American Rehabilitation Counseling Association (ARCA) 50th Educational Conference Tampa, Florida U.S.A. November 2007
The Status of Rehabilitation Counseling Services Across the Globe Rapporteurs/Coordinators: David Hershenson, Ph.D. Professor Emeritus, University of Maryland-College Park Irmo Marini, Ph.D. University of Texas, Pan America Daniel Wong, Ph.D. East Carolina University
International Panel Nicholas Buys, Ph.D. Griffith University, Australia Hal Cain, Ph.D. Queens University, Canada Kane Hattori, Ph.D. Kobe City College of Nursing, Japan Gail Kovacs Vocational Rehabilitation Association, United Kingdom
International Panel Li Jian Jun, MD Qiu Zhouying, Ph.D. Shi Hongmei China Rehabilitation Research Center, China Ming-Hung Wang, Ph.D. Ming-Yi Wu, Ph.D. Taiwan Rehabilitation Association, National Kaohsiung Normal University, Taiwan
International Panel Jun Yaeda, Rh.D. University of Tsukuba, Japan Dal Yob Lee, Ph.D. Taegu University, Korea
Voc Rehab Counselling Services Vocational rehabilitation counselling services are provided in several systems • Social security - Federal • Workers compensation - State • Motor accident – State
Provision of VR services • Range of disciplines include: • Rehabilitation Counsellors • Occupational therapists • Psychologists • Physiotherapists • Social workers • Range of titles: • Injury manager • Rehabilitation coordinator • Rehabilitation case manager • Disability employment worker • Training is usually a tertiary degree in one of the behavioural sciences or allied health
Status of Rehabilitation Counselling • Rehabilitation Counselling profession exists in Australia • Small numbers • RC degree programs exist at Bachelors and/or and Masters level at 7 universities No registration or licensure • Two professional bodies – RCAA & ASORC
Status of Rehabilitation Counselling Rehabilitation Counselling Association of Australasia is of the view that voc rehab counselling services should be provided by professionals with specific tertiary training in rehabilitation counselling
National legislation and policies • Federal Government avoided issue of which professions should deliver VR services • Focussed more on outcomes rather than which profession does the work • State Governments more prescriptive in workers comp • Queensland has Table of Costs specifying which professions can deliver what services and at what cost
Role of Rehabilitation Counsellors • Role depends on system and employer • VR services for social security recipients – case manage from intake through to job placement • Occupational rehab services in workers comp and motor accident: • Full program • Case coordination only • Specific services such as vocational evaluation or job placement • Disability employment services • Job placement and retention
Use of ICF in Rehabilitation Limited to date – main areas of use: • Data collection • Research - measure of therapy outcomes • Classification system • Identification of support needs • Education
Challenges for RC profession • Deprofessionalisation of VR services • Lack of recognition by governments • Governments want outcomes – not interested in who delivers services • Small numbers • Professional body lacks resources to lobby
Challenges to providing services • Fragmentation of service delivery system • Ongoing employer reluctance to hire • Aging population and increase in chronic conditions • Lack of services in rural and remote areas • Multiple service delivery systems • Lack evidence base to guide practice
Best outcomes & practices • Social security recipients: • Demand side approaches • Workers compensation recipients: • Employer-based disability management programs • Key stakeholders (doctors, employers, insurers, workers) fully engaged • Provision of suitable return to work duties • Focus on psychosocial issues not just medical issues • Build healthy organisations with positive workplace cultures • Reduce common law access
Similarities/Differences with US • Currently undertaking a study of RC competencies in Australia • Limited studies to date indicate role and function is similar • US has stronger focus on forensic rehab, possibly because more litigious
Responses in context of Canada: Rehabilitation Counselling Hal. M. Cain, Ph.D., CRC Queen’s University Kingston, ON Rehabilitation Counselling Association of Canada
Professional disciplines providing vocational rehabilitation counselling services? • a variety professional disciplines including, but not limited to: • occupational therapy • social work • psychology • nursing • a few practitioners specifically trained in counselling but fewer trained in rehabilitation counselling
Official professional title of this “professional”/“discipline”? • there is no “official” professional title in Canada • many practitioners call themselves “Rehabilitation Consultants” • others adopt job titles, including “Rehabilitation Counsellor,” as set by various employers and employment settings • “Rehabilitation Counsellor” and “Vocational Rehabilitation Counsellor” included in the National Occupational Classification (NOC)
training or academic credential needed? • no particular level or academic training specified • in the NOC, under the category of “Family, Marriage and Other Related Counsellors” • a “master’s degree in counselling, mental health, or related social service field is usually required” • however, the NOC also indicates that, “An undergraduate degree or college diploma in a social science is required for certain areas of counselling.”
national legislation, policy and/or regulation to support? • no stand-alone legislation or policy in at the national level in Canada • however, non-discrimination and rights laws are integrated into various legislation, such as the Canadian Charter of Rights and Freedoms • some federal funding and policy is given in support of disability related issues – largely administered at a provincial level • disability / rehab legislation and policy exists at the provincial and territorial level
rehabilitation services guided by the classifications of disabilities? • The International Classification of Functioning, Disability, and Health (ICF) is used for classification of disabilities in Canada.
role and function? • role and function of rehabilitation counsellors in Canada is very similar to that of rehabilitation counselors in the U.S. • rehabilitation counsellors do assessments/evaluations, manage cases, provide counselling, provide expert testimony, conduct research, etc.
type of services rehabilitation counselors provide? • rehabilitation counsellors in Canada provide a variety of services depending on the setting • these services include, but are not limited to: • case management • vocational evaluation • career/vocational counselling • employment training.
challenges of this profession? • some of the challenges for rehabilitation counselling in Canada are the same as in the U.S. • few lay people and not many allied rehabilitation professionals know what rehabilitation counselling is about • issues of professional identity within the profession
challenges of this profession? (continued) • major specific challenges for rehabilitation counselling in Canada • lack of rehab counsellor education programs (only one at this time) • credentialing issues: loss Canadian Certified Rehabilitation Counsellor (CCRC) & no regulation of counselling in Canada except in Québec.
challenges of providing vocational & psychosocial services to persons with disabilities? • widely accepted, typically supported, and largely available • depending of province or territory, may be funding and procedural issues that pose a challenge for service providers
best outcomes (e.g., employment outcome) and best practices? • Best outcomes in Canada are based on community integration, in general, and sustained employment. • “Best practice” includes a whole-person approach.
variables that play a major role in the voc rehabilitation process? • no major socio-demographic variables play a role in the vocational rehabilitation process in Canada • in addition, everyone has equal access and protected from discrimination based on gender, age, and socio-economic, etc.
role and function: United States v. Canada? • the role and function of rehabilitation counsellors in Canada are very similar to that of rehabilitation counselors in the U.S. • differences in settings impact particular role and functions depending on the focus or mission of these various settings
role and function: United States v. Canada?(continued) • a major difference is the settings in which rehabilitation counselling is practiced • In the U.S., the majority of rehabilitation counsellors appear to work in state/federal systems (public sector) • In Canada rehabilitation counsellors work more in the private sector (for-profit and not-for-profit).
Rehabilitation and Disability in China Li Jian Jun, MD Qiu Zhuoying, Ph.D. Shi HongMei, M.S. China Rehabilitation Research Center Beijing, China 100068
Rehabilitation for People with Disabilities in China: Approaches and Development Background Information on China • History • China is the one of the world’s most ancient civilizations with a recorded history of nearly 4,000 years. • UNDP Human Development Index • According to the Human Development Report 2005 (UNDP), China's Human Development Index (HDI) value in 2003 was 0.755, ranking 85th worldwide.
Rehabilitation for People with Disabilities in China: Approaches and Development • Population & Natural population growth rate • Fifth national census on 1 Nov 2000 by NBS • Total Population: 1,295,330,000. • Population growth rate: less than 10 per thousand.
Rehabilitation for People with Disabilities in China: Approaches and Development Statistics of Disability and Birth Defects Disabilitystatistics in China • UN estimates: 10% population with disability • In 1996, China Disabled Persons Federation (CDPF) estimated 60 million disabled persons in China. • About 5% of the total population has some type of a diagnosed disability.
Rehabilitation for People with Disabilities in China: Approaches and Development Composition of Disability
Rehabilitation for People with Disabilities in China: Approaches and Development Laws, Policies and Coordination Mechanism of disability and rehabilitation in China • Laws and regulations on rehabilitation, education and protection for children • LAW OF THE PEOPLE'S REPUBLIC OF CHINA ON THE PROTECTION OF DISABLED PERSONS • People with disabilities have the right to rehabilitation, education and social life • National Rehabilitation Office • Regulations and policies of rehabilitation • Rehabilitation for All
Rehabilitation for People with Disabilities in China: Approaches and Development Rehabilitation and Disability System • Administrative System • State Council • Ministries • CDPF • Professional Institutions • Hospitals • Rehabilitation Centers at national, provincial and other local levels • Rehabilitation Stations (clinics) at grass-root level • Social Services Institutions
Rehabilitation for People with Disabilities in China: Approaches and Development Rehabilitation for All • Policy: • The ministries of Health, Civil Affairs, Finance, Public Security, Education and China Disabled Persons’ Federation had issued Comments on the Rehabilitation for People with Disabilities on August 24, 2004 • Total Target: Rehabilitation for All by the year of 2015 • Assessment Indexes: Baseline survey
Rehabilitation for People with Disabilities in China: Approaches and Development Rehabilitation Delivery System • Public Health System • Primary care: • Neonatal care: Early diagnosis and treatment, referral services • Secondary care: Rehabilitation treatment and surgery • Tertiary care: Rehabilitation Departments • National Rehabilitation Networks • National, Provincial, cities • PT, OT, ST and others • Rehabilitation services by non-governmental organizations (NGOs) • Community Based Rehabilitation (CBR)
Rehabilitation for People with Disabilities in China: Approaches and Development Institution and hospital-based services for people with disabilities • Early screening and diagnosis • PT, OT, ST and other rehabilitation services • Psychosocial support
Rehabilitation for People with Disabilities in China: Approaches and Development Community-based rehabilitation (CBR) • Concept • CBR has been defined as a strategy in communities for the rehabilitation, equalization of opportunities, and social integration of people with disabilities (ILO, UNESCO, and WHO, 1994; UNICEF, and the Ministry of Education and Science, Spain, 1994). • Home-based and model center-based approaches. • CBR for Disabled Children and their families • to encourage children with disabilities to attend public schools with the goal for them not be limited by different social expectations, negative attitudes and environmental constraints. • to mobilize local resources to enable people with disabilities and their communities to create their own solutions to eliminate barriers and create programs for rehabilitation.
Rehabilitation for People with Disabilities in China: Approaches and Development Prevention to Disability • National Action Plan • In 2002, Ministry of Health and CDPF issued a National Action Plan for Improvement of Quality of Health for the Population and Reduction of Birth Defects and Disability (2002-2010). • Reduce 0.8-1 million congenital birth abnormalities per year. • 40% coverage of reproductive health services for all women. • Established a System of Rehabilitation Services • Publicity and advocacy of knowledge and methods for disability prevention.
Rehabilitation for People with Disabilities in China: Approaches and Development National Work Programmes National Work Programmes on Rehabilitation for all People with Disabilities Key National Rehabilitation Projects (2001-2005) Main and update advances in rehabilitation for children and youth with disabilities (1988-2002）
Rehabilitation for People with Disabilities in China: Approaches and Development National Work Programmes on Rehabilitation for People with Disabilities • National Work Programme for children rehabilitation • The rehabilitation programmes had been integrated into National Disability-related Development Programmes • National Work Programme 1991-1995—rehabilitation • Hearing and speech training for deaf children, surgery and rehabilitation for children and youth with polio and cataract • National Work Programme 1996-2000—rehabilitation for low vision, mental retardation, physical disability, development of assistive devices, and prevention to disability. • National Work Programme 2001-2005-rehabilitation • establishment of rehabilitation system for children, national days for eye care, ear/hearing care and prevention to shortage of Iodine, etc.
Rehabilitation for People with Disabilities in China: Approaches and Development Key National Rehabilitation Projects (2001-2005) • Key Rehabilitation Projects • Functional training and assistive devices for children with low vision 0.1 million • Hearing and speech training for deaf children 0.8 million • Rehabilitation for CP 0.2 million • Rehabilitation for MR 0.8 million • Other projects: • Orientation walking/mobility training for the blind • Rehabilitation for children with autism • Assistive devices and services • Community Based Rehabilitation (CBR)
Current state of rehabilitation in China • 60 million disabled people, only 8 million received rehabilitation services • Rehabilitation goal: By 2015, every disabled person will receive rehabilitation services • Rehabilitation institutions: 24 at provincial level, 608 at city level, 3044 at community level • Professionals: 18,000 rehabilitation doctors, 300,000 PT, OT & ST. • It is vital for the development of rehabilitation to train professionals at different levels
Rehabilitation Medicine and Related Education • Research oriented medical school • Diploma, B.S., M.S., Ph.D. education • On-job training of rehabilitation medicine education nationwide • Accreditation of professionals