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

These findings are consistent with a similar study conducted by Chan et al. (2003) investigating the training needs of rehabilitation counselors among public, non-public and proprietary settings. Specifically. the authors found that VR counselors working in the public sector reported less than optimal preparation for mental health and substance abuse issues in addition to more traditional vocational rehabilitation knowledge areas including employment development. Their study also found that rehabilitation counselors working in non-profit settings reported training needs in the area of case management with individuals with mental illnesses. benefits counseling, and working with community mental health service providers. In sum, the current study offers additional support for the inclusion of psychiatric rehabilitation training at both the academic and professional level. Specifically, this study finds that state VR counselors in this particular setting, who have caseloads consisting primarily of persons with psychiatric disabilities have inadequate training in areas such as psychiatric rehabilitation, case management of persons with mental health issues, psychopharmacology, substance abuse, psychopathology, and neuropsychological assessment.

The need for training in psychiatric rehabilitation is not surprising given the complex and unpredictable nature of mental illnesses. In fact, it has been suggested that individuals with severe and persistent mental illnesses struggle with a variety of disabilities resulting in deficits that affect an array of domains including social, emotional, cognitive, and interpersonal functioning. Further, these individuals typically have poor coping skills, reduced motivation, difficulty managing symptoms and performing activities of daily living, and are vulnerable to comorbid substance abuse disorders (Corrigan, Rao, & Lam, in press). In addition, maintaining medication compliance and managing the continuous cycle of side effects and medication ineffectiveness can be as challenging as the very symptoms for which they are treating.

Important treatment components of psychiatric rehabilitation include social skills training, cognitive rehabilitation, and supported employment. For example, skills training, which is based on social learning theory, is designed to assist individuals with severe and persistent mental illnesses develop social skills and adaptive coping mechanisms in order to improve functional independence, increase social supports, and develop better skills to manage symptoms and reduce stress levels (Corry & Jewell, 200l: Dilk & Bond, 1996; Liberman & Kopelowicz, 2002; Wallace, 1998). This area is particularly important to vocational planning and placement as job loss is often attributed to poor social functioning and symptom management. Cognitive rehabilitation, another treatment tool within the psychiatric rehabilitation model, is designed to assist individuals improve information processing deficits. Specifically, individuals with severe and persistent mental illnesses often experience neuropsychological deficits such as poor attention, reduced memory functioning, language and speech deficits, and reduced executive functioning (Corrigan & Yudofsky, 1996). Enhancing cognitive skills can undoubtedly improve the ability to understand the social world and match appropriate behaviors to the demands of specific situations (Storzback & Corrigan, 1996). With regards to employment, the primary vocational model used within psychiatric rehabilitation is supported employment, which depending on the individual, may entail prevocational training and job seeking workshops, transitional employment or some form of work adjustment training, individual or group supported employment placements with job coaching and long term supports, with the ultimate goal being competitive employment (Becker & Drake, 1994; Bond, 1992).