Rehabilitation Counselors' Experiences with Client Death and Death Anxiety.
Despite the probability of increased exposure to client death when working with high-risk populations, little empirical evidence has documented the level of preparation of rehabilitation counselors regarding the effect of death or death anxiety. The research literature does show, however, that client death has an effect on counselors and on their work with clients. Some counselors may find they have more empathy for clients and a better appreciation of life as a result of a client dying (Allen & Miller, 1988), but some counselors may experience negative reactions as well. For example, negative reactions to clients with life-threatening or terminal illnesses include premature termination of the counseling relationship; feelings of helplessness, anxiety, and discomfort; denial or avoidance on the part of the counselor to death with the inevitability of a client's death; and impaired work ability and efficiency (Allen & Miller, 1988; Allen & Sawyer, 1984; Hayes & Gelso, 1993; Humphrey, 1993). Regardless, working with dying and grieving clients can make counselors confront their own losses, as well as the losses their clients are experiencing (Rando, 1984).
Allen and Jaet (1982) surveyed 198 vocational rehabilitation counselors about their experiences with client death and bereavement training. Of the respondents, 77% had experienced the death of a client during the previous four years. The range of clients who died was between one and 30, and about half had experienced the death of one to three clients during that time period. Counselors who had experienced the death of a client reported that their work and home life were affected by the death, as well as their emotional state. When asked about training received, 24% said they had received some training in death and bereavement issues, 59% thought training about death and dying issues was needed to perform their jobs, and 70% expressed a need for training specifically to work with people with terminal illness. Allen and Jaet made the call for further training in death and dying issues and expressed a need for onsite support and supervision for counselors who experienced the death of a client on their caseload.
With respect to training, Bascue, Lawrence, and Sessions (1977) surveyed 54 vocational rehabilitation counselors and found that 61% had had a client with whom they were working die in the previous 12 months. Yet 72% of these counselors reported that they had never received any training related to death education. As a result of their findings, Bascue et al. called for more death and dying education for rehabilitation counselors, stating "the liklihood [sic] that counselors face such death-related issues makes the need for training compelling" (p. 38).
Allen and Miller (1988) replicated Allen and Jaet's (1982) study by surveying 627 certified rehabilitation counselors (CRC) about their training and experiences with client death between 1982 and 1985. With respect to death and dying issues, 98% thought training was needed, but only 22% had received such training. Of the CRCs who provided direct client services (n=371), 61% had one or more clients die during a three-year period, with 85% of these people experiencing the death of between one and six clients. CRCs who had experienced the death of a client reported the death had an effect on their professional and personal lives. Of the CRCs who had experienced the death of a client, the majority (59%) reported that peers and colleagues were their greatest source of support at work. On the other hand, only 4% reported receiving support from their supervisors.
In a study of 160 master's level rehabilitation counselors-in-training, (Hunt & Rosenthal, 1997) found 34% of the trainees had experienced the death of a client. Of the students surveyed, 31% stated they would prefer not to work with clients who are dying. With respect to training, 83% thought death and dying training would be needed for their jobs, yet only 23% reported receiving any training on the topic. The researchers also assessed the students' level of death anxiety using the Templer Death Anxiety Scale (1970) and found that the majority of respondents (75%) fell in the moderate death anxiety group. Students who preferred not to work with clients with a terminal illness (31%) had higher death anxiety scores. Students who had experienced the death of a client had lower death anxiety scores than students who had not experienced the death of a client. The authors called for more grief and loss training in graduate school and in continuing education programs.
Thus, the literature provides evidence that rehabilitation counselors do experience the death of clients on their caseload and that their training to deal with such losses has been minimal at best. Knowledge deficits exist, however, regarding two issues: (a) whether the experiences of rehabilitation counselors with respect to client death have changed over the past 12 to 20 years, as people are now living longer with life-threatening and terminal conditions; and (b) whether graduate and continuing education programs have answered the call for more training. Therefore, this study was designed to address these issues, as well as assess rehabilitation counselors' levels of death anxiety (Templer, 1970). Neimeyer and Van Brunt (1995), in their review of the death anxiety literature, noted that people who are in contact with death as a result of their profession have shown both increased and decreased rates of death anxiety. Given that higher rates of death anxiety "may adversely affect the quality of care" provided to clients (p. 69), they cite the need for research that addresses the vocational implications of death anxiety. We included the death anxiety component in this study in response to their call, and as a result of reviewing the counseling literature, which shows increased death anxiety and fear of death may negatively affect clients (e.g., Allen & Miller, 1988; Allen & Sawyer, 1984; Hayes & Gelso, 1993; Humphrey, 1993).
The current study had two main purposes. First, we wanted to update the previous research about the incidence and experience of client death, as well as the level of grief and loss training rehabilitation counselor received. Second, we wanted to increase the fund of knowledge about rehabilitation counselors and their experiences with client death. We addressed the second purpose of the study by: (a) assessing rehabilitation counselors' levels of death anxiety, which has not been studied to date; (b) asking what would help respondents feel more competent when working with clients with a life-threatening illness; and (c) investigating what client-related death situations respondents thought might be the most challenging. We used both quantitative and qualitative research methods to address the two purposes of this study.
A cover letter and survey were sent to 400 randomly selected members of the American Rehabilitation Counseling Association (ARCA). Each potential participant's name was obtained from ARCA's mailing list. Because of a low initial response rate, a second letter and survey were sent. Of the surveys distributed, 28 were not useable for this study leaving 372 possible respondents. The response rate was 41% (N = 153).
Sixty-seven percent of the respondents were female (n = 102), with an age range from 23 to 78 and a mean age of 43. With regard to ethnicity, 87% (n = 133) of the respondents self-identified as White, 3% (n = 5) as Black/African American, 3% (n = 5) as Hispanic, and 2% (n = 3) marked the "other" category; 5% (n = 7) did not respond to this question. Participants had worked as rehabilitation counselors for an average of 10 years (ranging from 1 to 52 years), and 89% (n = 137) had earned a master's degree or higher.
The two-page survey was developed by the authors and consisted of five sections. In section one, respondents were asked to provide basic demographic information including gender, age, ethnicity, highest degree earned, and how long they had been working as rehabilitation counselors. In section two, respondents described their experiences related to death and dying issues, by answering the following questions and statements: (a) How important do you think training in death and bereavement issues is for rehabilitation counselors?, (b) Have you received any professional training related to death, dying, and grief issues?, (c) If I had a choice, I would prefer not to work with people who have a life-threatening or terminal illness, and (d) Have any of the clients you worked with in the past 5 years died? If yes, how many?
In section three, respondents who had experienced the death of a client were asked to indicate whether they experienced any feelings from a pre-defined list of 11 feelings when they thought about the death of a client. In the fourth section, respondents were asked to respond to two open-ended questions: (a) What would help you feel more comfortable and/or competent when working with clients who have a life-threatening or terminal condition?, and (b) When you think about the death of a client, what situation(s) might be the most difficult for you?
In the fifth section, respondents completed a revised version of the Templer Death Anxiety Scale (DAS; Templer, 1970). The DAS contains 15 true/false items and is a widely used paper and pencil assessment (Neimeyer & Van Brunt, 1995). Developed to assess a range of life and death experiences (Templer, 1970), the DAS measures the "extent to which the respondent is preoccupied with and anxious about death" (Rasmussen & Johnson, 1994, p. 315). The original DAS has good construct, concurrent, and discriminant validity (Hayes & Gelso, 1993), with a test-retest reliability of .83 (Templer, 1970). Rather than use the original true-false format for the DAS, respondents used a five-point Likert scale from 1 (strongly disagree) to 5 (strongly agree) to increase the sensitivity of the instrument (Hayes & Gelso, 1993; McMordie, 1979; Thorson & Powell, 1994). McMordie (1979) found that using a Likert scale increased ability to discriminate between high and low scores. Moreover, Hayes and Gelso (1993) found that using a five-point Liken scale increased the instrument's sensitivity to differences among respondents.
Respondents scored between 1 and 5 points for each answer given in the keyed high death anxiety direction (based on the true/false responses on the original DAS). Responses for five statements (items 2, 3, 5, 6, 7, 15) were reverse scored. Final scores range between 15 to 75, with higher scores indicating higher levels of death anxiety. Given this range, it seemed appropriate to divide the scale into thirds for analysis purposes. Therefore, we determined that scores between 15-35 indicated low death anxiety, 36-55 moderate death anxiety, and 56-75 high death anxiety.
In response to the question, "How important do you think training in death and bereavement issues is for rehabilitation counselors?," 1% thought training was not important, 16% thought it was somewhat important, 6% were neutral, 44% thought it was important, and 32% believed training was very important. When asked "Have you received any professional training related to death, dying, and grief issues?," 62% (n=95) stated they had received some level of training dealing with dying, death, and grief issues, including lectures in undergraduate and graduate courses and by content of professional workshops and conferences as part of continuing education.
Participants were also asked, "Have any of the clients you worked with in the past five years died? If yes, how many?" Of the 153 respondents, 67% (n=102) experienced a client death in the past 5 years (1991-1996), with a range from 1 to 50 deaths. Of the counselors who had experienced client death, 73 had between 1 and 4 clients die and 21 had between 5 and 10 clients die. Of these deaths, 39 were the result of suicide, 78 were other unexpected (e.g., homicide, accident), and 343 were expected (e.g., chronic or life-threatening condition or disability). In response to the statement, "If I had a choice, I would prefer not to work with people who have a life-threatening or terminal illness," 18% (n=27) strongly disagreed, 33% (n=51) disagreed, 26% (n=40) were neutral, 17% (n=26) agreed, and 5% (n=7) strongly agreed. Two people did not respond to this statement.
Feelings of Rehabilitation Counselors Who Had Experienced Client Death
Respondents who had a client die within the previous five years were asked which of a list of 11 feelings they experienced using a five-point Likert scale from "strongly disagree" to "strongly agree." The list was adapted from one Harry Allen (personal communication, September 25, 1995) used in two previous studies (Allen & Jaet, 1982; Allen & Miller, 1988). The list was expanded to 11 words (i.e., sad, shock, frustration, anger, confusion, despair, depression, irritability, guilt, ambivalent, and relief) after reviewing the literature on feelings commonly experienced in grief and loss situations. Results indicated that sad (M=2.51, SD=2.21) and shock (M=2.15, SD=2.038) were the most common feelings respondents associated with client death. At the other end, ambivalent (M=1.23, SD=1.34) and guilt (M=1.15, SD=1.28) were the least associated.
Responses to Open-Ended Questions
To hear, in their own words, what rehabilitation counselors said would help them feel more effective when working with clients who have life-threatening or terminal conditions and what these counselors saw as their major challenges when in these situations, we included two open-ended questions. Responses to these questions were coded using content analysis, a procedure commonly used in qualitative research (Lincoln & Guba, 1985; Patton, 1980). Using this type of analysis allows themes or categories to emerge from the data (i.e., the participants answers to the questions) based on consensus among responses. To conduct the analysis, the authors individually read all of the responses and grouped them into similar content categories. Having the researchers code the data separately and then meeting to compare their results allowed for greater inter-rater reliability. Once the final categories were developed, representative samples of responses were selected for each category. The results of the content analysis follow. Because of space limitations, however, only condensed category descriptions will be provided. For a more complete description of the responses, please contact the first author.
A total of 131 people responded to the first open-ended question: "What would help you feel more comfortable and/or competent when working with clients who have a life-threatening or terminal condition?" Content analysis of the responses revealed 12 categories. The top category was labeled need for more training and knowledge with 60 responses, including "more extensive education on this issue." The second category was labeled need for more medical knowledge and information with 14 responses, including "being more medically informed overall and also being well versed in specific illnesses/conditions." The third category, counselor personal issues, contained 13 responses including "the opportunity to have worked through my own issues relating to death and loss" and "increased comfort with my own feelings about death." The fourth category, need for consultation and supervision, contained 12 responses, including "backing from supervisor that we are being supported in this effort" and "support of experienced coworker or supervisor." The next six categories were: (a) already comfortable with this population (n = 11), (b) need for both training and experience (n = 8), (c) need for more experience (n = 7), (d) knowledge about community resources (n = 5), (e) knowledge about the client's level of spirituality (n = 4), and (f) need for a support system for counselors who experience client death (n = 4). The final two categories were labeled nothing would make me feel more comfortable (n = 3) and unsure what would help me feel more comfortable (n = 3).
The second open-ended question asked: "When you think about the death of a client, what situation(s) might be the most difficult for you?" A total of 130 people responded to this question. Content analysis of the responses led to 11 categories. The top four categories and examples of statements are provided below. The first category, client suicide, contained 40 responses, including "suicide during ongoing outpatient treatment" and "clients committing suicide after threatening to do so." The second category, working with surviving family members, contained 22 responses including "working with `charged' emotion of family" and "the sadness & pain of the family." The third category, labeled counselor personal issues, contained 16 responses including "anything with similarities to family members or self" and "getting over the shock related to the death." The fourth category, violent death or murder, had 12 responses including "death due to violence (murder)" and "violence/torture." The remaining seven categories were (a) long or close relationship with the client (n = 8), (b) death of children or youth (n = 9), (c) unexpected death/accidents (n = 9), (d) long and/or painful dying process (n = 8), (e) client nonacceptance of death (n = 9), (f) negative effect on surviving children (n = 6), and (g) being present when the client died (n = 4).
Responses to the Templer Death Anxiety Scale (DAS)and Analysis of Variance Results
As stated earlier, part of the second purpose of this study was to determine what level of death anxiety, if any, rehabilitation counselors expressed. This level was determined using the DAS. Final scores ranged from 22 to 66, with a possible range from 15 to 75. The mean score was 40.49, with a standard deviation of 8.42. As stated earlier, the authors categorized total scores into three groups-low, moderate, and high death anxiety. For this study, 31% (n = 48) of the respondents fell into the low anxiety group, 66% (n = 100) fell into the moderate anxiety group, and 3% (n = 5) in the high death anxiety group. See Table 1 for specific responses to the DAS.
Templer Death Anxiety Scale Questions (Number of Responses to Each Question, N=153)
NR SD D N A SA 0 41 49 32 25 6 I am very much afraid to die. 1 12 49 49 28 14 The thought of death seldom enters my mind. 3 1 16 19 66 48 It doesn't make me nervous when people talk about death. 0 27 36 33 35 22 I dread thinking about having to have an operation. 1 14 48 31 39 20 I am not at all afraid to die. 0 33 46 30 37 7 I am not particularly afraid of getting cancer. 0 11 73 28 31 10 The thought of death never bothers me. 1 17 29 42 45 19 I am often distressed by the way time flies so very rapidly. 0 16 25 31 55 26 I fear dying a painful death. 0 78 38 26 10 1 The subject of life after death troubles me greatly. 0 43 43 49 12 6 I am really scared of having a heart attack. 0 43 43 49 12 6 I often think about how short life really is. 0 55 30 42 15 11 I shudder when I hear people talking about a World War III. 2 35 45 44 22 5 The sight of a dead body is horrifying to me. 0 13 33 42 43 22 I feel that the future holds nothing for me to tear.
Note. NR = No Response, SD = Strongly Disagree, D = Disagree, N = Neutral, A = Agree, SA = Strongly Agree
As part of our study of death anxiety, we analyzed how the following variables affected the respondents' levels of death anxiety: (a) gender, (b) age, (c) training received, (d) experience with client death, and (e) desire to work (or not work) with dying clients. These variables were selected by reviewing the death anxiety literature to determine which variables were most commonly used in previous research and by considering the research questions for this study. This study utilized a static, group-comparison, pre-experimental design (Campbell & Stanley, 1963) in which the DAS scores were compared across status variables. For purposes of this study, participant ages were converted into categorical variables depicting younger ([is less than or equal to] 44) and older ([is greater than or equal to] 45) respondents using a median split as the cutoff criterion. The dependent measure DAS scores were analyzed as continuous variables.
One-way analyses of variance (ANOVA) were conducted investigating death anxiety scores in relation to the variables listed above. Results of the ANOVA indicate, of the variables investigated, only age, F(1, 151) = 5.12, p [is greater than] .05, and preference to work with dying clients, F(1, 109) = 16.07, p [is less than] .05, were found to demonstrate significant group differences across respondents' death anxiety scores. The variables gender, F(1, 151) = 2.75, p [is greater than] .05; training received, F(1, 151) = .0076, p [is greater than] .05; and experience of client death, F(1, 149) = 1.76, p [is greater than] .05; were found to be nonsignificant. Data in Table 2 provide mean scores, standard deviations, and significance of the analyses.
Templer DAS Mean Scores, Standard Deviations, and Analysis of Variance
N M SD Age [is less than or equal to] 44 73 42.08 8.43 [is greater than or equal to] 45 80 39.03 8.18 Gender Female 102 41.28 8.91 Male 51 38.90 7.14 Training Had Training 95 40.53 8.49 No Training 58 40.41 8.37 Preference to Work Yes 78 37.69 7.40 No 33 44.39 9.43 Experienced client death Yes 102 39.93 8.37 No 49 41.87 8.54 F Ratio p Value Age 5.12 .025(*) [is less than or equal to] 44 [is greater than or equal to] 45 Gender 2.75 .099 Female Male Training .0076 .930 Had Training No Training Preference to Work 16.06 .0001(***) Yes No Experienced client death 1.76 .186 Yes No
(*) p < .05 (**) p .01 (***) p < .001
Results of this study provide preliminary information about rehabilitation counselors and their thoughts and reactions to possible client death. Of the 153 respondents, 22% stated a preference not to work with clients who have a life-threatening or terminal illness. This choice, however, may not be one that rehabilitation counselors are able to make. Even if counselors can avoid working with people with a terminal illness, results of this and other studies show that more than half of rehabilitation counselors surveyed have had the experience of a client dying. Moreover, in this study approximately a quarter of these deaths were unexpected. Participants who preferred not to work with clients with life-threatening illnesses scored significantly higher than other respondents on the DAS, although the mean was still in the moderate death anxiety range. Respondents who said they would work with clients with a life-threatening illness had lower DAS scores and more experience with client death. Women in this study did not have significantly higher levels of death anxiety than men. Younger respondents ([is less than or equal to] 44 years of age) had higher level of death anxiety than older respondents. Both of these findings are contrary to previous studies (e.g., Neimeyer & Van Brunt, 1995; Templer & Ruff, 1971; Templer, Ruff, & Franks, 1971; Thorson & Powell, 1994).
Based on previous research (e.g., Brent, Speece, Gates, Mood, & Faul, 1991; Neimeyer & Van Brunt, 1995), we expected there to be significant differences on death anxiety scores between rehabilitation counselors who had worked with a client who died and those who had not, but that was not the case. This finding is contrary to a previous study of nursing students (Brent et al., 1991). The authors of this study found that students with a wide range of death-related experiences, such as training and personal and professional experiences, had more positive and accepting attitudes toward patients who were dying. We did find, though, that counselors who would choose to work with terminally ill clients, given the option, saw a greater need for training on the issues of death and dying (with 65 respondents viewing training as "important" and "very important"). This finding is in comparison to respondents who did not want to work with this population (21 viewed training as "important" or "very important"). Implications of this finding might be that people who do not want to work with this population may not seek out the necessary training when they are working with a client who has a terminal or life-threatening illness.
Comparison of Results to Related Studies
Comparing the results of the current study to previous studies sheds light on where we are now with respect to rehabilitation counselors' experiences with client death and their training on this topic. Sixty-seven percent of the rehabilitation counselors in this study experienced the death of a client in the past 5 years, which is comparable to the results of previous research (Allen & Jaet, 1982; Allen & Miller, 1988; Bascue et al., 1977). In the current study, 62% of the respondents had received some level of death and dying training, compared to 22 to 28% in previous studies (Allen & Jaet, 1982; Allen & Miller, 1988). Because the rehabilitation counselors in the current study had been working an average of 10 years in the field, this finding may serve as evidence that counselors are receiving more education and training related to death and dying issue, both in school and as continuing education.
When comparing rehabilitation counselors with rehabilitation counselors-in-training, Hunt and Rosenthal (1997) found 34% of the trainees had experienced client death. When asked whether they would prefer not to work with a client with a terminal or life-threatening illness, 31% of trainees would prefer not to compared to 22% of rehabilitation counselors in this current study. With respect to death anxiety, the mean score for counselors-in-training was 44 (out of a range of 15 to 75) and the mean score for counselors in the present study was 40. Both groups fell within the moderate death anxiety range. Only 23% of students reported receiving any training on death and dying issues, compared to 62% of practicing rehabilitation counselors.
Limitations of the Study
There are several limitations that should be considered when interpreting the results of this study. First, this study relied on a self-report paper-and-pencil measure and, as such, may not generalize to all rehabilitation counselors, or even all members of the American Rehabilitation Counseling Associate. Second, 59% of the people surveyed did not respond. Participants who did respond may have done so because they thought the topic was an important one or vice versa.
Although significant group differences were not found for most of the variables with respect to the aims of this study, further investigation seems warranted to establish the meaning of such findings. For example, why was there no difference in death anxiety scores between counselors who had worked with clients who died and those who did not? Due to the lack of specific information regarding types and length of grief and loss training, the similar death anxiety scores between respondents who indicated they had no training and those indicating they had should be interpreted with caution, because previous research showed a difference between these two groups (e.g., Brent et al., 1991; Neimeyer & Van Brunt, 1995).
Recommendations for Rehabilitation Counselors and Educators
Results from this and other research studies document that the majority of rehabilitation counselors will experience the death of at least one client during their careers. This experience can have positive and negative implications for both counselors and for their clients. Based on the qualitative responses of participants in this study, it seems important to provide rehabilitation counselors with opportunities to explore their thoughts, feelings, and reactions with respect to client death, if they choose to, in a variety of ways. For example, agencies that provide services primarily to clients with life-threatening or terminal illness can develop support groups and in-house training programs to give staff avenues to process their feelings and experiences surrounding client dying and death. For agencies that typically have a low incidence of client death, allowing counselors time during staff meetings to talk about their feelings and reactions when a client dies or setting a meeting specifically for this purpose can be very helpful. Such meetings not only provide opportunities for the counselor whose client died to talk, but also provide opportunities for other counselors to talk about their experiences with client death in the past. Also, counselors who have not had the experience can talk about their fears and concerns in a safe and supportive environment. If supervisors are not trained or do not feel prepared to lead such a discussion, one option is to bring in a facilitator from another agency, for example a counselor from a local hospice or an AIDS support organization, to run such a group. To reciprocate, rehabilitation counselors could offer to give a training program about counseling people with disabilities or some other rehabilitation topic.
Counselors who are deeply affected by the death of client should be encouraged to talk to colleagues and supervisors as a way to cope with their experience. They may also need to be reminded that it does not necessarily mean that counselors are overly involved or enmeshed if they experience intense feelings when a client dies. It is a shared sense of humanity and the ability to empathize that allow rehabilitation counselors to be truly effective at their jobs, so of course they may have strong reactions when a client dies. Some counselors may need to talk with their supervisor about reducing their caseload for some period of time, or they may need to take a brief leave of absence to grieve over the death of the client. Personal counseling may also be helpful. Finally, and most importantly, counselors should be given the opportunity to talk about the experience with supportive colleagues and supervisors as a way to normalize the experience.
Based on the qualitative responses given in this study, many participants were aware of the issues that would be most difficult for them to address. This information could be used to develop graduate and continuing education programs that meet the stated needs of practicing rehabilitation counselors. Providing training opportunities for supervisors to help them learn how to be supportive to counselors who experience the death of a client would also be useful. In addition, rehabilitation practitioners could be encouraged to give presentations at state and national conferences sharing their own experiences about what was helpful for them. Another way to increase the level of information practitioners receive is to publish more articles related to this topic in rehabilitation journals. Examples could include articles about grief and loss, pathological grief, anticipatory grief, and effects on the family.
While experience and anecdotal evidence point out that client death does present challenges for counselors, we do not know necessarily what those specific effects are or how counselors can be prepared to work through them. For example, do counselors have a different response depending on whether the death is a result of a life-threatening or terminal illness, an unexpected death (such as homicide or accident or suicide)? What level and kinds of grief and loss training are most effective? What kinds of support mechanisms are most helpful for counselors who experienced the death of a client? Answers to these questions could positively influence the kinds of training experiences educators provide to rehabilitation counselors.
When rehabilitation counselors experience the death of a client, many domains of counselor's lives are affected. Further research and training in this area can assist counselors in better understanding themselves and their responses and can potentially diminish the negative impact of such experiences on their practice. This result can only help counselors to provide more effective and appropriate services for clients with disabilities.
We wish to thank the editor and anonymous reviewers for their thoughtful and helpful comments on this manuscript. We also want to thank the rehabilitation counselors who participated in this study.
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David A. Rosenthal University of Wisconsin--Stout
Brandon Hunt, Ph.D., Counselor Education, Counseling Psychology, and Rehabilitation Services, 327 CEDAR Building, The Pennsylvania State University, University Park, PA 16802. Email: firstname.lastname@example.org
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|Author:||Rosenthal, David A.|
|Publication:||The Journal of Rehabilitation|
|Article Type:||Statistical Data Included|
|Date:||Oct 1, 2000|
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