Research directions related to rehabilitation practice: a Delphi study.
Szymanski, Rubin Ru´bin
n. 1. A ruby. , and Rubin (1988) challenged the rehabilitation counseling rehabilitation counseling,
n counseling started in the United States in 1920 to assist individuals disabled by industrial accidents; originally included physical, psychologic, and occupational training; expanded over the next 70 years and laid the profession to reconceptualize its identity, value structure, and mission. They identified several trends as the basis of their argument for change, including major legislative and policy initiatives; the emergence of new or newly recognized disability groups; recognition of the importance of the environment and related intervention A procedure used in a lawsuit by which the court allows a third person who was not originally a party to the suit to become a party, by joining with either the plaintiff or the defendant. strategies; and changing paradigms regarding disability and rehabilitation rehabilitation: see physical therapy. .
Ten years later, their call for self-evaluation is even more relevant. In spite of in opposition to all efforts of; in defiance or contempt of; notwithstanding.
See also: Spite the employment provisions of the Americans with Disabilities Act Americans with Disabilities Act, U.S. civil-rights law, enacted 1990, that forbids discrimination of various sorts against persons with physical or mental handicaps. (ADA Ada, city, United States
Ada (ā`ə), city (1990 pop. 15,820), seat of Pontotoc co., S central Okla.; inc. 1904. It is a large cattle market and the center of a rich oil and ranch area. ), labor force participation rates for people with severe disabilities remains unacceptably low (Weaver
The Weavers are small passerine birds related to the finches.
These are seed-eating birds with rounded conical bills, most of which breed in sub-Saharan Africa, with fewer species in tropical , 1994). There is considerable dissatisfaction among people with severe disabilities with the state-federal vocational rehabilitation Noun 1. vocational rehabilitation - providing training in a specific trade with the aim of gaining employment
rehabilitation - the restoration of someone to a useful place in society (VR) system (Weaver, 1994). People with mild to moderate disabilities, who are low on the priority list for VR services due to the order of selection criteria, are equally hostile toward the public system. Block grant and voucher A receipt or release which provides evidence of payment or other discharge of a debt, often for purposes of reimbursement, or attests to the accuracy of the accounts. systems are examples of whole-sale changes that have been proposed in this decade (e.g., Weaver, 1993; Thomas (language) Thomas - A language compatible with the language Dylan(TM). Thomas is NOT Dylan(TM).
The first public release of a translator to Scheme by Matt Birkholz, Jim Miller, and Ron Weiss, written at Digital Equipment Corporation's Cambridge Research Laboratory runs & Strauser, 1995).
Proprietary rehabilitation systems have had their share of setbacks as well. After two decades of steady and uninterrupted growth, some state worker compensation boards began to modify or remove requirements for mandatory participation in VR (Habeck, 1996). Unfortunately, rehabilitation professionals in the private sector had not been able to demonstrate the efficacy of their intervention through research support and were vulnerable to criticisms that VR services represented little more than an additional cost. At the same time, ADA, Social Security Administration reforms involving disability insurance, and the movement toward managed care and integrated benefit systems have dramatically altered the prospects for private sector VR professionals, restricting or eliminating some areas of practice, while creating entirely new areas of opportunity (Leahy
Leahy is the name of a Canadian folk music group. The eight band members, all from the Leahy family of eleven siblings, are from Lakefield, Ontario and have been , Chan, Shaw, & Lui LUI Local User Interface
LUI Language User Interface (speech recognition technology)
LUI Learning Unique Identifier (Australian education)
LUi Level-Up! Inc. , 1997). These changes in both the private and public sectors underscore The underscore character (_) is often used to make file, field and variable names more readable when blank spaces are not allowed. For example, NOVEL_1A.DOC, FIRST_NAME and Start_Routine.
(character) underscore - _, ASCII 95. the importance of having "qualified personnel" deliver necessary services in order to maximize rehabilitation outcomes and protect consumers.
For example, the 1992 Rehabilitation Act Amendments require that state personnel standards be "consistent with any national or state approved or recognized certification, licensing, registration or other comparable requirements." In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke"
put differently , in the case of rehabilitation counselors, holding a state license (as a professional counselor or VR specialist) and/or and/or
Used to indicate that either or both of the items connected by it are involved.
Usage Note: And/or is widely used in legal and business writing. the Certified See certification. Rehabilitation Counselor (CRC (Cyclical Redundancy Checking) An error checking technique used to ensure the accuracy of transmitting digital data. The transmitted messages are divided into predetermined lengths which, used as dividends, are divided by a fixed divisor. ) credential credential verb To determine or verify titles, qualifications, documents, completion of required training, and continuing education, in those persons who function in a professional or official capacity–eg, ER physician, neurosurgeon, etc. Cf Credentials. appears to be required for VR counselors. Consistent with that legislative mandate, on February February: see month. 11, 1997 the Rehabilitation Services Administration issued its final regulations. The regulations make it unequivocal that state personnel standards must be based on national certification national certification Lab medicine A voluntary form of regulation that affirms that a person has the knowledge and skill to perform essential tasks in a given field, in the lab or in nursing; NC is granted by nongovernmental agencies or associations with standards or state licensure/certification requirements (for disciplines in which such standards exists, as they do in rehabilitation counseling). Credentialing Credentialing is the administrative process for validating the qualifications of licensed professionals, organizational members or organizations, and assessing their background and legitimacy. has long been an important consideration in managed disability and health care systems as payers seek to improve both outcome and consumer satisfaction.
While the American health American Health Inc. is a company that manufactures health supplements. It is located in Holbrook, New York. One of its products is labeled the "Chewable Original Papaya Enzyme" with the attached registered trademark, "The 'After Meal Supplement'". care system and the rehabilitation industry undergo major structural changes, there are currently increased demands for research to demonstrate the efficacy of various professionals and their intervention programs. The purpose of this article is to solicit the opinions of individuals who are leaders in rehabilitation credentialing and certification regarding research priorities that will help rehabilitation counseling and related professions become more responsive in these times of change. Prior to presenting results of the study, a brief history of the three rehabilitation practitioner groups involved in this study is presented.
History of Rehabilitation Credentialing
Rehabilitation can be defined as a comprehensive sequence of services, mutually planned by the consumer and the rehabilitation counselor to maximize employability, independence, integration, and participation of people with disabilities in the workplace and/or the community (Jenkins Jen´kins
n. 1. A name of contempt for a flatterer of persons high in social or official life; as, the Jenkins employed by a newspaper s>. , Patterson Patterson, family of American journalists.
Robert Wilson Patterson, 1850–1910, b. Chicago, grad. Williams, 1871, became (1871) a reporter on the Chicago Times and after 1873 was attached to the Chicago Tribune. , & Szymanski, 1992). In the ongoing development of various rehabilitation professions, there has been a long-standing long-stand·ing
Of long duration or existence: a long-standing friendship.
existing for a long time
interest in responding to demands by people with disabilities and financial providers for higher levels of accountability. For this reason, accountability mechanisms have been established such as accreditation accreditation,
n a process of formal recognition of a school or institution attesting to the required ability and performance in an area of education, training, or practice. of rehabilitation facilities and education programs, as well as national certification and state licensing programs for rehabilitation professionals. All of these activities involve active participation by relevant professional organizations and consumer groups, and all are believed to be characteristics of established professions which serve the public interest.
Certified Rehabilitation Counselor (CRC) Group
Rehabilitation counseling is defined as "a profession that assists individuals with disabilities in adapting to the environment, assists environments in accommodating the needs of the individual, and works toward full participation of persons with disabilities in all aspects of society, especially work" (Szymanski, 1985, p. 3). Research conducted in recent years has established the link between educational attainment Educational attainment is a term commonly used by statisticans to refer to the highest degree of education an individual has completed.
The US Census Bureau Glossary defines educational attainment as "the highest level of education completed in terms of the and actual rehabilitation counselor performance in state VR agencies. A number of independent researchers have conducted a series of studies (Cook & Bolton Bolton or Bolton-le-Moors (bōl`tən-lə-mrz), city (1991 pop. 143,960) and metropolitan district, NW England, located in the Manchester metropolitan area. , 1992; Szymanski, 1991; Szymanski & Danek, 1992; Szymanski & Parker, 1989a, 1989b) to investigate the relationship of counselor education and experience to client outcomes in Arkansas Arkansas, river, United States
Arkansas (ärkăn`zəs, är`kənsô'), river, c.1,450 mi (2,330 km) long, rising in the Rocky Mts., central Colo. , Maryland, New York Maryland is a town in Otsego County, New York, United States. The population was 1,920 at the 2000 census.
The Town of Maryland is on the county's south border, and was named for the U.S. state of the same name. , and Wisconsin Wisconsin, state, United States
Wisconsin (wĭskŏn`sən, –sĭn), upper midwestern state of the United States. It is bounded by Lake Superior and the Upper Peninsula of Michigan, from which it is divided by the Menominee . They found that counselors with master's degrees master's degree
An academic degree conferred by a college or university upon those who complete at least one year of prescribed study beyond the bachelor's degree.
Noun 1. in rehabilitation counseling (or closely related fields) had better outcomes for clients with severe disabilities compared to counselors without such educational preparation. Their findings underscore the importance of mastering, through formal education, the knowledge domains essential to rehabilitation counseling practice. Rehabilitation counseling knowledge and skill standards have also been empirically derived from roles-and-function studies such as Leahy, Szymanski and Linkowski (1993), Leahy, Shapson, and Wright (1987), Rubin et al. (1984), Emener and Rubin (1980), and Muthard and Salamone (1969).
For nearly 40 years, the Years, The
the seven decades of Eleanor Pargiter’s life. [Br. Lit.: Benét, 1109]
See : Time rehabilitation counseling profession has been conducting field-based research to identify the types of knowledge, skills, and abilities required of the rehabilitation counselor to work effectively with persons with disabilities in achieving employment outcomes. Utilized extensively by the profession, these data provide the foundation for graduate training curricula and standards for certification.
The Certified Rehabilitation Counselor (CRC) credentialing process is the oldest certification mechanism in the counseling or rehabilitation professions in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. (Leahy & Holt holt
A wood or grove; a copse.
[Middle English, from Old English.]
the lair of an otter [from , 1993). The Commission on Rehabilitation Counselor Certification (CRCC CRCC Commission on Rehabilitation Counselor Certification
CRCC Center for Religion and Civic Culture (California)
CRCC China Railway Construction Corporation
CRCC Center for Research on Concepts and Cognition ) was officially incorporated in January 1974 to conduct certification activities on a nationwide basis. Leahy, Szymanski, and Linkowski (1993) surveyed CRCs to examine the perceived importance of the knowledge areas underlying rehabilitation counseling credentialing. They found 10 common core knowledge areas that are important to the contemporary practice of rehabilitation counseling: Vocational Counseling and Consultation Services; Medical and Psychosocial psychosocial /psy·cho·so·cial/ (si?ko-so´shul) pertaining to or involving both psychic and social aspects.
Involving aspects of both social and psychological behavior. Aspects of Disability; Individual and Group Counseling; Program Evaluation Program evaluation is a formalized approach to studying and assessing projects, policies and program and determining if they 'work'. Program evaluation is used in government and the private sector and it's taught in numerous universities. and Research; Case Management and Service Coordination service coordination Case management, see there ; Family, Gender, and Multicultural mul·ti·cul·tur·al
1. Of, relating to, or including several cultures.
2. Of or relating to a social or educational theory that encourages interest in many cultures within a society rather than in only a mainstream culture. Issues; Foundations of Rehabilitation; Workers' Compensation workers' compensation, payment by employers for some part of the cost of injuries, or in some cases of occupational diseases, received by employees in the course of their work. ; Environment and Attitude Barriers; and Assessment.
Since 1974, more than 23,000 qualified professionals have participated in the certification process. There are 14,081 CRCs currently practicing in the United States and in several other countries (Leahy & Holt, 1993). The primary purpose of certification is to provide assurance to consumers of rehabilitation counseling services (service recipients and payers) that providers have met acceptable minimum national standards of professionalism professionalism
the upholding by individuals of the principles, laws, ethics and conventions of their profession. . Therefore, certification standards are considered by the profession to be in the best interest of the consumers of services (Leahy & Holt, 1993; Schmitt, 1995).
Certified Disability Management Specialists (CDMS CDMS Cryogenic Dark Matter Search
CDMS Certified Disability Management Specialist
CDMS Certification of Disability Management Specialists
CDMS Clinical Data Management System
CDMS Climate Data Management System ) Group
Disability management is defined by CDMSC CDMSC Certification of Disability Management Specialists Commission as "the practice of providing preventive preventive /pre·ven·tive/ (pre-vent´iv) prophylactic.
pre·ven·tive or pre·ven·ta·tive
Preventing or slowing the course of an illness or disease; prophylactic.
n. and remedial REMEDIAL. That which affords a remedy; as, a remedial statute, or one which is made to supply some defects or abridge some superfluities of the common law. 1 131. Com. 86. The term remedial statute is also applied to those acts which give a new remedy. Esp. Pen. Act. 1. services to minimize the impact and cost of disability and to enhance productivity" (CDMSC, 1996). A more specific definition is provided by Akabas, Gates, and Galvin (1992) as a ".... work place prevention and remediation strategy that seeks to prevent disability from occurring or, lacking that, to intervene intervene v. to obtain the court's permission to enter into a lawsuit which has already started between other parties and to file a complaint stating the basis for a claim in the existing lawsuit. early following the onset of disability, using coordinated, cost-conscious, quality rehabilitation service that reflects an organizational commitment In the study of organizational behavior and Industrial/Organizational Psychology, organizational commitment is, in a general sense, the employee's psychological attachment to the organization. to continued employment of those experiencing functional work limitations" (p.2).
The Certified Insurance Rehabilitation Specialist (CIRS CIRS Composite Infrared Spectrometer
CIRS Circles (street type)
CIRS Currency Interest Rate Swap
CIRS Contractor Inventory Redistribution System
CIRS Critical Incidents Reporting System
CIRS Customer Infrastructure Readiness Survey ) credential was established in 1985 to recognize and certify cer·ti·fy
v. cer·ti·fied, cer·ti·fy·ing, cer·ti·fies
a. To confirm formally as true, accurate, or genuine.
b. the knowledge and skills of the practitioners who work in this specialized spe·cial·ize
v. spe·cial·ized, spe·cial·iz·ing, spe·cial·iz·es
1. To pursue a special activity, occupation, or field of study.
2. area of rehabilitation practice. The primary purpose of the certification was to assure that professionals engaged in insurance rehabilitation met acceptable minimum national standards of professionalism (e.g., education, experience, and knowledge). Such standards are considered to be in the best interests of the clients served by CIRSs (Matkin, 1995).
To validate To prove something to be sound or logical. Also to certify conformance to a standard. Contrast with "verify," which means to prove something to be correct.
For example, data entry validity checking determines whether the data make sense (numbers fall within a range, numeric data the CIRS examination, the CIRS Commission funded a series of studies in the 1980s and 1990s to identify the work activities and associated knowledge required to perform them (e.g., Matkin, 1995). Specifically, Matkin surveyed 3,500 CIRS applicants during the certification grandfathering period in 1985-1986, and again five years later (1991) at the end of the first certification renewal phase. He found the knowledge requirements for insurance rehabilitation practice during the two time periods to be quite similar, with the 1991 data providing a clearer labeling of work role categories: Case Management and Human Disabilities; Job Placement and Vocational Assessment; Rehabilitation Services and Care; Disability Legislation; and Forensic Belonging to courts of justice.
forensic 1) adj. from Latin forensis for "belonging to the forum," ancient Rome's site for public debate, and currently meaning pertaining to the courts. Rehabilitation. The knowledge requirements associated with these work categories formed the basis of the CIRS national examination.
More recently, Leahy, Chan, Taylor, Wood, and Downey (in press) identified seven empirically derived knowledge factors as important for effective private rehabilitation practice. These knowledge factors are: Vocational Assessment and Planning; Case Management and Reporting; Expert Witness Testimony; Employment and Disability Related Legislation and Regulations; Community Resources; Psychosocial and Functional Aspects of Disability; and Job Analysis and Modification. Their research has identified factors which have broadened the roles and functions of practitioners in insurance rehabilitation. Practitioners in their study also conveyed that disability management has become an emerging practice area for private rehabilitation practitioners.
In 1996, the Certified Insurance Rehabilitation Specialists Commission (CIRSC) changed its name to the Certification of Disability Management Specialists Commission (CDMSC), to better reflect the current practice focus of private sector rehabilitation specialists. The associated credential is now known as the Certified Disability Management Specialist (CDMS) designation. Presently, there are 4,593 CDMS practitioners.
Certified Case Managers (CCM CCM Contemporary Christian Music
CCM Critical Care Medicine
CCM County College of Morris (New Jersey)
CCM Chama Cha Mapinduzi (political party, Tanzania)
CCM CORBA Component Model ) Group
Case management is defined by the Commission for Case Manager Certification (CCMC CCMC Commission for Case Manager Certification
CCMC Communications Consortium Media Center
CCMC Certified Career Management Coach
CCMC Community Coordinated Modeling Center (NASA) ) as "a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost-effective cost-effective,
n the minimal expenditure of dollars, time, and other elements necessary to achieve the health care result deemed necessary and appropriate. outcomes" (CCMC, 1996). In the late 1980s, case management began to develop its own impetus Impetus is a stimulus or impulse, a moving force that sparks momentum.
Impetus may also refer to:
Plural of auspex.
under the auspices of with the support and approval of [Latin auspicium augury from birds]
Noun of CIRSC. Although the process is only four years old, there are currently 18,516 Certified Case Mangers (CCMs) who have completed the certification requirements.
The Foundation for Rehabilitation Education and Research (Foundation) was established in place of the Board for Rehabilitation Certification in 1993. It is an independent organization sponsored by three separate credentialing bodies: the Commission on Rehabilitation Counselor Certification (CRCC), the Certification of Disability Management Specialists Commission (CDMSC), and the Commission for Case Manager Certification (CCMC). The mission of the Foundation is twofold: to promote and support the credentialing processes of its sponsors through education and research; and to enhance quality of service provided to individuals with disabilities. With technical and administrative support from the Foundation, Leahy (1994) surveyed 14,078 practicing case managers representing multiple professional disciplines (e.g., registered nurses, rehabilitation counselors, and social workers) in a variety of work settings (e.g., independent case management companies, workers' compensation insurers, and managed care companies). His research suggested that case managers do share a common knowledge base required for case management practice comprised of five factors: Coordination and Delivery of Services; Physical and Psychosocial Aspects of Disability; Benefit Systems and Cost Benefit Analysis; Case Management Concepts; and Principles of Community Re-entry RE-ENTRY, estates. The resuming or retaking possession of land which the party lately had.
2. Ground rent deeds and leases frequently contain a clause authorizing the landlord to reenter on the non-payment of rent, or the breach of some covenant, when the .
Purpose of the Study
It is well known that the emergence of managed care and integrated health care integrated health care,
n healthcare services combining the best of conventional and complementary health care. systems has enhanced the importance of accountability mechanisms, including accreditation, certification, and licensure licensure
(lī´snsh . In response, the CRCC, CDMSC, and CCMC have combined to certify more than 30,000 rehabilitation practitioners working in the full spectrum of disability and health care services in both the public and private sectors. All three commissions and the Foundation are continuously engaging in programmatic pro·gram·mat·ic
1. Of, relating to, or having a program.
2. Following an overall plan or schedule: a step-by-step, programmatic approach to problem solving.
3. research to establish the value and relevance of these credentialing processes as an indicator of the ability of certified individuals to provide quality services and produce desired outcomes. The purpose of this article is to report the results of a Delphi study, the objective of which was to obtain a consensus regarding priorities for rehabilitation credentialing and certification research in this era of health care and disability policy reform.
A total of 23 professionals were selected for this study. They consisted of either board members of the Foundation or commissioners representing the Commission on Rehabilitation Counselor Certification (CRCC), the Certification of Disability Management Specialists Commission (CDMSC), or the Commission for Case Manager Certification (CCMC). These individuals are nominated nom·i·nate
tr.v. nom·i·nat·ed, nom·i·nat·ing, nom·i·nates
1. To propose by name as a candidate, especially for election.
2. To designate or appoint to an office, responsibility, or honor. by a variety of rehabilitation and disability-related organizations. Appointing organizations include the American and National Rehabilitation Counseling Associations (ARCA, NRCA NRCA National Roofing Contractors Association
NRCA Natural Resources Conservation Authority
NRCA National Rehabilitation Counseling Association
NRCA Natural Resources Council of America
NRCA Natural Resources Conservation Areas ), the Council on Rehabilitation Education (CORE), the National Council on Rehabilitation Education (NCRE NCRE National Council on Rehabilitation Education
NCRE National Cereals Research and Extension (Cameroon)
NCRE Naval Construction Research Establishment ), and the Vocational Evaluation and Work Adjustment Association (VEWAA VEWAA Vocational Evaluation and Work Adjustment Association ). Thus the researchers assume that this group represents leaders in the field who are knowledgeable of and committed to professionalism in rehabilitation practice. More specifically, the individuals surveyed included those who held professional positions such as Chair of the CRCC, CDMSC, and the CCMC, or Chair of the Research and Examination Committees of these commissions.
Procedures and Data Analysis
The Delphi technique (programming, tool) Delphi Technique - A group forecasting technique, generally used for future events such as technological developments, that uses estimates from experts and feedback summaries of these estimates for additional estimates by these experts until reasonable consensus was employed in this study to obtain a consensus regarding a research agenda for the Foundation. In Questionnaire A, an open-ended approach was used to solicit input. Participants were asked to list three rehabilitation research questions that they felt were important and relevant for rehabilitation credentialing and certification research. They were also asked to provide a brief rationale rationale (rash´nal´),
n the fundamental reasons used as the basis for a decision or action. for the importance of each research question submitted.
A total of 38 questions was received. A content analysis was performed on the data obtained to minimize redundancy. A revised questionnaire (Questionnaire B) comprised of 28 research questions was developed, arranged in random order, and circulated to the same group of participants. Twenty of the original 23 participants responded to Questionnaire B for a response rate of 87%. This time, they were asked to rate the centrality of each of the 28 questions in relation to the research priorities for the three commissions (i.e., to promote and support the respective credentialing process, and to enhance the quality of services provided to individuals with disabilities), using the following 5-point Likert-type scale:
1 = Should not be at all central
2 = Somewhat central
3 = Moderately central
4 = Very central
5 = Extremely central
Finally, based upon responses to the second questionnaire, a third questionnaire was developed (Questionnaire C). For each item in Questionnaire B, the median centrality score and interquartile range In descriptive statistics, the interquartile range (IQR), also called the midspread, middle fifty and middle of the #s, is a measure of statistical dispersion, being equal to the difference between the third and first quartiles. were computed. In completing Questionnaire C, participants were:
* instructed to compare their individual ratings from Questionnaire B with the median score (reflecting the group's position), and
* encouraged to change their original centrality rating if they wished.
The inter-quartile range for each item on Questionnaire B2 was also provided to give participants an idea of the variability of responses. Participants whose responses to Questionnaire C remained extremely discrepant dis·crep·ant
Marked by discrepancy; disagreeing.
[Middle English discrepaunt, from Latin discrep relative to the median response were asked to provide a rationale for their ratings. The intent was to move participants toward a consensus and reduce the variability among responses from Questionnaire B to Questionnaire C. Eighteen of the original 23 participants responded to Questionnaire C, for a response rate of 78%. The tenet TENET. Which he holds. There are two ways of stating the tenure in an action of waste. The averment is either in the tenet and the tenuit; it has a reference to the time of the waste done, and not to the time of bringing the action.
2. underlying the Delphi technique is that the consensus will improve with successive rounds of anonymous group judgment (Hornsby, Smith, & Gupta, 1994). These same researchers found the Delphi technique to be superior to the focus group approach because it allows the greatest degree of anonymity In anonymity networks (e.g. Tor, Crowds, Tarzan, etc.) it is important to be able to measure quantitatively the guarantee that is given to the system. The degree of anonymity according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. mean score.
The 28 research questions were ranked in order of their importance and were examined more closely by members of the Foundation's Research Committee. These items appeared to reflect three major themes:
* Who are CRCs, CDMSs, and CCMs and how are they similar and different in terms of their roles and functions and the underlying knowledge and skill required to perform those functions?
* What is the effectiveness of services provided by individuals holding the CRC, CCM, and CDMS credentials CREDENTIALS, international law. The instruments which authorize and establish a public minister in his character with the state or prince to whom they are addressed. If the state or prince receive the minister, he can be received only in the quality attributed to him in his credentials. ?
* Where are the CRC, CCM, and CDMS specializations headed and are our educational, accountability, and funding processes prepared to address changes in direction?
Next, items with a mean centrality rating greater than 3.5 were classified according to these three themes. Within each of the three broad categories or themes, the items were then ranked ordered. This information is presented in Table 1. Research questions with centrality ratings of less than 3.5 are presented in Table 2.
Table 1 Research Questions Organized by Major Themes Item Mean Centrality No. Research Question Rating Theme No. 1: Similarities and Differences Among CRCs, CDMSs, and CCMs 1. What are the underlying knowledge 4.56 dimensions of the CRC, CDMS, and CCM examinations? 6. What items in the CRC, CDMS, and CCM 4.33 examination item pool are significantly related to the service delivery effectiveness of rehabilitation counselors, disability management specialists, and case managers? (Directed at establishing the predictive validity of certification examinations.) 8. What are the similarities and differences 4.00 in knowledge domains identified as important by the applicants for various rehabilitation certifications? How are these similarities and differences changing over time? (To identify important trends in the evolution of knowledge competencies for various areas of practice--Are the groups becoming more alike or more diverse?) 9. What is the relationship between 4.00 discipline, education, years of practice and performance on each certification examination? (This will provide information to various disciplines regarding educational preparation for rehabilitation practice roles.) 2. What are the trends in examination scores 3.72 over time? 3. What are the examinee characteristics over 3.56 time? Theme No. 2: Outcome Related Research 5. On what service delivery criteria should 4.56 the service delivery effectiveness of rehabilitation counselors, disability management specialists, and case managers be assessed? (Directed at establishing the predictive validity of certification examinations.) 14. What is the relationship between client 4.39 outcomes (e.g., employment) and the certification status (e.g., CRC) of the rehabilitation professional providing services in various rehabilitation settings? (In other words, do those with a CRC, CDMS, or CCM achieve more positive outcomes than those who do not have the requisite education and experience to apply for certification?) 10. What is the relationship between 4.28 performance on the certification examination and effectiveness of clinical decision-making in rehabilitation practice? (Recognizing that this question requires data collection beyond what is currently available, the goal is to create the link between knowledge and clinical performance and outcomes. Are there other ways to test minimum clinical knowledge beyond a basic paper and pencil test and what is the cost/benefit of doing so?) 17. How do employers benefit by hiring 4.00 certified rehabilitation professionals? (Cost-effectiveness of service delivery by certified rehabilitation professionals needs to be established.) 18. What benefits do people with disabilities 4.00 accrue from services rendered by certified rehabilitation professionals? 16. What rehabilitation approaches, under what 3.94 condition, with what types of client problems, appears to be most effective in the attainment of desired outcomes? What are the most appropriate outcome measurement/criteria for rehabilitation? (This line of inquiry would assist the profession in establishing empirically based standards of practice.) 15. What is the relationship between consumer 3.61 satisfaction with services provided in various rehabilitation settings and the certification status of the providers? Theme No. 3: Future Trends 25. Is the CORE curriculum meeting the 4.28 expected needs of the employers? Are rehabilitation counselor education program curricula sufficiently current? 27. Where is our field going? -- counseling, 4.28 disability management, case management? 24. In what ways are the Rehabilitation 4.22 Counselor Certification Examination contents and the CORE standards relevant to the current and future practice of rehabilitation counseling? 12. What impact has managed care had on the 4.11 need and use of rehabilitation counseling, disability management and case management? If any, how are they different? 11. What are the effects of licensed 4.00 professional counselor laws on rehabilitation counselor certification? 22. What ethical guidelines are needed to 3.83 address issues raised by managed care and other challenges? Item No. Research Question Rank Theme No. 1: Similarities and Differences Among CRCs, CDMSs, and CCMs 1. What are the underlying knowledge 1 dimensions of the CRC, CDMS, and CCM examinations? 6. What items in the CRC, CDMS, and CCM 4 examination item pool are significantly related to the service delivery effectiveness of rehabilitation counselors, disability management specialists, and case managers? (Directed at establishing the predictive validity of certification examinations.) 8. What are the similarities and differences 10 in knowledge domains identified as important by the applicants for various rehabilitation certifications? How are these similarities and differences changing over time? (To identify important trends in the evolution of knowledge competencies for various areas of practice--Are the groups becoming more alike or more diverse?) 9. What is the relationship between 11 discipline, education, years of practice and performance on each certification examination? (This will provide information to various disciplines regarding educational preparation for rehabilitation practice roles.) 2. What are the trends in examination scores 17 over time? 3. What are the examinee characteristics over 19 time? Theme No. 2: Outcome Related Research 5. On what service delivery criteria should 2 the service delivery effectiveness of rehabilitation counselors, disability management specialists, and case managers be assessed? (Directed at establishing the predictive validity of certification examinations.) 14. What is the relationship between client 3 outcomes (e.g., employment) and the certification status (e.g., CRC) of the rehabilitation professional providing services in various rehabilitation settings? (In other words, do those with a CRC, CDMS, or CCM achieve more positive outcomes than those who do not have the requisite education and experience to apply for certification?) 10. What is the relationship between 5 performance on the certification examination and effectiveness of clinical decision-making in rehabilitation practice? (Recognizing that this question requires data collection beyond what is currently available, the goal is to create the link between knowledge and clinical performance and outcomes. Are there other ways to test minimum clinical knowledge beyond a basic paper and pencil test and what is the cost/benefit of doing so?) 17. How do employers benefit by hiring 13 certified rehabilitation professionals? (Cost-effectiveness of service delivery by certified rehabilitation professionals needs to be established.) 18. What benefits do people with disabilities 14 accrue from services rendered by certified rehabilitation professionals? 16. What rehabilitation approaches, under what 15 condition, with what types of client problems, appears to be most effective in the attainment of desired outcomes? What are the most appropriate outcome measurement/criteria for rehabilitation? (This line of inquiry would assist the profession in establishing empirically based standards of practice.) 15. What is the relationship between consumer 18 satisfaction with services provided in various rehabilitation settings and the certification status of the providers? Theme No. 3: Future Trends 25. Is the CORE curriculum meeting the 6 expected needs of the employers? Are rehabilitation counselor education program curricula sufficiently current? 27. Where is our field going? -- counseling, 7 disability management, case management? 24. In what ways are the Rehabilitation 8 Counselor Certification Examination contents and the CORE standards relevant to the current and future practice of rehabilitation counseling? 12. What impact has managed care had on the 9 need and use of rehabilitation counseling, disability management and case management? If any, how are they different? 11. What are the effects of licensed 12 professional counselor laws on rehabilitation counselor certification? 22. What ethical guidelines are needed to 16 address issues raised by managed care and other challenges?
Table 2 Research Questions with Low Centrality Ratings (Mean ratings [is less than] 3.5)
Item Mean Centrality No. Research Question Rating 4. How did examinees with disabilities and 3.33 examinees from diverse ethnic backgrounds perform (as compared to the majority group) on the examination? 26. What will be the major funding sources 3.28 for vocational and medical rehabilitation services in the next decade? 7. Is there a significant relationship between the amount of focus placed on multicultural issues in rehabilitation education programs and the effectiveness of their graduates in service delivery to clients from minority populations? (Addresses a distributive justice issue in RCE curricula.) 19. What are supervisory skill tasks and 3.17 levels of the certified rehabilitation professionals, especially as related to service delivery and benefit to clients and employers? 23. What is the relationship of the Scope of 3.17 Practice statement to the Rehabilitation Counselor Certification Examination? (The statement has been accepted by CRCC, CORE, and other professional counseling organizations. Is the statement relevant to the examination?) 20. Are "counseling skills" for nurses and 3.11 "medical knowledge" for rehabilitation counselors two areas of skill deficit among practicing case managers? 28. What are the primary disabilities 3.11 anticipated on our caseloads in the next decade? 13. What impact has the Americans with 3.00 Disabilities Act had on the provision of rehabilitation counseling services? 21. Why should an "Approved Supervisor" 2.56 structure be explored as part of the case manager certification process? Item No. Research Question Rank 4. How did examinees with disabilities and 20 examinees from diverse ethnic backgrounds perform (as compared to the majority group) on the examination? 26. What will be the major funding sources 21 for vocational and medical rehabilitation services in the next decade? 7. Is there a significant relationship between the amount of focus placed on multicultural issues in rehabilitation education programs and the effectiveness of their graduates in service delivery to clients from minority populations? (Addresses a distributive justice issue in RCE curricula.) 19. What are supervisory skill tasks and 23 levels of the certified rehabilitation professionals, especially as related to service delivery and benefit to clients and employers? 23. What is the relationship of the Scope of 24 Practice statement to the Rehabilitation Counselor Certification Examination? (The statement has been accepted by CRCC, CORE, and other professional counseling organizations. Is the statement relevant to the examination?) 20. Are "counseling skills" for nurses and 25 "medical knowledge" for rehabilitation counselors two areas of skill deficit among practicing case managers? 28. What are the primary disabilities 26 anticipated on our caseloads in the next decade? 13. What impact has the Americans with 27 Disabilities Act had on the provision of rehabilitation counseling services? 21. Why should an "Approved Supervisor" 28 structure be explored as part of the case manager certification process?
Although the items were subjectively classified into the categories given, the participants gave more valency valency - degree to the nine "future trend" items (M=3.79) and the nine "professional similarities and differences" items (M=3.75) than the ten "effectiveness" items (M=3.37). Interestingly, multicultural concerns do not receive high centrality ratings, at least from this group of participants. Finally, the Delphi technique appeared to have the intended effect of building consensus as evidenced by the reduction in the variability of ratings from Questionnaire B to Questionnaire C. The average reduction in variability was .12 SD per item. The variability of some items, particularly those with respect to future trends, was lowered by as much as .59 SD (item 27) and .33 SD (item 22).
Participants appear concerned about the future of all rehabilitation specializations. In particular, there is concern about changes in work settings, professional activities, funding streams, client populations, ethical challenges, regulations, and legislation. In disciplines with established educational standards, there is concern regarding the responsiveness and flexibility of educational accrediting bodies. Historically, directions in rehabilitation have been determined by major shifts in legislation, primarily at the federal level. Recently, directions appear more affected by changes in reimbursement Reimbursement
Payment made to someone for out-of-pocket expenses has incurred. policies and practices, which also have a substantial impact upon which (if any) services will be rendered to people in need.
Participants are equally concerned regarding the similarities among and differences between rehabilitation specializations. While the nature and scope of each has been thoroughly studied and documented, questions remain about the relative importance of these differences versus an underlying, core body of knowledge and responsibilities common to all rehabilitation endeavors. Certainly most CRCs are trained as counselors or rehabilitation counselors, whereas most CCMs are trained as nurses. CDMSs represent both groups. Is it possible that the common pursuit of rehabilitation objectives could lead to a generic rehabilitation professional over time, with differences being more a matter of emphasis?
Consistent with the history and traditions of rehabilitation, participants expressed the continuing need to demonstrate and document the cost and benefits of services rendered by qualified professionals in all three specializations. This realistic focus on accountability to people with disabilities and financial providers, the ongoing search for what works best for whom and under what conditions, and the overall preoccupation pre·oc·cu·pa·tion
1. The state of being preoccupied; absorption of the attention or intellect.
2. Something that preoccupies or engrosses the mind: Money was their chief preoccupation. with outcome will likely serve rehabilitationists well when compared to other human services professions.
The potential ramifications ramifications npl → Auswirkungen pl of answering these questions are staggering. For example, if clinical competence could be predicted from examination results (item #6, #10), recruitment and selection practices in all sectors of rehabilitation endeavor might change. Alternately, if underlying knowledge domains in the various specializations are indeed merging (item #1, #8), perhaps certification should focus upon a generic rehabilitation credential which could be pursued by members of many more professional disciplines than typically make application today. Suppose that educational standards were discovered to be obsolete OBSOLETE. This term is applied to those laws which have lost their efficacy, without being repealed,
2. A positive statute, unrepealed, can never be repealed by non-user alone. 4 Yeates, Rep. 181; Id. 215; 1 Browne's Rep. Appx. 28; 13 Serg. & Rawle, 447. and irrelevant to current and future practice patterns (item #25, #24)? Would we find our educators responsive?
Although the focus of this study was on research directions in relation to rehabilitation credentials, many of the questions generated have direct implications for the rehabilitation field in general. Examples include the differentiation of professional specializations, and relevance of professional preparation; future career opportunities and directions; effectiveness of rehabilitation interventions; measurement of outcomes produced; and the like. Also, there are certain research questions which are suggested by these findings that did not emerge as specific items per se. For example, should these credentials and their differences be more clearly articulated ar·tic·u·la·ted
Characterized by or having articulations; jointed. to consumers and the public in general? Can the nature or extent of education, nature of academic major, and/or years of experience predict performance on the examinations?
How are the low centrality ratings to be interpreted? Are participants comfortable with the current status of the specializations with respect to issues of multicultural competency COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like.
2. , access to future funding, professional supervision, and ADA? Are these less important, or are they somehow more imposing, more complex, and thus, less achievable?
Certainly it would be desirable to repeat this process directly with the leadership of relevant professional organizations (e.g., ARCA, NRCA, CORE, NCRE, VEWAA, etc.) as well as consumer groups representing persons with disabilities. It would be extremely interesting and relevant to compare and contrast the research priorities of all stakeholders Stakeholders
All parties that have an interest, financial or otherwise, in a firm-stockholders, creditors, bondholders, employees, customers, management, the community, and the government. before government funding sources (such as the National Institute for Disability and Rehabilitation Research) or research foundations finalize fi·nal·ize
tr.v. fi·nal·ized, fi·nal·iz·ing, fi·nal·iz·es
To put into final form; complete or conclude: "They have jointly agreed ... their national research agendas. In the interim, for individual researchers, each item offers a potential research question which has been determined to have value by the participants described herein.
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