Vol. XIV, No. 1 (1992) ISSN: 0732-2623 NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES DEPARTMENT OF EDUCATION * WASHINGTON, D.C. 20202 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Counselor Characteristics And Rehabilitation Outcomes "We dance round in a ring and suppose But the Secret sits in the middle and knows." Robert Frost With diminishing tax dollars to support the work of vocational rehabilitationists, reviewing past performance to determine the most effective way to allocate shrinking resources is vital for the success and survival of the program. Reviewing past performance is not a straightforward task. The measurement of success is not universally agreed upon, nor is there an exclusive path to analyze the outcome data that are available from vocational rehabilitation (VR). This Rehab BRIEF summarizes three sources of information related to outcomes of counseling and the rehabilitation process. * The Rehabilitation Services Administration (RSA) publishes an annual report that analyzes selected outcomes of the state vocational rehabilitation agencies. (Figures from the 1988 fiscal year represent the most recent of these reports.) The economic gains of rehabilitants with severe and non-severe disabilities are compared, and the findings can be used as benchmarks by which VR agencies can assess their achievements. * Three related studies were conducted by Edna Szymanski et al. of the Department of Rehabilitation Psychology and Special Education of the University of Wisconsin-Madison. Funded in part by the National Institute on Disability and Rehabilitation Research (NIDRR) of the Department of Education, they analyze the relationship between rehabilitation client outcomes and levels of rehabilitation counselor education. * Another study funded by NIDRR examines the way that three factors influence how counselor credibility is viewed by individuals who have a physical disability: the counselor's disability status, the counselor's professional credentials, and the content of the counseling session. Margaret Nosek et al. of The Institute for Rehabilitation and Research and Baylor College of Medicine conclude that these factors have impact in varying degrees, depending on circumstances. BACKGROUND There is no uniform nationwide hiring practice for rehabilitation counseling personnel within state-federal vocational rehabilitation agencies. The Rehabilitation Act Amendments of 1986 mandated that services be provided by "qualified personnel," but left the specifics to the state agencies to determine. People hired as counselors have varying education levels, degrees, and work experience, but no core set of competencies has been agreed upon as a minimum. A recent Rehab BRIEF, Vol. 12, No. 8, summarized a 5-year NIDRR-funded study on VR effectiveness. The conclusions of the Enhanced Understanding of the Economics of Disability (EUED) study were tentative but positive: Involvement with VR does have a payoff for the client, both in terms of average earnings and significant increases in functioning. The report also pointed out the need for developing a methodology to assess non-dollar-linked benefits, such as those obtained by individuals who do not enter the labor force with reportable earnings (such as homemakers and unpaid family workers), as well as personal and social benefits. VR OUTCOMES-TRADITIONAL VIEW The Rehabilitation Services Administration analysis of VR closures for fiscal year 1988 is as positive as the EUED study, for people with severe and non-severe disabilities. It does, however, note disparities in outcomes between the two groups. The percent of competitive rehabilitations for clients with severe disabilities was 76.9, compared to 91.6 for non-severely disabled individuals. The same groups showed an hourly wage at closure (including competitive and noncompetitive employment) of $4.70 compared to $5.50. But for clients rehabilitated into competitive employment, the comparative hourly wage was $5.60 and $5.80. As summarized in the RSA report, "Less favorable gains in economic functioning...were noted for severely disabled persons than for those not severely disabled because of the presence of: (a) higher proportions of non-wage-earning homemakers and unpaid family workers and (b) low-wage earning sheltered workshop workers among the severe group." The same report notes that the amount of money spent by VR for case services varied substantially, depending upon the severity of disability reported. Nearly 50 percent more was spent for case services for clients with severe disabilities, compared to those with non-severe disabilities. Additionally, "...more than four-fifths of all individuals having $5,000 or more spent on their behalf were severely disabled." EDUCATION/OUTCOME STUDIES Counselors and Caseloads Studies were conducted in three states: New York (Szymanski and Parker), Maryland (Szymanski and Danek), and Wisconsin (Szymanski). In each, questionnaires were distributed by the state agency to all field counseling staff to determine years of VR case-carrier work experience and education, including degrees and major. In New York, the study included 238 (66%) complete caseload-carrying counselor profiles, with total closures of 19,114 clients of whom 8,808 were classified as having severe disabilities. In Maryland, there were 100 (79%) case carriers included in the study, with 6,995 closures; and there were 144 counselors included in Wisconsin with 11,862 closures. Counselors were classified as having master's degrees in rehabilitation counseling (MRC), related master's degrees (RM), or bachelor's and unrelated master's degrees (UMB). In Wisconsin, the UMBs included some individuals with less than a bachelor's degree but excluded those with a bachelor's in rehabilitation. Study Design An Aptitude-Treatment-Interaction (ATI) design was used in each study, allowing the researchers to work with a number of variables, including counselor education and length of counselor agency work experience. Where differences in performance between the three educational groups were found, they are reported in terms of regions of significance; the regions denoted are the range of years of agency work experience where the performance discrepancy is statistically significant. Alternative Successful Outcome Measurements A variable not traditionally analyzed was considered to be a critical measure in the study. The competitive closure rate is the ratio of the number of competitive Status 26 closures (persons closed working at least part-time for at least the minimum wage) to all closures, rather than the raw number of 26 closures, or the customary ratio of 26s to all "post-acceptance" closures. Szymanski et al. determined that the competitive closure rate would (a) provide a statistical control for the differences among types of 26 closures that are usually grouped together and (b) reflect all closure activities, including 08s (closed from applicant status), that transpired during a given period of time. It was reasoned that the differences between these types of closures and Status 26 closures in sheltered employment or homemaking status may be more a function of counselor case management style than of counselor skill or knowledge. Another outcome designed to be sensitive to differences between competitive and noncompetitive 26s is the number of noncompetitive closures (the sum of all closures minus those closed as competitively employed in Status 26). This measure includes Status 08 closures in the study, a primary option for closing cases as unsuccessful. Within each of these factors, case closures were broken into two mutually exclusive groups: (1) severely disabled and (2) non-severely disabled plus non-classified (08) closures. Use of the competitive closure rate and partitioning by severity of disability were said to point to "important dimensions of quality and intensity of rehabilitation counseling services." A third outcome studied is net case service encumbrances/expenditures for noncompetitive closures, defined as a "gross measure overall of counselor inefficiency [sic]." In Wisconsin and Maryland, the total number of competitive closures for clients with severe disabilities and the number of noncompetitive closures (by type) for clients designated as severely disabled were also evaluated. Findings * In New York, counselors with master's degrees in rehabilitation counseling (MRC) were shown to have significantly higher competitive closure rates for clients with severe disabilities than did counselors with unrelated master's or bachelor's degrees (UMB) from the beginning of their careers to 10.5 years of tenure. In Maryland, MRCs had higher competitive closure rates than UMBs through only 3 years of experience. Wisconsin figures also showed that both MRCs and counselors with related master's (RM) performed better on this measure than the UMB group through 14.2 and 13.5 years of employment, respectively. * In New York, clients with severe disabilities whose cases were handled by MRCs had significantly fewer noncompetitive closures than did clients with UMB counselors, when counselors had from 4.5 through 14.9 years of agency experience. The noncompetitive closure variable was not analyzed in Wisconsin, because it was noted that the state had a rate of competitive closures higher than the national average and a history of encouraging competitive Status 26 closures. In Maryland, no significant differences in performance were found between the groups studied. In New York, analysis of net encumbrances for noncompetitive closures of clients with severe disabilities revealed that MRCs spent less than UMBs from 0 through 14.8 years of work experience. In Maryland, both MRCs and RMs encumbered less than the UMBs, regardless of the level of severity of client disability, from 4.2 through 26 years-of experience. This factor was not analyzed in Wisconsin due to its emphasis on achieving competitive 26 closures. * In Wisconsin, both MRCs and RMs had more competitive closures of clients with severe disabilities than their UMB counterparts, from 2 to 19.5 years of experience and 1 to 13.9 years of experience, respectively. * Additional findings in Maryland were that MRCS, compared to UMBS, had (a) higher encumbrances for noncompetitive closures among clients with non-severe disabilities, from 0 through 19 years of agency work experience (RMs had lower encumbrances than the UMBs from 6.7 through 15 years.); (b) fewer clients with severe disabilities closed in sheltered employment, from 7.3 through 26 years of work experience; and (c) lower encumbrances for all noncompetitive closures, from 4+ through 26 years, as did RMs. In Maryland, MRCs had fewer 08 closures of clients with severe disabilities than did the RMs for 4.1 through 10 years of employment. Comparing Results In all three states, counselors with master's degrees in rehabilitation counseling obtained better competitive closure rates than those with unrelated master's degrees or with bachelor's degrees or less education. However, findings were statistically significant only for varying periods of agency work experience. No other measurements showed such a consistent pattern of results in all three states. Only in New York did MRCs perform significantly better than the UMBs in the number of noncompetitive closures and only after 4+ years of agency experience. Also, only in New York, MRCs showed lower encumbrances on noncompetitive closures of severely disabled clients than UMBs, from 0 through almost 15 years of agency experience. In Maryland, the MRCs and RMs spent less but did so regardless of disability severity levels and only after 4+ years of agency experience. In Maryland and Wisconsin, a number of results were reported which were not duplicated elsewhere. In Wisconsin, the number of competitive closures of clients with severe disabilities was higher for MRCs and RMs than for UMBS. In Maryland, the number of 08 closures of clients with severe disabilities was lower for MRCs than for RMs for 4 through 10 years of experience. Discussion In several areas, performance differences among the three groups of counselors changed after a number of years had passed since obtaining agency employment and, presumably, academic training and credentials. Szymanski and Parker suggest that the absence of statistically significant performance before 4.54 years of experience in New York "may be the result of counselors being assigned smaller caseloads in the beginning of agency service." At the core of the research are some underlying premises about the role of the counselor, the nature of counseling, and its importance within the context of VR. Clients with severe disabilities usually need more rehabilitation counseling intervention than clients with mild disabilities, and one would expect that rehabilitation counseling outcomes of clients with mild disabilities would be more affected by factors other than rehabilitation counseling services (e.g., labor market fluctuation, client skill level) than would the outcomes of clients with severe disabilities (Szymanski, Parker and Butler). COUNSELOR CREDIBILITY STUDY The Rating System Seventy-one volunteers with mobility impairments and at least seventh grade reading levels were recruited for the study by three independent living centers. They were presented with pictures and biographical material about four actual "counselors," two of whom were described as able-bodied and two of whom were pictured as seated in wheelchairs. Two (one disabled, one not) were depicted as having doctoral degrees and practices in counseling, and the other two were characterized as volunteer counselors at an independent living center. The volunteers completed rating forms for each counselor regarding five credibility components: experience, expertness, interest, understanding, and ability. Additionally, they ranked the counselors on their ability to help each client with his/her problem. Findings * Disabled counselors obtained higher rankings than non-disabled counselors on all five components, regardless of the counseling problem being presented. Where the nature of the problem was disability linked, the difference in ratings between disabled and non-disabled counselors was considerably greater. * When counselors were viewed as professionals, the disabled counselor was rated somewhat higher in all credibility factors; but when both were non-professionals, the disabled counselor obtained a much higher rating. * Where the counseling issue was related to a disability, the professionals were consistently rated higher in the five factors than the non-professionals. The professionals were less consistently rated higher when the problem was a general one, receiving a lower score in understanding than the non-professionals and an identical score in expertness. * The disabled counselors were viewed as more capable than the non-disabled counselors of helping the client regardless of the issue involved, but with a larger variation of rating when the content of the problem was disability-related. Discussion Nosek et al. conclude that counselors with disabilities are perceived by clients as being more credible, particularly when the counseling problem is disability related; this perception is more pronounced among nonprofessional counselors than professional ones. IMPLICATIONS In order to evaluate the relationship of counselor characteristics to outcomes of the rehabilitation process, one can analyze any combination of four major factors: the counselor, the client, the service delivery system, and the labor market. This Rehab BRIEF reviews data compiled by the federal government about observed outcomes and the findings of two groups of researchers about counselor variables. There is no shortage of viewpoints on the vital criteria by which a counselor should be judged; there is, however, a lack of consensus. The plausibility of researchers' findings is limited by their world view and focus. Moreover, the absence of major pieces of the puzzle, such as service delivery system variables and world of work variables, further limits attributions of causality. The counselors' crucial role in the rehabilitation process makes them target-rich for research. The need to improve delivery systems to enhance successful outcomes and maximize use of limited resources requires policymakers to weigh the relative significance of frequently conflicting research findings. Szymanski et al. point out that "logical follow-up efforts for research would include measurement of the relationship of counselor attitude or counselor skill to both level of counselor education and to client outcome." Such additional creative programs of research are needed to isolate definable characteristics that predict successful performance in the workplace and help to meet the ethical, legal, and practical requirements that services be provided by "qualified personnel." SOURCES Nosek, M.A., Fuhrer, M.J., & Hughes, S.O. (in press). Perceived counselor credibility by persons with physical disability: Influence of counselor disability status, professional status, and the counseling content. Rehabilitation Psychology. Rehabilitation Services Administration Information Memorandum, (1990). Transmittal of report, Comparing economic gains attained by persons rehabilitated in fiscal year 1988, by severity of disability. Szymanski, E.M. (in press). Relationship of level of rehabilitation counselor education to rehabilitation client outcome in the Wisconsin Division of Vocational Rehabilitation. Rehabilitation Counseling Bulletin. Szymanski, E.M., & Danek, M.M. (in press). The relationship of rehabilitation counselor education to rehabilitation client outcome: A replication and extension. Journal of Rehabilitation. Szymanski, E.M., & Parker, R.M. (1989, Fall). Relationship of rehabilitation client outcome to level of rehabilitation counselor education. Journal of Rehabilitation. Szymanski, E.M., Parker, R.M., & Borich, G.D. (in press). Aptitude treatment interaction designs in research on the relationship between rehabilitation counselor education and rehabilitation client outcome. Rehabilitation Education. Szymanski, E.M., Parker, R.M., & Butler, A.J. (in press). Sensitivity of client outcome measures in relating state vocational rehabilitation agency counselor performance to level of counselor education. Rehabilitation Education. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * A Rehabilitation Counselor Educator In 1980 I published a study in the Rehabilitation Counseling Bulletin (Vol. 23, No. 3, pp. 183-192) that reported correlational relationships among 17 rehabilitation counselor characteristics and five traditional state vocational rehabilitation agency client outcome measures...This investigation did not find any relationships between counselor characteristics and the traditionally important state vocational rehabilitation agency client outcome measure of Rehabilitated--closed Status 26...I urged that alternative rehabilitation outcome MeaSures be included in future research in this area as well as by state vocational rehabilitation agencies. My appreciation of the findings of the studies summarized in this Rehab BRIEF, as well as my awareness of other (parallel) investigations, coupled with my clinical experiences and observations over the past 25 years, compel me to ask: How much data do we need to do what we need to do to do things right? I ask students/trainees...Who would you go to for help?...Over the years, in over a hundred courses with thousands of students/trainees, many of the same characteristics have surfaced. The person they would go to for help would be professionally prepared, competent and credentialed; warm, and understanding; a good listener; genuine, real and open; personally healthy and secure; and aware and knowledgeable, among other characteristics. Within the field of rehabilitation, these characteristics are those of Certified Rehabilitation Counselors (typically graduates of CORE-accredited master's degree programs in rehabilitation counseling). Essentially, Certified Rehabilitation Counselors (CRCS) are our best. William G. Emener, Professor Department of Rehabilitation Counseling University of South Florida * * * * * * * * * * * * * * * * * * * * * * * * * * * * * A Rehabilitation Counselor Employer I found the BRIEF interesting but troubling. I am not ready to concede, without a great deal more research, that successful rehabilitation counselors must have a master's degree in rehabilitation counseling or a closely related field. In order for a rehabilitation counselor to help a client move from an unemployed state to the status of wage earner, certain skills and knowledge are required. In my experience, counselor training programs at universities rarely provide the training and skills needed by counselors to do the job. Inservice training, self-study, and tutoring by senior colleagues are factors most often cited by counselors as being key elements in their development. Few counselors that I know credit their master's degree training with providing them with the skills necessary to do their job. A young woman who recently graduated from a master's program spoke for many of her colleagues when she said, "I have my union card, and now I can get a job and learn to be a rehabilitation counselor." Counselors who are committed to their clients' success and who are willing to put forth extraordinary effort to help the client achieve this success invariably record high numbers of clients placed in employment, meeting agencies' standards of stability. But how do we measure this personal work ethic? At the time of hire, can we select the candidates who have this characteristic? I am afraid we can't, but I am convinced we must try. Anthony Mckey, Partner RHD Associates Sacramento, CA * * * * * * * * * * * * * * * * * * * * * * * * * * * * * A Senior Rehabilitation Counselor With a Disability I don't think that there's a correlation between severity of disability and the need for counseling in the VR setting. Dealing with non-severely disabled clients often requires as much or more rehabilitation intervention because it's a whole new ball game for them-just dealing with the fact that they have a disability, for example. Most severely disabled clients already know what their limits are; that's not true with non-severely disabled clients. They've usually had a lot of counseling experiences prior to coming in. I question whether it's realistic to use level of severity as a major factor in predicting counseling hours and types of counseling needed. I spend time dealing with issues that are not linked to severity of disability-housing, independent living skills, locating resources, handling the effects of families that aren't encouraging them to work, job seeking skills, and so forth. In training programs, I spend more time with non-severely disabled clients. When you put a client with a severe disability into a training program, the disability is known and dealt with from the start; but with a non-severely disabled client, I have to meet with all of the involved parties to be sure that messages are clear and that limits are understood. The factors that get in the way of a successful rehabilitation are not as obvious as with a severely disabled client. David Clingerman, Senior Counselor California State Department of Rehabilitation ---------------------------------------------------------- We welcome your comments on this BRIEF and on BRIEFS put out during the past year, as well as your suggestions for topics and for improving this publication of Conwal Incorporated. Prepared by Conwal Incorporated, 510 N. Washington St., Suite 200, Falls Church, VA 22046. =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=- This document was scanned into electronic form for ABLE INFORM BBS: 301/589-3563 or FTS 301/427-0280 (data); Silver Spring, MD USA Internet telnet: fedworld.gov, then dd115 from the Top Menu Internet mail: naric@cap.gwu.edu Electronic release date: January, 199