Psychiatric rehabilitation training needs of state vocational rehabilitation counselors: a preliminary study

Journal of Rehabilitation, July-Sept, 2005 by Gloria K. Lee, Julie Chronister, Hector Tsang, Kirby Ingraham, Eugene Oulvey

Rehabilitation provision is often influenced by society needs and legislations. As far back as the Smith-Fess Act 1920, civilian vocational rehabilitation program was launched, with an emphasis of providing vocational education to individuals with physical disabilities. With the Barden-Lafollette Act 1943, the provision of rehabilitation service was expanded to people with mental retardation and mental illnesses. The Rehabilitation Act of 1973 and the Rehabilitation Act Amendments of 1986 mandated to expand the emphasis on serving people with severe disabilities (Parker & Szymanski, 1998; Rubin & Roessler, 2001). The trend off increasing needs of serving people with severe and persistent mental illnesses continued to grow as the scope of disability groups broaden and rehabilitation counselors are required to meet the diverse needs of a wider and more complex spectrum of disability groups. Of particular interest are those clients served by vocational rehabilitation (VR) programs who have a psychiatric disability or experience comorbid mental health issues. According to Ingraham, Rahimi, Tsang, Chan, and Oulvey (2001), several state VR programs have reported an increase in the number of clients served who have mental health concerns. The increasing demand for VR by this disability group is not surprising given that community reintegration and independent living are standard treatment goals for those with even the most severe and persistent forms of mental illnesses. Moreover, the need for VR by this disability group is underscored by an 85% unemployment rate among working-age people with psychiatric disabilities (National Institute on Disability and Rehabilitation Research; [NIDRR] 1993).

Nonetheless, people with psychiatric issues present unique challenges for rehabilitation counselors, and the need for requisite skills to meet those challenges may not be met by traditional rehabilitation counseling training programs (Kress-Shull, 2001). Historically, rehabilitation counseling training programs have not provided training in clinical mental health counseling or required coursework in psychopathology or substance abuse; while some programs may offer this coursework through cross disciplines such as mental health counseling or social work, these domains are primarily de-emphasized (NCRE, 2002 as cited in Tansey, Chan, Chou, & Cardoso, 2004). Yet, rehabilitation counselors are increasingly being required to serve individuals with a broad spectrum of psychiatric impairments including those with sex ere and persistent mental illnesses, substance abuse disorders, dual diagnoses, as well as an array of comorbid emotional conditions that coexist with other physical or neurological conditions.

Importantly, research suggests that rehabilitation counselors may not be adequately trained in the area of mental health. For example, in studies investigating the training needs of certified rehabilitation counselors, knowledge and skills in mental health counseling, substance abuse, and dual diagnoses have been consistently identified as important training needs (Chan et al., 1998; Chan et al., 2003; Emener, Evans, Lowe, & Richard, 2001; Harley, Greer, & Hackerman, 1997; Ingraham, Kaplan, & Chan, 1992). Chan et al. (2003) suggest these training needs reflect not only the rise in VR clients served with mental health and substance abuse issues, but also the overarching increase in the severity and complexity of the disabilities experienced by VR clients, as well as the emerging trends of counselor licensure. In addition, current

behavioral health care practices and community-based programs have consistently underscored the need for trained psychiatric rehabilitation practitioners as revealed by the numerous proposals designed to help guide curricular development in rehabilitation counseling (Chan et al., 1998; Farkas & Anthony, 2001; McReynolds & Garske, 2002). This, coupled with studies revealing lower rates of successful employment outcomes for people with psychiatric disabilities (NIDRR. 1993) strongly supports the need to better understand the competencies and knowledge base necessary to facilitate appropriate and effective VR services for clients with a broad spectrum of psychiatric issues.

Despite the identification of this need, minimal efforts to facilitate training in this area have occurred (Farkas & Anthony, 2001). This is particularly striking, given the well developed psychiatric rehabilitation model which parallels the philosophical tenets of rehabilitation counseling and has contributed significantly to shaping and facilitating educational, vocational, and community opportunities for persons with severe and persistent mental illnesses through a skills training and supported employment approach.

For individuals with psychiatric disabilities, they may have deficits in various life roles such as hygiene, symptoms management, cognition, coping skills, personal management, social skills, interpersonal skills and coping skills (Corrigan, Rao, & Lam, in press). Skills trainings have been consistently demonstrated as effective treatment for people with disabilities. For example, Bolton and Akridge (1995) conducted a meta-analysis of skills training interventions for people with disabilities in general. The results indicated a substantial benefit to the clients, with a high effect size of .93. Skills trainings have also been shown to be effective in assisting individuals with psychiatric disabilities to better manage their life. More recently, research also advocated for specific and structured social skill training to be beneficial lot people with persistent and severe mental illnesses can enhance the role functioning and autonomy of individuals (e.g., Corry & Jewell, 2001; Liberman, & Kopelowicz, 2002; Wallace, 1998), and to increase skill acquisition and reduce psychiatric symptoms (Dilk & Bond, 1990).