Improving employment outcomes through quality rehabilitation counseling (QRC).
Along with an emphasis on employment, the 1992 Amendments mandate rehabilitation counselors to serve more people with severe disabilities. People with severe disabilities are deemed as individuals experiencing significant disability-related limitations in one or more life functions (Rubin & Roessler, 1995). This mandate comes at a time when funding for rehabilitation services is described, at best, as level or, more realistically, as shrinking when inflation is taken into account (Schriner, 1995).
To respond to the employment "mandate" in the 1992 Amendments, rehabilitation agencies are in the process of "reinventing" or "reengineering" their service delivery programs. In discussing changes needed in state agency programs, Jackson (1995) called for quality rehabilitation counseling services that result in increased employment outcomes and customer satisfaction (i.e., satisfaction of people with severe disabilities and employers). To define quality rehabilitation counseling (QRC), this investigation explored, in a qualitative analysis, the perceptions of 11 exemplary field counselors in vocational rehabilitation regarding the following issue: "What is Quality Rehabilitation Counseling (QRC), i.e., what do exemplary VR counselors do to help people with severe disabilities become employed?" Pertinent to provision of quality rehabilitation counseling, results from these interviews are organized in terms of the concurrent counseling model developed by Wachler and Lenox (1994).
Portraying the counseling process as discrete activities occurring simultaneously in varying degrees (Wachler & Lenox, 1994), the concurrent counseling model contrasts with the traditional stage model which depicts counseling as proceeding from initial counselor-client contact to termination in sequential steps. Rather than occur as a sequence, relationship building (e.g., establishing rapport), assessment (e.g., exploring, understanding, and defining problems/needs), goal setting (e.g., making decisions, setting goals), intervention (e.g., counseling, coordinating, and consulting), and termination (closing the case) occur throughout the counseling process. For example, relationship building and maintenance are important throughoUt counseling. Moreover, counselors and clients discuss issues related to successful termination in even the earliest phases of counseling. Hence, in addition to providing categories useful for presenting the observations of the 11 exemplary counselors, the concurrent counseling model underscores the fact that different phases of counseling are occurring throughout the engagement of counselor and client.
Using a qualitative research method (Heppner, Kivlighan, & Wampold, 1992; Hoshmand, 1989), this study focused on the insights of exemplary counselors (N=11) regarding factors that affect achievement of employment outcomes for people with severe disabilities. The methods of the present study were designed to discover questions, processes, and relationships rather than test them (Wolcott, 1990) and to enable the investigator to pursue patterns and theories as they emerged in the data (Marshall & Rossman, 1989).
The sample was theoretically derived (Miles & Huberman, 1994), i.e., selected in reference to a conceptual question rather than on the assumption of "representativeness." To address the question of what VR counselors do to meet the employment outcome mandate, researchers interviewed two types of exemplary counselors. Described in a previous study (Cook & Bolton, 1993), the sample consisted of 11 rehabilitation field counselors who were recognized as skillful practitioners. Five of the counselors were empirically nominated (ENs) for the study because their case statistics indicated that they had closed the most cases with outcomes resulting in competitive employment. Five field counselors were nominated by their co-workers (peer nominated - PN) as being highly skilled in helping people with severe disabilities attain employment. The final counselor qualified both as an empirical and peer nominated participant.
Ranging in age from 40 to 62, the average age of the exemplary counselors was 51 years, and counselors 50 to 55 years old comprised 73% of the participants. Two counselors (18.2%) were women and 9 (81.8%) were men. Education levels for the sample included either bachelor's (54.5%) or master's (45.5%) degrees as follows: bachelor's non-rehabilitation (n=6), master's non-rehabilitation (n=4), and master's degree in rehabilitation (n=1). The participating counselors had worked with the agency for approximately two to over twenty seven years. The average length of employment was 14.7 years. Although one counselor had an office in a metropolitan center, the other 10 exemplary counselors had their offices in areas having school districts containing over 2,500 students. Reporting responsibility for multiple counties, most counselors served many clients from rural areas, that is, places of under 2,500 population.
A doctoral student in rehabilitation counseling with 10 years counseling experience interviewed the 11 counselors in their offices at a prearranged time. In the 90 minute structured interview designed to elicit descriptions of quality rehabilitation counseling (QRC), the 11 exemplary counselors responded to the "Mandate" question: "What do you do to help people with severe disabilities become employed that might be different from what other counselors do?" The interviewer followed up with probes such as "Is the Mandate (i.e., improved employment outcomes for more people with severe disabilities) an appropriate goal for VR? Why or why not?", "How have you responded to the Mandate?", and "How has the Mandate affected your agency?"
Using a model recommended by Patton (1990), a team of five experienced researchers and counselors in rehabilitation served as connoisseurs [expert raters) in the process of data analysis. After a proper orientation, the connoisseurs used (a) grounded theory coding techniques to generate open, axial, and selective codes (Strauss & Corbin, 1991); (b) Spradley's (1979) strategy for analyzing semantic relationships; and (c) constant comparative analytic techniques (Glaser & Strauss, 1967) with discrepant case analysis (Erickson, 1986) to compare both within and between case similarities and differences. Systematic qualitative procedures implemented by "seasoned" connoisseurs is a sound method for non-prolonged engagement research (Patton, 1990) that is maximally trustworthy, the analog to reliability and validity in quantitative investigations.
After the senior author edited the interview transcripts, the five connoisseurs individually identified the open codes in the interviews (available from the senior author), i.e., the specific events or incidents in the data. In 11 three-hour periods over three months, the connoisseurs (a) presented, discussed, and compared their open coding results; (b) identified the interrelationships among the open codes; and (c) reached consensus as to the various axial codes (italicized in the text) in the open code data (Strauss & Corbin, 1991). Text-based open code documentation for axial codes described in the Results section is presented in parentheses following the italicized code label for Counselor #1 only. The parentheses include the counselor number, the page of the interview transcript, and the line of the transcript. For example, Counselor #1 made frequent references to her Counselor Work Experience (axial code) on page 2, lines 14- 15 and 17, of her interview transcript(e.g., 1.2.14-15 and 1.2.17). Open code documentation for all 11 counselors' reports is presented in a longer report available from the second author (Mulling & Roessler, 1996).
Abstracts, data displays, and story lines are used to communicate the connoisseurs' structuring of the counselors' interviews. The abstract is a brief, comprehensive summary of the contents of the data display. Data displays portray the relationships among constructs that emerged from a grounded theory analysis of counselor responses to the mandate question (i.e., open codes). The dynamics of each exemplary counselor's description of his or her own system of providing QRC emerged during the development of the data display. The story lines following the data displays are abbreviated reports of the exemplary counselors' versions of how they practiced QRC. Unfortunately, in an article format, it is not possible to discuss all 11 counselors' perspectives (see Mullins & Roessler, 1996). For this reason, four representative analyses are presented which reflect a range of complexity of counselor reporting. The discussion and conclusion sections of the article are, however, based on observations from the interviews of all 11 counselors.
Counselor #1's Response to the Mandate Question
Abstract. As depicted in Figure 1, counselor #1 reported that her past Counselor Work Experience in supported employment was an important factor in forming her current attitude of Acceptance of people with severe disabilities. Counselor #1 had an Egalitarian Empowering Attitude toward people with severe disabilities, and she was in Agreement with the Mandate to serve people with severe disabilities first. Although she Perceived the Impact of the,Mandate to be problematic for some counselors, she did not believe that it had caused her to change her counseling approach.
Story line. Counselor #1 said her past background, i.e., Counselor Work Experience, had prevented her from having problems working within the context of the new Mandate (1.4.17). Although not sure what she did differently from other counselors (1.1.13), she thought her past work experience in supported employment (1.1.14) helped her in working with people with the most severe disabilities (1.1.15). She indicated that a difference between herself and other counselors might possibly be her willingness, due to her previous work experience (1.2.17), to give people with even the most severe disabilities a chance to prepare for employment (1.2.15).
Counselor #1 said she was not doing anything differently as a result of the Mandate. She had always worked with people with the most severe disabilities, and therefore the Mandate was neither unfamiliar nor problematic for her. She stated that, since coming to VR from supported employment two years earlier, her philosophy of rehabilitation had not changed. The only difference in her current counseling role was that she worked with a wider range of disabling conditions (1.2.10 through 1.2.14). In fact, she said it was easier for her to work with VR clients with severe disabilities than with some of the population she had previously served in supported employment (1.3.11 - 1.3.17).
Counselor #1 said she had no fear of severe disability (1.2.19b) and felt comfortable working with people with the most severe disabilities (1.2.[19.sup.a]). She thought that clients with the most severe disabilities recognized that Acceptance in her (1.2.[18.sup.b]). She said she was nonjudgmental (1.2.21) and believed clients responded well to her orientation (1.2.23). Counselor #1 said that she had an Egalitarian Empowering Attitude (1.2.22) and that she gave everybody who wanted to work a chance to participate in the rehabilitation process (1.1.[18.sup.a]). She did not screen anybody out because of severe disability (1.1.[18.sup.b]). She further stated that her criteria for eligibility were not tied to a client's disability but to his or her desire to be employed (1.1.16).
Counselor #1 reported that she was in Agreement with the Mandate and believed the Mandate was an appropriate goal for VR (1.2.1) because people with the most severe disabilities could not be employed without VR services (1.2.3; 1.2.6) and that people with mild disabilities could probably find employment without VR's assistance (1.2.5). Because the VR agency had adopted an order of selection (i.e., serving people with severe disabilities first), she believed that agency resources were being spent on people with the most severe disabilities. However, services were still available for people with less severe disabilities if the services were in-house and/or non-purchased (1.3.2-5), i.e., provided by the counselor. Counselor #1 said she was in accord with the priorities placed on agency resources (1.3.7).
Counselor #1 said that the Perceived Impart of the Mandate has only been experienced recently (1.4.5a), but suggested it had been difficult for some counselors without much past experience with severe disabilities to meet the Mandate (1.3.10). She said that many VR counselors had less experience working with people with severe disabilities (1.3.20) and that some of them, particularly counselors who had been in service the longest, were having the most difficult time adjusting to the Mandate (1.3.21). She said the Mandate, coupled with order of selection procedures, will deter counselors from working the "easy" cases first (1.4.5b; 1.4. 10).
Counselor #2's Response to the Mandate Question
Abstract. Understanding that the Mandate is a federal requirement, counselor #2 saw no point "moaning and complaining" about it. In his opinion, counselor negativity detracts from the effectiveness of counselors. Counselor #2 believed that competitive employment is more difficult for people with severe disabilities; hence, the agency can expect to see closure rates decrease. To cope with the Consequences of the Mandate, he used several Counselor Strategies such as his Insider Status with local employers, careful Client Selectivity for services and referral to employers, Job Market Knowledge, and Innovation in placement such as self-employment in farming. According to counselor #2, the success of these strategies is affected by local conditions such as the state of the Local Economy (a rural area with little industry), Disincentives to employment faced by people with severe disabilities, and a Changing Agency Climate caused by fewer funds and an emphasis on serving more difficult cases.
Story line. Because counselor #2 had worked in a 5-county area for 20 years, he had established working relationships with many local employers. In his experience, representatives of other government agencies did not have this advantage. Familiar with available jobs, equipment used in those jobs, and the skills of his clients, counselor #2 was accepting of the Mandate. In his opinion, rejecting the Mandate would result in fewer people with severe disabilities being served. He recognized an inconsistency between serving more people with severe disabilities and increasing the rate of competitive closures, because employers want people who can produce more as time passes, and people with severe disabilities may find this difficult. According to counselor #2, the more severely disabled a person is, the more difficult he or she is to place in competitive employment.
Counselor #2 reflected on more affluent times when rehabilitation was involved in many activities, some of which may have been less than central to the organization's mission. But the current scene is different. Even if he experiences a decreased number of closures, counselor #2 must work with people with more severe disabilities who require more time. He noted that counselors are not free to select easier cases, e.g., people requiring only surgery, people who are less disabled and more easily closed self-employed (farmers), or probationers for whom the counselor needs only to purchase some tools and work clothes and then close the case after 60 days of employment.
Counselor #2 is working harder for closures because people with severe disabilities are more difficult to place in competitive employment due to Disincentives such as possible loss of Social Security disability checks and medical benefits. According to counselor #2, many people with severe disabilities are uninsurable so they cannot afford to take a minimum wage job and give up these benefits, particularly when one considers additional costs such as transportation and child care. Even so, counselor #2 is able to place people, particularly if they are willing to relocate for employment or undertake self-employment in farming. According to counselor #2, placement may become even more difficult with new federal standards requiring a longer period of trial employment before closure. He reported that farming areas typically offer seasonal employment in which growers must hire every available hand. Individuals who are not employed during harvest time might as well be closed because they are not going to work at all when demand for workers is less pressing. Of course, many will work 6-8 months for 60 to 80 hours a week and then go on unemployment. "It is a way of life here."
Counselor #3's Response to the Mandate Question
Abstract. Counselor #3 reported that the Mandate had a direct effect on Agency Contextual Variables such as Agency Purpose, Resources, and Closure Expectations. Although concerned about the Ambiguity of Agency Purpose and the Definition of Severe Disability, he stated that counselors encountered more barriers to employment when serving people with severe disabilities first. Hence, he believed that his efforts to meet agency Closure Expectations regarding Quantity and Quality would be Negatively affected. He was, however, in Accord with the Mandate and agency Quantity and Quality expectations for clients described as Rational, Goal Oriented, and Responsible who would respond best to his style of rehabilitation counseling which he described as Work Ethic Promoter, Supportive, Information Oriented, and Respectful.
Story line. Counselor #3 wanted to impress upon all VR clients that they were ultimately responsible for themselves and their own rehabilitation. He saw the agency and the counselor as assisting client information processing that was based on a firm foundation of rationality and logic. In counselor #3's system, both the counselor and the client made use of rational problem-solving techniques to arrive at well reasoned and "realistic" decisions. For counselor #3, the counselor's input remained supportive of and subordinate to the client's individualistic efforts to rehabilitate him or herself.
Counselor #3 emphasized the importance of personal involvement in goal setting if people are to successfully complete their vocational rehabilitation plans. The importance of goal setting was accented by counselor #3's revelation that he had not been able to help some clients who were potentially employable because they were not able to formulate "what they're after." Therefore, Goal Oriented behavior was integral to his perception of the VR agency's purpose of "putting people back to work." Counselor #3 possessed both a "golden rule" concept and a respect for others that encourage a client to demonstrate successful goal-setting behavior.
Counselor #3 emphasized a client's responsibility for his or her own successful rehabilitation and suggested that barriers to successful employment outcomes did not usually stem from disability type, but that, more often, they resulted from the case-by-case impact of particular situational variables. Additionally, he did not perceive severe disability as a significant detriment to forming a positive working relationship; however, a client's lack of interest in and commitment to achieving employment was perceived as such.
Counselor #3 indicated that the appropriateness of the Mandate was somewhat difficult to assess due to ambiguities surrounding the definition of severe disability as presented in the Mandate. In cases where an applicant was not deemed eligible for rehabilitation services, i.e., not a person with a severe disability, Counselor #3 viewed referral as a means to (a) serve the Mandate because he would have more time for people with severe disabilities, and (b) help people with nonsevere disabilities because they would receive needed services elsewhere. He stated it was important to understand that the purpose or goal of VR was not to "do good," but to put people "back to work."
Counselor #3 perceived the crux of successful rehabilitation to be accord with the Mandate from the client, the counselor, and the agency. He did not view the mission of VR as significantly altered by the Mandate, but indicated that (a) available resources, (b) closure criteria, (c) job market attributes, (d) quantitative agency expectations, and (e) qualitative agency expectations must correspond to the Mandate. In summary, Counselor #3 viewed successful employment outcomes as the result of a rational, goal-oriented approach based on client responsibility, individualism, and a solid work ethic.
Counselor #4's Response to the Mandate Question
Abstract. Counselor #4's View of Rehabilitation as a process designed to facilitate Client Choice accounted both for her Accord with Mandate and her Counselor View of Self and Counseling Activities. Describing herself as a counselor with Knowledge/Expertise/Experience, she grouped effective counseling behaviors (QRC) into Purposeful Client Contact (including f liens Activation and Community Involvement), Ecological Evaluation (including Information Gathering and Affective Counseling). Information Providing, Counselor Initiative, Counselor Innovation, and Resource Utilization (including Use Rehabilitation Resources, Use Family Constellation, and Use Student Interns).
Story line. Counselor #4 believed that her Knowledge/Expertise/Experience enabled her to make valid order of selection and service delivery decisions regarding people with severe disabilities. Her Knowledge/Expertise/Experience influenced her strategies for (a) generating client training options, (b) involving clients in job exploration, and (c) conducting employer education programs. Purposeful Client Contact, Affective Counseling, Information Providing, Counselor Initiative, and Counselor Innovation had a reciprocal relationship with the expertise construct, i.e., they helped counselor #4 make a determination of and provide services relevant to severe disability.
Arising from her view of self and of rehabilitation counseling activities, Client Choice was an integral part of counselor #4's approach. Describing herself as not of the "old school" of rehabilitation counseling, she avoided gender-specific stereotypes and sought a wide range of occupational and educational choices for all clients with severe disabilities. In her delivery of QRC, she used Purposeful Client Contact to (a) facilitate client choice, (b) encourage active client participation, (c) increase client adjustment, (d) increase the likelihood of successful employment outcomes, and (e) achieve accord with the mandate. Counselor #4 indicated that the initial phase of client contact was critical for building trust and increasing client self-esteem. Incorporated into her strategy of Purposeful Client Contact were the axial constructs Client Activation and Community Involvement.
Counselor #4 stated that Client Activation increased the probability of achieving the above five rehabilitation goals because keeping clients active and involved was an important aspect of successful rehabilitation. She stressed the need to follow-up with clients with severe disabilities as a means of keeping them activated. She mentioned concrete examples of follow-up activities such as (a) not leaving a client alone, (b) sending people to get clients out of the house, and (c) taking a client out of the house in his or her wheelchair.
According to counselor #4, Community Involvement was another way to motivate clients. Counselor #4 gave examples that included (a) taking clients to a college campus, (b) taking a client to a vocational technical school, and (c) involving clients in community activities because the community offered support for VR and provided preparation for employment. She stated that recreational opportunities in the community could also lead to increased employability.
Consistent with her emphasis on Ecological Evaluation, counselor #4 said she began Information Gathering immediately, using it as a vehicle to provide Affective Counseling to help clients define their goals and identify barriers to employment. Counselor #4 underscored the strength of the reciprocal relationship between Affective Counseling and Information Gathering and stated that, if a counselor does not communicate a genuine concern about the individual's situation and feelings, then the person will not disclose essential information. She said that a client will, in fact, talk about personal problems, feelings, and family situations if a counselor asks about them because asking is the first step to building trust in the relationship.
Counselor #4 made use of Information Gathering in the service of Information Providing so that the counselor could better (a) inform the client of rehabilitation services, (b) motivate the client to participate, (c) enhance adjustment to disability, and (d) increase the probability of successful client outcomes. She stated that, during the initial interview or from the very beginning of client contact, she stressed that satisfactory employment was the primary goal of the vocational rehabilitation process.
Counselor #4 used Counselor Initiative, Innovation, and Resource Utilization to achieve the Mandate. She gave numerous examples of her initiative including (a) "I found all kinds of information about a disabled fishing group", (b) "I try to do whatever I can to get them involved...rather than close them out as...not interested", (c) "It was my idea to start the head injury group", and (d) "I went into their home and I met the whole family". Her statements, (a) "I might do things that we've [her agency] not done before", (b) "I do not go with what I think is old school rehabilitation counseling", and (c) "I'm always looking for innovative ways to use my practicum students" described how she practiced Innovation. Counselor #4 described Resource Utilization as a way to (a) Use Rehabilitation Resources to overcome any constraints such as time or funding shortfalls, and (b) Use the Family Constellation in an effort to reduce or remove barriers to successful client outcomes. Counselor #4 made an effort to Use Student Interns to perform tasks for which she did not have time -- a solution to personal time constraints that might prevent or delay achievement of rehabilitation goals.
The discussion section is a synthesis of the open and axial codes in the interviews of the 11 exemplary counselors who responded to the question "What is Quality Rehabilitation Counseling (QRC), i.e., what do you do to help people with severe disabilities become employed that might be different from what other counselors do?" Before discussing the counselors' observations in relation to the concurrent counseling model, one must highlight counselor commitments or predispositions that underlie QRC, e.g., the counselors' expectations regarding (a) their proper role and function, (b) the significance of disability and other client characteristics, and (c) attitudes toward the mandate.
Orientation to VR counselor role. QRC requires an active counselor who is committed to maximizing the client's freedom of choice. Active counselors take the initiative to provide people with the services they need and to encourage them to take advantage of those services. The commitment to freedom of choice encompasses not only a belief in the right of the person to select goals for the rehabilitation plan, but encouragement to select goals that represent the person's interests rather than stereotypical gender or disability-based notions about employment. Effective counselors are "supportive of and "subordinate to" their clients' individual efforts to direct their own rehabilitation programs. At the same time, counselors have the responsibility to help people minimize the probability of failure. Minimizing failure means that counselors must promote the work ethic in clients, help them choose jobs for which they are qualified, and resolve barriers to employment.
Voicing a strong commitment to serve people with severe disabilities, one counselor believed not only in clients' rights to employment, but also in their capabilities to succeed in competitive employment. In fact, without a priority on serving people with severe disabilities, this counselor believed that vocational rehabilitation might cease to exist. People coping with less severe conditions could find employment on their own; therefore, the commitment to serve people who needed help the most was entirely appropriate. Another counselor did, however, stress the importance of referring people who did not qualify for rehabilitation to appropriate agencies.
The impact of disability and other characteristics. Based on their experiences, exemplary counselors held certain assumptions about the factors affecting employment outcomes. First, some of the counselors stated that people with severe disabilities are more difficult to place. Another counselor stated that a visible condition is often more easily understood by an employer and, thus, less likely. to lead to barriers to employment than an invisible condition. For several counselors, case difficulty is more a function of low levels of work motivation, intelligence, and education than functional limitations resulting from a medical condition.
Based on his experience in vocational rehabilitation, another counselor described individuals who have experienced severe disabilities as overwhelmed. To regain control of their lives, people seeking VR services need information, support, inspiration, motivation, self-esteem, empowerment, and a return-to-work vision. Without the help of the rehabilitation counselor, they are unable to imagine themselves "two years down the road" (an employment vision) and, therefore, cannot identify or commit to the intermediate steps needed to achieve a more productive and independent status.
Attitudes toward the mandate. Although all of the counselors were strong advocates of rehabilitation's responsibility to help people with severe disabilities achieve employment, they held different views on the effect of the Mandate on their success. Believing that a caseload with more severe disabilities would require more counselor time and case service expenditures while resulting in fewer successful closures, some counselors were concerned about their abilities to meet agency closure expectations and, therefore, were less receptive to the Mandate. One counselor stressed that people with severe disabilities face more disincentives to employment, i.e., loss of financial and medical benefits and increased childcare and transportation costs, which decreases the probability that they will find suitable employment. Another counselor viewed the Mandate as a challenge that provided him with a sense of intrinsic satisfaction when he was successful in helping a person with a severe disability secure employment. The challenge presented by change brings out the best in counselors and prevents them from becoming "stagnant."
Other counselors viewed the Mandate as presenting inherently inconsistent expectations (i.e., increase employment outcomes while serving more people with severe disabilities). The Mandate diverts funds from individuals with less severe disabilities who have greater potential for acquiring and retaining employment. Without individuals with less severe disabilities on their caseloads, some counselors were concerned that they could not meet agency expectations for employment closures.
Stating that they should concentrate on helping people with the most severe disabilities become employed, other counselors viewed their colleagues as disgruntled because they could no longer serve the "easy" cases due to the Mandate. Examples of easy cases included individuals who only needed (a) minor surgery or (b) tools and uniforms in order to return to work. Indeed, one counselor believed that the purpose of the Mandate was to "discourage counselors from doing the easy ones twice."
At the same time, several counselors identified pressing needs that must be met to respond to the Mandate more effectively. First, guidelines are needed that clarify the definition of severe disability and the procedures for implementing order of selection at the local level. Second, if counselors are to serve more people with the most severe disabilities, they need additional resources from the agency. Finally, one counselor stressed the need for the agency to decrease its expectations regarding the number of successful closures in keeping with the more difficult cases that counselors were serving under the mandate. The preceding observations about counselor predispositions provide a proper foundation for examining the counseling process as depicted in the concurrent model.
Relationship building. Necessary throughout the counseling encounter, a relationship of trust with a person is an important outcome of affective counseling which one counselor implemented by expressing genuine concern for the client. Another counselor described interpersonal approaches he used to communicate genuine concern such as taking the client and the client's concerns seriously. Describing himself as trusting to a fault, he stressed the need to respect the person, i.e., "the person deserves to be treated just like I want to be treated."
Counselors who maintain these client-centered interpersonal styles believe they achieve positive outcomes with people in psychological, motivational, and informational areas. As a result of caring, empathic relationships with counselors, people develop an enhanced sense of self-respect and self-esteem (psychological). Furthermore, people in such a relationship with a counselor are motivated to pursue their rehabilitation goals (motivational) and to disclose information vital to diagnostic and planning processes (informational).
A working relationship with a person seeking rehabilitation services begins with acceptance of that individual by the counselor. Counselor acceptance means that counselors do not fear people with severe disabilities and that they approach them with a nonjudgmental, egalitarian, and empowering attitude. Regardless of how overworked these phrases may sound, they are descriptive of counselors who build therapeutic relationships with their clients that contribute to the achievement of rehabilitation goals. These phrases are also descriptive of counselors who do not lapse into negativity about job duties and expectations. The presence of such negativity can have a detrimental effect on the quality of the counselor's relationship with people on his or her caseload.
Assessment. Referring to assessment activities as information gathering, one counselor stressed that information on the following areas must be gathered: affective state (e.g., level of depression and self-image), extent of functional limitations e.g., mobility and lifting), level of academic and educational functioning, intelligence, level of vocational training and need for retraining, and nature and gravity of family conflict. Adopting a similar philosophy, another counselor emphasized the need for holistic assessment which focuses on "person in situation." No longer limiting himself to a medical perspective when assessing a person's needs, he stressed the need to identify and accommodate the functional limitations the disability imposes and/or to determine whether skills from past work experiences are transferable to a new job.
Incorporating both an ecological and individual focus, a holistic evaluation approach was adopted by another exemplary counselor. The ecological focus involves the counselor in determining how the individual's current life situation, opportunities in the local labor market, and past work experiences affect the person's potential for vocational success. By reviewing results from psychological (personality) and vocational (aptitudes and interests) evaluations, the counselor attempts to determine how the person's attributes (individual focus) will affect his/her success in employment. Given the complexity of severe disabilities and their multiple effects on functioning, this counselor relied on the assessment process to help him cope with the effects of the Mandate on his case outcomes.
Goal setting and planning. In a QRC approach to planning, the counselor performs functions of information provision, clarification, and organization. With regard to provision of information, the counselor explains his/her overall role, the purpose and parts of the rehabilitation plan, and relevant rehabilitation services. The counselor also prepares the person for the challenges that lie ahead in terms of completing the required counseling, restoration, and training stages as well as overcoming significant barriers to employment. The counselor assists the person in (a) establishing a vision of being able to return to employment, (b) clarifying his or her vocational goal, (c) relating assessment results to the goal, and (d) developing the objectives and steps in the vocational plan (IWRP).
During goal setting and planning, clients are often seeking more than factual information about their conditions and rehabilitation services. As previously stated, they are seeking a vision of the future. To instill this vision, one counselor shares stories about successful clients who have overcome many of the same challenges his current client is facing. These positive role models provide inspiration in a very effective way; they communicate to the person that a vision of employment is realistic and that help is available.
People in rehabilitation also need personal involvement in goal setting, i.e., the opportunity to direct the development of their own rehabilitation plans. One counselor spoke of losing clients because they were not able to "formulate what they are after" (vision), thus being unable to direct their own rehabilitation plans. With personal involvement comes goal-oriented action which is integral to achieving and maintaining employment.
Intervention. Service delivery or intervention in QRC takes several forms. One approach involves personal outreach to referral sources and employers. Referral sources need to understand the counselor's commitment to serving people with severe disabilities. With this knowledge, referral sources can send counselors the appropriate types of individuals, thus remaining a real asset in the case finding process. Appropriate individual's are those who both qualify for services based on the severity of their disabilities and who have the potential for successful employment in the community.
Another approach involves employer outreach. Counselors must prepare employers for the types of referrals that rehabilitation will provide under the Mandate. Individuals with severe disabilities may need additional on-the-job accommodations and support. Informing employers in advance about such needs facilitates the placement process. Advance preparation of employers also helps the counselor counter employer discrimination which one respondent identified as one of the main barriers to employment faced by people with severe disabilities.
Outreach to employers builds the counselor's knowledge of the local job market and of the jobs available in that market. This knowledge includes information on specific job demands and equipment used to meet those job demands. With this firsthand exposure to the work setting, i.e., an "insider status" with local employers, the counselor is more effective in matching people and jobs, thus building the employer's confidence in the counselor's ability to refer work-ready individuals. One counselor referred to this person/job match as an example of "client selectivity" that he considered essential to effective rehabilitation services. Of course, employment with local businesses is not always possible in areas with depressed and/or limited economies. As a result, creative solutions are needed such as self-employment in farming or relocation to other communities.
Counselors must maintain contact with the person throughout the service delivery process, making concerted efforts to keep the person active in the service program and in the community. Issues contributing to family conflict such as loss of income and unemployment must be identified and resolved immediately. Furthermore, rehabilitation interventions become more effective when all available resources are used in conjunction with the treatment plan. To control case service costs, several counselors stressed the need to use both counseling and guidance provided by the counselor and similar benefits available from community agencies and organizations (i.e., churches, civic groups, and other adult agencies). One counselor used student interns to involve clients in community recreational activities and educational programs, and to develop support groups for people with severe disabilities such as head injuries.
Termination. The exemplary counselors focused more on preparing to serve and serving people with severe disabilities than they did on the termination phase of counseling. One explanation for their process focus may be that the rehabilitation plan has an automatic termination phase, namely achievement of the vocational goal. At the same time, lack of discussion of termination raises some question as to whether additional planning is needed regarding on-the-job follow-up and postemployment counseling.
Based on open and axial codes, the exemplary counselors' views of QRC include beliefs about the counselor's role, the impact of disability, the effects of the mandate, and "best practices" of the concurrent counseling model, e.g., relationship building, assessment. goal setting and planning, and intervention practices. First and foremost, counselors are proactive, empowering, and creative. They initiate needed services ranging from offering traditional counseling and guidance to enrolling the person in community support or recreational groups. Empowerment means playing a supportive and subordinate role as the person develops and directs his/her rehabilitation plan. Creative counselors link clients to vocational roles based on individuals' pest experiences, skills, and preferences rather than on gender or disability stereotypes.
Counselors were of two minds about the impact of severe disability on the employment prospects of people. Several counselors stressed that disability is not the primary issue. They were more concerned about the person's (a) commitment to the work role (work ethic) and (b) optimism about successful resumption of work. Therefore, counselors must know how to assess the person's status on these variables.
Other counselors stressed that disability is an issue in several ways. Although counselors should not fixate on the medical condition, they must determine the functional limitations the condition presents. Second, counselors should recognize that some types of disabilities, particularly invisible conditions, may create more employer discrimination than more visible disabilities. Finally, one counselor explained that the psychological impact of severe disability left some clients in a state of shock in which they were unable to establish and achieve vocational directions for their lives. Counselors must relate genuinely to this emotional state as well as help the person reestablish an employment vision.
Beliefs about the impact of the mandate on QRC was another important counselor predisposition. Recognizing the need to serve people with severe disabilities first, some counselors were concerned that the additional time and money required rendered previous closure quotas obsolete. They reported that competitive employment closures would decrease as the result of serving people with more severe conditions and more disincentives to employment. To provide QRC to people with the most severe disabilities, counselors requested (a) clearer guidelines for defining severe disability and making order of selection decisions, (b) additional staffing and case service funds, and (c) realistic outcome expectations regarding number of people closed in integrated, competitive employment. Counselor suggestions for meeting these needs could be generated as part of any inservice training effort.
Consistent with the concurrent model which shows the relationship as a constant in counseling, the counselors stressed the importance of training in affective counseling. Taking the person seriously, accepting the person, believing in the person's right to employment, expressing genuine concern, trusting the person, and respecting the person were key tenets of affective counseling. Good relationship skills on the counselor's part (a) motivate people to pursue their rehabilitation goals, (b) encourage people to share important information, and (c) help people develop feelings of self-respect and self-esteem. Information provided in the QRC interviews suggests that microskills laboratory experiences, internship assignments with experienced counselors, and mentoring relationships with counselors are effective ways to teach affective counseling skills.
Described as information gathering, client assessment encompassed both an ecological and individual focus. Consistent with an ecological focus, counselors stressed the need to understand the person's current family situation and the conflict and support that exists therein. The ecological approach involves the counselor in understanding the types of jobs in the local labor market, the equipment and accommodations used in those jobs, and the employment projections for those positions. The individual focus in assessment directs counselors to gather information on the person's affective state, aptitudes, skill potential, vocational interests, level of academic functioning, and functional limitations and strengths. Training in vocational evaluation must include interview techniques and orientation to instrumentation that will help counselors implement an individual and ecological approach in their assessment.
Information provision, clarification, and organization are three goal setting and planning processes. The counselor provides information on his/her role, the purpose and parts of the rehabilitation plan, and relevant rehabilitation services. The counselor helps the person clarify a vocational vision and develop and direct a plan to achieve that goal. Counselors can learn these goal-setting and planning skills through case examples and simulations.
Intervention activities of counselors include utilization of traditional purchased services, similar benefits from other programs and community-based facilities, and student interns from local universities. Counselors monitor the person's progress in the treatment plan and intervene in family conflicts. Training sessions on similar benefits and community resources, case management, and family counseling can provide counselors with the knowledge needed to improve their service delivery skills.
Counselor outreach went beyond the family to include working directly with referral sources and employers. If they are to refer appropriate people to rehabilitation, referral sources need to understand how the Mandate to serve people with severe disabilities has affected eligibility criteria and decisions. By spending time with employers at the job site, counselors can prepare them to accept job support services such as job coaches and to provide on-the-job accommodations for people with severe disabilities. Through involvement at the workplace, counselors learn more about job demands in the community and thus become more effective in vocational counseling and placement. Particularly in inservice training sessions, counselors can share their own innovative strategies for conducting referral and employer outreach.
The task ahead is to create, with the input of agency administrators, practicing counselors, and rehabilitation educators, inservice and preservice training experiences that improve counselors' abilities to deliver quality rehabilitation counseling (QRC). QRC training programs should reflect the priorities and wisdom of these 11 exemplary counselors as manifested in the axial codes, data displays, and story lines in this article.
The authors wish to thank Arkansas Rehabilitation Services, Director Bobby Simpson, and, most of all, the 11 exemplary field counselors for,their support of this project. Contact the second author for information regarding the availability of a longer report describing the perspectives of all 11 exemplary counselors (including open coding documentation): Research and Training Center, Department of Rehabilitation, 346 N. West Avenue, University of Arkansas, Fayetteville, AR 72701.
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Richard Rossler, College of Education, Department of Rehabilitation, University of Arkansas, 346 NW Avenue, Fayetteville, AR 72701
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|Publication:||The Journal of Rehabilitation|
|Date:||Oct 1, 1997|
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