Improving Employment Outcomes: Perspectives of Experienced Counselors Regarding the Importance of Counseling Tasks.

In both public and private settings in rehabilitation, practitioners place a high priority on helping people with disabilities become employed. The importance of the employment goal is stressed in recent rehabilitation legislation as well, which also emphasizes serving individuals with severe disabilities who require multiple services over an extended period of time (Schriner, 1996). Given the value attached to employment and to serving people with severe disabilities, a need exists to study the importance of different rehabilitation counseling tasks for achieving employment outcomes from the perspectives of experienced counselors. Experienced counselors can also provide valuable information regarding the personal characteristics and system factors that influence their abilities to complete these rehabilitation counseling tasks.

Increased understanding of the tasks that counselors deem essential to achieving employment outcomes (Mullins, Roessler, Schriner, Bellini, & Brown, 1997) has dual value. With such knowledge, in-service trainers can design continuing education programs so that they focus on critical activities and abilities. Preservice educators can shape counselor preparation programs to help students develop the skills required to become more effective with complex cases. Hence, the purpose of this research was to further develop the knowledge base regarding important counseling tasks and to analyze in-depth the one task that the majority of counselors considered most important for improving placement rates.

According to Schwab and Fenoglio (1992), additional research is needed to address the provision of quality rehabilitation counseling services that result in employment. Recent case-load statistics also underscore the need for such research. In a recent information memorandum, the Rehabilitation Services Administration (1994) documented that the FY 1992 rehabilitation rate of 58% was the lowest rate in the past 40 years, and that the number of people rehabilitated in FY 1992 fell below the 200,000 mark for the first time in 25 years. For these reasons, the investigators conducted a qualitative study to examine two research questions from the perspectives of experienced counselors: (a) what counselor tasks promote client employment outcomes, and (b) what factors affect counselor performance of those tasks? To learn more about the factors influencing performance of high priority counseling tasks, we adopted Ajzen's (1992) planned action model to structure the qualitative inquiry. In the planned action model, behavior is the result of the intention to perform. The intention to perform critical rehabilitation counseling tasks is influenced by several mediating variables:

1. Behavioral beliefs or response outcome beliefs: What skills and attitudes does the rehabilitation counselor need to perform this counseling task?

2. Knowledge (i.e., knowledge of disability and rehabilitation counseling): What does a rehabilitation counselor need to know to successfully perform this task?

3. Perceived behavioral control: To what extent do counselors report that they have adequate time and resources (e.g., case service funds) to complete the task?

4. Efficacy expectations: To what extent do counselors believe they have the required skills and to what extent do they believe they will achieve desired outcomes using those skills?

5. Normative beliefs of supervisors: What skills and attitudes do counselors report that supervisors expect them to have to complete the task? How do supervisors reinforce or correct counselors for good or poor performance of the task?

6. Normative beliefs of clients: What skills and attitudes do counselors report that clients expect them to have to complete the task? How do clients reinforce or correct counselors for good or poor performance of the task?

Method

Eleven (N = 11) experienced Vocational Rehabilitation (VR) counselors rated the importance of 31 counseling activities selected from prior role and function research (Beardsley & Rubin, 1988; Rubin et al., 1984; Wright, Leahy, & Shapson, 1987). Counselors then selected one of the 31 tasks as the most important for achieving employment outcomes. To explore factors affecting completion of each counselor's "most important" task, the first author completed an Intention Interview with each of the 11 counselors.

Sample

Researchers selected participants for the study because of their unique perspectives regarding the research questions rather than on the assumption of "representativeness" (Miles & Huberman, 1994). To address the question of what VR counselors do to meet the employment outcome mandate, research staff interviewed two types of exemplary counselors (N~ = 11) in Arkansas Rehabilitation Services field offices. Described in a previous study (Cook & Bolton, 1993), the sample consisted of five empirically nominated counselors selected because their case statistics indicated they had closed the most cases with outcomes resulting in competitive employment. Five other VR counselors were nominated by their coworkers (peer-nominated) as being highly skilled in helping people with severe disabilities attain employment. Finally, one additional counselor, identified by both procedures, was included to produce the total sample of 11.

The experienced counselors ranged in age from 40 to 62 (M = 51.45). Two counselors (18.2%) were women and 9 (81.8%) were men. Educational levels for the sample included either bachelor's (54.5%) or master's (45.5%) degrees as follows: bachelor's non-rehabilitation (6), master's non-rehabilitation (4), and master's degree in rehabilitation (1). The participating counselors had worked with the agency from two to 27 years, with the average length of employment being 15 years. One counselor worked in a metropolitan area; the other 10 counselors served a combination of small city/rural areas.

Instrumentation included a self-report mail-in survey and a structured intention interview. The self-report survey consisted of 31 empirically derived items based on two role and function studies (Beardsley & Rubin, 1988; Wright, Leahy, & Shapson, 1987). The tasks were grouped in three factors that paralleled three counselor types reported by Bolton (1974): (a) Service Planning and Evaluation activities (12 items; Beardsley & Rubin, 1988); (b) Therapeutic Service activities (10 items; Beardsley & Rubin, 1988); and (c) Job Placement activities (9 items; Wright et al., 1987). Using a 1-5 rating scale, counselors rated each of the 31 rehabilitation counselor tasks based on its importance in securing employment outcomes for people with severe disabilities. Counselors chose one task in each cluster that they believed was the most important to help clients achieve competitive employment, and then one task from the three most important ones to discuss in the Intention Interview.

Following recommendations in the qualitative literature (Fontana & Frey, 1994; Patton, 1990), the research team designed the Intention Interview to provide the interviewer with the exact wording and sequence of questions, as well as a scheme for recording counselors' comments. Consistent with the wording in the previous list of mediational variables, the questions in the Intention Interview addressed six factors influencing behavioral intentions (Ajzen, 1992): behavioral beliefs, knowledge, perceived behavioral control, efficacy expectations, normative beliefs about supervisors, and normative beliefs about clients.

Procedure

With permission from the agency director and field office supervisors, the first author contacted the 11 exemplary counselors. Following a particular counselor's agreement to participate, research staff mailed a cover letter explaining the study along with the survey questionnaire. Upon receiving the completed survey questionnaire, the interviewer, a doctoral student in rehabilitation with 10 years of experience in rehabilitation, contacted participants by telephone and scheduled the 60-minute Intention Interview.

Data Collection and Analysis

Data collection. The first phase of data collection was completed when all 11 self-report surveys were returned. The second phase of data collection was completed when transcriptions of the 11 Intention Interviews were available. The Intention Interview concentrated on a single counseling function: a job task chosen by each counselor from the list of 31 functions. To arrive at the single most important task, counselors rated each of the items based on its importance and then rank-ordered the three most important tasks in each cluster. Finally, each counselor selected the one task that he or she believed contributed the most to achieving employment outcomes for people with severe disabilities. Information regarding task importance is presented in terms of descriptive statistics (means and standard deviations of importance ratings), frequency distributions regarding counselors' selections of their top three tasks, and tabular information displaying each counselor's top task and the factor in which it belonged.

Data Analysis. Using a model recommended by Patton (1990), three expert raters analyzed the Intention Interview transcripts. Each expert had a graduate degree in rehabilitation or counseling and considerable experience in rehabilitation research and service delivery. The raters used: (a) grounded theory coding techniques to generate open, axial, and selective codes from the interview transcripts (Strauss & Corbin, 1991); (b) Spradley's (1979) strategy to analyze semantic relationships; and (c) constant comparative analytic techniques (Glasser & Strauss, 1967) with discrepant case analysis (Brickson, 1986) to determine case similarities and differences.

After the senior author edited the transcripts, he participated with the two other raters in identifying the open codes in the Intention Interviews, i.e., the specific events or incidents in the data. The raters met approximately three times a month during a three month period to develop a mutually agreed upon grouping of open and axial codes (Strauss & Corbin, 1991). During these regularly scheduled "peer debriefings", the raters (a) presented, discussed, and compared their open coding results; (b) identified the interrelationships among the open codes; and (c) reached consensus as to the various axial codes in the data. Axial codes evolved as the raters achieved consensus on the names and linkages among categories represented in the open codes.

Results

The purpose of the study was to identify high priority rehabilitation counseling tasks related to improved placement rates for people with severe disabilities. This information is pertinent to the development of both pre-service and in-service educational programs.

Survey of Counseling Tasks

The sections to follow describe findings based on the Counselor Functioning Survey. Tables display the counselors' average importance ratings, their rank ordering of the tasks, and their choices regarding the single most important counseling task.

Importance ratings. Table 1 presents the means (M) and standard deviations (SD) for importance ratings (1 = low, 5 = high), i.e., the significance of the task for achieving employment outcomes. In addition, the number of times a counselor ranked the task as one of the three most important tasks within a specific domain is indicated. Although exemplary counselors rated all of the 31 counseling tasks as important, some tasks were rated as relatively more important than others. For example, participating counselors rated the following items as the most important (Importance [is greater than] 4.50): (a) instruct clients in preparing for the job interview (M = 4.73, SD = .47); (b) counsel with clients to help them achieve an acceptance of the disability (M = 4.55 SD = .69); (c) inform clients of job openings suitable to their needs and abilities (M = 4.55, SD .52); and (d) use local resources to assist with placement (M =4.55, SD = .52). Respondents rated the following rehabilitation counseling activities as the least important (Importance [is less than] 3.75): (a) perform case recording and reporting activities (M = 3.09, SD = 1.14); (b) monitor clients' postemployment adjustment to determine need for additional services (M = 3.73, ~D = 1.10); (c) converse with people with disabilities in an effort to learn of the social and economic impact of disability in general (M = 3.55, SD = 1.37); (d) ensure that clients understand their rights and responsibilities in the rehabilitation process (M = 3.64, SD = 1.12); and (e) evaluate the effect of services on individual clients (M = 3.73, SD = .79).

Table 1 Importance and Rankings (N = 11)

Service Planning and         M      SD    #1   #2   #3
Evaluation

Ensure that clients         3.64   1.12   2    1    0
understand their rights
and responsibilities in
the rehabilitation
process

Evaluate the effect of      3.73   0.79   0    0    0
services of individual
clients

Counsel with clients to     4.55   0.69   2    1    0
help them achieve an
acceptance of the
disability

Coordinate services with    4.45   0.52   0    0    2
other agencies and
professionals

Explain the extent to       4.09   1.14   0    0    0
which communications
between the client and
rehabilitation
practitioner are
confidential

Identify rehabilitation     4.09   0.83   0    0    1
facilities, centers,
agencies, or programs
that provide services
to persons with
disabilities

Develop a rehabilitation    4.09   1.14   0    6    4
facilities plan with
the client

Perform case recording      3.09   1.14   0    1    0
and reporting activities

Formulate short-term and    4.09   0.70   0    1    1
long-term service goals
with individual clients

Ensure continuity of        3.82   0.75   0    0    1
services to
rehabilitation clients

Establish timetables for    3.82   0.87   0    0    0
performing various
rehabilitation services

Evaluate the client's       4.00   0.89   7    1    1
stated needs to determine
what rehabilitation
services may be needed

Therapeutic Services

Help clients face and       4.45   0.52   4    3    3
realistically asses
problems that seem
insurmountable to them

Interview clients to        4.36   0.67   2    2    0
obtain relevant
background information

Conduct affective           4.36   0.67   1    0    0
counseling activities

Review client background    3.91   0.94   0    1    0
material obtained from
the referral source or
sources

Describe client             4.00   0.63   0    0    1
adjustment problems
orally or in writing

Therapeutic Services

Discuss with the client     3.82   0.87   0    0    3
his or her interpersonal
relationships

Converse with people with   3.55   1.37   1    0    1
disabilities in an effort
to learn of the social
and economic impact of
disability in general

Communicate directly        4.36   0.92   2    0    2
(face-to-face) with
persons who have
disabilities

Identify significant        4.18   0.60   1    5    0
 behavior clues that are
important in
rehabilitation planning

Interpret motivations       4.00   0.63   0    0    1
underlying clients'
behavior

Job Placement

Instruct client in          4.73   0.47   7    3    0
preparing for the job
interview (e.g., job
application, attire,
interviewing skills)

Apply labor market          3.91   0.83   0    0    2
information influencing
the tasks of locating,
obtaining, and
progressing in employment

Inform clients of job       4.55   0.52   0    2    6
openings suitable to
their needs and abilities

Use local resources to      4.55   0.52   0    0    1
assist with placement
(e.g., employer contacts,
colleagues, state job
service)

Instruct clients in         4.45   0.82   2    2    1
methods of systematic job
search skills

Use supportive counseling   4.36   0.81   1    3    0
techniques to prepare
clients for the stress of
job hunting

Provide prospective         4.18   0.87   1    1    1
employers with
appropriate information
on clients' work
skills and abilities

Respond to employers with   4.27   0.90   0    0    0
appropriate
information on clients'
work skills and
abilities

Monitor clients'            3.73   1.10   0    0    0
post-employment
adjustment to determine
need for additional
services

Priority rankings. Reported in Table 1, the rank ordering of tasks within each domain is discussed in terms of one high priority activity per factor. In service planning and evaluation, counselors ranked "evaluate the client's stated needs to determine what rehabilitation services may be needed" as one of the most important employment-related tasks they perform. "Instruct clients in preparing for the job interview (e.g., job application, attire, and interviewing skills)" received a number of first and second place votes among the job placement tasks. In therapeutic services task rankings, counselors placed great importance on "help clients face and realistically assess problems that seem insurmountable to them." Table 2 presents specific rehabilitation tasks chosen by each of the 11 exemplary counselors as the most important activity he or she performs to increase levels of competitive employment for people with severe disabilities. Overall, exemplary counselors placed the highest priority on service planning and evaluation activities, with seven counselors picking a task from that domain as "most important." Within that factor, five counselors selected "evaluate the client's stated needs to determine what rehabilitation services may be needed" as their most important task.

Table 2 Most Important (First Choice) Rehabilitation Counseling Tasks

Counselor       Service            Job Placement    Therapeutic
                Planning and       Activities       Service
                Evaluation                          Activities
                Activities

Counselor #1    Evaluate the
                client's
                stated needs
                to determine
                what RHAB
                services may
                be needed

Counselor #2                                        Help clients
                                                    face and
                                                    realistically
                                                    assess problems
                                                    that seem
                                                    insurmountable
                                                    to them

Counselor #3    Counsel with
                clients to
                help them
                achieve
                acceptance
                of the
                disability

Counselor #4                                        Interview
                                                    clients to
                                                    obtain
                                                    relevant
                                                    background
                                                    information

Counselor #5                       Use supportive
                                   counseling
                                   techniques to
                                   prepare
                                   clients for
                                   the stress of
                                   job hunting

Counselor #6    Evaluate the
                client's
                stated needs
                to determine
                what RHAB
                service may be
                needed

Counselor #7    Evaluate the
                client's
                stated needs
                to determine
                what RHAB
                service may be
                needed

Counselor #8                       Instruct
                                   clients in
                                   preparing for
                                   the job (e.g.,
                                   job
                                   applications,
                                   attire,
                                   interviewing
                                   skills)

Counselor #9    Evaluate the
                client's
                stated needs
                to determine
                what RHAB
                service may be
                needed

Counselor #10   Ensure that
                client's
                understand
                their rights
                and
                responsibilities
                in the RHAB
                process

Counselor #11   Evaluate the
                client's stated
                needs to
                determine what
                RHAB service may
                be needed

Planned Action Variables Affecting Client Evaluation. During the Intention Interview, counselors discussed how the factors in the planned action model influenced their performance of the evaluation task. Using data from the interview transcripts, the three raters reached consensus regarding open and axial codes.

Behavioral beliefs. The five exemplary counselors listed a number of skills and attitudes as essential to "evaluating the client's stated needs to determine what rehabilitation services may be needed." They stressed rapport building through relationship skills such as caring, empathy, openness, and listening. Process-oriented skills were noted, such as identifying problems, establishing common goals with the client, sharing information about evaluation activities, collecting evaluation Information through intake interviews, understanding the implications of diagnostic information, and using evaluation results to select and plan services. Counselors mentioned the need for personal expertise in evaluating client job-seeking skill deficiencies and for a strong work ethic to implement comprehensive evaluations. One counselor emphasized the skill of screening clients for their motivation to return to work prior to investing time and money in the evaluation process.

Knowledge. In describing what a rehabilitation counselor needs to know to complete the evaluation task, participants mentioned areas such as intake interview skills, rapport building, information provision, awareness of counselor limitations regarding service provision, rehabilitation planning, and recognition of signs of physical and mental abuse in clients. Counselors stressed knowledge of the "real" world of work and the local community, as well as of problem-solving and consensus-building techniques. Other practical areas of knowledge included a functional understanding of the impact of disability on employment potential (i.e., medical and psychological aspects of disability), an awareness of the variety of VR services, and an understanding of agency paperwork and recording procedures. One counselor mentioned the need to know about the client's attitudes toward the work role.

Perceived behavioral control. To cope with time constraints affecting client evaluation, the counselors suggested the following techniques: using interns to participate with the client in community activities and provide the counselor with information regarding the person's strengths and limitations; working longer hours; using the telephone, instead of personal visits, to make contacts; and becoming better organized. To make evaluation activities more affordable, counselors used discounted evaluation services, similar benefits, and "no-cost" agency evaluation services. When resources, particularly transportation, were not available for a timely evaluation, one counselor arranged for an extended period of time in which to conduct the evaluation (i.e., permission from the client to take more than 60 days to establish eligibility).

Efficacy expectations. Counselor efficacy ratings were of two types: (a) self-efficacy expectations (1 to 5, 5 = high) of capacity to evaluate the client's stated needs and (b) outcome expectations (1 to 7, 7 = high) that the use of evaluation skills would produce positive outcomes. Counselors rated their self-efficacy quite high, with two counselors marking "5" and two marking "4". One counselor expressed lower self-efficacy with respect to evaluation, circling a "2". All of the counselors believed that use of their evaluation skills would result in positive outcomes for clients. Two counselors used the rating of "7", two used "6", and one used "5."

Normative beliefs - supervisor. Counselors emphasized that their supervisors expected them to conduct the evaluation phase effectively (i.e., in an error-free manner) and efficiently (i.e., in an organized and autonomous manner). Encouraging them to be informed about evaluation providers and techniques, supervisors expected counselors to (a) move clients quickly through the evaluation phase using effective case management skills, (b) use good judgment in committing to expensive evaluations, and (c) understand clearly what the supervisor's expectations were regarding an adequate diagnostic (evaluation) base for case planning decisions. For most of the counselors, supervisors acknowledged acceptable performance of the evaluation function either verbally or with tangible feedback. Although one counselor believed that no reinforcement was provided, several others noted that they had received verbal praise for good performance in the evaluation area. One counselor experienced increased autonomy in developing cases as a reinforcer for good evaluation performance, and several noted that their supervisors made specific mention of their good work in performance evaluations. With respect to correction of poor performance in evaluating clients, counselors reported receiving negative verbal feedback, coupled frequently with instruction. According to one counselor, the supervisor simply pointed out paperwork errors. Several counselors noted that probation is the ultimate consequence of continued poor performance.

Normative beliefs - clients. Counselors believed that clients expected skillful performance in evaluation based on positive counselor attributes such as an "open attitude" and respect. In addition to stressing the importance of counselor availability, clients expected counselors to be good problem solvers and holistic thinkers. Counselors should understand the client's goals and guard against allowing their own biases and preconceptions to influence their reactions to the client's goals. Counselors stressed that clients expected them to be knowledgeable about rehabilitation, active in the community, and aware of local employment opportunities. One counselor observed that clients expected less than counselors have to offer.

According to the counselors, clients reinforced them for effective performance in several ways. Some clients verbally expressed their appreciation, while others sent written notes of thanks or even gifts (e.g., flowers). One counselor mentioned that positive client comments occasionally appeared on agency follow-up forms. Another counselor reported receiving additional referrals from satisfied clients. Clients registered their dissatisfaction verbally and tangibly. According to several counselors, some clients made comments in person or over the telephone to the counselor. Other counselors noted that clients sent notes to the supervisor or made comments on the follow-up form as ways of expressing their displeasure.

Discussion

Results clearly indicate that therapeutic service, service planning and evaluation, and job placement tasks represent essential functions of the rehabilitation counselor. All of the 31 tasks in the three dimensions were rated as important. Hence, pre-service and in-service training programs should continue to emphasize skill training in those areas. Naturally, some variation existed in the counselors' ratings, providing insights into their priorities. For example, counselors selected one service planning and evaluation task and three job placement tasks as among the most important duties they perform. The service planning and evaluation task involved helping people achieve acceptance of their disabilities, which indicates a need for counseling skills and a knowledge base regarding psychological and medical aspects of disability. In the other three tasks selected (e.g., training clients for the job interview process, informing clients about suitable job openings, and using local resources to assist with placement), counselors focused on the placement process.

The issue of "immediacy to the placement event" may provide a rationale for why several of the 31 tasks received lower ratings. For example, completing tasks such as case recording, conversing with people to learn of the social and economic impact of disability in general, ensuring that clients understand their rights and responsibilities, and evaluating the impact of services are somewhat removed from the placement process. Monitoring clients' post employment adjustment, while important, comes well after successful closure in employment, and may not be viewed by the respondents as a primary responsibility of the vocational rehabilitation counselor.

The emphasis on employment outcomes is continued in the ranking results. When asked to select the most important task, counselors singled out activities such as evaluating the client's stated needs to determine what rehabilitation services may be needed, helping clients face and realistically assess problems that may seem insurmountable, and instructing clients in preparing for the job interview. Counselors did not, however, gravitate toward a task as directly related to preparation for placement when asked to select the most important task for achieving the employment mandate. Instead, five of the 11 counselors selected evaluation of clients' stated needs as the most important task.

The counselors' endorsement of client evaluation as a high priority task makes sense given the importance of the vocational plan or individualized written rehabilitation program. Properly developed vocational plans specify a feasible vocational goal for the client, the intermediate objectives to achieve in order to reach that goal, and the services needed to achieve objectives and goals in the plan. For the client and the counselor to collaborate in making informed choices about each segment of the vocational plan, they must have a comprehensive evaluation base on which to draw.

Educators and in-service trainers must address a variety of issues, such as counselor characteristics, knowledge, and skills in order to prepare counselors to evaluate clients' stated needs and select appropriate rehabilitation services. According to the counselors, openness, caring, empathy, and a strong work ethic are important personal characteristics. Skills needed to complete the evaluation function include problem solving, holistic thinking, goal setting, information dissemination and collection, and case management and planning. Counselors should be knowledgeable about opportunities in the local community; about demands in the "real" world of work; and about the impact of disability on cognitive, emotional, and physical functioning.

Fortunately, the exemplary counselors believed they possessed the necessary skills to evaluate clients (efficacy expectations) and that use of those skills would contribute to achieving vocational goals (outcome expectations). Being realistic, they noted that time and money limitations have an effect on the evaluation process, but they suggested strategies to lessen the impact of both on counselor practice, such as using "no-cost" agency evaluation services or similar benefits to cover evaluation costs.

The exemplary counselors reported that their supervisors had appropriate expectations for their performance in evaluation, e.g., helping clients progress efficiently and effectively through the process. Counselors noted that simple strategies such as supervisor praise and corrective feedback, coupled with instruction when needed, affected their performance. Similarly, clients made an impression on counselors in terms of their expectations for professionalism, which clients occasionally acknowledged through written or verbal feedback.

Future research should address limitations in the study related to the sample, the reliance on self-report information, and the qualitative analysis of data. In addition to being small, the majority of participants did not have a master's degree. Since level of education affects service delivery outcomes (Cook & Bolton, 1992; Szymanski, 1991; Szymanski & Danek, 1992), future research should include more master's degree graduates, preferably those with degrees in rehabilitation or a related counseling field. In addition, the study makes no distinction between the perspectives of the two types of counselors, namely those counselors identified through the empirical and peer nomination processes. These two groups may have different perceptions of the counseling tasks (Bolton, 1974). Finally, additional data gathered either through a survey with a larger sample or through behavioral observations of experienced counselors would serve to corroborate findings from the grounded theory qualitative analysis.

Footnote

We wish to thank the 11 counselors who gave of their time to make this study possible, and Eunice Millett, who assisted in the analysis of the counselor interviews. We also appreciate the support of Arkansas Rehabilitation Services; James Swartz, Ph.D., Daniel Cook, Ph.D., and Kay Schriner, Ph.D.

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James A. Mullins, Research Associate, School of Public Health, 140 Warren Hall, University of California, Berkeley, CA 94720-7360

James A. Mullins University of California, Berkeley

Richard T. Roessler University of Arkansas, Fayetteville3