Rehabilitation Counseling Practice Research Articles

COVID-19, Employment, and Quality of Life Among People Living With HIV

The COVID-19 pandemic led to substantial changes in the work conditions related to employment status and health-related quality of life (HRQOL) of many people. The pandemic also magnified systemic inequities among marginalized groups, including people with disabilities and chronic illnesses, and people living with HIV (PLHIV). The purpose of this study is to (a) understand PLHIV’s employment status, employment needs, and use of employment services during the COVID-19 pandemic; and (b) to examine the factors associated with HRQOL among both employed and unemployed PLHIV during the COVID-19 pandemic. This cross-sectional survey study was conducted from 2020 to 2021 as the COVID-19 pandemic emerged in the U.S. We used both online surveys and structured phone interviews for data collection. A total of 759 responses were used in the current analysis. Study findings show that 65.5% of the employed participants experienced changes in work conditions (i.e., layoffs, reduced work hours, furloughs) and 73% of the unemployed participants reported that the pandemic had an impact on their interest and/or ability to enter employment. Our results show that concern about contracting COVID-19 at work or commuting to work, and employment status have significant relationships with HRQOL. Implications for rehabilitation counseling practice and research are discussed.

Importance of Clinical Judgment Skill Competencies Across Practice Settings: Certified Rehabilitation Counselors’ Perceptions

Accurate clinical judgments are critically important for counselors in their work with clients. To date, there are no studies that have assessed rehabilitation counselors’ knowledge of clinical judgment and its importance to implement in practice. In this internet-based study, a random sample of certified rehabilitation counselors (CRCs;n= 579) were surveyed using the clinical judgment skill inventory (CJSI). The CJSI measures clinical judgment skills across seven clinical judgment skill areas (scientific attitude, cognitive complexity, cultural bias, confirmatory bias, memory bias, negative bias, and evidence-based practice). CRC participants overall rated clinical judgment skills to be important. Significant multivariate analysis of variance (MANOVA) test indicated significant mean differences between practice settings (Wilks’ LambdaF= 3.31,pvalue <.01) in “scientific attitude” (F-statistic = 3.91,pvalue <.01), “cultural bias” (F-statistic = 3.71,pvalue <.01), “confirmatory bias” (F-statistic = 3.02,pvalue = .01), and “evidence-based practice” (F-statistic = 5.62,pvalue <.01). Specifically, CRCs working for a college or university perceived clinical judgment skill areas to be more important than CRCs working in other practice settings. Implications for rehabilitation counseling practice are discussed.

A Way Forward With Multicultural Considerations, Advocacy, and Accessibility Across the 2023 Revised Code of Professional Ethics for Rehabilitation Counselor Educators and Practitioners

While the 2017 version of the Commission on Rehabilitation Counselor Certification (CRCC) Code of Ethics engrained diversity considerations across the 12 main sections of professional practice, more explicit ethical expectations related to multicultural competence are needed to govern the future of rehabilitation counseling practice. The 2023 revised CRCC Code of Ethics will include a newly added unit labeled, Section D: Multicultural Considerations, which seeks to reduce bias, minimize discrimination, and prevent harm in practice. This section infuses cultural competencies introduced to the profession and tenets of advocacy as more than just aspirational directives but also as enforceable tenets of conduct. This article provides an overview of the changes made to Section C: Advocacy and Accessibility and explains the significance of Section D across the principles that instruct professional behavior. The authors will describe best practices for operationalizing the ethics code to ensure that services are comprehensive, equitable, and inclusive. Finally, we will present strategies for becoming a culturally competent and ethically conscientious Rehabilitation Counselor.

Career Transitions Caused by Chronic Illness: A Career Construction Perspective

Purpose:People living with chronic illness face significant challenges with employment. This study explores the impact of participating in the Career Construction Interview (CCI) on the career exploration of individuals facing a forced career transition due to the onset or exacerbation of a chronic illness.Method:An instrumental multiple case study design was used in this qualitative study. A purposeful, homogeneous sample of three female adults was used to gain multiple perspective of forced career transitions. The participants were within 2 years of their diagnosis or exacerbation of one or more chronic health conditions and had to change their career because of the impact of their condition(s).Results:Eight open codes and five axial codes were discovered through the process of constant comparative analysis. For this study one open code (CCI experience) and five axial codes will be discussed.Conclusions:This study found patterns related to chronic illness and career and that the Career Construction Interview was helpful to the participants in assisting them with making decisions about potential careers and options for employment. Implications for rehabilitation counseling practice and suggestions for future research.

Doctoral Dissertation Research in Rehabilitation Counseling: 2013

Our team recently examined the 2012 doctoral dissertation research in our field. This article continues a series of annual reviews of rehabilitation doctoral dissertation research. In 2013, there were a total of 22 doctoral dissertations completed from identified doctoral programs in rehabilitation counseling. Dissertations were organized by research topic, methodology used, model, and statistical analysis, and an annotated bibliography was provided. The analysis also included institutional productivity and trends in employment outcomes for doctoral graduates. Findings of the current analysis demonstrated that majority of the studies consisted of quantitative descriptive research designs. Compared to analyses from previous years, in 2013 advanced statistics were used at the highest rate since 2005. The proportion of dissertations focusing on professional issues topics was greater than any of the prior reporting periods. Implications for the practice of rehabilitation counseling, education, and future research are discussed.

A Vision for Rehabilitation Counseling: Appreciative Inquiry Through the Eyes of Our Legacy Leaders

Rehabilitation counseling (RC), which grew out of vocational rehabilitation legislation in 1920, has quietly developed and expanded its range of services for people with disabilities. As a smaller specialty of counseling, RC has faced challenges to being recognized and valued for its diverse expertise within the counseling field, as well as the broader social service and allied health fields. With a changing landscape of accreditation, state licensing, and service reimbursement requirements, there is now a need for guidance, leadership, and collaborative planning to preserve the vitality of the profession. The purpose of this project was to capture the positive history of the profession through its leaders, utilizing an appreciative inquiry framework, to become more aware of strengths and opportunities, to begin drafting a blueprint for the future of RC. The authors conducted semi-structured interviews with 18 leaders in rehabilitation counselor education and research. Four main themes emerged: (a) formative influences, (b) threats, (c) current assets, and (d) future direction. Focusing on the influence of threats to the RC profession, a solution-focused response model is presented toward a vision of the future of RC practice, education, and research.

Psychometric Validation of the Wisconsin Community Participation Scale in a Sample of People with Chronic Health Conditions and Disabilities Living in the Community

Increasing community participation can reduce the risk for functional disabilities; participation is influenced by person and environment contextual factors. Development and validation of a brief community participation assessment can advance and support evidence-based assessment in clinical rehabilitation counseling practice. It will be an invaluable rehabilitation and public health surveillance tool that can be used to gauge the health conditions and participation of people with disabilities. The current study evaluated and validated the Wisconsin Community Participation Scale (WCPS) in 982 individuals with chronic health conditions and disabilities. Participants indicated five most meaningful life roles: (a) being able to get around with or without help, (b) live independently with or without help, (c) live a healthy lifestyle, (d) work, and (e) engage in leisure and recreation activities. The WCPS scores were positively associated with physical health, mental health, and life satisfaction and negatively related to functional disability in the theoretically expected directions. The WCPS can help rehabilitation counselors assess their clients’ current level of participation in meaningful life roles that are important to them. Rehabilitation counselors can use the WCPS assessment data to guide treatment planning and empower clients to build confidence and self-efficacy to participate in personally meaningful activities in the community.

Development and validation of the social motivation scale in people with disabilities.

Social effectiveness is key to success in the labor market. For decades, social motivation has been empirically studied as both a presumed cause and consequence of social effectiveness. Yet, few direct measures of social motivation exist, and even fewer have been validated with a disability population. This study provides the measurement structure and psychometric properties of a newly created measure of social motivation tested with a general disability population. Participants included 1,013 US adults with disabilities. Exploratory factor analysis (EFA) and Confirmatory Factor Analysis (CFA) were implemented to validate the measure. Results of the EFA suggest that a reduced 26-item inventory exhibits a 5-factor structure in a general population of people with disabilities. These results were confirmed with the CFA. Concurrent validity analysis revealed that most factors were significantly associated with relevant psychosocial variables in the expected directions. The Social Motivation Inventory provides a useful tool for enhancing understanding of social motivation in rehabilitation psychology and rehabilitation counseling research and practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Fifty-Five Books That Shaped Rehabilitation Counseling

This article attempts to construct a history of the first half-century of the field of rehabilitation counseling by identifying the seminal books that initiated or documented significant developments in the field. Those books fall into three categories: (a) books on theories and principles of human behavior, vocations, and counseling that underlie rehabilitation counseling practice (9 books); (b) books on disability (9 books); and (c) books on rehabilitation (37 books). By arraying books in each subcategory in chronological order, one can trace the evolution of the field. Unmet and future needs of the literature are suggested.

Doctoral Dissertation Research in Rehabilitation Counseling: 2012

This article continues a series of reviews of rehabilitation doctoral dissertation research. In 2012, there were 30 doctoral dissertations completed from identified doctoral programs in rehabilitation counseling. Dissertations were indexed by research topic, methodology used, model, and statistical analysis. An annotated bibliography is provided. A consideration of institutional productivity and doctoral graduate employment outcomes were also included in the analysis. Results of the current analysis show that a majority of studies comprised quantitative descriptive research designs. Unlike analyses from previous years, advanced and basic statistics were utilized equitably. The proportion of dissertations focusing on attitudes toward persons with a disability was greater than any of the prior reporting periods. Predictive outcome studies and clinical population research also remain prevalent. Implications for the practice of rehabilitation counseling, education, and future research are discussed.

Foundations for Living: Evaluation of an Integrated Employment and Housing Program for People Living With HIV

Unstable housing and unemployment have been identified as major structural barriers to optimal HIV treatment outcomes among people living with HIV (PLWH). One solution is to provide integrated services that combine medical, employment, housing, and other psychosocial services to address the complex needs of PLWH. This program evaluation reports outcomes of the Foundations for Living program: an integrated employment and housing services program designed for PLWH. Employment and housing outcomes of participants who completed at least one 6-month reassessment were reported by frequency analysis. HIV immune health (CD4 count and viral load) are examined using a matched paired t test. HIV prevention outcomes were assessed by examining changes in the percent of participants with an undetectable viral load. Our findings indicate that among the participants who completed reassessments, 44.8% gained or maintained employment, 86.2% achieved viral load suppression, 75.9% achieved undetectable at the final reassessment. There was no statistical difference between the mean of CD4 count and viral load reported at intake and those reported during the final reassessment. Over half of the participants experienced unstable employment during the program, indicating that significant barriers to employment remain for this population. Implications for rehabilitation counseling practice and research are discussed.

The Commission on Rehabilitation Counselor Certification Code of Ethics: An Emerging Approach to Digital Technology

BackgroundRehabilitation counselors are becoming more adept at providing distance services.ObjectiveFocused on the ethical use of digital technology, the purpose of this article is to highlight ethical considerations when using digital technologies professionally.MethodsReviewing the ethical standards of the 2017 Code of Professional Ethics for Rehabilitation Counselors, this article examines the current ethical standards governing the use of technology, distance counseling, and social media.FindingsIt is critical for rehabilitation counselors to understand how affordances and constraints of technology will continue to mediate the professional practice of rehabilitation counseling.ConclusionThe professional practice of rehabilitation counseling will increasingly involve digital technology.

Are You Getting Enough to Eat? Addressing Food Insecurity in Rehabilitation Clients

Food insecurity is a well-known risk factor for poor health and quality-of-life outcomes. Recent explorations of census data have concluded that it is experienced disproportionately by individuals with disabilities, making it an important area of focus for rehabilitation counseling and research. The purpose of this study is to explore the relationship between food insecurity and work barriers and intrapersonal characteristics that are often the focus of rehabilitation counseling. Findings from a national sample of adults with disabilities ( N = 435) reveal that individuals with less than a bachelor’s degree or in a household earning less than $40,000 per year were more likely to report high food insecurity. In addition, food insecurity correlated with unfavorable outcomes in measures of self-reported health, depression, social support, acceptance of chronic illness and disability (CID), and vocational self-efficacy. Implications are presented for increasing attention to the issue of food insecurity within the context of rehabilitation counseling practice and research, including strategies for augmenting services to include food assistance in a way that is sensitive to the experience of individuals with significant resource gaps.

Clinical Judgment and the Utilization of Psychometric Instruments for Vocational Assessment

BackgroundOver the last 40 years advances in the field of rehabilitation counseling continue to play a major role in the professional identity, skills, and competencies of rehabilitation counselors. While advances have developed in several areas (e.g., multiculturalism, ethics) within the scope of rehabilitation counseling research and practice, there are research gaps for vocational evaluation and the psychometric properties of instruments utilized for assessment.ObjectiveThis study sought to investigate what psychometric instruments rehabilitation counselors utilize for assessment. Primarily, our goal was to seek major details in how practicing rehabilitation counselors utilize psychometric assessments in their work environments and any ethical concerns involved with their use. We sought to investigate the presence of what assessment tools are commonly used by rehabilitation counseling practitioners and the frequency with which they are used.MethodsData from 228 participants was analyzed using a mixed-methods research design with a goal of obtaining both quantitative and qualitative data simultaneously. We sought to determine if there were any statistically significant differences on whether demographic variables affected the selection and use of psychometric assessments.FindingsAverage use of psychometric instruments for assessment use for the entire sample was low, at .66 (between “never” and “sometimes”). Average assessment use for the five subgroups ranged from .37 (body system function) to .99 (interests). Average use for individual assessments ranged from .08 to 2.07. There was a significant effect for education, (R2 = .039 F(1) = 8.82, p = .003).ConclusionsResults indicate higher education levels were associated with increased utilization of psychometric instruments. In addition, collaboration between psychometric assessments and clinical judgment have proven to be valuable in overall quality of rehabilitation services provided.

An Exploratory Survey of the Employment Concerns and Experiences of People With Parkinson's Disease: Implications for Rehabilitation Research, Policy, and Education

PurposeLittle is known about the employment-related decisions made by people with Parkinson's disease (PD). This study investigated the extent to which individuals diagnosed with PD would prefer to continue working or, if currently unemployed, reenter the workforce.MethodThis quantitative survey research design consisted of a purposive sample of people with PD. A total of 80 surveys were completed and returned and, after eliminating those not meeting the inclusion criteria, 58 usable surveys were included in the final analysis.ResultsOver 82% of participants reported leaving work as a direct result of symptoms associated with PD, with the most common being inability to keep up with the physical demands (17.9%), fatigue (12.5%), psychological or cognitive issues (10.7%), and tremors (7.1%). The majority of respondents (64.3%) responded that they were moderately-to-very interested in returning to work if given the right conditions and supports.ConclusionsThe results indicated that individuals with PD would, in the right situation, prefer to reenter the workforce. Rehabilitation counselors need to be adequately equipped with information and resources to assist those with PD in determining potential employment options and ensuring that acceptable accommodations are provided. Implications for rehabilitation counseling practice, research, policy, and education are presented.

Emerging Disabilities That Result From or Are Exacerbated by Severe Weather Events: Implications for Rehabilitation Counselors

BackgroundRehabilitation counselors can anticipate providing services to growing numbers of individuals who have disabilities that were acquired in (or exacerbated by) severe weather events. The impact of these events on individuals’ psychosocial and vocational functioning is an important factor to address in holistic rehabilitation assessment and planning.ObjectivesThe objectives of this article are to (a) provide an overview of how severe weather events contribute to the onset and exacerbation of chronic illnesses and disabilities, (b) identify populations most at risk of experiencing the negative consequences of severe weather events, and (c) consider implications for rehabilitation counseling policy and practice.MethodsWe reviewed literature on severe weather events and their impact on human health and functioning to better understand the impact of these events on affected individuals.ResultsThe review revealed that severe weather events have increased in frequency, intensity, and length, and this trend is expected to continue into the foreseeable future. Severe weather events are an emerging cause of disability that requires unique assessment and planning considerations for rehabilitation counselors.ConclusionsThe increase in recent decades of severe weather events as a cause or contributor to disability has numerous implications for rehabilitation counseling practice that are discussed in this article.

The Disability Community Ain’t What It Used to Be: Implications of Emerging Disabilities for Rehabilitation Research, Policy, and Education

BackgroundThis article introduces the concept of emerging disabilities as it applies to rehabilitation counseling practice, research, policy, and education.DefinitionEmerging disabilities are those that are either new to medical science or becoming more prevalent in specified subpopulations of people. A case study of a person with an emerging disability (diabetes mellitus) is presented.ImplicationsImplications of emerging disabilities for the field of rehabilitation counseling are discussed.

Preliminary Validation of a Short Form of the Perceived Stress Questionnaire for Use in Clinical Rehabilitation Counseling Research and Practice

BackgroundThe purpose of this study was to develop and validate a short form of the Perceived Stress Questionnaire (PSQ) in people with spinal cord injury (SCI).MethodsThe sample consisted of 274 individuals with SCI. Measures administered were the PSQ-20, Center for Epidemiological Studies-Depression Scale, and Rand Short-Form 36 General Health Scale.ResultsResults showed that after selecting two items from each subscale of the PSQ-20, factor analysis results supported a unidimensional measure for the PSQ-8. The PSQ-8 total score demonstrated a high correlation with the PSQ-20 total score. The reliability of the PSQ-8 was adequate and similar to the PSQ-20. The PSQ-8 measurement correlated well with the external correlates of depression and health status. The mediation analysis indicated depression as a partial mediator for the relationship between perceived stress and health status, indicating people with higher levels of perceived stress had poorer health outcome in this study.ConclusionsThis study provides evidence to support the psychometric properties of PSQ-8 in people with SCI. The PSQ-8 is a brief, reliable, unidimensional, and psychometrically sound measure of perceived stress that can be used in clinical rehabilitation and mental health counseling research and practice.

Empirically Derived Test Specifications for the Certified Rehabilitation Counselor Examination: Revisiting the Essential Competencies of Rehabilitation Counselors

The purpose of this article is to examine the results of the certified rehabilitation counselor (CRC) knowledge validation study conducted in collaboration with the Commission on Rehabilitation Counselor Certification (CRCC). The research design for the present study includes both descriptive and ex post facto approaches. Three hundred ninety-four CRCs completed the Knowledge Validation Inventory–Revised (KVI-R) survey. Factor analysis results revealed six knowledge domains: (a) rehabilitation and mental health counseling, (b) employer engagement and job placement, (c) case management, (d) medical and psychosocial aspects of chronic illness and disability, (e) research methodology and evidence-based practice, and (f) group and family counseling. The findings of this study provide important information for CRCC to examine and develop test and item specifications that will guide future versions of the CRC examination. The findings also inform the description of the knowledge base underlying the practice of rehabilitation counseling and contribute further empirical evidence regarding the knowledge domains identified in this replication and extension of the previous study completed in 2012.

Educators’ Perceptions of Clinical Judgment Skill Competencies in Rehabilitation Counseling

Purpose:To address a significant gap in the clinical judgment competency research by adding new knowledge of important clinical judgment skill competencies in rehabilitation counseling.Method:This Internet-based survey design is a follow-up inquiry to Austin and Leahy’s (2015) instrument validation study; this same sample of rehabilitation counselor educators (n= 126) rated the importance and student preparedness in using clinical judgment skill competencies (i.e., scientific attitude, cultural bias, cognitive complexity, memory bias, confirmatory bias, negative bias, evidence-based practice [EBP]).Results:Clinical judgment skills were perceived to be highly important. Students were rated as least prepared in scientific attitude and evidence-based practice. Ten skills of high importance/limited student preparation across four clinical judgment skill areas were identified.Conclusions:This study’s findings provide initial empirical support of important clinical judgment skill competencies for effective rehabilitation counseling practice. Identified student preparation gaps may be used to help prioritize potential clinical training needs for rehabilitation counseling programs to prepare students in the use of clinical judgment skill competencies that address cultural bias, cognitive complexity, confirmatory bias, and evidence-based practice. Most importantly, data generated from this study can be used when preparing students to effectively address their biases and improve their clinical judgments when applying EBP.