Data Collection in Rehabilitation Counseling

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Data Collection in Rehabilitation Counseling

• Lecture 7
• September 16, 1998

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Today and Next Monday

• Two lectures on Data Collection in Rehabilitation
• Intake interview, Medical Evaluation,
  Psychological Evaluation
• Vocational Evaluation, Vocational Analysis,
  Planning the Program

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Today

• Intake Interview
• Medical Evaluation
• Psychological Evaluation

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Last time

• Job Placement in Rehabilitation Counseling
• Associated Professional Organizations
• Policy and Placement
• Models of placement
• What were they?

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Review Models of Placement

• Traditional
• A. Counselor-provided placement
• B. Placement-Specialist
• C. Contracted Services
• D. Supported Employment
• New Models
• E. Marketing
• F. Team networking/mentoring
• G. Demand-side placement

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Review Employer concerns

• Hiring pwds increases workers comp insurance
  premiums
• The data refute this
• Secondary injury funds buffer the impact
• Productivity is adversely affected
• Production rate, turnover, and absenteeism were
  all worse for non-disabled employees in a study
  review conducted in 1986
• Harris survey (1987) as well or better

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Review Employer concerns

• Issues related to acceptance of difference
• Mental disabilities
• Emotional disabilities
• Communication disabilities

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Resuming Mondays lecture...

• Making recommendations for reasonable
  accommodations
• Note functional limitations
• Muellers 15 categories (1990) page 145
• Note impact on essential functions
• Note reasonable accommodations that will allow
  the performance of the essential functions (ADA,
  Title 1)
• Table 9.1, page 146
• Not very expensive (i.e., undue hardship)

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Policy Support

• Sections 501 and 504 or the Rehab Act of 1973
• ADA
• Expands the coverage of the Rehab Act (p. 148
  out of sequence)
• Title I Anti-discrimination
• Title II Public Services
• Title III Public Accommodations
• Title IV Telecommunications, Misc.

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Keeping Up-to-Date

• Professional organization memberships and
  journals help to keep you apprised
• Keep employers informed
• Tax legislation changes frequently
• Incentives for employers who hire pwds
• e.g., tax deduction for barrier removal
• Work Opportunity Tax Credit
• up to 2,100 for each individual hired
• Sub-minimum wage standard

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Equal Employment Opportunity Commission (EEOC)

• Rules for interviewing pwds (1995)
• Become very familiar with table 9.2, p. 150, for
  future employer training opportunities
• You can also help employers meet ADA-specific
  guidelines....you are an information resource!
• Trial questions....

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Outcomes of Job Placement Efforts

• 1986 report indicated that 75 of the clients
  were dissatisfied w/ services
• What can you do to help?
• Help create realistic expectations based upon
  your knowledge of the world of work, and the job
  application process
• Train in interviewing skills, application
  completion
• Practice through role-play

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Suggestions in the text...

• ...for the above activities are very helpful
• Start developing folders to store information
  that you come across, which may later be helpful
  in meeting the demands of your future vocational
  activities
• A great interview technique, an innovative
  role-play, a great summary for clients/employers,
  how-to lists, etc.

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Attitude

• Job placement has been considered by some to be
  the low-prestige task of the profession
• Hershenson (1988) called for a more sophisticated
  treatment of this activity in program curricula
• We now embrace the idea of counselor-employer as
  well as counselor-employee relationship in our
  practice

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End of Maki Riggar Chapter

• Paints a bleak picture of preparation for
  placement activities
• Such a statement could be made about any of the
  knowledge areas
• Experience comes with doing, which is why we
  encourage you to engage in placement activities
  at some level within your practica and/or
  internship
• Youll have a good foundation in this program!

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Data Collection in Rehabilitation Counseling

• CASE MANAGEMENT AND
• Intake Interview
• Medical Evaluation
• Psychological Evaluation

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Intake Interview

• Conversation between client and counselor with
  mutual purpose
• Microcounseling skills are essential here
• The counselor pre-intake interview planning
  should include reviewing available data
• Certain general goals
• Providing the client with information about the
  role of the agency, available services, and
  client responsibilities
• Initiating the diagnostic process
• Development of rapport

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Four General Questions for Planning

• (1) What are my goals for interview ?
• (2) What information should be provided to the
  client during the intake interview ?
• (3) What information do I need to collect from
  the client during the intake interview?
• (4) What is the most efficacious manner to
  exchange information?

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Service Orientation Session

• Let the client know your intentions
• During the intake interview a service orientation
  should include
• (a) agency purpose
• (b) service eligibility criteria
• c) rehabilitation counselors function
• d) clients responsibilities
• Explain in a manner complimentary to the clients
  ability

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Agency Purpose

• Make the content of this section relevant to the
  specific client
• Its not necessary to do a canned speech on the
  history of rehabilitation
• Literature suggests that much of the information
  shared is not maintained, so handouts that you
  develop can be helpful

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Counselors Role

• Direct provider of services
• Remember the scope of practice statement
• Coordinator of other services
• Provide clear explanations for referrals
• Client advocate
• Confidentiality (and informed consent)

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Clients Responsibilities

• Collaborative relationship
• Follow-through
• Ask the client to summarize whats been discussed
• Help the client to summarize the entire session
• Document your process

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Initiating the Diagnostic Process

• Information gaps, and their undesirable
  consequences
• Failure to arrange for important medical,
  psychological, educational, or vocational
  evaluation
• Failure to develop the optimal rehabilitation plan

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5 questions...(see also table 3.1)

• which can analyze whether the counselor has most
  of social and vocational history
• 1) Does the client have a specific vocational
  objective?
• 2) Does the client have more than one potential
  vocational goal?
• 3) How optimistic or pessimistic is the client
  about their ability to achieve each vocational
  goal?
• 4) Is the client interested in vocational
  training?
• 5) Is the client interested in any specific type
  of vocational training?

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Exercise

• Establish three working groups
• Draw a comparison/contrast of strengths and
  weaknesses of the Shirley Steed Case Study and
  the Donald Jones case study
• Pencil-pusher example (following a form vs.
  getting to know the client)

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Developing Adequate Rapport

• The first contact in the office is important and
  there are several consideration to enhance the
  rapport process
• effective furniture arrangement
• preventing interruptions, and
• proper time planning.

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Response Style During the Interview

• The style of nonverbal and verbal counselor
  responses
• The counselor should provide the client with all
  of their attention
• A proper distance should be established and
  refrain from distracting movement
• Remember your intentional interviewing skills!
• Remember the impact of culture!

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Verbal Behavior

• Paraphrasing
• checking for accuracy
• clarifying clients point of view
• reflection of feelings
• reflection of meaning
• using continued responses and focus responses
• Encouragers, good attending skills, use of focus

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Medical Evaluation

• The medical evaluation should provide the
  rehabilitation counselor with full report of
• medical limitations
• remaining capacities
• (The clients ability to fulfill various
  vocational demands)

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Areas of Focus

• There are four areas of focus in medical
  evaluation
• (a) choosing an physician
• (b) making an effective medical referral
• (c) knowing what to expect from evaluating
  physicians
• (d) using the medical consultant

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Choosing a Physician

• The guidelines for a selecting are
• physicians ability to establish rapport with
  their patients
• physicians knowledge of the clients medical
  history
• physicians medical expertise with specific
  disabilities
• See Table 4.1 (great future resource!)

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Making an Effective Referral

• Specifying information needed
• Clients general health
• Progressive nature, stability, or controllability
  of the disability(ies)
• Recommended treatment (source location)
• Life stressors/exacerbating factors
• Disability-imposed limitations on daily
  activities
• Potential effects of prescribed medications on
  work performance
• Potential future complications stemming from the
  disability
• Additional medical evaluation needed

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Exercise

• Lets use Donald Jones as an example of writing a
  medical referral
• Same three groups
• See Table 4.2
• Remember, be specific and concrete in your
  requests

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Knowing What to Expect From Evaluation Physicians

• Types of information
• (a) the presence of physical or mental disability
  
• (b) the degree to which the condition limits the
  activities that the individual can perform
• c) the extent and means by which the disabling
  condition may be corrected or ameliorated through
  physical restoration services.

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The Medical Report

• The medical report should discuss
• extent of residual effects
• medical terminology
• You need an adequate understanding of medical
  terminology to comprehend both oral and written
  reports.
• Decisions
• the degree to which heavy work vs. sedentary work
  are appropriate
• or the client is not fit for work at all at the
  present time

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Using a Medical Consultant

• Effective use of a medical consultant, to
  clarify...
• basic understanding of disease, disability, or
  injury
• process of medical diagnosis and treatment
• role of medical specialists in the process
• The medical consultant can help in clarifying
  aspects of the medical report contain technical
  data, provide further diagnosis, and treatment,
  help counselors coordinate services, assisting
  counselors in selecting rehabilitation facilities
  with medical programs.

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Psychological Evaluation

• What to expect from psychological evaluation?
• Diagnosis of a learning disability, mental
  retardation
• Diagnosis of an emotional disturbance
• Awareness of intellectual functioning for career
  exploration
• Awareness of personality and interests for
  congruence with a given vocation, coping skills
• Neuropsychological functioning post brain trauma

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Exercise

• I want to be a rocket scientist.

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The main objective...

• in psychological evaluation is to determine
  persons ability to cope with vocational demands
• Interpersonal skills
• ability to learn new jobs
• emotional stability
• commitment to vocational goals

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Choosing a Consulting Psychologist

• Rehabilitation Psychologists
• Understanding the psychosocial and medical
  aspects of disability
• Knowledge of the world of work
• Neuropsychologists
• For more in-depth assessment of complex
  functioning
• Attitude...
• toward disability (assessment practices)
• Professionals can be prejudiced (recommendations)
• Professionals can have pre-conceived notions that
  are harmful to your client (limiting potential)

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Psychological Reports

• The psychological reports contain descriptions of
  psychological function
• The counselor needs statements from the
  psychologist that predict the persons potential
  reactions to specific situations
• Results from the report will be strongly
  associated to the specificity of your questions
• Information you provide (pp. 73-75)
• Sample referral, pp. 75-76

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Exercise

• Lets use Donald Jones as an example of writing a
  medical referral
• Same three groups

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