Professional fragmentation in rehabilitation counseling.
Numerous concerns have been voiced about rehabilitation counseling's status in the current literature. This article focuses on professional status, identifies four areas of professional fragmentation that impact our current standing, (title transition, professional preparation, credentialing, and professional associations) and suggests ways in which to enhance professional growth.
Since the 1940s, rehabilitation counseling has been evolving as a major, service-providing profession. Nadolsky (1985) noted, for example, that as the rehabilitation movement has continued to expand, rehabilitation personnel have become an integral part of modern society. Field and Emener (1982) commented that its growth and development over the last few decades has established rehabilitation counseling as a viable and credible program for providing services to persons with disabilities.
The distinction between rehabilitation and rehabilitation counseling should be established at the outset. Rehabilitation counseling refers to a specific group of professionals who provide services in rehabilitation and related programs. Rehabilitation, on the other hand, refers to the entire field, including public and private rehabilitation, and involving a multitude of related professionals including physiatrists, rehabilitation nurses, occupational and physical therapists, administrators, work evaluators, work adjustment trainers, and vocational experts as well as rehabilitation counselors.
Rehabilitation counseling has the uniqueness of being established by Congress. Nevertheless, it has experienced numerous problems, some of which have been generated by state and federal activities in rehabilitation. For example, although legislative and administrative actions have shaped the structure and status of rehabilitation counseling practice, they have also created havoc in areas of funding, litigation, target populations, and accountability. Many of these impact rehabilitation counseling's status and professional identity.
Numerous authors (Collins, 1980; McFarlane and Frost, 1981; Field and Emener, 1982; and Nadolsky, 1984) have speculated that in the 1980s there would be a number of critical issues confronting the profession, and during the past six years it has been evident that many problems have surfaced. These issues represent challenges that must be resolved, if the discipline is to continue positive professional growth.
This article examines how rehabilitation counseling has maintained and improved its professional status, identifies factors that have impeded its growth, and suggests how these problems might be resolved.
Perhaps the issue most threatening to the profession's continued growth is fragmentation in the areas of title transition, professional preparation, credentialing, and professional associations, which could prove harmful to the professional identity and the attainment of greater status for rehabilitation counseling as a profession.
This discussion will examine the following key questions:
(a) What is the status of rehabilitation counseling's professional identity?
(b) What are the criteria for attaining professional status?
(c) What is rehabilitation counseling's current status?
Professionalism in Rehabilitation Counseling
Professional Identity/Professional Status
Identity, among other things, is related to an individual's sense of membership in a professional group. Status is determined by established standards and represents an ultimate goal for a profession as a whole. Thus, a discipline could have professional identity but not a high degree of professional status. At the same time, attaining professional status may result in strengthened identity.
The attainment of professional status often represents identity (personal and group), prestige, power, authority, social status, work autonomy, authority, job security, and better income (Lynch and McSweeney, 1981). Because of the rewards associated with the attainment of a high degree of professionalism, occupations generally strive to move up in status (Lynch and McSweeney, 1981).
Rehabilitation counseling's lack of a clear professional identity is not a new problem. Some 20 years ago, Sussman (1965) commented, "...the layman is for the most part unfamiliar with the field [of rehabilitation], those who work in it, and the tasks they perform... The consequence is extensive variability in the perception of the field and the workers within it...(p. 210)." Nearly twenty years later, Jellinek and Lynch (1983) noted this perception has not changed to any great degree.
This lack of identity has been attributed to various causes. These include: (1) the lack of an accepted definition of rehabilitation counseling (Jellinek, 1982); (2) a lack of uniformity in training programs (Jellinek and Lynch, 1983; (3) varied titles, expectations, and job settings (Jellinek and Lynch, 1983); and, (4) an emphasis on specialization (Wright, 1984).
If professional identity presents a problem for rehabilitation counselors, think of what it implies for consumers, legislators, and other professionals. A significant aspect of professional identity is how others perceive the group in question. Recall that the focus here is rehabilitation counseling, one area of total rehabilitation. It becomes apparent that confusion can occur because the rehabilitation counselor does not have an identity separate from the many disciplines involved in the overall rehabilitation profession.
Most authorities agree on critical elements necessary for evaluating and achieving professional status. These include: "...(a) a systematic body of knowledge, (b) professional authority based on extensive education, (c) strict rules regarding entry into the occupation, (d) a service orientation, (e) community sanction based on social values, (f) ethical codes, and (g) a professional culture..." (Lynch and McSweeney, 1981, p. 86). Professional status is determined by the extent to which each of these objectives is achieved.
Authorities such as Brubaker (1977), and Lynch and McSweeney (1981) conclude that rehabilitation counseling has not attained full professional status. They cite several factors for this situation, including the lack of many of the critical elements stated above. Additionally, they note rehabilitation counseling's shortcomings, generally speaking, in areas such as: (1) a career ladder in many instances, (2) adequate public visibility, (3) professional authority, (4) input into the bureaucratic structure, (5) a permanent commitment to the discipline by many members, and (6) a single professional organization or publication.
Wright (1984) stated that rehabilitation counseling suffers fragmentation like no other profession and is going in all different directions. This view is echoed in other literature, particularly in discussions of: (a) title transition, (b) professional preparation, (c) credentialing, and (d) professional associations.
Areas of Fragmentation
Although McFarlane and Frost (1981) stated that rehabilitation is currently in a state of transition, Cassell and Mulkey (1985) emphasized that rehabilitation has been in a state of change since its inception. Cassell and Mulkey (1985) commented that rehabilitation's direction may shift focus as a result of economic or political climate, consumer assertiveness or activity, or a number of other elements. For example, target populations may change as a result of a decrease in funds so that a priority might be placed on serving only the severely disabled. This type of change impacts all aspects of rehabilitation. However, perhaps the most significant impact is on the rehabilitation counselor in terms of performance, role expectations, employment availability, and so on. Because changes often lead to more accountability, auditing, pressure to increase performance, and work overload, the result is often increased stress, role strain, and burnout (Emener and Rubin, 1980).
It seems that the constant changes often result in title transition, a suspected source of professional fragmentation. For example, rehabilitation counseling graduates who trained under a standard curriculum may need additional, specialized training in order to get a job. This training might be for a specific disability or preparation for employment in a non-traditional setting, such as private rehabilitation. According to Dohanian (1981), graduates are forced to look for jobs in non-traditional settings because traditional state/federal programs, private nonprofit agencies, or universities have declined significantly as prospective employment settings.
Lynch and Herbert (1984) have documented the use of rehabilitation counselors in numerous nontraditional settings, such as the court system, diagnostic and treatment clinics, educational settings, insurance companies, major corporations, various industrial settings, private medical settings, and private rehabilitation practice. However, Nadolosky (1985) cautions that these activities are often confused with rehabilitation counseling. One example of this would be when a rehabilitation counselor offers his services for vocational expert testimony to attorneys or insurance companies. Several authorities (Nadolosky, 1985; Nadolosky, 1984; Field and Emener, 1982; Brubaker, 1981) note these activities are not related to the primary goal of rehabilitation, which has traditionally been the provision of services to persons with disabilities enabling them to become fully self-sufficient and as independent as possible. At times, the traditional goals of rehabilitation have been overlooked in a desire to meet the needs of the referral source.
Also, graduates may be confronted with contradictions about role expectations. The traditional and nontraditional employer may have quite different expectations due to differences in employment settings, philosophies, or functions. Or, graduates may encounter situations where different titles are used to denote the same or similar jobs. At other times, a single title may be used for a variety of people, each of whom has varied roles and functions. An example is where an insurance company hires a person as a rehabilitation "specialist" who may be trained as either a rehabilitation counselor or as a registered nurse. For other professionals or the general public, this could create confusion and skepticism due to the fact that persons with obviously different educational and training backgrounds have been hired for identical employment.
If colleagues continue to accept positions in nontraditional employment, where roles and functions are obviously different, there could be a danger to rehabilitation counseling's professional growth. As professionals, do we dissuade persons from seeking jobs in nontraditional settings (because of the ethics of accepting a position for which one is not trained)? Or do we remain compliant, realizing that traditional positions are limited? Hopefully, concerned parties can generate effective solutions, since it would likely increase their professional credibility. Furthermore, it seems imperative that rehabilitation counselors recall the traditional goals and basic principles upon which rehabilitation counseling has been founded.
Professional preparation for rehabilitation counseling includes both preprofessional graduate training and continuing education after employment. In graduate rehabilitation counselor education programs there are prescribed accreditation standards. Despite these standards, Emener and McFarlane (1985) note that rehabilitation education in its entirety appears to be mediocre, unimaginative, and in the past, reactionary. They comment that rehabilitation counselor education needs to be modified in order to accomodate the future. A few of the modifications suggested were an increased knowledge base for computer technology, vocational expert testimony, and marketing and business components. To accomplish this goal they propose an educational model encompassing professional career planning for life, based on predictions for future needs.
Does educational specialization lead to fragmentation? Wright (1984), and Emener and McFarlane (1985), comment that specialization is a reality and in all probability will continue. Although there appears to be a need for specialization because it promotes diversification, it may lead to greater fragmentation if there are no controls for training preparation or certification. Wright noted that we are particularly fragmented in specialization by function, such as counselor, evaluator, work adjustment specialist, and others.
A significant problems arises when a group is not satisfied with their restricted domain and comes to view themselves as competent for another, without having the necessary training and skills. An example would be when someone trained as a vocational evaluator, rehabilitation nurse, teacher, psychologist, or educational diagnostician accepts a job as a rehabilitation counselor. Wright (1984) further notes that, unlike rehabilitation counseling, many of these specializations, such as vocational evaluator and work adjustment specialist, do not have the benefit of years of research in areas of client needs, instructional content, and competencies on which to base a sound body of knowledge.
Jellinek and Lynch (1983) speculated that fragmentation might be traced to a lack of uniformity across rehabilitation counselor education programs in regards to degrees awarded, and transcript wording. It is not unusual to find persons with nearly identical training graduating with a Masters of Education, a Masters of Arts and Sciences, or a Masters in Rehabilitation. They stated that inconsistencies tend to confuse the public, other professionals, prospective employers, and the graduates. Their research indicated that although programs in rehabilitation counseling are producing the same product, they appear not to be because of different labels.
A primary need of rehabilitation educators and rehabilitation counselors, would be to educate and prove our worth to prospective employers. The need exists to demonstrate that having training as a rehabilitation counselor signifies competence to the highest degree and therefore, the best employee choice.
Professional practice credentials include registry, certification, and, in several states, licensure (Scofield, Berven, and Harrison, 1981; and Cottone, Pullen, and Wilson, 1983). Concerns in this paper are certification and licensure.
Evidence indicates state vocational rehabilitation administrators do not support the certification process, as they do not require training or certification as a rehabilitation counselor as a prerequisite for employment, nor do they plan to do so in the future (Lynch and McSweeney, 1981). This lack of support from a major component of rehabilitation certainly affects rehabilitation counseling's professional status.
Credentialing is also affected by personnel providing services in the name of rehabilitation who may or may not be appropriately trained for the specific position, such as private rehabilitation. Unfortunately, similar to state rehabilitation, a person in private practice is often not required to be certified or licensed to perform a job. To date, numerous specializations have developed their own certification standards or are in the process of doing so. Certification for specializations, such as Certified Insurance Rehabilitation Specialists (CIRS), Certified Vocational Evaluator (CVE), and Certified Work Adjustment Specialist (CWA), and so on, although important, may result in professional fragmentation for the Certified Rehabilitation Counselor (CRC), if persons are allowed to drift into rehabilitation counseling simply because they have a certification in a specialization.
Scofield, Berven, and Harrison (1981) commented on another aspect of credentialing and its potential impact on professionalism. They question how certification standards are established with a wide diversity of people in a profession that is not adequately defined and continuously changes. They stress caution in accepting an examination as a valid indicator of professional competence. They question whether the certification examination actually indicates competence. Therefore, they suggested that it might be premature to use existing credentialing procedures to determine who is competent to practice, and, definitely question certification as a forerunner of more strict and mandatory credentials such as licensing. Second, they question whether practitioners will support a credentialing process, due to the fact that the rehabilitation counselor perceives limited return for money spent to be certified. Rehabilitation counselors certainly do not appear to be getting jobs, promotions, salary increases, job security, and skills simply because they are certified.
How certification and licensure could be related is uncertain at this time, but could result in some interesting situations, confusion, and conflicts (Hardy, Luck, and Chandler, 1982). For example, a counselor might attain the necessary certification credentials for public agency employment, but find it useless in a private setting requiring a license. Therefore, one's professional credibility might depend upon the specific setting rather than one's professional practices (Hardy, Luck, and Chandler, 1982).
It would appear that credentialing, a needed declaration of professionalism, could also be professionally fragmenting. Rehabilitation counseling's professional status becomes weaker when the validity of credentialing becomes suspect, when it is not a consideration for hiring, when it does nothing to denote one's appropriate role and function, or when there is overlap among specializations. All of these have impeded-the attainment of greater professional status.
Matkin (1983) has suggested, in order to promote guidelines, standardization, and control for all rehabilitation certifications, that there be a single practitioner credentialing agency, as opposed to bodies functioning independently of each other as is the case now. This agency would have the responsibility for both core and specialty examinations.
Nadolosky (1985) predicted that in the 1990s, the provision of services would be based on a practitioner's ability to meet needs and not on external achievements of the service providers, such as accreditations, certifications, licenses, or degrees awarded. Although skills and abilities are of utmost importance, a profession must have rules for entry into the discipline. Therefore, a profession must have a credentialing procedure in order to attain full professional status. Perhaps rehabilitation counseling needs to scrutinize the existing credentialing process to insure efficacy and use more stringent guidelines and controls for certification.
There are several professional organizations with which rehabilitation counselors could affiliate, such as the National Rehabilitation Counseling Association (NRCA), the American Rehabilitation Association (ARCA), or the National Association of Rehabilitation Professionals in the Private Sector (NARPPS). Several authorities have perceived this as fragmentation rather than healthy diversification in the field (Brubaker, 1981a; Matkin, 1984; Wright, 1984). Sinike's perception, as noted by Brubaker (1981a), was that a splitting of the field occurred in 1957 when NRCA and ARCA became professional affiliation alternatives and has continued to be a problem and an area of confusion for many people. He speculated the greatest problems may be due to the possibility that NRCA, which is a part of the National Rehabilitation Association, is perceived by professionals as being more closely affiliated with Rehabilitation Services Administration and state rehabilitation. Therefore, if one were interested in state employment, NRCA would be the likely choice, whereas someone with a broader orientation, would likely be affiliated with ARCA. As Brubaker noted (1981a), fragmentation has made it virtually impossible for the profession to acquire widespread public visibility, legislative support, and professional respect. This has been an area of widespread concern for years and has been fully discussed in a special 1981 issue of Journal of Applied Rehabilitation Counseling (volume 12, number 2).
A number of alternatives to resolve this perceived fragmentation, have been suggested in the literature. One suggestion was that the different associations consolidate and combine their efforts (Matkin, 1984; Rubin, 1981). However, as noted by Wright (1984), this talk of merger has been going on for years and might never be possible because of legal and other problems associated with the process of dissolution of either association. Instead, Wright recommended that association leaders develop a master plan delineating responsibilities. To ensure continued professional growth in this area, perhaps the appointment of a task force to explore solutions would be the best answer. Otherwise, the profession will suffer even more.
Although rehabilitation counseling has been a mainstay in our society, the profession seems to be troubled. Severe fragmentation in several areas seems to have had a negative impact on its professional identity and status. Perhaps Brubaker (1977) was correct in his notion that the term "professional" is viewed as an ideal concept not existing in the real world. The fact that the profession does not fully meet the traditional criteria at this point should not steer us away from this issue. Professional rehabilitation counselors must take the steps necessary to resolve these weaknesses, thereby moving toward full professional status.
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|Author:||Irons, Thomas R.|
|Publication:||The Journal of Rehabilitation|
|Date:||Jul 1, 1989|
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