As a member of the interdisciplinary team in a medical setting, speech-language pathologists diagnose and treat disorders of speech sound production, resonance, voice, fluency, language, cognition, feeding, and swallowing. At times, the therapists encourage development of untapped potential and skill. In working with those with chronic disabilities, the speech-language pathologist may focus on the appreciation and development of the patients’ preserved abilities. Older adults exhibit retrieval difficulties in spelling, suggestive of challenges with word phonology and orthography. In the acute hospital arena, the speech-language pathologist serves to identify cognitive communication or swallowing deficits, educates patients and families regarding areas of concern, and suggests appropriate discharge treatment options aimed to enhance self-sufficiency. The goal of intervention is not geared to “cure” a disability, but rather, to foster an optimal level of independence and function.
The ultimate purpose of rehabilitation research is to improve clinical and community-based practice and service delivery to maximize the function and quality of life of individuals with disabilities. This chapter begins with the history of rehabilitation and rehabilitation research, describes the key values that should be included in conducting rehabilitation research, and introduces some common frameworks that can assist researchers in designing and describing their studies. It also describes the current status of rehabilitation research, discusses the need for knowledge translation at all stages of the research process, and concludes with future directions. The very nature of rehabilitation is to involve multiple disciplines physiatry; physical, occupational, and recreational therapies; speech language pathology; neuropsychology; social work; nursing; and other medical disciplines. Throughout rehabilitation research, knowledge translation needs to be implemented so that decisions informing practice and future research can be made on a solid evidence base.
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.
Chronic pain syndromes are composed of a multifactorial relationship between biologically based neurological triggers and pathways; psychologically mediated moods, emotions, and behaviors; and socially developed responses, interactions, and consequences. The complex interplay between these factors can devastate a patient’s quality of life, as well as make the diagnoses, treatment, and ongoing management of chronic pain syndromes by health care professionals exceedingly difficult, resulting in psychological and physical disability. In chronic pain, the imprinted signals and perceived pain may persist for several weeks, months, or even years after the original injury has healed. Treatment of chronic pain creates yet another dimension of complexity, as it requires a multimech-anistic, multimodal, or multidisciplinary approach for effective management. Chronic pain often is mixed nociceptive and neuropathic or primarily neuropathic and is associated with imprinted neuroanatomical and chemical changes in the peripheral and central nervous systems, which results in abnormal processing.
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 discusses integrative medicine utilizing the classification approaches devised by the National Center for Complementary and Integrative Health (NCCIH), and provides selected research findings regarding some of their most popular examples. It is no surprise to those in the modern medical field, that integrative medicine is indeed an enmeshed part of the fabric of health care approaches, whether we choose to accept them or not. It is also no surprise in the scientific communities that integrative medicine needs to continue being studied and researched to validate its integration into “mainstream medicine”. The term “integrative medicine” has been borne out of the scientific need to translate “non-conventional” health therapies and systems, to better serve modern society’s health care needs. It is no surprise that the main driver of increased use of complementary alternative medicine (CAM) derives from the demand of consumers of health care.
Health care has been transforming since its inception when public health issues were not understood, through epidemics and a plethora of infectious diseases, to today’s sophisticated medicine with its myriad levels of subspecialization. As the impact of illnesses transformed over time, so did the medical professions, the health care facilities, and the concept of insurance to assist in covering the rising cost of care. As a subset of telehealth, telerehabilitation has become a viable option for providers and payers to effectively manage rehabilitation care in the postacute environment. Although physicians are primarily focused on their clinical duty to their patient, payment methods clearly have an effect on care delivery. Examples of this, relative to bundled payments, could include the utilization of diagnostic imaging, frequency of physician office visits, inpatient length of stay, and the number of follow-up visits between hospitals and physicians.
This chapter focuses on two broad types of developmental disabilities, namely, intellectual disability and autism spectrum disorder. In 1959, the American Association of Mental Deficiency now called the American Association on Intellectual and Developmental Disabilities (AAIDD) defined an intellectual disability in terms of a person’s level of intelligence and level of adaptive behavior. Intellectual disability has traditionally been divided into levels of severity, with these levels linked to the individual’s level of intellectual functioning or IQ score. In regard to classification of intellectual disability, mild intellectual disability is the most commonly diagnosed category, with it being suggested that as many as 85" of those people diagnosed as having an intellectual disability fall within this category. The three major known causes of intellectual disability are Down Syndrome, fetal alcohol syndrome, and fragile X syndrome; however, there are hundreds of other factors that have been identified as contributing to intellectual disability.
Musculoskeletal disorders (MSDs) are among the most common causes of disability in the community. Disorders of the musculoskeletal system may result from hereditary, congenital, or acquired pathologic processes. This chapter provides the clinician with an overview of the most commonly occurring musculoskeletal disorders (MSDs) affecting the working population, including low back pain, rotator cuff (RTC) tendinopathy, acromioclavicular (AC) joint arthritis, and carpal tunnel syndrome (CTS). The difficulty of treating MSDs, whether it is back pain, shoulder pain, or carpal tunnel syndrome (CTS), is the multifactorial issues that surround each condition. Although effective treatment options may be in place for the physical disorder, the overall treatment of each condition is complicated by non-occupational, emotional, and psychosocial factors. The ideal treatment includes a multidisciplinary approach coupled with effective communication regarding treatment goals and outcomes. Prevention through education and ergonometric evaluation of workstations is ideal.
Visual impairment was categorized as moderate, severe, profound, near-total, or total vision loss depending on the degree of loss of visual acuity or visual field. The main impairments affecting visual function are reduced visual acuity, visual field loss, poor contrast sensitivity, lighting and glare problems, and visual skills and binocularity problems. Visual acuity is usually written as a fraction, the numerator represents the test distance, and the denominator represents the letter size. Primary care physicians should be especially aware that, vision loss is a leading cause of falls in the elderly. Perimetry, which is the technique of measuring the visual field, uses a variety of techniques. These may include manual and automated evaluation of the entire visual field with kinetic or static stimuli. The automated perimeter has paved the way for more standardized and accurate visual field testing in all types of patients, including those with low vision.
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.
Stroke is a common and prevalent disease. Stroke presents a greater burden of disease to minority populations and older patients. Ischemic strokes can be caused by a variety of disease processes including small vessel disease, large vessel disease, and cardioembolism. Small vessel strokes are present in 25" of ischemic stroke patients. They result from damage that occurs to the small, nonmuscular, perforating arteries that branch from the middle cerebral and basilar arteries. This damage occurs from sustained damage to the vessels from chronic diseases such as hypertension, diabetes, and hyperlipidemia. Over time, these vessels can become occluded through a process called lipohyalinosis, causing strokes. While many of these strokes are silent and without any clear clinical correlates, some can result in severe acute neurologic symptoms such as unilateral weakness and unilateral numbness.
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.
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.
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 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.
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.
- Go to chapter: The Ticket to Work and Self-Sufficiency Program and Key Employment and Civil Rights Legislation: Are they Working for People With Disabilities?
The Ticket to Work and Self-Sufficiency Program and Key Employment and Civil Rights Legislation: Are they Working for People With Disabilities?
This chapter reviews how the practice of Vocational rehabilitation (
VR) counseling has facilitated or encouraged employment of people with disabilities since the establishment of a national policy on employment of people with disabilities. It examines the intent and the impact of Ticket to Work and Self-Sufficiency Program of the Ticket to Work and Work Incentives Improvement Act of 1999. The chapter presents an overview of key legislation with implications for employment to provide a cursory understanding of the purpose and significance of these laws for people with disabilities. It presents basic information on the Ticket and amendments to its regulations and program components. The chapter provides a labor force characteristics of people with disabilities. It presents a discussion of policy and practices of one state VRagency and reviews the impact of the Ticket and implications. The chapter discusses the recommendations for future directions.
This book is useful to a wide range of readers and can readily serve as a core textbook or resource to explain the history, development, and current practice of rehabilitation counselors (RCs) within the context of the contemporary practice of counseling. Although most clearly useful to counselors-in-training in an introductory course, people think that those RCs at the doctoral level or already in practice interested in the field and its broader positioning and potential will find this book appealing. The book consists of 22 chapters that are divided into parts that emphasize different themes important to understanding both the people and types of situations with which RCs work and the specific roles and skill sets that describe professional practice. It consists of basic information about the structure and professional practice of rehabilitation counseling, and serves the important role of introducing the readers to the RC’s most important partner in the counseling process, the person with a disability. The book also focuses on the professional practice of rehabilitation counseling and introduces the new work in the field that sharpens the emphasis on evidence-based practices and research utilization in the field. It describes in detail, the specific functions that constitute the work of rehabilitation counseling: assessment, counseling, forensic and indirect services, clinical case management and case coordination, psychiatric rehabilitation, advocacy, and career development, vocational behavior, and work adjustment of individuals with disabilities. Further, the book introduces the competencies that provide the types of skills, knowledge, and attitudes that must infuse the practice of rehabilitation counseling because of their pervasive and overarching importance in all aspects of practice.
Entering or reentering the workforce can be a challenging task for individuals following disabilities. Appropriate use of vocational interest measures in career counseling, however, can facilitate this process. This chapter reviews and familiarizes the readers with the construct of vocational interests, to update them with the most recent advances and new findings in interest research, especially with regard to gender differences in interests and the relationship between interests and performance. It provides a brief description of appropriate interest measures for rehabilitation counseling, their psychometric properties, and their usage. The assessment of interests is the starting point and a critical component in career counseling for clients with disabilities. Following interest assessment and assessments of other important individual characteristics, such as work values, aptitudes, and skills, additional information and resources are provided based on clients’ needs to facilitate their career entry or reentry after disabilities.
For over a century since the beginning of career counseling, the role that primary and secondary occupational and labor market data play in the career counseling and placement process has been recognized. This chapter places occupational and labor market information into a visual model called Labor Market Search to serve as a framework for discussing such data as are applied to individuals with disabilities. It helps to understand the theoretical constructs upon which these data are developed are defining terms emanating from the disciplines developing such information so that rehabilitation professionals and students could be better consumers of such data. The chapter explains occupational and labor market primary and secondary data and sources as they apply to the econometric, ergometric, and ergonometric information needs in career counseling, placement, or related activities. It offers conceptual and analytic methods for integrating such data into the career counseling process for individuals with disabilities.
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.