Vocational Counseling Research Articles

Motivating disability pensioners with back pain to return to work - a randomized controlled trial

To investigate the outcome of a brief vocational-oriented intervention aiming to motivate disability pensioners with back pain to return to work, and to evaluate prognostic factors for having entered a return to work process during the following year. A randomized controlled trial was conducted. Participants (n = 89) (mean age 49 years, 65% women) who had received disability pension for more than one year were randomized into an intervention group (education, reassurance, motivation, vocational counselling, n = 45) and a control group (n = 44). Primary outcome measures were return to work or having entered a return to work process. Secondary outcome measures were life satisfaction, disability, fear avoidance behaviour and expectancy. The intervention had no statistically significant effect on return to work or having entered a return to work process at 1-year follow-up. Twice as many in the intervention group (n = 10, 22%) had entered a return to work process compared with the controls (n = 5, 11%). The number needed to treat was 9.2 (95% confidence interval (CI) = 3.4, Inf). Only minor differences in secondary outcome measures were demonstrated. Positive expectancy, better physical performance and less pain were related to return to work. The effort of returning disability pensioners to work by a brief vocational-oriented intervention may be of clinical relevance. The effect needs to be explored further in larger samples of disability pensioners.

Return to work after lower limb amputation

Purpose. To review the literature on return to work after lower limb amputation.Method. A comprehensive review of literature on return to work after lower limb amputation was carried out, searching MEDLINE and PubMED.Results. Most authors found return-to-work rate to be about 66%. Between 22 and 67% of the subjects retained the same occupation, while the remainder had to change occupation. Post-amputation jobs were generally more complex with a requirement for a higher level of general educational development and were physically less demanding. The return to work depends on: general factors, such as age, gender and educational level; factors related to impairments and disabilities due to amputation (amputation level, multiple amputations, comorbidity, reason for amputation, persistent stump problems, the time from the injury to obtaining a permanent prosthesis, wearing comfort of the prosthesis, walking distance and restrictions in mobility); and factors related to work and policies (salary, higher job involvement, good support from the implementing body and the employer and social support network).Conclusions. Subjects have problems returning to work after lower limb amputation. Many have to change their work and/or work only part-time. Vocational rehabilitation and counselling should become a part of rehabilitation programme for all subjects who are of working age after lower limb amputation. Better cooperation between professionals, such as rehabilitation team members, implementing bodies, company doctors and the employers, is necessary.

An Innovative Job Placement Model for Unemployed Methadone Patients: A Randomized Clinical Trial

This article presents the outcomes of an innovative vocational rehabilitation model designed for methadone-maintained patients—the Customized Employment Supports (CES) model. CES counselors work intensively with a small caseload of patients to overcome the vocational as well as non-vocational barriers that hinder employment, with the goal of attaining rapid job placement. A randomized clinical trial was implemented at two methadone treatment programs in New York City and was funded by the National Institute on Drug Abuse The study tested the hypothesis that patients assigned to the experimental (CES) condition would have better employment outcomes than those assigned to a control condition who received standard vocational counseling at the programs. The data were collected from May 2001 through April 2005. The efficacy sample for the analysis consisted of 168 patients who completed follow-up interviews. The sample was 58% male, 75% minority group, average age 45 years, and in methadone treatment for an average of five years. The results supported the hypothesis for two measures of employment; i.e., the CES group was significantly more likely than the control group to obtain both any paid employment and informal paid employment. However, there were no significant differences for competitive employment or total earnings. The study's limitations are noted. Implications of the findings for the improvement of vocational rehabilitation for addiction patients are discussed.

MEJORA DE LA MADUREZ VOCACIONAL EN FUNCIÓN DEL NIVEL DE AUTOEFICACIA

The purpose of the present investigation was to develop a program of vocational counseling, which allows the participants, students of Secondary Education, to improve their vocational maturity taking into account their level of vocational self-efficacy. Three groups were made considering their level of career self-efficacy. The results obtained in this investigation show that the students belonging to the experimental group improved better than the students belonging to the control group in most of the analyzed variables. The three groups established considering their level of career self-efficacy obtained significant improvements in the postest, showing no significant differences among them.

Participation in specific treatment components predicts alcohol-specific and general coping skills

This study identified which aspects of substance abuse treatment in community residential facilities (CRFs) were correlated with patients' post-treatment coping. A total of 2376 patients supplied demographic information and completed measures at baseline (coping and abstinence self-efficacy) and one year after treatment (coping, level of drug and alcohol use, and substance-related problems). Staff provided information about treatment orientation and patients' participation in treatment (e.g., life skills training, vocational counseling). The data were used to predict coping 1 year after treatment. As expected, higher levels of general approach coping and alcohol-specific coping and lower levels of general avoidance coping were associated with less 1-year alcohol and drug use and fewer drinking problems. Patients' greater level of participation in life skills counseling predicted more approach coping at 1 year. In addition, positive social relationships and participation in 12-step self-help groups predicted less general avoidance coping and more alcohol-specific coping at 1 year post-treatment. Life skills training, 12-step self-help groups, and enhancement of supportive relationships during CRF treatment for substance abuse are related to healthy coping. Future research should examine the effect of these components in less intensive programs and with women.

Nachhaltigkeit orthopädischer Rehabilitation bei chronischen Rückenschmerzen - Das Integrierte orthopädisch-psychosomatische Behandlungskonzept (IopKo)

Chronic diseases of the musculoskeletal system rank first as causes of early retirement in Germany. Therefore orthopaedic rehabilitation has to identify patients with work-related problems and to promote return to work through differential treatment and vocational counselling. In the framework of the IopKo-Project such measures were developed and evaluated. These measures encompass: (1) an intensive and multiprofessional diagnostic pathway which allows early detection and treatment of mental disorders and job related problems; (2) homogeneous treatment groups based on multiprofessional diagnostics; (3) differential treatments, among these a multidisciplinary programme for patients with chronic low back pain or high risk of chronification (Rückenfit); (4) interactive training modules which mediate principles of performance and disability expertise, the legal bases of retirement pensioning, and measures to support occupational rehabilitation; and (5) a work hardening training programme. To evaluate the effects of these measures in comparison to a control group with usual care, a prospective longitudinal study was conducted. A total of 307 patients were assigned to the multidisciplinary in-patient treatment programme, whereas 176 patients in the control group had a standard rehabilitation programme. The results show positive moderate and strong effects in the intervention group concerning function, pain, psychic strains as well as the number of sick days and return to work rates 10 months after discharge. The effects in the intervention group exceeded the effects achieved in the control group. PATIENTS WITH HIGH RISK OF CHRONIFICATION: Beside the full sample, a subgroup of patients with chronic pain or high risk of chronification was analyzed, who had received a multidisciplinary functional restoration treatment. Also for this subgroup we found moderate and strong effects of treatment for function, psychic strains and sick days superior to those in the control group. By this study we were able to show that orthopedic rehabilitation in a multimodal and multidisciplinary setting with a focus on activating and motivating therapy can have sustainable positive effects on pain, function and psychic well-being as well as on economic parameters. We interpret these persistent and superior effects in the treatment group (1) as a result of multiprofessional diagnosis and assignment which helps to subdivide the inhomogeneous group of patients with unspecific back pain into more homogeneous and thus more effective subgroups, (2) as a result of increased motivation by closed treatment groups, (3) as a result of intense and multilevel counselling of work related problems, (4) as a result of work hardening modules, and (5) as a result of direct and efficient treatment of psychic strains. The results also demonstrate the significance of inpatient rehabilitation, which will be efficient if differential treatment - adequate to the problems of the patient - is offered.

The effect of a “training on work readiness” program for workers with musculoskeletal injuries: A randomized control trial (RCT) study

This is a clinical randomized trail (RCT) to investigate the effects of a three-week training program on work readiness designed for musculoskeletal injured workers with long-term sick leave who had difficulties resuming their work role. The program was planned to help injured workers overcome the psychological and psychosocial problems and to facilitate their Work Readiness on Return to Work (RTW) based on the Employment readiness model. A total of 64 injured workers were recruited and randomly assigned into the training (T) and control (C) groups. Observations were blinded between service providers and evaluators. A three-week intensive training on work readiness program was given to the T group while subjects in the C group were given advice on job placement by social workers in a community work health center. The training program was comprised of individual vocational counseling and group therapy using cognitive behavioral approach to alleviate symptoms of stress, pain and anxiety. The Chinese Lam Assessment of Stages of Employment Readiness (C-LASER), the Chinese State Trait and Anxiety Inventory (C-STAI) and the Short form of Health Survey (SF-36) were used to evaluate all subjects' psychological health status and behavioral changes on job readiness before and after the intervention. Subjects in the T group showed significant improvement in their work readiness (p < 0.05), level of anxiety (p < 0.05) and their self perception of health status measured by SF-36 (p < 0.02) when compared with subjects in the C group. Control of chronic pain, negative motivation, and anxiety level were some of the key behavioral changes found from the study. The TWR program appeared to improve injured workers' motivation and employment readiness. Further study on the employment outcomes of subjects is recommended.

Programme d'aide à la réinsertion sociale et professionnelle de jeunes adultes cérébrolésés : résultats à cinq ans du réseau UEROS–Aquitaine

Introduction Difficulties in social and vocational adjustment are common in adults with brain damage. A French government-funded program, UEROS (Unit for Evaluation, Training and Social and Vocational Counselling), was developed to improve cognitive adjustment, social autonomy and return to work for these people. Objectives To describe the outcome and satisfaction with life after 5 years for patients who participated in the UEROS–Aquitaine network program. Main Outcome Measures EBIS Document to evaluate people with traumatic brain injury. Results Seventy-five of the 102 patients participating in UEROS from 1997 to 1999 were assessed during a phone-structured interview based on the EBIS Document. The sample consisted of young adults (mean age 28.5 years), most (65, 85%) with brain injury and moderate disability (Glasgow Outcome Scale 2: 57%) or severe disability (Glasgow Outcome Scale 3: 42%). On entering the program, 33% of the subjects needed no help physically or cognitively. None were employed. At the end of the program, 9% were students or were learning a job, 8% worked full-time, 16% were in sheltered conditions, and 13% had volunteer activities. At 5-year follow-up, 50% of the subjects were independent, 4% were in school, 10.6% worked full-time, and 26.7% were in sheltered conditions. Playing sports was associated with good social adjustment. The professional status at 5 years was significantly correlated with following the UEROS program (r = 0.30, P < 0.01) and status at the end of the program (r = 0.29, P < 0.05). However, 41.3% of the subjects were still unsatisfied with their conditions of life. Discussion–conclusion In patients with brain damage, the UEROS–Aquitaine network program improves independence in daily living and allows for nearly one inactive adult in two (42%) to be engaged in an activity or a job.

Multiple sclerosis: disability profile and quality of life in an Australian community cohort

The objective of this study was to determine the experience of disability and reported symptoms in multiple sclerosis in an Australian community sample, comparing the perceptions of patients, carers and treating doctors, and to examine effects on quality of life, carer stress and utilization of health services. The study design used a prospective cross sectional community survey. The participants were persons with a confirmed diagnosis of multiple sclerosis, with quantified neurological, mobility and cognitive deficits, from a tertiary hospital database (n=101), who lived at home, and their carers and doctors. The study method used demographic, diagnostic and disease severity data extracted from the database. Structured interviews conducted at home included: (1) open questionnaires for participant, carer and general practitioner, prioritizing symptoms/problems affecting daily living; and (2) standardized assessments for patient quality of life, caregiver strain and perceived burden of care. The mean age was 49 years (range 28-64). Those more severely affected had a significantly reduced quality of life and increased carer burden than those with milder disability, but discordance between patients, carers and doctors was noted in their perception of problems and symptom experience. Rates of depression (67%) and work-related problems were high, but vocational support was rarely provided. Forty persons used interferon, of whom 20 had secondary progressive multiple sclerosis; 39% reported difficulty in accessing rehabilitation services and only 10% were referred to medical rehabilitation units. In conclusion, the rates of disability and symptom experience were similar to other series; however, access and utilization of appropriate rehabilitation and support services appears to be lacking. There were higher reported rates of depression and poor quality of life. Opportunities may possibly exist to re-deploy resources to develop vocational support, counselling and rehabilitation.

Counselor Confounds in Evaluations of Vocational Rehabilitation Methods in Substance Dependency Treatment

Evaluation research on vocational counseling in substance dependency treatment should distinguish between the effects of counselors and counseling methods on clients' employment outcomes. Three experimental designs permit investigation of possible confounds between these types of effects: (a) nested designs (each counselor delivers one counseling method so counselors are nested under methods), (b) crossed designs (each counselor delivers all counseling methods so counselors are crossed with methods), and (c) no-treatment control group designs (experimental group's counselors all deliver the same method). Each design is optimal for one stage of evaluation research. No-treatment control group designs are best for exploratory evaluations of new types of vocational counseling. Nested designs are best for outcome evaluations of different types of interventions. Crossed designs are best for (causal) process evaluations of counseling methods of demonstrated efficacy. Despite the importance of methodological issues and problems, vocational rehabilitation in substance dependency treatment has a greater need for stronger interventions than better evaluation designs.

Transition-Age Adults with ADHD: Gender and Predictors of Vocational Rehabilitation Outcomes

Differences in rates of case closure, case service cost, hours worked per week, and weekly wage between White males and females with Attention Deficit/Hyperactivity Disorder were examined using the Rehabilitation Service Administration national data base of 2002. Females had statistically significantly higher case service costs than males. Using logistic regression, the customer demographic variable related to successful competitive employment for males was age. Case service variables related to successful competitive employment for males were vocational rehabilitation counseling, job search assistance, and job placement. The customer case service variable related to successful competitive employment for females was job search assistance. Implications for rehabilitation professionals and for future research on vocational rehabilitation outcomes with consumers with ADHD are provided.

Obesity as a Disability: Medical, Psychosocial and Vocational Implications

Obesity has become the second leading cause of death following smoking in the United States and is considered to have reached epidemic proportions over the past decade. It is estimated that almost two thirds of the U.S. population are overweight or obese. Obesity is also a contributor to a number of secondary disabling conditions such as coronary heart disease, type 2 diabetes, respiratory dysfunction, and musculoskeletal disorders. The psychosocial, medical and vocational implications for persons who are obese are becoming an increasing important area for rehabilitation counselors. Discrimination in employment, social situations, education, and the medical community is well documented. These issues in addition to mental health and vocational counseling strategies are discussed in this article.

Predictors of Engagement in Vocational Counseling for Methadone Treatment Patients

Employment enhances the outcomes of substance dependency treatment. Unfortunately, although unemployed methadone treatment patients frequently state they are interested in a job, many fail to participate in vocational services when available. Unless patients become engaged, vocational services do not have an opportunity to be effective. This is the first study to explore a broad array of factors that may be associated with differential engagement in vocational services among methadone patients. The study was conducted in two methadone programs in New York City during 2001–2004. Unemployed methadone patients (n = 211) were voluntarily randomly assigned to either of two vocational counseling programs (standard vs. experimental) and followed for 6 months. The sample was 59% male, 75% minority group, aged 45 years on average, and in methadone treatment for 5 years on average. Being engaged in the vocational counseling programs was defined as five or more sessions with the counselor in the first 6 months after study entry. In multivariate analysis, the factors associated with higher engagement in vocational counseling were being non-Hispanic, having more education, a drug injection history, a crack use history, having chronic emotional/mental problems, better work attitudes, and assignment to the experimental vocational program. The results indicate that it is often the most “needy” unemployed methadone patients who become more engaged in vocational counseling. A vocational counseling model which emphasizes assertive outreach and attends to nonvocational clinical issues as well is more likely to engage patients.

The Relationship Between Vocational Rehabilitation Client Outcomes and Rehabilitation Counselor Multicultural Counseling Competencies

Multicultural issues in rehabilitation counseling continue to be a focus of practice and research because of the rapidly changing racial and ethnic profiles of persons with disabilities seeking services in the United States. This study investigated the relationship between vocational rehabilitation client outcomes and the rehabilitation counselor multicultural counseling competencies of 118 rehabilitation counselors working in a large midwestern vocational rehabilitation agency. The results of this study, which used hierarchical linear modeling (HLM), suggest that the characteristics the client brings to the counseling relationship are the primary variables in explaining differences in client outcomes. Counselor multicultural competencies were not found to be significant in explaining differences in client outcomes. The findings of this study are discussed in relation to previous studies and implications for future research.

Rehabilitation Management of Peripheral Neuropathy

The goals of rehabilitation for patients with peripheral neuropathy are to maximize and prolong independent and safe locomotion and function, inhibit physical deformity, and provide access to full integration into society. The services of multiple disciplines are required to fully achieve these goals and include physicians, nurses, therapists, orthotists, social and vocational counselors, and psychologists. Treatment is goal-oriented, using various modalities including exercise, bracing, adaptive equipment, medication, and surgery.

Frank, We Hardly Knew Ye: The Very Personal Side of Frank Parsons

Little is known about the personal of Professor Frank Parsons, the person who is one of the preeminent figures in the development of, and credited with founding, the career counseling specialization of modern day professional counseling as well as professional counseling and the related fields of vocational psychology and counseling psychology (Aubrey, 1977; Salomone, 1988; Whiteley, 1984). Almost who write on the of Frank Parsons have focused on the facts one might find in any biography. Parsons was born on such-and-such a date, went to such-and-such school, did such-and-such, died on such-and-such date, and was buried in such-and-such cemetery. There is also some information persons with whom he worked and information on the very few who were his friends, but rarely are readers given any in-depth assessment of the type or quality of these relationships. Nowhere is there any data on persons whom Frank Parsons cared about, loved, flirted with, dated, slept with, or married. In fact, it is only after Parsons's illness that his archives contain information of a more personal nature. It could have been that Professor Parsons felt no need to preserve his more personal writings or it could have been that he was only able to personally edit his archival legacy while he was still in good health. We can only speculate on the cause of this difference. Such personal information as this can be useful in helping to bring the historical figure to in the eyes of those unable to experience the actual person. It has been left to people like us to piece together the bits of extant data to attempt to provide a more complete picture of Frank Parsons. Watts (1994) reviewed what had been written previously about the personal side of Frank Parsons and found that regarding Parsons' private life, his biographers agree little is known. There are very few papers of a personal nature among the Parsons Collection at Yale University (p. 266). Although John Brewer (1942) was a personal acquaintance of Parsons, Brewer's account of Parsons was limited to Parsons's ideas and accomplishments, with limited hints about those with whom Parsons was intimate. H. V Davis (1969) provided another account of Parsons's life, but focused on Parsons's more negative traits, specifically his peculiarity of attitude (p. 21) and lack of a sense of humor. Gummere's (1988) article on Parsons also noted his more eccentric behavior. Flower (1915), who also knew Parsons personally, and Mann (1950) both described Parsons clearly, placed him into his historical context, and provided some insight into what motivated Parsons's public life. According to Watts (1994), all of Parsons' biographers have [had] a true Victorian reticence his personal life (p. 265). Each of the previous biographers, however, has added a piece to the Parsons's personal puzzle. The intent of this article is to take these pieces and put them together to form a whole picture of Frank Parsons, the person. Using personal papers from the Parsons Archives at Yale University, reports from other biographers, and personal interviews with family members and acquaintances of Parsons, this article is divided into sections on Frank Parsons's physical appearance; character and personality; quirks, eccentricities, and prejudices; traumatic events in his life; and personal relationships and, in that context, sexual orientation, including an historical analysis of the climate for the expression of one's sexuality in the United States from 1854 to 1908 (Parsons's birth and death years). Physical Appearance The best physical portrait of Frank Parsons is a black-and-white view of the left side of his face provided on the page facing the title page of Brewer's (1942) History of Vocational Guidance. In this portrait, he is a slender man with short, dark, wavy hair; a well-trimmed, short but full beard that creeps past the meeting of his neck and face; and sad, almost indifferent eyes. …

The Characteristics of Vocational Counseling and Guidance of Public Employment Security Offices

The Characteristics of Vocational Counseling and Guidance of Public Employment Security Offices

Constructing a Life That Works: Part 2, An Approach to Practice

The 1st article (C. Campbell &amp; M. Ungar, 2004) of this 2‐part exploration of postmodern approaches to family therapy and narrative approaches to career counseling explored the differences between traditional trait and factor counseling models and postmodern approaches using life narratives and social constructionism. In this 2nd article, the authors discuss 7 aspects of their practice as postmodern career counselors that ask clients to (a) know what you want, (b) know what you have, (c) know what you hear, (d) know what constrains you, (e) map your preferred story, (f) grow into your story, and (g) grow out of your story. Several case studies demonstrate the applicability of these theories to practice.

Health services needs and quality of life assessment of individuals with brain injuries: a pilot cross-sectional study

Background and purpose: Quality of Life (QoL) studies have received a substantial amount of attention in medical and rehabilitative practices. However, there is still a paucity of studies in the area, especially on persons with brain injuries (BI). This pilot study, on the QoL of individuals with brain injuries in Hong Kong, attempts to fill this void. It is hoped that the finding of this study will guide the development of programmes and services to people with brain injuries.Methods: Through the Self-help Group for People with Brain Damage in Hong Kong, 35 subjects (22 men and 13 women) were successfully recruited to participate in this study by convenience sampling. Demographic data were collected through face-to-face interviews guided by a questionnaire and QoL data were gathered using the Comprehensive Quality of Life Scale—Intellectual/Cognitive Disability—5th edition (ComQol-I5). The general emotional condition of the participants over the past 2 months was measured by a validated Chinese version of the Positive and Negative Affect Scale (PANAS). The participants’ ratings on the importance of and their satisfaction with 20 health services areas were also collected.Results: Preliminary results show that the overall mean quality of life score, as measured by ComQol-I5, was slightly less than two-thirds of the maximum score. Among the seven QoL domains, health and safety received some of the highest scores, while the lowest scores were obtained in the area of material well-being, place in community and productivity. People whose injuries had occurred relatively recently (less than 5 years ago) were found to have higher intimacy QoL scores than their counterparts injured more than 5 years ago. In the domain of safety, persons with a brain injury who were employed scored significantly higher than those who were not. Positive affect scores and the total affect of PANAS scores correlated significantly with the overall QoL scores. Moreover, persons with a brain injury usually felt satisfied with the services they valued as important. The top five most important services were medical services, occupational therapy, physiotherapy, vocational counselling and social work.Discussion and conclusion: The QoL profile of people with brain injuries in Hong Kong was initially obtained and low scores in the ComQoL were identified in the domains of material well-being, community activities and responsibility and productivity. These might be the consequences of their physical and cognitive limitations due to brain injury. This implies that appropriate interventions to improve their daily life conditions and their social integration would be necessary to improve their QoL. On the other hand, the BI sample also rated relatively high scores in other ComQoL areas such as safety and health, reflecting a good living environment and probably good health care services. Those whose brain injuries had occurred less than 5 years ago tended to have a higher ComQoL intimacy score than those whose injuries occurred more than 5 years ago. In other words, their social relationships may deteriorate with the longer period post-injury so that this group may need more supportive services. In the safety domain, it was found that subjects who were employed after their brain injury scored significantly higher than those who were not, which matched studies about the significant contribution of work towards life satisfaction. The satisfaction of their needs in the services they received, which may affect their QoL, was also investigated. It is clear that they valued the medical and rehabilitation services they received and felt satisfied with them.

Contributions of Thinking Styles to Vocational Purpose beyond Self-Rated Abilities

The present study predicted vocational purpose from thinking styles, a construct at the interface of intelligence and personality. 233 students majoring in history and computer science from a large research-oriented university in the People's Republic of China completed the Thinking Styles Inventory and the Iowa Vocational Purpose Inventory. The participants also rated their own analytical, creative, and practical abilities. In general, results indicated that thinking styles contributed to vocational purpose beyond self-rated abilities. Specifically, the more creativity-generating and complex thinking styles tended to contribute positively to vocational purpose, whereas the more conforming and simplistic thinking styles tended to contribute negatively to vocational purpose. This article points to the need theoretically for integrating the construct of thinking style into the definition of differential psychology. Practical data argue for a collaborative working relationship between teachers and vocational counselors in institutions of higher education.