Psychiatric rehabilitation training needs of state vocational rehabilitation counselors: a preliminary study.

Rehabilitation provision is often influenced by society needs and legislations. As far back as the Smith-Fess Act 1920, civilian vocational rehabilitation program was launched, with an emphasis of providing vocational education to individuals with physical disabilities. With the Barden-Lafollette Act 1943, the provision of rehabilitation service was expanded to people with mental retardation and mental illnesses. The Rehabilitation Act of 1973 and the Rehabilitation Act Amendments of 1986 mandated to expand the emphasis on serving people with severe disabilities (Parker & Szymanski, 1998; Rubin & Roessler, 2001). The trend off increasing needs of serving people with severe and persistent mental illnesses continued to grow as the scope of disability groups broaden and rehabilitation counselors are required to meet the diverse needs of a wider and more complex spectrum of disability groups. Of particular interest are those clients served by vocational rehabilitation (VR) programs who have a psychiatric disability or experience comorbid mental health issues. According to Ingraham, Rahimi, Tsang, Chan, and Oulvey (2001), several state VR programs have reported an increase in the number of clients served who have mental health concerns. The increasing demand for VR by this disability group is not surprising given that community reintegration and independent living are standard treatment goals for those with even the most severe and persistent forms of mental illnesses. Moreover, the need for VR by this disability group is underscored by an 85% unemployment rate among working-age people with psychiatric disabilities (National Institute on Disability and Rehabilitation Research; [NIDRR] 1993).

Nonetheless, people with psychiatric issues present unique challenges for rehabilitation counselors, and the need for requisite skills to meet those challenges may not be met by traditional rehabilitation counseling training programs (Kress-Shull, 2001). Historically, rehabilitation counseling training programs have not provided training in clinical mental health counseling or required coursework in psychopathology or substance abuse; while some programs may offer this coursework through cross disciplines such as mental health counseling or social work, these domains are primarily de-emphasized (NCRE, 2002 as cited in Tansey, Chan, Chou, & Cardoso, 2004). Yet, rehabilitation counselors are increasingly being required to serve individuals with a broad spectrum of psychiatric impairments including those with sex ere and persistent mental illnesses, substance abuse disorders, dual diagnoses, as well as an array of comorbid emotional conditions that coexist with other physical or neurological conditions.

Importantly, research suggests that rehabilitation counselors may not be adequately trained in the area of mental health. For example, in studies investigating the training needs of certified rehabilitation counselors, knowledge and skills in mental health counseling, substance abuse, and dual diagnoses have been consistently identified as important training needs (Chan et al., 1998; Chan et al., 2003; Emener, Evans, Lowe, & Richard, 2001; Harley, Greer, & Hackerman, 1997; Ingraham, Kaplan, & Chan, 1992). Chan et al. (2003) suggest these training needs reflect not only the rise in VR clients served with mental health and substance abuse issues, but also the overarching increase in the severity and complexity of the disabilities experienced by VR clients, as well as the emerging trends of counselor licensure. In addition, current

behavioral health care practices and community-based programs have consistently underscored the need for trained psychiatric rehabilitation practitioners as revealed by the numerous proposals designed to help guide curricular development in rehabilitation counseling (Chan et al., 1998; Farkas & Anthony, 2001; McReynolds & Garske, 2002). This, coupled with studies revealing lower rates of successful employment outcomes for people with psychiatric disabilities (NIDRR. 1993) strongly supports the need to better understand the competencies and knowledge base necessary to facilitate appropriate and effective VR services for clients with a broad spectrum of psychiatric issues.

Despite the identification of this need, minimal efforts to facilitate training in this area have occurred (Farkas & Anthony, 2001). This is particularly striking, given the well developed psychiatric rehabilitation model which parallels the philosophical tenets of rehabilitation counseling and has contributed significantly to shaping and facilitating educational, vocational, and community opportunities for persons with severe and persistent mental illnesses through a skills training and supported employment approach.

For individuals with psychiatric disabilities, they may have deficits in various life roles such as hygiene, symptoms management, cognition, coping skills, personal management, social skills, interpersonal skills and coping skills (Corrigan, Rao, & Lam, in press). Skills trainings have been consistently demonstrated as effective treatment for people with disabilities. For example, Bolton and Akridge (1995) conducted a meta-analysis of skills training interventions for people with disabilities in general. The results indicated a substantial benefit to the clients, with a high effect size of .93. Skills trainings have also been shown to be effective in assisting individuals with psychiatric disabilities to better manage their life. More recently, research also advocated for specific and structured social skill training to be beneficial lot people with persistent and severe mental illnesses can enhance the role functioning and autonomy of individuals (e.g., Corry & Jewell, 2001; Liberman, & Kopelowicz, 2002; Wallace, 1998), and to increase skill acquisition and reduce psychiatric symptoms (Dilk & Bond, 1990).

The supported employment approach is another commonly adopted method of assisting people with psychiatric disabilities in rehabilitating them to have a better and meaningful quality of life through work. Work is considered to be a fundamental human right for people with disabilities and that work is a therapeutic intervention for humans (Davis, 1987). Vocational intervention, therefore, becomes the central theme in the rehabilitation counseling philosophy (Chan et al., 1997). Researchers in the field have been conducting studies in validating the effectiveness of supported employment for the psychiatric population (see Tsang, Chan & Bond, 2002 lot a comprehensive reviews). While supported employment has been shown to be a useful tool, it has also been criticized for its generalizability to real life situations. In order to counterbalance the issue of generalizability, more recent supported employment model is developed. Drake, McHugo, Becker. Anthony and Clark (1996) advocated the Individual Placement and Support (IPS) model as a more favorable model within the supported employment model for successful employment outcome for individuals with persistent and severe mental illnesses. The IPS model is considered to be a manualized intervention of the supported employment model in which it integrates within mental health settings where clinical and on-going support for clients are provided (Becker & Drake, 1993; Twamley, Jeste, & Lehman, 2003). Ample research has been conducted to support the effectiveness of the IPS in terms of employment outcomes for this population, including increased in cumulative working hours and wages (Drake, et al., 1996; Lehman et al., 2002), higher client satisfaction with finances and vocational services (Drake, Becker, Clark, & Mueser, 1999; Drake et al., 1999), and higher rates of employment with continued vocational service (McHugo, Drake, & Becket, 1998).

Professional training in understanding the concept, case management and psychiatric intervention such as social skills training and supported employment has much to offer vocational rehabilitation counselors who are working with clients with mental illnesses. Unfortunately, it is a professional practice area that remains separate and distinct from traditional rehabilitation counseling training programs, and is in fact an area that many rehabilitation counselor education programs have not enthusiastically embraced (Nemec, Spaniol, & Dell Orto, 2001). Authorities have attributed this reluctance to several factors including: (a) perceptions that those with severe psychiatric disabilities were not good candidates for traditional interventions; (b) historically limited funding for programs to serve this population in the community (Farkas & Anthony, 2001), and (c) the potential effects of negative attitudes among rehabilitation educators affecting curriculum choices (Nemec et al., 2001).

Rehabilitation counselors and the educational and professional training they received appear to be in a favorable position to understand the uniqueness of the psychosocial impact of injuries and illnesses for people with disabilities. Traditionally, rehabilitation counselors are trained to be equipped to assist individuals with employment. In light of the increasing number of VR cases served with mental health issues coupled with the growing demand for training in this area, the reasons for which the rehabilitation counseling profession has had only limited involvement with psychiatric rehabilitation needs to be re-examined. Undoubtedly, psychiatric rehabilitation offers the broader field rehabilitation counseling an established model and training paradigm that could be utilized to address the psychiatric training needs of rehabilitation counselors.

The purpose of this study, therefore, is to shed light on the training needs of state VR counselors in a mid-western state, who work predominantly with clients with psychiatric disabilities so as help identify and facilitate an effective in-service training model for those VR counselors working with clients with mental health issues. Ultimately, further evidence from continuous larger-scale research studies would help providing guidelines for education and in-service training for rehabilitation students and practitioners.

Method

Participants

Forty-eight counselors carrying predominantly psychiatric caseloads from a state VR agency in the midwest were recruited for this study. These counselors were participants of two in-service training workshops in psychiatric rehabilitation conducted by the fourth and fifth authors of the paper, who were, at the time of the study, mental health coordinators in the Illinois Office of Rehabilitation Services. Participants included 29 females (60.4%) and 19 males (39.6%) with M=9.08 (SD=8.69) years of state VR experience and M=3.07 years (SD=3.6) of experience with psychiatric caseloads. The mean age of the participants was M=47.73 (SD=7.92). The majority of the respondents identified themselves as European Americans (n=30. 62.5%); the remainder of the sample included: African Americans (n=8, 16.7%), Latina/o (n=4. 8.3%), Native Americans (n=12, 2.1%), others (n=2, 4.2%) and missing information (n=3, 6.3%).

Of the 48 participants, 4.2% obtained a bachelor degree, 93.8% obtained a master's degree and 2.1% obtained a doctorate degree. In terms of specialty of their education training, 31.3% acquired a general area of counseling practice, 43.8% acquired a psychiatric rehabilitation specialization (PRS), 10.4% obtained both a general and a PRS specialty while 14.6% did not respond. In terms of the types of certification obtained, 10.4% obtained a licensed professional counseling (LPC), 6.3% obtained a certified rehabilitation counseling (CRC), 10.4% obtained a licensed social work. About 6.3% obtained both a LPC and CRC. Another 6.3% obtained other types of certification while 60.4%, of the information regarding certification was missing.

Instruments

A survey instrument was developed based on a comprehensive review of the psychiatric rehabilitation literature, an examination of the Commission on Certification of Rehabilitation Counselors (CRCC) Knowledge Validation Inventory-Revised (KVI-R) (Leahy, Chan, & Saunderss, 2003), interviews with selected VR counselors with a psychiatric rehabilitation specialization, and input from the fourth author of the present study, who at the time of the study was one of the two mental health coordinators in the Illinois Office of Rehabilitation Services. The inventory is composed of 70 items. The first section of the survey is comprised of 35 knowledge importance items; each item is rated based on a 5-point Likert scale: 0=not important; 1=somewhat important; 2=important; 3=very important; and 4=extremely important; The second section of the survey is comprised of identical items. Instead of importance, participants were asked to rate the items in terms of their perceived preparedness in the knowledge area indicated by the item. Each item is again rated based on a 5-point Likert scale: 0=no preparation; 1-little preparation; 2=moderate preparation; 3=high degree of preparation; and 4=very high degree of preparation. Psychiatric rehabilitation training needs of the participants were determined by comparing the ratings of knowledge items they considered important (with ratings of 3=very important and ratings of 4=extremely important) with the ratings of items they reported to be less than adequately prepared (with ratings of 0=no preparation, 1-little preparation and 2=moderate preparation) (Berven, 1979).

Procedures

The data analysis technique used by Berven (1979) was exclusively employed in the current study in order to identify training needs of state VR counselors working in this midwestern state. The first step was the frequency counts. In order to identify the psychiatric training needs of state VR counselors, frequency counts for each of the 35 items of important items and 35 items of preparedness items were calculated. According to Berven (1979):

Importance ratings, considered alone, provide information on the preprofessional training needs of state agency counselors. The combined percentage of "very high" and "high" importance ratings of the respondents was computed for each item. This provided an index of high importance for each competence area. The median proportion of high importance ratings [among the 35 items] was [94.0%]. (p. 324).

For the important ratings in the present study, the percentages of the very important and extremely important ratings were then combined and receded as one, and not important, somewhat important, and important were receded as zero for each of the items for the purpose of calculating the median. The items were ranked hierarchically, from the highest percentage of endorsement to the lowest percentage of endorsement. Items with percentage of endorsement greater than the median (calculated to be 94%) were considered "highly important" items.

Similarly, for the preparedness ratings, Berven (1979) indicated that:

Looking at competence ratings alone, the combined percentage of "none" and "some" competence ratings of all responding counselors was computed for each item. This provided an index of self-perceived limited competence in each area. The median proportion of limited competence ratings among the [35 items] was [54.0%]. (p. 324).

For the preparedness ratings in the present study, similar methods of calculation were employed but from the reverse direction. Those items with the rating of no preparation, little preparation and moderate preparation were combined individually and ranked hierarchically, from the highest percentage of endorsement to the lowest percentage of endorsement. Items with percentage of endorsement greater than the median (calculated to be 54%) were considered as "limited" preparedness items.

The information on importance and preparedness alone indicate the perceived level of essential professional practice areas and the perceived level of professional practice areas that are not adequately trained respectively. By combining the information on importance and preparedness, training needs, therefore, is defined as those item areas that have a "relatively large proportion" in which the rehabilitation counselors perceived to be important knowledge to attain but current preparation regarding those particular item areas was perceived as "limited and less than adequate". The criteria of "relatively large proportion" and "limited and less than adequate" were adopted from the original study by Berven (1979), which was defined as "areas of competence that rank highest in both importance and limited competence may be defined as the highest priority postemployment training needs". (p. 325). Consequently, the areas where training needs become the most critical were determined by examining the items that were ranked above the median in the "high" importance item hierarchy. This was compared to those preparedness items that were ranked as the median in the "limited" preparedness item hierarchy. For instance, in this study, the median percentage for the "high" importance items was 94% as endorsed by the rehabilitation counselors, while the median percentage for the "limited" preparedness items was 54% as endorsed by the rehabilitation counselors. The median percentage cutoff scores, however, of both the importance and preparedness percentages were lowered to 90% and 50% respectively in order to incorporate the wider range of potential training needs item areas. Therefore, critical training needs is defined as the items in which both the importance and preparedness scales fell above the median scores.

Results and Discussion

Tables 1 and 2 present the importance items and the preparedness items respectively for the state VR counselors who have psychiatric caseloads in the present study. Table 1 lists the 26 knowledge items and the associated percentages in descending order, ranging from the most importance to the least importance, as perceived by state VR counselors in working with people with psychiatric disabilities.

Table 2 presents the 23 preparedness items and the respective percentages in descending order, ranging from the most limited preparedness to the least limited preparedness, as perceived by slate VR counselors.

Among those important knowledge items and preparedness items, 16 items were found to overlap. These items represent psychiatric rehabilitation knowledge areas that were perceived by state VR counselors as very important, yet at the same time, were considered areas which counselors felt inadequately prepared. In fact, of the 35 knowledge items, nearly half of the items (45.7%) were identified as areas that the counselors felt they were inadequately prepared.

Based on the content of the items identified in the present study, the 16 training needs items were arbitrarily categorized into five major training need areas. The method of categorization was based on the nature of the content, relevance to the area of psychiatric rehabilitation, as well as adoption based on various knowledge domains identified by Leahy, Chan, & Saunders (2001)'s training needs study. The categorization of the items was purposed to present a better and clearer perspective by grouping similar items into those unique areas, as compared to presenting the individual items separately.

The first area involves skills related to counseling intervention techniques for working with people with psychiatric disabilities. Items in this area include: (a) cognitive-behavioral intervention procedures, (b) behavioral intervention techniques, (c) brief psychotherapy, and (d) multicultural counseling. The second area relates to knowledge related to principles and techniques of psychiatric rehabilitation. Items in this area include: (a) principles and techniques of psychiatric rehabilitation, (b) principles and techniques of skills training (e.g., social and coping skills), (c) job placement and employer development for people with psychiatric disabilities, (d) benefits counseling, (e) the Individual Placement and Support (IPS) program model, and (f) state mental health services. The third area relates to the medical and psychosocial aspects of disability. Items in this area include: (a) psychopharmacology, (b) psychopathology (e.g., DSM diagnoses), and (c) substance abuse and disability. The fourth area relates to assessment, with only one item included in this area--neuropsychological assessment. The filth area relates to case and caseload management. The items in this area include: (a) principles and techniques of case and caseload management with people with severe mental illnesses, and (b) professional roles, functions, and collaborative relationships with other mental health service providers.

Among the five different categories, the average of the importance and preparedness was calculated and shown in Table 3. In Category 1-Counseling Intervention Techniques, there were four items. The mean and standard deviations of the perceived high importance was 92.5% (SD=1.9) and the mean and standard deviations of the perceived limited preparedness was 56.8% (SD=5.9). In Category 2 Principles and Techniques of Psychiatric Rehabilitation, there were six items. The mean and standard deviations of the perceived high importance and perceived limited preparedness were 95.3% (SD=3.9) and 59.3% (SD=7.7) respectively. The third category--Medical and Psychosocial Aspects, there were three items. The mean and standard deviations of the importance and preparedness were 94.7% (SD=1.2) and 57.0% (SD=11.3) respectively. The fourth category--Assessment, there was one item. There was no mean and standard deviation for this category and the importance and preparedness were 91% and 58% respectively. Finally, the fifth category--Case and Caseload Management, consisted of two items. The mean and standard deviations of the importance and preparedness were 93.0 (SD=1.4) and 67.5 (SD=3.5) respectively. Among the five different categories, Assessment and Case Caseload Management were rated as the most limited in preparedness (mean difference between importance and preparedness of 33.0% and 25.5% respectively). The other three areas (Counseling Intervention Techniques, Principles and Techniques of Psychiatric Rehabilitation and Medical and Psychosocial Aspects), the mean differences between the importance and preparedness are relatively similar (35.7%, 36.0% and 37.7% respectively).

The primary role of traditional vocational rehabilitation programs has been to assist individuals with disabilities gain or regain their independence through employment or some form of meaningful activity. This goal is based on the fundamental assumption that work provides one venue to which persons with disabilities can become productive members of society, establish social networks and interpersonal relations, and ultimately experience a high quality of life. The path to employment undoubtedly varies depending on the individual: as such, VR programs have, over the years, increasingly broadened their scope of services to insure individualized service planning and successful long-term placement. Importantly, the need to provide services to those with the most severe disabilities has required state VR programs to utilize an array of vocational planning and placement services including such services as situational assessment, work adjustment training, and long term supported employment programs. To use these and other VR resources successfully and cost-effectively, counselors rely not only on the individuals' expressed desires and personal history, but also their knowledge base and skill repertoire regarding specific disability groups.

Findings from this study and prior studies suggest that VR counselors have an inadequate knowledge base and skill repertoire regarding psychiatric disabilities. Of particular importance are competencies related to working with those clients with psychiatric disabilities. As mandated by the Rehabilitation Acts, public VR service provisions have been mandated to serve people with severe disabilities, in which mental illnesses fall into one of the most significant disability category, notably, persons with severe and persistent mental illnesses. These individuals typically have functionally debilitating mood or psychotic disorders, or a combination of both, and in many cases have multiple medical and psychosocial limitations as well. Consequently, this population has unique symptoms and complex manifestations that demand additional knowledge and skills for effective community integration and vocational placement.

These findings are consistent with a similar study conducted by Chan et al. (2003) investigating the training needs of rehabilitation counselors among public, non-public and proprietary settings. Specifically. the authors found that VR counselors working in the public sector reported less than optimal preparation for mental health and substance abuse issues in addition to more traditional vocational rehabilitation knowledge areas including employment development. Their study also found that rehabilitation counselors working in non-profit settings reported training needs in the area of case management with individuals with mental illnesses. benefits counseling, and working with community mental health service providers. In sum, the current study offers additional support for the inclusion of psychiatric rehabilitation training at both the academic and professional level. Specifically, this study finds that state VR counselors in this particular setting, who have caseloads consisting primarily of persons with psychiatric disabilities have inadequate training in areas such as psychiatric rehabilitation, case management of persons with mental health issues, psychopharmacology, substance abuse, psychopathology, and neuropsychological assessment.

The need for training in psychiatric rehabilitation is not surprising given the complex and unpredictable nature of mental illnesses. In fact, it has been suggested that individuals with severe and persistent mental illnesses struggle with a variety of disabilities resulting in deficits that affect an array of domains including social, emotional, cognitive, and interpersonal functioning. Further, these individuals typically have poor coping skills, reduced motivation, difficulty managing symptoms and performing activities of daily living, and are vulnerable to comorbid substance abuse disorders (Corrigan, Rao, & Lam, in press). In addition, maintaining medication compliance and managing the continuous cycle of side effects and medication ineffectiveness can be as challenging as the very symptoms for which they are treating.

Important treatment components of psychiatric rehabilitation include social skills training, cognitive rehabilitation, and supported employment. For example, skills training, which is based on social learning theory, is designed to assist individuals with severe and persistent mental illnesses develop social skills and adaptive coping mechanisms in order to improve functional independence, increase social supports, and develop better skills to manage symptoms and reduce stress levels (Corry & Jewell, 200l: Dilk & Bond, 1996; Liberman & Kopelowicz, 2002; Wallace, 1998). This area is particularly important to vocational planning and placement as job loss is often attributed to poor social functioning and symptom management. Cognitive rehabilitation, another treatment tool within the psychiatric rehabilitation model, is designed to assist individuals improve information processing deficits. Specifically, individuals with severe and persistent mental illnesses often experience neuropsychological deficits such as poor attention, reduced memory functioning, language and speech deficits, and reduced executive functioning (Corrigan & Yudofsky, 1996). Enhancing cognitive skills can undoubtedly improve the ability to understand the social world and match appropriate behaviors to the demands of specific situations (Storzback & Corrigan, 1996). With regards to employment, the primary vocational model used within psychiatric rehabilitation is supported employment, which depending on the individual, may entail prevocational training and job seeking workshops, transitional employment or some form of work adjustment training, individual or group supported employment placements with job coaching and long term supports, with the ultimate goal being competitive employment (Becker & Drake, 1994; Bond, 1992).

Important knowledge domains within psychiatric rehabilitation that are considered important when working with this population is an understanding of financial benefits and psychopharmacology. Specifically, like many persons with severe disabilities, persons with severe and persistent mental illnesses are often reliant on SSI or SSDI benefits for their income. Unfortunately, the incentive to work while on these programs is not always clear, nor are the ramifications of working while receiving benefits typically known to recipients. As such, vocational counseling within psychiatric rehabilitation involves a solid understanding of the benefit programs and how work will affect payments. In addition, given the fundamental role of medication in the treatment of severe and persistent mental illnesses, knowledge of psychotropic medications, the symptoms to which these medications target, and an understanding of the vast array of potential side effects, is an important domain of knowledge to have when working with this population.

Conclusions and Implications

The present study suggest that VR counselors working in the state setting in this particular midwestern state are not well prepared to work with people with severe and persistent mental illnesses, as 16 out of 35 items (45.7%) were identified as important but poorly met training needs. The trend appears to be consistent with the results from prior studies (e.g., Chan et al., 2003). The present study finds two major areas to be particularly limited in training--case and caseload management in psychiatric rehabilitation, and principles and techniques of psychiatric rehabilitation. In addition, the remaining three training categories identified involved areas important to understanding the nature and treatment of mental illnesses including psychopathology, substance abuse, psychopharmacology, neuropsychological assessment, and types of therapies typically utilized when treating this population including cognitive-behavioral interventions and brief psychotherapy. Importantly, knowledge of state mental health services was identified as the most important training need item, indicating the need for a better understanding of, and collaboration with, state mental health services. Understanding the mental health system is critical for rehabilitation counselors working with persons with mental illnesses as state mental health services typically provide case management for this population and fund an array of ancillary support services necessary for stabilization. Moreover, the strength of the collaboration between VR and state mental health services can, without question, open up collaborative funding opportunities that are important for long-term vocational support, which can boost outcomes for this population.

These results suggest that state VR programs would need to provide more adequate in-service training in the area of psychiatric rehabilitation for their counselors--particularly those who carry caseloads of clients with severe and persistent mental illnesses. In addition, it is highly probable that traditional rehabilitation counseling training programs are not adequately preparing students in the areas identified in this study. As such, it is suggested that rehabilitation educators consider strengthening their curriculum to incorporate the training needs identified in the present study so as to adequately prepare students to meet the growing demands of a broader and more complex disability group, with particular emphasis on psychiatric disabilities. Given the well-established psychiatric rehabilitation model, it is strongly-suggested that the field of rehabilitation counseling draw on this model and practice area to meet these training needs.

Limitations

The results of the present study provide some insights to the inadequacy of the training needs of VR counselors in this particular setting, who has a caseload of working with the psychiatric population. It reflects that the rehabilitation provision for this particular disability population is consistent with the legislations passed over the years, and that people with persistent and mental illnesses and people with the most significant disabilities needed to be served with priority in the public rehabilitation system. In addition, the results appear to be consistent with the current literature and research indicating that the implementation of psychiatric rehabilitation both at the graduate education level for students and continuing education training for practitioners are in demand. Even though the results of this study further confirm what the existing practice and trends are in the field, it is not without its limitations. There are potentially two methodological issues in this study that could further be improved for stronger evidence and that interpretation of the result should be subjected to readers' discretion. The first limitation relates to the psychometric properties of the instrument and the second one relates to the sampling method, which leads to the generalizability of the results. Although the development of the instrument was based on the scrutiny of a comprehensive review of the psychiatric rehabilitation literature, the CRCC KVI-R's content of the survey developed specifically for training needs for rehabilitation counseling by Leahy et al. (2003), and expert opinions from selected psychiatric practitioners, this modified instrument itself has not been subjected to a sole validation process. This preliminary study use this modified instrument as a tester to its validity, and further adoption of this instrument can be used to add evidence to its psychometric scrutiny. The second limitation relates to the issue of generalizability. The participants in this study were selected from one state VR agency, which would not make the results generalizable to all state VR agencies across the United States. Given that the results of the study appear to provide some potential applications for graduate education and continuing education for students and practitioners in the rehabilitation field, it can be used as a pilot study for exploratory purpose in preparation for potentially larger-scale studies adopting improved instrumentation and sampling method. Finally, further studies are necessary in the area of training needs for psychiatric rehabilitation for rehabilitation counselors so that the results can be a better reflection of the training needs of rehabilitation counselors with psychiatric caseload in the public state agencies in general. Subsequently, such training needs can be implemented for preparation of future rehabilitation counselors in graduate school as well as provision of in-service training for practitioners in the field of vocational rehabilitation for rehabilitation counseling.

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Rubin, S. E., & Roessler, R. T. (Eds.). (2001). Foundations of the vocational rehabilitation process (5th ed.). Austin, TX: Pro-Ed.

Storzback, D., & Corrigan, P. W. (1996). Cognitive rehabilitation of schizophrenia. In P. W. Corrigan & S. C. Yudofsky (Eds.), Cognitive rehabilitation of neuropsychiatric disorders. Washington, DC: American Psychiatric Press.

Tansey, T. N., Chan, F., Chou, C. C., & Cardoso, E. (2004). Perspectives of rehabilitation counselors in psychiatric settings: Critical issues and training needs. Rehabilitation Education, 18(1), 39-47.

Tsang, H. W. H., Chan, F., & Bond, G. (2002). Psychiatric rehabilitation and supported employment: An interview with Professor Gary Bond. Hong Kong Journal of Mental Health, 30(1), 10-31.

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Gloria K. Lee

University at Buffalo--State University of New York

Julie Chronister

Hunter College, City University of New York

Hector Tsang

The Hong Kong Polytechnic University

Kirby Ingraham

Illinois Office of Rehabilitation Services

Eugene Oulvey

Illinois Office of Rehabilitation Services

Gloria K. Lee, Ph.D., CRC. Assistant Professor. Department of Counseling, School and Educational Psychology. 419 Baldy Hall, University at Buffalo--State University of New York. Buffalo, NY, 14260-1000. E-mail: [e-mail]

Table 1

Psychiatric Rehabilitation Knowledge Items Endorsed by VR
Counselors as Highly Important

Item                                                      % Importance

15. Benefits counseling (e.g., SSI, SSDI, welfare
    benefits)                                                 100
23. Employer development/job development                      100
6.  Community-based assessment (situational assessment)        98
11. Job placement techniques for people with severe
    mental illness                                             98
35. Job seeking-skills training                                98
4.  Community support and resources development                96
10. Principles and techniques of supported
    employment for people with severe mental illness           96
25. Consumer choice and empowerment concepts                   96
30. Psychopathology (e.g., DSM diagnoses)                      96
13. Individual Placement and Support (1PS) Programs            95
14. Medical and psychosocial aspects of mental illness         94
16. Health care benefits                                       94
18. Brief psychotherapy                                        94
24. Principles and techniques of psychiatric
    rehabilitation                                             94
33. Principles and techniques of case and caseload
    management with people with severe mental illnesses        94
34. Behavioral intervention techniques                         94
28. Substance abuse and disability                             94
2.  Psychopharmacology                                         94
5.  Ethical standards for psychiatric rehabilitation
    practices                                                  94
17. Multicultural issues                                       92
22. State mental health services                               92
26. Professional roles, functional, and collaborative
    relationships with other mental health service
    providers                                                  92
9.  Internet resources                                         91
27. Principles and techniques of skills training
    (e.g., social and coping skills training)                  91
29. Neuropsychological assessment                              91
7.  Cognitive-behavioral intervention procedures               90

Table 2

Psychiatric Rehabilitation Knowledge Items Endorsed by VR Counselors as
Having Limited Preparedness

Item                                                       % Limited
                                                          Preparedness

8.  Assertive community treatment (ACT) programs               77
22. State mental health services                               74
33. Principles and techniques of case and caseload
    management with people with severe mental illnesses        72
2.  Psychopharmacology                                         70
12. Managed care concepts related to mental health
    practices                                                  65
26. Professional roles, functions, and collaborative
    relationships with other mental health service
    providers                                                  65
7.  Cognitive-behavioral intervention procedures               65
32. Job clubs techniques                                       63
19. Research method, program evaluation, and
    outcome measurement                                        62
13. Individual Placement and Support (IPS) Programs            62
31. Federal/state legislations related to mental health
    and rehabilitation services                                60
29. Neuropsychological assessment                              58
34. Behavioral intervention techniques                         57
15. Benefits counseling (e.g., SSI, SSDI, welfare
    benefits)                                                  56
24. Principles and techniques of psychiatric
    rehabilitation                                             55
23. Employer development/job development                       55
20. Group approaches for people with severe mental
    illnesses                                                  55
27. Principles and techniques of skills training
    (e.g., social and coping skills training)                  54
18. Brief psychotherapy                                        53
17. Multicultural issues                                       52
30. Psychopathology (e.g., DSM diagnoses)                      51
21. Theories and techniques for family counseling in
    psychiatric rehabilitation                                 51
28. Substance abuse and disability                             50

Table 3

Training Needs as Identified by Categories

                                    Limited         Limited
Category/Item                     Importance     Preparedness

Category 1: Counseling Intervention Techniques

7.  Cognitive-behavioral
    intervention procedures           90%              65%
34. Behavioral intervention
    techniques                        94%              57%
17. Multicultural issues              92%              52%
18. Brief psychotherapy               94%              53%

Mean:                                 92.5 (SD=1.9)    56.8 (SD=5.9)

Category 2. Principles and Techniques of Psychiatric Rehabilitation

22. State mental health
    services                          92%              74%
13. Individual Placement and
    Support (IPS) Programs            95%              62%
27. Principles and techniques
    of skills training (e.g.,
    social and coping skills
    training)                         91%              54%
24. Principles and techniques
    of psychiatric
    rehabilitation                    94%              55%
15. Benefits counseling
    (e.g., SSI, SSDI,
    welfare benefits)                100%              56%
23. Employer development/
    job development                  100%              55%

Mean:                                  95.3(SD=3.9)    59.3(SD=7.7)

Category 3: Medical and Psychosocial Aspects

2.  Psychopharmacology                94%              70%
28. Substance abuse and
    disability                        94%              50%
30. Psychopathology
    (e.g., DSM diagnoses)             96%              51%

Mean:                                 94.7(SD=1.2)     57.0(SD=11.3)

Category 4: Assessment

29. Neuropsychological
    assessment                        91%              58%

Mean: No mean value is calculated with one item.

Category 5. Case and Caseload Management

26. Professional roles,
    functions, and
    collaborative
    relationships with other
    mental health service
    providers                         92%             65%
33. Principles and techniques
    of case and caseload
    management with people
    with severe mental
    illnesses                         94%             72%

Mean:                                 93.0(SD=1.4)    67.5(SD=3.5)

Category/Item                       Preparedness *

Category 1: Counseling Intervention Techniques

7.  Cognitive-behavioral
    intervention procedures             25.0%
34. Behavioral intervention
    techniques                          37.0%
17. Multicultural issues                40.0%
18. Brief psychotherapy                 41.0%

Mean:                                    35.7

Category 2. Principles and Techniques of Psychiatric Rehabilitation

22. State mental health
    services                            18.0%
13. Individual Placement and
    Support (IPS) Programs              33.0%
27. Principles and techniques
    of skills training (e.g.,
    social and coping skills
    training)                           37.0%
24. Principles and techniques
    of psychiatric
    rehabilitation                      39.0%
15. Benefits counseling
    (e.g., SSI, SSDI,
    welfare benefits)                   44.0%
23. Employer development/
    job development                     45.0%

Mean:                                    36.0

Category 3: Medical and Psychosocial Aspects

2.  Psychopharmacology                  24.0%
28. Substance abuse and
    disability                          44.0%
30. Psychopathology
    (e.g., DSM diagnoses)               45.0%

Mean:                                    37.7

Category 4: Assessment

29. Neuropsychological
    assessment                          33.0%

Mean: No mean value is calculated with one item.

Category 5. Case and Caseload Management

26. Professional roles,
    functions, and
    collaborative
    relationships with other
    mental health service
    providers                           27.0%
33. Principles and techniques
    of case and caseload
    management with people
    with severe mental
    illnesses                           22.0%

Mean:                                    25.5

* Difference Calculated by Subtracting the Preparedness Score from the
Importance Score.