REHABILITATION COUNSELOR SELF-EFFICACY AND WORK ENVIRONMENT
FACTORS THAT PROMOTE THE USE OF EVIDENCE-BASED PRACTICES IN
VOCATIONAL REHABILITATION SERVICE DELIVERY
By
Roy J. Del Valle

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
Rehabilitation Counselor Education - Doctor of Philosophy
2015

ABSTRACT
REHABILITATION COUNSELOR SELF-EFFICACY AND WORK ENVIRONMENT
FACTORS THAT PROMOTE THE USE OF EVIDENCE-BASED PRACTICES IN
VOCATIONAL REHABILITATION SERVICE DELIVERY
By
Roy J. Del Valle
The National Institute of Disability and Rehabilitation Research (NIDRR) have
emphasized the focus on evidence-based practices (EBP) in all research projects publicly funded
through NIDRR (Brannon, 2010). There is now a heightened emphasis on the meaning of
research findings and translating and disseminating evidence-based practices so they affect and
inform practice and policy (Leahy & Arokiasamy, 2010). NIDRR and the Rehabilitation
Services Administration (RSA), as the major funding sources of rehabilitation research, are
working to close the gap between practice and EBP research. In a resource-limited environment,
evidence of efficacy and effectiveness can help make programmatic funding decisions more
rational and, hopefully, more equitable (Brannon, 2010). The current climate calls for empirical
evidence to justify VR services, along with the emphasis on the development and
implementation of evidence-based practices that can assist state-federal VR programs that are
under increasing pressure to demonstrate the effectiveness of VR service provision.
The current study was undertaken to explore rehabilitation counselor self-efficacy,
perceived benefits of EBP, perceived barriers to the use of EBP, and rehabilitation counselor
readiness to use EBP. A sample of 318 certified rehabilitation counselors (CRC) employed in
the state-federal VR program, community rehabilitation organizations (CRO), private for
profit/workers compensation, and other practice settings within the United States was obtained

for this study from the Commission on Rehabilitation Counselor Certification (CRCC)
membership base.
Results of this study indicate that CRCs demonstrate self-efficacy in the use of EBP by
selecting appropriate interventions for their clients in the provision of VR services, understand
and value the potential benefits of EBP for clients, and acknowledge barriers to EBP use at the
organizational and practitioner levels. In addition, counselor education level, i.e., holding a
doctorate degree was found to be a significant, positive predictor or rehabilitation counselor selfefficacy while employment in the state-federal VR program was a significant, negative predictor
of rehabilitation counselor self-efficacy.
The data generated by this study can be used by a rehabilitation administrators,
researchers, educators and counselors to promote the use of EBP in order to improve
employment outcomes for individuals with disabilities. The data may also be used to develop
pre-service curriculum to train future rehabilitation counselors how to develop and implement
EBP in their practice. Specific implications for EBP in VR service delivery and future research
are provided.

Copyright by
ROY J. DEL VALLE
2015

ACKNOWLEDGEMENTS

I want to thank the faculty and staff of the MSU Rehabilitation Counselor Education
program for their patience, guidance and willingness to assist me throughout this endeavor. I
particularly want to thank Dr. Michael J. Leahy for the opportunity to pursue my doctoral degree
and the ideal education I received through his supportive mentorship. In particular, I want to
thank Dr. Leahy for the research opportunities made available to learn firsthand the importance
of rigorous research and to contribute to the rehabilitation counseling literature through
participation in the RRTC-EBP-VR NIDRR grant. The lessons learned from these experiences
will not be forgotten and will serve as a solid foundation as I move forward in my own research
and practice.
I wish to thank the members of my dissertation committee, Dr. Kosciulek, Dr.
Konstantopoulos, and Dr. Sung. Their guidance and willingness to assist me during any point of
my studies or dissertation development was greatly appreciated. I also wish to thank Dr. Fong
Chan from the University of Wisconsin – Madison for his support, encouragement and openness
to sharing his thoughts and ideas to make my work better.
Finally, a heartfelt thanks to my wonderful wife Jan. Without her patience, guidance and
level-headedness, completion of this program and dissertation would not have been possible. I
am truly blessed to have her by my side.

v

TABLE OF CONTENTS

LIST OF TABLES ............................................................................................................. ix
LIST OF FIGURES ........................................................................................................... xi
CHAPTER 1 .......................................................................................................................1
INTRODUCTION..............................................................................................................1
Statement of the Problem .................................................................................................3
Purpose of the Study ........................................................................................................5
Description of the Study ..................................................................................................6
Research Questions ..........................................................................................................6
Assumptions and Limitations ..........................................................................................7
Definition of Terms..........................................................................................................9
CHAPTER 2 .....................................................................................................................11
LITERATURE REVIEW ...............................................................................................11
The Current State of Evidence-Based Practices in VR Service Delivery:
Emphasis on Counseling Skills......................................................................................11
Understanding EBP and Levels of Evidence .................................................................12
Evidence-Based Practices and Environmental Factors ..................................................15
Evidence-Based Practices and Rehabilitation Counselor Perceptions...........................16
Ajzen & Fishbein: Theory of Reasoned Action .............................................................18
Individual Attitude and Social Influence .......................................................................19
Bandura: Social Cognitive Theory.................................................................................22
Mastery of Behavior ......................................................................................................22
Reciprocal Determinism ................................................................................................23
Outcome Expectancy .....................................................................................................24
Self-Efficacy Beliefs ......................................................................................................25
Effects of Self-Efficacy Beliefs .....................................................................................26
Prochaska & Norcross: Stages of Change (SOC) ..........................................................28
Eisenberger: Perceived Organizational Support (POS) .................................................30
Roessler & Mullins: Interactional Psychological Model ...............................................31
Conceptual Framework: Counselor Self-Efficacy and EBP Service Delivery
Model .............................................................................................................................34
Summary ........................................................................................................................37

vi

CHAPTER 3 .....................................................................................................................39
METHODS .......................................................................................................................39
Research Questions ........................................................................................................40
Participants .....................................................................................................................40
Instrumentation ..............................................................................................................41
Evidence-Based Practice in Vocational Rehabilitation Survey (EBP-VR Survey) .......42
Evaluation and Psychometric Properties of the EBP-VR Survey..................................42
Variables ........................................................................................................................43
Data Collection ..............................................................................................................44
Procedures ......................................................................................................................44
Pilot ................................................................................................................................45
Dissemination ................................................................................................................45
Response Bias ................................................................................................................46
Ethical Precautions.........................................................................................................46
Data Analysis .................................................................................................................46
Limitations of the Study.................................................................................................49
Summary ........................................................................................................................50
CHAPTER 4 .....................................................................................................................51
RESULTS .........................................................................................................................51
Participants ......................................................................................................................51
Response Rate .................................................................................................................52
Participant Demographics ...............................................................................................53
Missing Data ...................................................................................................................56
Exploratory Factor Analysis of the EBP-VR Survey .....................................................58
EBP-VR Survey Scales ...................................................................................................58
EFA: Self-Efficacy, Perceived Benefits, Perceived Barriers and Readiness Scales .......59
Factor 1: Perceived Benefits ...........................................................................................62
Factor 2: Rehabilitation Counselor Self-Efficacy ...........................................................62
Factor 3: Perceived Barriers............................................................................................63
Supplementary Data Analysis of the EBP-VR Survey ...................................................66
Summary .........................................................................................................................67
Research Question 1: What are rehabilitation counselor’s perceived self-efficacy,
perceived benefits, perceived barriers and readiness to use evidence in current
VR service delivery practices?........................................................................................69
Perceived Benefits Factor ...............................................................................................70
Self-Efficacy Factor ........................................................................................................71
Perceived Barriers Factor ................................................................................................73
Summary .........................................................................................................................75
Research Question 2: What is the difference between practice settings and
Rehabilitation Counselor EBP Self- Efficacy (RCSE) and Environmental Factors (EF)
that influence the use of evidence-based service delivery practices: a.) State-Federal
VR Program, b.) Community Rehabilitation Program (CRO), c.) Private for Profit/
Worker’s Compensation Rehabilitation? ........................................................................76
Self-Efficacy and Practice Setting ..................................................................................76
Perceived Barriers and Practice Setting ..........................................................................77
Summary .........................................................................................................................77
vii

Research Question 3: Are there differences between CRC demographics
(i.e. gender, years of practice, practice setting, etc.) that influence Rehabilitation
Counselor EBP Self-Efficacy (RCSE)? ..........................................................................78
Model Preparation ...........................................................................................................78
Model Equation ...............................................................................................................79
Outcome Measure ...........................................................................................................79
Results .............................................................................................................................79
Summary .........................................................................................................................81
CHAPTER 5 .....................................................................................................................82
DISCUSSION ...................................................................................................................82
EBP-VR Survey: Readiness Scale ..................................................................................82
Relationship with Previous Evidence-Based Practice Research .....................................84
Study Limitations ............................................................................................................85
Implications for Rehabilitation Administrators and Counselors ....................................87
Implications for Rehabilitation Counselor Educators .....................................................89
Implications for Disability Advocates and Policymakers...............................................89
Implications for Rehabilitation Researchers: Closing the Gap .......................................90
Conclusion ......................................................................................................................91
APPENDICES ...................................................................................................................94
APPENDIX A: Evidence-Based Practices in VR Service Delivery Survey ................95
APPENDIX B: Participant Practice Setting ...............................................................101
APPENDIX C: Participant Highest Educational Level & Major Area of Study .......102
REFERENCES ................................................................................................................103

viii

LIST OF TABLES

Table 1. Hierarchical Levels of Evidence ..........................................................................14
Table 2. Study Sample Gender & Race/Ethnicity vs. CRCC Population
Gender & Race/Ethnicity .....................................................................................53
Table 3. Study Sample Age Range vs. CRCC Population Age Ranges ............................54
Table 4. Study Sample CRC Years of Work Experience ..................................................54
Table 5. Study Sample Practice Settings vs. CRCC Population Practice Settings ............55
Table 6. EBP-VR Survey Item Loading Across Factors ...................................................59
Table 7. Total Variance Explained by the Three-Component Solution
of All EBP-VR Items ...........................................................................................61
Table 8. Rotated Component Matrix of Perceived Benefits, Self-Efficacy
and Perceived Barriers Scale Items......................................................................61
Table 9. Mean and Standard Deviation for Perceived Benefits, Self-Efficacy
and Perceived Barriers Factors ............................................................................64
Table 10. Total Variance Explained by Three-Component Solution of
Perceived Benefits, Self-Efficacy & Perceived Barriers ..................................66
Table 11. Rotated Component Matrix of Perceived Benefits, Self-Efficacy
and Perceived Barriers .......................................................................................67
Table 12. EBP-VR Survey Perceived Benefits Factor Items by Practice Setting .............71
Table 13. EBP-VR Survey Self-Efficacy Factor Items By Practice Setting......................72
Table 14. EBP-VR Survey Perceived Barriers Scale Items by Practice Setting ...............74
Table 15. Self-Efficacy and Practice Setting .....................................................................77
Table 16. Perceived Barriers and Practice Setting .............................................................77
Table 17. Full Model Multiple Regression ........................................................................80
Table 18. Correlations for All Predictors and Outcome Measure .....................................81
Table 19. Participant Practice Settings ............................................................................101
ix

Table 20. Participant Highest Educational Level ............................................................102
Table 21. Major Area of Study ........................................................................................102

x

LIST OF FIGURES

Figure 1. Factors Determining a Person’s Behavior .........................................................20
Figure 2. Schematic Representation of Three Alternative Conceptions of Interaction ....24
Figure 3. Relationship of Efficacy and Outcome Expectations ........................................25
Figure 4. Quality Rehabilitation Counseling:
Environmental x Personal Factors Model .........................................................33
Figure 5. Unidirectional Model of Self-Efficacy, EBP & VR Service Outcomes ............35
Figure 6. Counselor Self-Efficacy & EBP Service Delivery Conceptual Model .............36

xi

CHAPTER 1
INTRODUCTION
The unemployment rate for people with disabilities remains high as compared to people
without disabilities, and has remained constant despite programs and resources devoted to the
employment of people with disabilities. In federal fiscal year 2011, the U.S. federal government
spent $3,997,671,547 dollars for the provision of vocational rehabilitation (VR) services to
eligible individuals with disabilities (Annual Disability Statistics Compendium, 2013).
However, of the 326,627 individuals who either initiated or completed services and received
services through the state-federal vocational rehabilitation program in federal fiscal year 2011,
only 175,441 achieved a successful employment outcome for a 53.7% rehabilitation rate (Annual
Disability Statistics Compendium, 2013).
While the general effectiveness of vocational rehabilitation counseling has been
empirically demonstrated (Pruett, Rosenthal, Swett, Lee & Chan, 2008), there is a serious lack of
specific evidence-based practices (EBP) that accurately define what specific VR service(s)
produce employment outcomes for individuals with disabilities that participate in the statefederal VR program (Leahy & Arokiasamy, 2010). Aside from supported employment
programs, few examples of evidence-based VR service delivery practices are known to exist.
Law (2002) states that current rehabilitation interventions are not empirically supported, but are
primarily based on experience, and are eminence or habit based. State-federal VR agencies will
need to know what service provision patterns have a high probability of predicting successful
outcomes for VR customers. The new emphasis on demonstrating VR service delivery
effectiveness challenges state-federal VR agencies to address the long-standing question of,
“What treatment, by whom, is most effective for this individual with that specific problem, and
1

under which set of circumstances?” (Paul, 1967, p. 111). State-federal VR agencies have
attempted to address this challenge through the development and implementation of innovative,
best practices designed to enhance employment outcomes for eligible agency customers.
In addition to determining which approach works best for whom, how and under what
conditions, there are both internal and external pressures for rehabilitation counselors in statefederal VR programs to demonstrate they are using an array of evidence-based interventions in
their practice to improve employment outcomes for customers with significant disabilities
(Rubin, Chan & Thomas, 2003). The Work Incentives Improvement Act of 1999 and the
Workforce Investment Act of 1998, require the state-federal VR program to demonstrate service
efficacy in order to maintain and expand program funding and services (Kosciulek, 2004). In
addition, the National Institute of Disability and Rehabilitation Research (NIDRR) has
emphasized the focus on EBP in all research projects publicly funded through NIDRR (Brannon,
2010). There is now a heightened emphasis on the meaning of research findings, and translating
and disseminating evidence-based practices so they affect and inform practice and policy (Leahy
& Arokiasamy, 2010).
In a resource-limited environment, evidence of efficacy and effectiveness can help make
programmatic funding decisions more rational and more equitable (Brannon, 2010). The current
climate calls for empirical evidence to justify VR services, along with an emphasis on the
development and implementation of evidence-based practices that can assist state-federal VR
programs demonstrate effectiveness of VR service provision. As Chan, Tarvydas, Blalock,
Strauser & Atkins (2009) state, “rehabilitation counseling must [begin to] embrace an evidence-

2

based practice paradigm to remain a vital and respected member of the future community of
professionals in rehabilitation and mental health care” (p. 114).
Statement of the Problem
Little is known about what specific and manualized services or interventions might
contribute differentially to improve employment rates of subpopulations with low employment
outcomes (Leahy, et al., 2014). EBP research has centered on the efficacy of EBPs in the
provision of VR service delivery with an acknowledgement of how EBPs influence other areas
of rehabilitation counseling practice and service delivery. Current EBP initiatives described in
the literature cover a variety of topics ranging from EBP decision models, knowledge translation
(KT), pedagogy, ethics, rehabilitation counselor knowledge, application of EBP and adaptation
of emerging best practices (Leahy, et al., 2014).
Fleming, Del Valle, Kim & Leahy (2013) conducted a literature review of empirical
studies related to employment-focused interventions and present models of best practice existing
in the literature. Of the 561 empirical articles reviewed, only 35 empirical studies met the search
criteria of presenting services or models with initial evidence of supporting employment
outcomes. The research concluded that evidence-based practices, although existing in specific
areas of rehabilitation counseling and VR service delivery, are still not a common practice at the
system or practitioner level, are inconsistent in application and scope, and lack a formal
methodological approach on how to design, implement, and analyze results.
Recently, Leahy et al. (2014) completed a multiple qualitative case study of four statefederal VR agencies to determine the use of innovative, best practices. The research captured
many innovative practices at the system and practitioner levels. However, outside of particular
3

established practices such as evidence-based supported employment, few of the innovative best
practices incorporated an evaluation or measurement component to demonstrate service delivery
effectiveness.
At the practitioner level, there are multiple barriers that preclude the use of EBP in VR
service delivery. Graham et al. (2013) conducted a study to identify barriers and facilitators
regarding the use of EBP by professional staff of state-federal VR agencies. The results indicate
that the majority of VR staff who participated in the study value research for practice. The
multiple barriers described included; EBP is not widely encouraged by the agency, rehabilitation
counselors are not expected to use EBP in service provision, lack of agency resources, limited
counselor time to research EBP, and lack of agency incentives to incorporate EBP into service
provision. Graham et al. noted the consistently high unemployment rate for individuals with
disabilities and stress the importance of EBP in VR service delivery as a bridge for unemployed
individuals with disabilities to gain employment.
Bezyak, Kubota and Rosenthal (2010) reported rehabilitation counselors hold generally
positive attitudes toward EBP. However, they report lack of knowledge and insufficient
academic preparation as major obstacles hindering implementation. In addition, professionals
point to limited motivation and interest, poor confidence, negative attitudes, and limited
understanding of the value of research as barriers to EBP (Winch, Henderson, & Creedy, 2005).
O’Donnell (2004) suggests that the most significant of these barriers is time. Practitioners are
often required to spend at least eight hours each day providing direct service, and as a result,
there is limited time for trainings of new evidence (Corrigan, Steiner, McCracken, & Barr,
2001). Certainly, many of these variables must be considered when attempting to increase the
application of evidence in vocational rehabilitation counseling and VR service provision.
4

Despite obvious barriers, EBP holds counselors accountable and provides an indication of
cost-effective services in an increasingly expensive healthcare system. This accountability is
necessary because healthcare systems, including vocational rehabilitation, are moving from
provider-driven to payer-driven systems (Chan et al., 2003). This move will demand increased
accountability, but it may also lead to additional funding opportunities. According to
Tannenbaum (2003), public policy makers equate accountability with numbers. Quantitative
research provides these numbers, which indicates that money, effort, and resources are not being
wasted, and it allows counselors to provide the best possible services for their clients (Chan et
al., 2009). During a time in which local, state, and national budgets are declining and
expenditures on services are coming under even greater scrutiny, state vocational rehabilitation
agencies must prove the effectiveness of services in order to compete for and receive funding to
provide services (Rubin, Chan & Thomas, 2003).
Purpose of the Study
A recent study by Tansey, Bezyak, Chan, Leahy & Lui (2014) found that counselors in
four state-federal VR agencies were confident in their ability to use EBP at a conceptual and
decision-making level and less confident in the technical understanding of research design and
statistical methods, and interpreting the best evidence information from multiple sources. The
VR counselors also did not see insurmountable agency and personal barriers to use EBP in VR
practices. Specifically, they identified agency barriers, such as the lack of support from senior
management/supervisors, as significant barriers to EBP use in practice. This study will explore
the relationship between counselor self-efficacy and work environment factors that influence
and/or inhibit the use of EBP in VR service delivery.

5

Description of the Study
This study will support the use of the Evidence-Based Practice in Vocational
Rehabilitation Survey (EBP-VR Survey; Chan, Bezyek & Lui, 2013). Tansey, Bezyek, Chan,
Leahy & Lui (2014) administered the Evidence-based Practice in Vocational Rehabilitation
Survey, (EBP-VR Survey) to counselors in four state-federal VR agencies. This study will use
the EBP-VR Survey to explore counselor self-efficacy, perceived benefits, perceived barriers and
readiness in the use of EBP on a larger sample, i.e. the Commission or Rehabilitation Counselor
Certification (CRCC) membership data base.
Research Questions
This study will explore rehabilitation counselors’ self-efficacy in the use of evidencebased practices and organizational support for the use of evidence-based practices in VR service
delivery. Specifically, this study will explore the relationship between counselor self-efficacy
and work environment factors that influence and/or inhibit the use of EBP in VR service
delivery. The research questions of interest in this study are as follows:
1. What are rehabilitation counselor’s perceived self-efficacy, outcomes expectancy, barriers and
readiness to use evidence in current VR service delivery practices?
2. What is the difference between practice settings and Rehabilitation Counselor EBP SelfEfficacy (RCSE) and Environmental Factors (EF) that influence the use of evidence-based
service delivery practices:
a. State-Federal VR Program
b. Community Rehabilitation Program (CRO)
6

c. Private for Profit/Workers Compensation Rehabilitation
3. Are there differences between CRC demographics (i.e. gender, years of practice, practice
setting, etc.) that influence Rehabilitation Counselor EBP Self-Efficacy (RCSE)?
Assumptions and Limitations
A major assumption of this study is rehabilitation counselor understanding of evidencebased practices. Graham et al. (2013) asked state-federal VR counselors and other professional
rehabilitation staff what they know about evidence-based practice and how do they use the
information. The results indicated that rehabilitation professionals held multiple definitions of
evidence-based practice, “research-based”, “documented evidence”, “proven effective” and
“practice or experience” reflecting a basic knowledge of EBP. Another assumption concerns
how EBP is valued by rehabilitation counselors across the three proposed areas of study, i.e. the
state-federal VR program, community rehabilitation organizations, and private
rehabilitation/workers compensation practice settings. While each practice setting strives to
achieve competitive employment outcomes for their clients, program effectiveness and outcomes
are measured differently. RSA standards and indicators are the measurements for the statefederal VR program and the Commission on Accreditation of Rehabilitation Facilities (CARF)
provides standards for private and community rehabilitation programs. These outcome
measurements drive the VR service delivery process, and may challenge the development and
use of EBP within the different service delivery models. Additionally, each group is accountable
to different stakeholders that hold considerable influence over service delivery efforts. For
example, state-federal VR programs are accountable to RSA, client advocacy organizations and
political entities while private rehabilitation providers are accountable to insurance providers in
7

order to receive payment for services rendered. To ignore these realities is to neglect
environment and systemic issues that challenge the implementation of EBP in VR service
delivery.
Potential limitations considered within the framework of this study include the sample,
sample size, and use of electronic surveys and questionnaires. First, this study will utilize a
convenience sample comprised of Commission on Rehabilitation Counselor Certification
(CRCC) members. CRCC members who are employed and belong to a professional organization
may be different than rehabilitation professions who are employed but do not belong to a
professional organization (Zanskas & Strohmer, 2011). Second, sample size may be a limitation
based on survey response frequency. Current trends in survey research reflect that refusal and
non-response rates have doubled for all surveys, regardless of type during the past decade
(Birnbaum, 2004; Sheehan, 2001; Survey Monkey, 2008; Tourangeau, 2004). Heppner,
Kivlingham, and Wampold (1992) reported that survey research is often published with less than
40% response rates. A monograph published by RAND reflects web survey response rates range
from 7%-44% (Schonlau, Fricker, & Elliot, 2002). The overall decline in e-mail survey response
rates has been attributed to the number of people who do not read their e-mail (Birnbaum, 2004;
Welker, 2001). Welker (2001) studied the web-based response rate of 900 individuals with fixed
email accounts. An overall response rate of 14% was reported and it was determined that over
one-third of the random sample simply did not read their e-mail over a two month period.
This study will explore the relationship between rehabilitation counselor self-efficacy and
work environment factors that influence the use of EBP in VR service delivery. Bandura’s
(1986) Social Cognitive Theory and Prochasha & Norcross’ (1992) Stages of Change Theory
will serve as the theoretical frame work.
8

Definition of Terms
Certified Rehabilitation Counselor. Rehabilitation counselors who are certified
through the Commission on Rehabilitation Counselor Certification (CRCC) as having at least an
acceptable minimum level of knowledge and skills to practice as a professional in rehabilitation
counseling.
Evidence-Based Practice (EBP). A clinical decision-making process beginning with
formulating clinical questions to ask, determining the best practice, and critically appraising the
evidence for validity and applicability to the particular situation. The best evidence must then be
applied by a clinician with expertise in considering the client’s unique values and needs. The
final aspect of the process is evaluation of the effectiveness of care and continual improvement
of the process (DePalma, 2002; Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996).
Rehabilitation Counselor. A counseling practitioner with a master’s degree who assists
persons with disabilities with physical, mental, developmental, cognitive, and emotional
disabilities to achieve their personal, career, and independent living goals in the most integrated
setting possible through the application of the counseling process. Techniques and modalities
used by rehabilitation counselors may include, but are not limited to: (a) assessment and
appraisal; (b) diagnosis and treatment planning; (c) career (vocational) counseling; (d) individual
and group counseling; (e) case management, referral, and service coordination, (f) program
evaluation and research; (g) interventions to remove environmental, employment, and attitudinal
barriers; (h) consultation services among multiple parties and regulatory systems; (i) job
analysis, job development, and placement services, including assistance with employment and
job accommodations; and (j) the provision of consultation about and access to rehabilitation
technology (CRCC Scope of Practice, 2012).
9

Self-Efficacy. Self-efficacy theory is defined as the individual’s perceived ability related
to their actual ability (Bandura, 1977; Bandura, 1982). According to the theory, an individual’s
perceptions impact their behaviors and actions. For example, if a counselor believes they can
provide an effective service to their client(s) (i.e. perceived competency to deliver evidencebased practices), their thoughts and behaviors are shaped by the perceived competency and they
are likely to provide the effective service to their clients.
Stages of Change. Prochaska & Norcross (2001) posit that behavior change is a
conceptualized process that unfolds over a time and involves progression through a series of six
stages: pre-contemplation, contemplation, preparation, action, maintenance and termination. The
six stages involve different processes of change that produce optimal progress and behavior
change.

10

CHAPTER 2
LITERATURE REVIEW
The purpose of this study is explore the relationship between counselor self-efficacy and
work environment factors (perceived barriers) that influence and/or inhibit the use of EBP in VR
service delivery. A literature review was conducted that begins with a description of the current
state of EBP in rehabilitation counseling and VR service delivery. This is followed by theories
that describe the concept of self-efficacy and behavior change, specifically Azjen & Fishbein’s
(1980) Theory of Reasoned Action, Bandura’s (1986) Social Cognitive Learning Theory, and
Prochaska & Norcross’ Stages of Change (2001). The literature review concludes with a review
of Eisenberger, Huntington, & Sowa’s (1986) Perceived Organizational Support (POS) theory
regarding perceived organizational support as motivation for individual behavior change, and
Roessler & Mullins (1995) Interactional Psychological model of counselor self-efficacy in terms
of an interaction between counselor personal factors and demands of the work environment.
The Current State of Evidence-Based Practices in VR Service Delivery:
Emphasis on Counseling Skills
The effectiveness of rehabilitation counseling has been empirically demonstrated (Pruett,
Rosenthal, Swett, Lee & Chan, 2008), however there is limited research regarding rehabilitation
counselor use of EBP in VR service delivery. As Leahy et al. (2014) noted, little is known about
what specific and manualized services or interventions might contribute differentially to improve
employment rates of subpopulations with low employment outcomes. This is especially true in
terms of counselor self-efficacy with the development and implementation of EBP into practice.
This is understandable given the profession’s emphasis upon counselor self-efficacy in terms of
counseling skills (McCarthy, 2012). The Commission on Rehabilitation Counselor Certification
11

(CRCC) Scope of Practice Statement (2012) states, “ individual and group counseling treatment
interventions focused on facilitating adjustment to the medical and psychosocial impact of
disability”(p.1) as an essential counseling function of rehabilitation counselors. Also, the need
for counseling skills are incorporated into the Council on Rehabilitation Education (CORE)
standards that students engage in practicum experiences that, “facilitate the development of basic
rehabilitation counseling skills” (CORE, 2009, p.16). Knowledge of individual and career
counseling has been reported by practicing certified rehabilitation counselors as important
effective practice (Leahy, Muenzen, Saunder, & Strauser, 2009), and clients want and need
rehabilitation counselors who employ counseling skills (Lustig, Strauser, Rice, & Rucker, 2002).
Recently, McCarthy (2012) explored the relationship between rehabilitation counselor
self-efficacy for counseling skills and client outcomes within the public VR system. Results of
the study indicate that efficacy for counseling microskills (e.g., paraphrasing, confrontation) and
efficacy for handling difficult client behavior (e.g., clients that lack motivation, clients in crisis)
were positively correlated with successful client outcomes. Of note, clinical supervision and the
work environment were not cited as contributing towards successful client outcomes.
McCarthy’s results reflect the traditional pre-service training and research that emphasize
counseling skills as a major foundation of the profession vs. implementing EBP in VR service
delivery.
Understanding EBP and Levels of Evidence
Understanding of EBP in VR service delivery reflects multiple issues ranging from
definitions of EBP, levels of EBP, developing and implementing EBP, ethical considerations
involving EBP, and barriers to EBP implementation. These issues are discussed below, however
it is important to bear in mind that the approach to developing and implementing EBP is
12

currently conceived as a linear process. Meaning that EBP appears to evolve from a linear
process of research to dissemination to practice. It should be noted that implementation of EBP
involves multiple layers of application according to the nature of the evidence, context or
environment in which the evidence is to be applied and how the evidence is facilitated into
practice.
According to Bezyak, Kubota & Rosenthal (2010) evidence-based practice has become a
focus in many healthcare arenas. Physicians, nurses, physical therapists, and occupational
therapists to name a few are increasingly interested in the available evidence to support practice
(Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). Sackett et al. stated that evidencebased practices are not only a focus for healthcare practitioners, but is also important to
purchasers, planners and the public. Sackett et al. defines evidence-based practices as integrating
individual clinical expertise with the best available clinical evidence from systematic research.
In this definition, clinical expertise refers to proficiencies and clinical decisions that evolve
within individual clinicians through clinical experience and practice. Ingersoll (2000) provided a
more general definition of EBP as a, “conscientious, explicit, and judicious use of theoryderived, research-based information in making decisions about care delivery” (p. 152).
McCluskey and Cusick (2002) added an important component to this definition by reminding
readers that EBP is about, “using, rather than doing research” (p.63).
Strauser & Wong (2010) contend that despite purported strengths of adapting a model of
evidence-based practice, there are a variety of challenges that may limit utilization and
adaptation of the evidence-based model in rehabilitation and rehabilitation counseling settings.
Strauser & Wong cite four prevailing issues that confront the use of evidence-based practice in
rehabilitation and rehabilitation counseling. First, is the broad multidisciplinary nature of
13

rehabilitation and rehabilitation counseling in which multiple outcomes are appropriate for the
individuals served (i.e. employment, independent living, etc.). Second, the breath and
complexity of rehabilitation service delivery complicate the rehabilitation research process.
Third, studies in rehabilitation use small sample sizes and do not use or analyze blinding or
placebo effects. Finally, of major concern is the overall lack of Level 1 studies or Randomized
Control Trials (RCT). In the hierarchical levels of evidence, rehabilitation counseling research
typically falls within Level 4 and Level 5. Table 1 below describes the hierarchical level of
evidence.
Table 1.
Hierarchical Levels of Evidence
Levels of Evidence
Description
Level 1

Strong evidence from at least one systematic review of multiple welldesigned randomized controlled trials.
Level 2
Strong evidence from at least one properly designed randomized
controlled trial of appropriate size.
Level 3
Evidence from well-designed trials without randomization, single
group pre-test, cohort, time series or matched case controlled studies.
Level 4
Evidence from well-designed non-experimental studies from more
than one center or research group.
Level 5
Evidence from opinions or respected authorities, based on clinical
evidence, descriptive studies, or reports of expert committees.
Source: Chronister et al., 2008.
Chan et al. (2010) cites multiple challenges to EBP implementation such as the broad
array of services provided within the rehabilitation counseling scope of practice, lack of
scientific rigor in rehabilitation counseling research, rehabilitation counselors may not possess
the skills necessary to evaluate and incorporate research findings into practice, limited training in
academic search skills, along with time and potential organizational barriers. However, in light
of the challenges facing evidence-based practices in rehabilitation counseling, Chan et al.
provide a four step clinical decision-making model to assist with implementing EBPs. The four
14

steps are 1) formulate a well-defined question(s), 2) seek best evidence to answer the
questions(s), 3) critically appraise the evidence, and 4) apply evidence to the individual client.
McCabe (2004) suggests an additional step to the process of evaluating outcomes on a
continuing basis.
Tarvydas, Addy & Fleming (2010) provide a new perspective of EBP research in
rehabilitation counseling as moving from a dichotomy for “either/or” to a dialectic of “this/and”
thinking. This approach allows for the inclusion of critical aspects of EBP to the longstanding
practices in rehabilitation counseling research and practice. Tarvydas et al. contend that EBP
upholds ethical principles in that it allows customers to make informed choices and supports the
five major ethical principles of autonomy, justice, fidelity, beneficence and non-maleficence.
This includes support for the CRCC Code of Professional Ethics (2010), specifically Standard
D.1: Competency to provide competent services to their clients and not to provide services not
personally competent to render and Standard D.6.a in which rehabilitation counselors are
obligated to use techniques and procedures that have an empirical or scientific foundation
(Neulicht, McQuade & Chapman, 2010).
Evidence-Based Practices and Environmental Factors
In addition to emphasis on the relationship between rehabilitation counselor self-efficacy
in the use of EBP, there are organizational elements (environmental factors) that may inhibit the
use of EBP. Winch, Henderson and Creedy (2005) noted that barriers to the use of EBP are
often symptoms of organizational contexts that have not been established to integrate evidence
into practice. Characteristics of the organization setting (e.g., hospital vs. outpatient setting)
were also related to the use of evidence-based practice and related attitudes (Nelson & Steele,
2007). Winch et al. (2005) noted professionals often point to limited motivation and interest,
15

poor confidence, negative attitudes, and limited understanding of the value of research as barriers
to evidence-based practice. Both organizational and individual characteristics include lack of
knowledge to properly assimilate evidence-based practice on the part of service providers, poor
leadership, bureaucratic constraints, and a change-averse culture (Corrigan, Steiner, McCracken,
Blaser, & Barr, 2001). Limited training and education of practitioners, limited access to
evidence, and the complexity of research databases serve as barriers to evidence-based practices
(Jette et al., 2003; Nelson & Steele, 2007). A study of occupational therapists and EBP revealed
that less than one-third of the participants searched the literature on research information to apply
to practice (Rappolt & Tassone, 2002). O’Donnell (2004) indicated that time is a major barrier
to fully implementing evidence-base practice with practitioners spending at least eight hours
each day providing direct service, resulting in limited time for training of new evidence or
practices as did Corrigan et al. (2001).
Evidence-Based Practices and Rehabilitation Counselor Perceptions
Bezyak, Kubota & Rosenthal (2010) examined the perceptions of evidence-based
practice among rehabilitation counselors. The results of their study indicate that rehabilitation
counselors believe the application of evidence-based practice is necessary, useful and will lead to
improved quality of VR service delivery. Rehabilitation counselors reported positive attitudes
towards evidence-based practices in general. However, there were mixed results related to the
knowledge and skills necessary to engage in evidence-based practices and somewhat limited use
of research literature in practice. A large majority of participants had access to professional
journals and access to research databases at in the work environment. Barriers to using
evidence-based practices included insufficient time, lack of generalizability to current practice

16

and the inability to apply research findings to individual clients (Bezyak, Kubota & Rosenthal,
2010).
Graham et al. (2013) asked state-federal VR counselors and other professional
rehabilitation staff what they know about evidence-based practice and how do they use the
information. The results indicated that rehabilitation professionals held multiple definitions of
evidence-based practice, “research-based”, “documented evidence”, “proven effective” and
“practice or experience”. The majority of participants reported they value research for practice,
understood how to interpret research literature and apply the information in their job. The study
participants described a wide variety of sources of information in relation to the job. Many
reported informal networks of collaboration with other professionals, meeting with consumers,
informal conversations in offices or with consumers’ families as methods to gather information
for practice. Other sources included training, a wide variety and accessibility to resources and
professional networking. Regarding agency promotion of evidence-based practices it was noted
that EBP was not widely encouraged, with little supervisory support for the use of EBP in
service delivery and making planning decisions.
Tansey, Bezyak, Chan, Leahy & Lui (2014) conducted a study to identify and describe
vocational rehabilitation professional’s perceived self-efficacy, outcome expectancy, barriers and
readiness to use evidence in current practice. The results from rehabilitation counselors
employed in four state-federal VR agencies reported moderately high self-efficacy in the use of
EBP and outcome expectancy. Participants reported moderately low levels of barriers to the use
of EBP. Perceived barriers were reported higher at the agency level than at the individual level.
Of the barriers reported were lack of support among agency colleagues, insufficient training to

17

incorporate EBP into practice, little support and encouragement from senior management and
lack of experience among supervisors and counselors experienced in EBP.
The understanding of EBP as applied to VR service delivery includes a variety of issues
within different dimensions of rehabilitation counseling. EBP can be defined and contrasted
with different levels of evidence, and steps are provided as to the development and
implementation of EBP. Ethical considerations, counselor knowledge of EBP and organizational
challenges are also noted as affecting EBP implementation. What is missing from the current
dialogue is counselor self-efficacy and environmental factors that influence the ability to institute
EBP in service delivery practices. To address this gap, a review of Azjen & Fishbein’s (1980)
Theory of Reasoned Action, Bandura’s (1986) Social Cognitive theory, and Prochaska &
Norcross (2001) Stages of Change (SOC) theory is presented below. The discussion will also
include Rosselor & Mullin’s (1995) interaction between counselor self-efficacy, counselor duties
and the environment.
Ajzen & Fishbein: Theory of Reasoned Action
Prior to describing self-efficacy, it is important to discuss the underlying concepts that
influenced the development of Bandura’s (1986) Social Cognitive Theory of Learning. A
Theory of Reasoned Action (Ajzen & Fishbein, 1980), posited that human beings are quite
rational and make systematic use of the information available to them. As described by Fall
(1991), Ajzen & Fishbein did not subscribe to earlier theories of human social behavior
controlled by unconscious motives or overpowering desires. They believed that human social
behavior was not “capricious or thoughtless” in nature (p.5). Instead, Ajzen & Fishbein argued
that people consider the consequences of their actions, before they decide to engage or not
engage in a given behavior leading to a “theory of reasoned action” (p. 5).
18

The decision to engage or not engage in a behavior was attributed to an individual’s
intention to perform or not perform a behavior as the immediate determinant of the action.
Individuals will most likely act in accordance with his or her intention (Ajzen & Fishbein, 1980).
Intentions do not operate in isolation, but are influenced by determinants that shape the intention
of whether or not to engage in a particular action (Fall, 1991).
Individual Attitude and Social Influence
Ajzen & Fishbein (1980) divided intention into two basic determinants; one that is
personal in nature and one reflecting social influence. The personal determinant, or attitude, is
the individual’s positive or negative evaluation of performing the behavior. Attitude toward a
behavior is the individual’s judgment whether performing the behavior is good or bad, or simply
for or against performing the behavior (Ajzen & Fishbein, 1980). Social influence is the
individual’s perception of the social pressures placed on him or her to perform the action in
question. The social influence determinant is referred to as the subjective norm and relates to the
perception that if others important to the individual believe the action should be engaged or not
engaged, individuals will act accordingly based on the important others perception. It is
important to keep in mind that both factors are determinants of intention. Each determinant will
vary in importance, one factor may have a greater weight than the other and the factors may vary
from one individual to another (Ajzen & Fishbein, 1980). Frequently, both attitude and
subjective norm are important determinants of the intention.
According to the theory of reasoned action (Ajzen & Fishbein, 1980), attitudes are a
function of beliefs. In general, if an individual holds a positive belief that performing an action
will result in a positive outcome, the individual will have a favorable attitude toward performing
19

the behavior. The opposite is also true. If an individual holds a negative belief that performing a
particular action will result in a negative outcome, the individual will hold a negative attitude
towards performing the behavior (Ajzen & Fishbein, 1980). Attitudes towards behaviors are
termed behavioral beliefs.
Fall (1991) states subjective norms also function as beliefs in relation to whether specific
individuals or groups think he or she should perform the behavior. These beliefs are called
normative beliefs as it describes the ability to perform or not perform a behavior based on social
pressure to comply with a referent group’s perceived preferences towards the behavior. If an
individual perceives the referent group to be favorable towards a behavior he or she will likely
engage in the behavior. Similarity, if the individual perceives the referent group to hold a
negative attitude towards the behavior he or she will avoid performing the behavior (Ajzen &
Fishbein, 1980). Figure 1 reflects the attitude and social factors that determine an individual’s
behavior.
Figure 1.
Factors Determining a Person’s Behavior
The person’s beliefs that the
behavior lead to certain
outcomes and his
evaluations of these
outcomes
The person’s beliefs that
specific individuals or
groups think he should or
should not perform the
behavior and his motivation
to comply with the specific
referents

Attitude toward the behavior

Relative importance of attitudinal
and normative considerations

Intention

Subjective Norm

Note: Arrows indicate the direction of influence (Ajzen & Fishbein, 1980).
20

Behavior

The Theory of Reasoned Action (Ajzen & Fishbein, 1980) provides an alternative theory
of human behavior based on intention to perform or not perform a behavior vs. early theories of
human behavior being simply a response to external stimuli. The Theory of Reasoned Action
describes human behavior as rational based on using the information available. Individuals
develop intention to engage or not engage in behaviors based on their attitudes towards the
behavior and subjective norms resulting from related social pressures (Fall, 1991). Additionally,
individuals used behavioral normative beliefs when determining whether to perform or not
perform a behavior. It should be noted that Ajzen (1991) later expanded the theory of reasoned
action to one of a prediction of individual behavior called the Theory of Planned Behavior.
Ajzen distinguishes the theory of planned behavior from his previous theory of reasoned action
in that people act in accordance with their intentions and perceptions of control over the
behavior, while intentions in turn are influenced by attitudes towards the behavior, subjective
norms and perceptions of behavioral control. The introduction of perceptions of control over the
behavior within the theory of planned action is what separates it from the earlier theory of
reasoned action. The theory of planned behavior extends into the Bandura’s (1986) social
cognitive theory in which the element of perceived control over behavior is a key element of
self-efficacy.
Missing from the Theory of Reasoned Action (Ajzen & Fishbein, 1980) and the Theory
of Planned Behavior (Ajzen, 1991) is an account of how an individual’s belief in their ability to
perform a behavior will influence outcome expectancy of the behavior. The theory of reasoned
action does not address an individual’s belief in their ability to perform behaviors nor how belief
in ability affects outcome expectancy. Addressing this gap is Bandura’s (1986) Social Cognitive
Theory of Learning. In his social cognitive theory of learning, Bandura contends that individual
21

learning is by observing and extracting rules and structures of behavior from social interactions
and the surrounding environment. Through vicarious learning individuals come to understand the
effects and results of behavior and can develop mastery of learned skills through various forms
of practice, leading to positive outcome expectancy (Bandura, 1986).
Bandura: Social Cognitive Theory
Prior to the arrival of Bandura’s (1986) Social Cognitive Theory of learning, it was
widely held that competencies and new patterns of behavior were learned through the
consequences of responses to stimuli, was controlled by situational influences or in response to
instincts, drives, traits, and other motivational forces within the individual (Bandura, 1978).
These early conceptions of human behavior portrayed learning as a trial and error process in
which learning effective behaviors in order to perform activities with successful outcomes not
only tedious, but difficult at best (Fall, 1991). Bandura (1978) posited that indiviual’s learn by
observing and extracting rules and structures of behavior from social interactions and the
surrounding environment. Individuals vicariously learn social behaviors and observe the effects
of these behaviors on others, the surrounding environment and the individual performing the
action. Cognitive images of the desired behavior are retained for future use until such a time a
symbolic construction of the behavior can be recall and used to guide behavior (Fall, 1991).
Mastery of Behavior
Once the behavior has been observed, individuals learn to master the behavior through
modeling. Mastery of a behavior usually begins with a model verbally sharing their thoughts and
actions during performance of the behavior, resulting in a vicarious learning experience. The
behavior is then broken down into small manageable progressive actions that are dependent on
22

previously demonstrated behaviors, leading to successful outcomes. These steps are repeated
until the individual can perform the behavior successfully without assistance or guidance (Fall,
1991). This success in outcomes instills a general sense of coping efficacy and changes an
individual’s belief in their ability to perform the required behaviors (Bandura, Jeffery & Wright,
1974).
It is important to note the question of how behavior is acquired and regulated. The theory
of self-efficacy states that cognitive based processes regulate behavior while reality demonstrates
that mastery of performance is the most influential in cognitive, affective and behavioral changes
(Bandura, 1986). This difference between theory and practice is not contradictory. Bandura
explains that while it is cognitive factors that mediate change, cognitive factors are induced and
altered most by the experience of mastery performance (Fall, 1991).
Reciprocal Determinism
A key concept within social cognitive theory is that of “reciprocal determinism”
(Bandura, 1986). Reciprocal determinism explains psychosocial behaviors in terms of a triadic
reciprocal causation (Bandura, 1986, Wood & Bandura, 1989). The triad elements are behavior
(B), environmental influences (E) and personal cognitive events that can influence perceptions
and actions (P). These three elements interact as determinants of each other and the intensity of
the three elements will vary. However, they interact in a way that each is both a product and
producer of the others (Wood & Bandura, 1989).

23

Figure 2.
Schematic Representation of Three Alternative Conceptions of Interaction.
P
B

E

In the figure above, B signifies behavior, P is the cognitive and other internal events that can
affect perceptions and actions, and E the external environment.
The personal determinants (P) in the interactional causal structure play a major role in
social cognitive theory. Bandura (1977) theorized that of these self-efficacy operates as a selfregulator of both motivation and performance. Perceived self-efficacy is the individual’s belief
that he/she possess the knowledge, skills and the ability to transform these into behaviors leading
to the desired action (Bandura, 1977). However, while the individual may possess the necessary
knowledge and skills, it does not mean they was able to translate either in action. The individual
needs to believe they can perform the necessary actions and it will result in the desired outcome
(Fall, 1991). “Perceived self-efficacy concerns people’s beliefs in the capabilities to mobilize
the motivation, cognitive resources, and other courses of actions needed to exercise control over
events in their lives” (Wood & Bandura, 1989, p. 364).
Outcome Expectancy
Bandura (1986) emphasized the difference in self-efficacy expectancy and outcomes
expectancy, including how they operate together. Efficacy expectancy is the belief that an
individual is or is not able to perform the necessary actions to reach the intended to goal, while
outcome expectancy is the belief that a certain behavior will have a specific outcome (Bandura,

24

1986). The expectancy that an individual holds concerning mastery is composed of these two
related expectancies (Maddux, Norton & Stoltenberg, 1986) as depicted in Figure 3 below.
Figure 3.
Relationship of Efficacy and Outcome Expectancies
PERSON

BEHAVIOR
EFFICACY
EXPECTATONS

OUTCOME
OUTCOME
EXPECTATIONS

Outcome expectancy and self-efficacy expectancy are independent in the sense that selfefficacy judgments are arrived at independently of potential outcomes (Bandura, 1977).
Outcome types anticipated are strongly influenced by self-efficacy judgments (Bandura, 1984).
Self-Efficacy Beliefs
There are four principal sources of self-efficacy beliefs: mastery experience, modeling,
social persuasion, and physiological indices (Bandura, 1977). Fall (1991) describes the four
principle sources of self-efficacy below:
1. Mastery experience exerts the most powerful influence on self-efficacy expectancies.
Performance success builds capability, while failure creates self-doubt.
2. Vicarious experiences consist of modeling, imitation and observational learning.
Observing success builds observers’ beliefs in personal capabilities. Observing failure
builds observers’ beliefs in personal inability to perform the behaviors satisfactorily.
Efficacy beliefs which are based on vicarious experience can be quickly altered when
performance is not in line with beliefs. These experiences are the second most powerful
source of efficacy information.
25

3. Verbal or social persuasion encourages people to exert extra effort and to believe in their
capabilities but can be extinguished by both performance and vicarious information.
4. Emotional arousal signals an individual through physiological indices that a certain level
of performance will probably be the result of these actions. Arousal can signal an
individual that an excellent or a poor performance will probably result.
These four types of experiences strengthen or weaken beliefs about capabilities (Fall,
1991). Information from the four sources is appraised by an individual in an inferential process
in which the contributions of personal and situational sources are weighed and combined
(Bandura, 1981). An efficacy judgment, of self-efficacy expectancy, was formed as a result of
this cognitive appraisal.
Effects of Self-efficacy Beliefs
Fall (1991) outlined three main effects of self-efficacy beliefs according to self-efficacy
theory. These beliefs are listed below;
1. Self-efficacy affects choice behavior. Individuals accept choices of activities and social
situations where they believe that they was successful (Bandura, 1988). Most people avoid
situations they believe will tax them beyond their capabilities.
2. Self-efficacy affects motivation. This is reflected in how long individuals will persevere
and how much effort they will contribute. Individuals with strong beliefs in their
capabilities will exert greater effort to master a situation or behavior (Bandura & Cervone,
1983), whereas individuals who doubt their abilities will only exert a small amount of
effort and quickly give up should they experience failure. Bandura states in personal
26

dialog that persistence and effort are responsible for many great achievements, since
famous individuals often refuse to abandon projects even when met with failure (Evans,
1989).
3. Self-efficacy affects thinking processes. When an individual experience challenges, their
thinking processes can assist or hinder the individual. Individuals with low self-efficacy
dwell upon personal deficiencies and environment barriers instead of attempting to effect
change (Beck, 1976, Meichenbaum, 1977). Self-referent misgivings create stress, lower
self-efficacy and can lead to possible depression and/or resignation of no change. On the
other hand, highly efficacious individuals will devote their energy and resources to
overcoming a problem. Environmental-referent misgivings will create little stress and
unchanged self-efficacy (Fall, 1991).
Self-efficacy theory is defined as the individual’s perceived ability related to their actual
ability (Bandura, 1977; Bandura, 1982). According to the theory, an individual’s perceptions
impact their behaviors and actions. For example, if a counselor believes they can provide an
effective service to their client(s) (i.e. perceived competency to deliver evidence-based
practices), their thoughts and behaviors are shaped by the perceived competency and they are
likely to provide the effective service to their customers. Self-efficacy theory can be used to
study the expectations individuals have regarding their performance in activities. Much like a
rehabilitation counselor’s perceived competency to deliver effective VR services using evidencebased practices, thereby enhancing their clients’ employment outcomes.

27

Prochaska & Norcross: Stages of Change (SOC)
Prochaska & Norcross (2001) posit that behavior change is a conceptualized process that
unfolds over a time and involves progression through a series of six stages: pre-contemplation,
contemplation, preparation, action, maintenance and termination. The six stages involve different
processes of change that produce optimal progress and are outlined below;
1. Pre-contemplation. A stage in which there is no intention to change behavior in the
foreseeable future.
2. Contemplation. Is the stage which individuals are aware that a problem exists and are
seriously thinking about overcoming it, yet have not made a commitment to take action.
3. Preparation. Combines intention and behavioral criteria. Individuals in this stage are
intending to take action in the near future and have unsuccessfully taken action in the past
year.
4. Action. In this stage individuals modify their behavior, experiences, and environment in
order to overcome their problems.
5. Maintenance. Individuals work to prevent relapse and consolidate the gains attained
during action.
6. Termination. Individuals are longer tempted by inappropriate behaviors and have the
confidence to cope with changes without fear of relapse. (Prochaska & Norcross, 2001).
SOC is not a linear process and has been conceptualized by Prochaska, DiClemente &
Norcross (1992) as a, “spiral pattern of change” (p.1104) in which individuals may relapse or
recycle through the stages in attempts to modify behavior. Prochaska, DiClemente & Norcross
stated it is important to match the intervention with the individual’s current stage as a method to
28

enhance success. For example, in a smoking cessation program for cardiac patients, presenting
intensive action and maintenance change strategies to individuals in the action stage was highly
successful as the participants were in the action stage and ready for action (change). The same
approach for participants identified as pre-contemplative or contemplative was unsuccessful.
One additional strategy that reinforced behavior change in study participants was proactive
treatment follow up with participants by treatment providers. Proactive treatment involved
reaching out to patients and customizing clinical communications to the patients’ stage of change
that resulted in an 80% participation rate in clinical services (Prochaska, DiClemente &
Norcross, 1992; Prochaska & Norcross, 2001). These results emphasize the importance of
correctly matching interventions to the individual’s stage of change (Prochaska, DiClemente &
Norcross, 1992) and engaging in proactive treatment to encourage patient participation in clinical
services.
While the SOC theory was derived from addiction research, it was recently used by Chan,
Bezyak, & Lui (2013) as a framework to develop the Evidence-Based Practice in Vocational
Rehabilitation (EBP-VR) survey to measure perceived self-efficacy, perceived benefits,
perceived barriers and readiness to use EBP in practice. The EBP-VR Survey items included
questions to determine the counselors stage of change in regards to EBP use: “I am interested in
learning more about EBP”, “I use EBP concepts in making decisions regarding services for my
clients”, and “I am using EBP my role as a rehabilitation counselor.” These questions were
intended to reflect various stages of change for rehabilitation counselors contemplating or putting
EBP into action.

29

Results of the EBP-VR Survey of a four-state sample of counselors working in the statefederal VR program revealed the three highest rated items on EBP Stages of Change were: (a) I
am interested in learning more about EBP, (b) I use best evidence for medical, psychological,
and vocational interventions in my rehabilitation practice, and (c) I can see the value of EBP in
vocational rehabilitation (Tansey, Bezyak, Chan, Leahy & Lui, 2014). The EBP-VR Survey
responses to the EBP Stages of Change items reflect a range of responses from wanting to learn
more about EBP to using medical, psychological and vocational interventions in practice. In
terms of SOC theory, the responses included counselors in a pre-contemplative or contemplation
stage to the action stage. The responses also indicate that EBP implementation is not a linear
process and involves a complex interaction of an individual counselor’s knowledge of EBP and
particular stage of change in conjunction with the practice environment.
Eisenberger: Perceived Organizational Support (POS)
Eisenberger, Huntington, Hutchinson & Sowa (1986) define perceived organizational
support (POS) as the employee developing global beliefs concerning the extent to which the
organization values their contributions and care about their well-being. It is an attributional
process similar to what people use generally to infer the commitment of others to social
relationships. POS would be influenced by the frequency, extremity, and judged sincerity of
statements of praise and approval (Blau, 1964). Other forms of support such as rewards or
influence over an organization’s policies or procedures could be perceived as organizational
support and the organization’s positive evaluation of the employee (Brinberg & Castell,1982).
Perceived support would raise an employee’s expectancy that the organization would reward
greater effort toward meeting organizational goals (effort-outcome expectancy). In later studies,

30

Eisenberger, Fasolo, Davis-LaMastro (1990) report a positive relationship of employees’
perception of being valued and cared about by the organization with a) conscientiousness in
carrying out conventional job responsibilities, b) expressed affective and calculative
involvements in the organization, and c) innovation on behalf of the organization in the absence
of anticipated direct reward or personal recognition. The POS theory is supportive of Bandura’s
(1986) self-efficacy theory in that individuals’ perception of support is reflective of the
subjective and normative determinants that influence individual attitudes and the inclination to
engage in certain behaviors. However, POS theory relies primarily on individual perceptions of
support as the determinant of motivation to engage or not engage in certain behaviors. The
theory does not take into account the individual’s belief in their ability to perform the behavior
and if their behavior will lead to the desired outcome. Thus, in terms of counselor self-efficacy,
POS fails to acknowledge an individual’s belief to perform certain behavior(s) and how
individual belief in their abilities may influence certain behaviors such as the use of EBP in order
to enhance more effective outcomes. However, POS may be one possibility of explaining
counselor perceptions regarding lack of organizational support for the use EBP in service
delivery.
Roessler & Mullins: Interactional Psychological Model
Roessler & Mullins (1995) proposed using an interactional psychological model based on
social cognitive theory for identifying and understanding the variables that influence the quality
of rehabilitation counseling. The key components of the model included environment, self and
behavior, each of which has an influence on the other. According to Bandura (1986), “behavior,
cognitive and other personal factors, and environmental influences operate interactively as

31

determinants of each other” (p.23). These influences of behavior, personal factors and
environmental factors have a bi-directional effect known as “reciprocal determinism”.
Roessler & Mullins (1995) expanded on the concept of reciprocal determinism
with a proposed application to rehabilitation counseling tasks and setting. Roessler & Mullins
suggested an interaction between personal factors labeled Self (S) and the task demands labeled
environment (E). They posited that the interaction of S x E variables provides insight into the
behavioral intentions of counselors. Each interaction represents counselor construal of the
demands of the environment as mediated by personal factors.
Roessler & Mulllins’ (1995) interactional psychological model suggested a relationship
between counselor self (S) x environment (E) and the effect on the quality of rehabilitation
service provision. This model is somewhat similar to more recent empirical research that
examined similar concepts. For example, in terms of the environment (E), Coordinating reflects
a demand on time that counselors consistently report as a barrier to the use of EBP (Winch et al.,
2005; O’Donnel, 2004; & Graham et al., 2013). Consult and Case Recording contain elements
of organizational characteristics that inhibit the use of EBP such as lack of knowledge to
properly assimilate evidence-based practice on the part of service providers, poor leadership,
bureaucratic constraints, and a change-averse culture (Corrigan et al., 2001). Figure 4 below
reflects the various interactions of the environment (E) and Self (S) factors.

32

Figure 4.
Quality Rehabilitation Counseling: Environment x Personal Factors Model

Information gathered at the
intersections from effective
counselors would increase
understanding of how
intentions are formed and
affect quality of responses to
rehabilitation counseling
tasks
Self – S
(Personal Factors)

Counseling
Building a
relationship
and
Informing
customer of
agency
policy.

Environment – E
(Task Demands)
Coordinating
Consulting
Selecting,
Organizing
and
monitoring
services.
Address
vocational
needs.

Advocating
for customer
with multiple
partners

Case
Recording
Documenting
eligibility,
service
needs,
services, &
outcomes per
agency
policies.

Behavioral Beliefs
(Response – Outcome
Beliefs)
Self-Efficacy Expectations
Normative Beliefs
(Supervisor)
Normative Beliefs
(Customer)
Perceived Behavioral
Control
(Adequate Opportunities or
Resources)
Knowledge
(Disability & Rehabilitation
Counseling)
Self-Appraised
Competencies
Intention

Behavior

The Self (S) categories contain similar concepts related to recent research on counselor
self-efficacy. In behavioral beliefs, rehabilitation counselors believe the application of evidencebased practice is necessary, useful and will lead to improved quality of VR service delivery
(Beyzak et al., 2010). Tansey, Bezyak, Chan, Leahy & Lui (2014) noted that self-efficacy and
outcome expectations for rehabilitation counselors from four state-federal VR agencies were
33

reported moderately high in the use of EBP. In terms of normative beliefs (supervisor), agency
promotion of evidence-based practices was not widely encouraged with little supervisory support
for the use of EBP in service delivery and making planning decisions (Graham et al., 2013;
Tansey, Bezyak, Chan, Leahy & Lui, 2014). Rehabilitation counselors reported perceived
behavioral control (adequate resources) such as access to professional journals and access to
research databases in the work environment (Bezyak et al., 2010), with other evidence-based
sources described as training, a wide variety and accessibility to resources and professional
networking (Graham et al., 2013). Knowledge under the Self (S) category included study
participants valuing research for practice, understood how to interpret research literature and
apply the information in their job (Graham et al., 2013).
Conceptual Framework: Counselor Self-Efficacy and EBP Service Delivery Model
A conceptual framework for determining rehabilitation counselor self-efficacy using
Roessler & Mullins’ (1995) interactional psychological model based on Bandura’s (1986) Social
Cognitive Theory and Stages of Change (Prochaska & Norcorss, 2001) is presented. The
conceptual framework is consistent with Roessler & Mullins’ (1995) interactional psychological
model based on social cognitive theory followed by the EBP Service Delivery Conceptual
Model.
While Roessler & Mullins’(1995) interactional psychological model is viewed through
the lens of the theory of reasoned action (Ajzen & Fishbein, 1980) and Bandura’s (1989) social
cognitive theory, it could be scaled down to a version that incorporates the concepts of selfefficacy and environment influence on evidence-based practices. The figure below reflects the
reduced model.
34

Figure 5.
Unidirectional Model of Self-Efficacy, EBP & VR Service Outcomes
Rehabilitation Counselor
EBP Self-Efficacy (RCSE)

Evidence-Base
Practice (EBP)

VR Service
Outcomes

Note: Adapted from Ajzen & Fishbein (1980)
The model above reflects a unidirectional model of rehabilitation counselor self-efficacy
(RCSE) on evidence-based practices leading to VR service outcomes. While this model places
emphasis upon counselor self-efficacy in the use of EBP, contextual factors that might influence
EBP are absent. A proposed conceptual, interactional model reflecting the interaction between
rehabilitation counselor self-efficacy and environmental factors is presented below.
The conceptual model reflects possible multiple interactions between counselor selfefficacy and environmental factors that influence the use of EBP in VR service delivery. This
model includes Bandura’s concept of reciprocal determinism reflecting the interaction between the
individual and environment that influences behavior towards proposed outcomes. It also includes
stages of change as an indicator of rehabilitation counselor readiness to use EBP. VR service
outcomes was removed as the focus of this study is to determine the relationships between the
multiple variables that contribute to the use of EBP in current practice, not how the variables lead
to VR service outcomes. This conceptual model is designed to integrate current research on
counselor self-efficacy in the use of EBP and environmental factors influencing use of EBP in
service delivery practices.

35

Figure 6.
Counselor Self-Efficacy & EBP Service Delivery Conceptual Model.

EBP Levels of
Understanding

Rehabilitation
Counselor
Perceived
Barriers

EBP

Self-Efficacy

Readiness:
Stages of
Change

36

Outcome
Expectancy

Summary
Rehabilitation counseling research has demonstrated that evidence-based practices are
acknowledged for their potential to improve VR service delivery and enhance employment
outcomes. What is missing from the research is an understanding of rehabilitation counselor
self-efficacy to select and implement evidence-based practices into their current practice.
Additionally, there has been limited exploration of context or environmental factors that inhibit
or encourage evidence-based practice. In order to move forward in this area of research an
examination of the interaction between counselor personal characteristics such as self-efficacy
and work environmental factors is warranted.
Evidence-based practices in VR service delivery have been identified as necessary to
provide ethical and research based interventions to people with disabilities as a method to
enhance employment outcomes. EBP is required to demonstrate vocational rehabilitation
services as effective in assisting individuals with disabilities achieve employment and justify
resource allocation. Rehabilitation counseling researchers and practitioners must work together
to close the gap between research and EBP in VR service delivery.
One approach to closing the research gap is to utilize the EBP-VR Survey (Chan, et al.,
2013). This will facilitate an examination of the relationship between rehabilitation counselor
self-efficacy as related to the development and use of EBP and environmental factors that
support and/or introduce barriers to the use of EBP. It will also contribute to the rehabilitation
counseling evidence-based research and literature by expanding upon the notion that EBP
development and implementation is a complex, multi-dimensional process vs. a simple linear
process of research to dissemination to practice. It will also provide a resource on which to base
37

future research on the implementation of EBP in rehabilitation counseling and VR service
delivery.

38

CHAPTER 3
METHODS
The purpose of this study was to explore the relationship between rehabilitation counselor
self-efficacy and work environment factors (perceived barriers) that promote the use of evidencebased practices in vocational rehabilitation service delivery. It is anticipated that the study
findings will inform rehabilitation researchers, educators and practitioners in a variety of settings
as to the barriers of implementation of EBP into VR service delivery. Rehabilitation researchers
and educators may also use the findings to inform pre-service pedagogy regarding the need to
prepare future rehabilitation counselors in the use of EBP.
This study used an internet-based survey to investigate Certified Rehabilitation
Counselors’ (CRCs) perceived self-efficacy, outcomes expectancy, barriers, and readiness to use
evidence in current VR service delivery practices. Perceived self-efficacy was described as
Rehabilitation Counselor EBP Self-Efficacy (RCSE) and perceived barriers are described as
Environmental Factors (EF) that influence the use of evidence-based service delivery practices.
The following practice settings were used: 1) the state-federal VR program, 2) community
rehabilitation programs (CRO), and 3) private for profit/workers compensation rehabilitation
settings. A final area of investigation was an exploration of differences between CRC
demographic characteristics of respondents (i.e. gender, years of practice, practice setting, etc.)
that influence Rehabilitation Counselor EBP Self-Efficacy (RCSE). The quantitative data was
used to conduct descriptive as well as ex post facto analysis.

39

Research Questions
The purpose of this study is to investigate rehabilitation counselors’ a) self-efficacy in their
understanding and use of EBP, b) determine rehabilitation counselors’ perceived benefits of
EBP, c) explore perceived barriers to EBP use by practice setting, and d) if the Stages of
Changes Theory could explain rehabilitation counselors’ readiness to use EBP. The specific
research questions of interest in this study are as follows:
1. What are rehabilitation counselor’s perceived self-efficacy, outcomes expectancy, barriers,
and readiness to use evidence in current VR service delivery practices?
2. What is the difference between practice settings and Rehabilitation Counselor EBP SelfEfficacy (RCSE) and Environmental Factors (EF) that influence the use of evidence-based
service delivery practices: (a) State-Federal VR Program, (b) Community Rehabilitation
Program (CRO), and (c) Private for Profit/Worker Compensation Rehabilitation?
3.

Are there differences between CRC demographics (i.e. gender, years of practice, practice
setting, etc.) that influence Rehabilitation Counselor EBP Self-Efficacy (RCSE)?

Participants
The population of interest selected for this study was Certified Rehabilitation Counselors
(CRC). According to the Commission on Rehabilitation Counselor Certification (CRCC, 2015),
there are approximately 17,000 CRCs in the United States. CRCs were chosen to be the
population of interest in this study as they have received professional training from accredited
rehabilitation counseling education programs, have passed the national certification examination
and practice in a wide variety of settings. CRCs represent qualified professionals who provide
40

quality rehabilitation counseling and vocational rehabilitation services to people with disabilities.
More importantly, CRCs are employed in a variety of settings including private/public agencies,
for profit/nonprofit organizations, centers for independent living, and education institutions
throughout the United States. The varied nature of this population was particularly useful for
this study given the demographic data available to investigate whether work environment factors
across different practice settings would yield different results of rehabilitation counselor selfefficacy in the use of evidence-based practices (Kuo, 2013).
Instrumentation
To measure CRC self-efficacy, perceived benefits, perceived barriers and readiness to use
EBP, the Evidence-Based Practice in Vocational Rehabilitation Survey (EBP-VR Survey) was
utilized. The EBP-VR Survey was developed by Chan, Bezyak, and Lui (2013) using socialcognitive theory (Bandura, 1986) and stages of change (SOC) theory (Prochaska, DiClemente, &
Norcross, 1992) as a framework to develop the EBP-VR Survey to measure perceived selfefficacy, perceived benefits, perceived barriers, and readiness to use EBP in VR practice. They
adopted some items from the EBP survey developed by Bezyak et al., (2010) and new items
were written based on a comprehensive review of the rehabilitation literature on surveys of EBP
among health professionals such as occupational therapists, physical therapists, and nurse
practitioners. In addition, the survey was reviewed and critiqued by a panel of vocational
rehabilitation experts including rehabilitation counselor educators, VR agency administrators,
and VR counselors. The following is a description of each section, including the name of the
instrument, definitions and sample questions.

41

Evidence-Based Practice in Vocational Rehabilitation Survey (EBP-VR Survey)
The EBP-VR Survey (Chan et al., 2013) is composed of 39 items and four subscales: (a)
perceived self-efficacy with 9 items (e.g., “formulate appropriate clinical questions about the
problems presented by the consumer;” “read and understand the best evidence information from
systematic;” and “provide VR interventions that have the highest level of scientific evidence and
support reviews/meta-analyses”); (b) perceived benefits with 10 items (e.g., “improve
employment rates and employment quality for VR clients;” “empower consumers to exercise
knowledgeable self-determination and truly informed choice;” and “protect clients from
ineffective or harmful services”); (c) perceived barriers with 8 items (e.g., “the use of EBP places
too much demand on my role as a rehabilitation counselor;” “I do not have sufficient training to
incorporate EBP in my practice;” and “there is a lack of empirically validated VR interventions
that I can use in my work as a VR counselor”); and (d) stages of change with 10 items (e.g., “I
am interested in learning more about EBP;” “I use EBP concepts in making decisions regarding
services for my clients;” and “I am using EBP in my role as a rehabilitation counselor”) (Tansey
et al., 2014)
Evaluation and Psychometric Properties of the EBP-VR Survey
Each item in the four subscales is rated on a 10-point Likert confidence rating scale. For
the self-efficacy subscale the responses ranged from 0 (no confidence) to 9 (complete
confidence). For the remaining three subscales of perceived benefits, perceived barriers and
readiness, the responses ranged from 0 (strongly disagree) to 9 (strongly agree). The internal
consistency reliability coefficients (Cronbach’s alpha) for perceived benefits, perceived benefits,
perceived barriers, and stages of change EBP were computed to be .94, .98, .71, and .86
42

respectively. To improve the reliability of the perceived barriers subscale, items in this subscale
can be further divided into a personal barriers factor (α = .74) and agency barriers factor (α = .77)
(Tansey et al., 2014).
Chan (personal correspondence, February 27, 2014) recommended that the four positive
worded items (3, 4, 6 & 8) in the Barrier section of the EBP-VR Survey be changed to negative
wording so that all eight items would refer to EBP barriers. Chan stated that study participants
had some problems responding to the positive wording barrier items. Therefore, the wording for
items 3, 4, 6 and 8 was changed to negative wording to reflect barriers to EBP for this study.
Variables
Demographic information was collected in the following areas to be used as variables: gender,
age, years of work as a CRC, years of other rehabilitation related work, race/ethnicity, highest
level of education, major area of study for highest degree, hold other certifications, hold
counselor licensure, attended in-service EBP training, primary practice setting, client primary
disability types, and caseload size. These questions were adapted from the EBP-VR Survey with
the exception of client primary disability and caseload size. These last two were added by the
researcher to explore the relationship between client primary disability characteristics, caseload
size and EBP.

43

Data Collection
Procedures
Institutional clearance to complete the study involving human subjects was obtained
through Michigan State University’s Institutional Review Board (IRB). Following approval
from the IRB, a request letter and the current study proposal was sent to the Council on
Rehabilitation Counselor Certification (CRCC) research committee for approval of the study.
The request letter was for CRCC to compile a 10% random sample for its 17,000 members.
After CRCC granted approval and the sample obtained, potential participants were
contacted via email soliciting participation in the study. A consent form, invitation to participate
in the study, and the link to the online survey was included in the email (Appendix A). A second
request was sent one week following the initial email, along with a second email to remind CRCs
who have not yet responded. A third and final reminder email was sent one week after the
second reminder email was sent.
Due to the geographic dispersion of CRCs, the instrument was administered using an on line
automated survey instrument “Qualtrics” to collect data from participants. Although
demographic information was collected, no personal identifying information was included in the
survey. Potential study participants accessing the instrument were provided with a web address
and link provided in the emails. The instrument was available for a four week period and
designed to prevent receiving multiple responses from the same study participant. Completion of
the instrument is estimated between 10-15 minutes. At the completion of the instrument
participants was offered the opportunity to obtain one free continuing education credit hour
toward their CRCC continuing education units (CEU).
44

Pilot
A limited pilot of the EBP-VR Survey instrument was conducted. Seven non-CRC
rehabilitation counselors familiar with EBP were provided access to the Survey through
Qualtrics. The counselors were asked to test accessibility, functionality of the survey,
appearance, clarity of instructions and access to the CRCC CEU Verification of Completion
form for the one CEU awarded for survey completion. Alterations were made to the instrument
according to suggestions mainly as to the selected instructions and formatting to increase clarity.
Dissemination
The instrument was disseminated through email via Qualtrics. The researcher obtained
an initial randomly selected number of emails from CRCC totaling 2,200. Of this initial number
five email addresses were determined to be unusable and not loaded into the Qualtrics member
panel for email distribution of the survey. The invitation to participant in the survey was emailed
to 2,195 individuals. Thirty one (31) emails bounced and were returned as undeliverable. A
decision was made by the researcher to remove the 31 emails from the survey membership panel.
Another four individuals contacted the investigator via email requesting they not be included in
the study, i.e. two were retired, one was no longer working in VR, and one individual could not
participate due to a family situation. These four individuals were also removed from the survey
membership panel, leaving 2,160 participants available for the study.

45

Response Bias
Given the exploratory nature of the study, there was some expected response bias. The
researcher made an effort to gather as large and varied sample of participants as possible and will
report limitations of the study given the kind of participants who completed the survey.
Ethical Precautions
The EBP-VR Survey was configured as to not associate responses with study
participants. All potential participants were informed about the purpose of the study,
confidentiality, and how the data was used and disseminated. Potential participants were
informed that they could withdrawal from the study at any time prior to the submission of data.
Individuals were informed they may request information and/or contact the researcher with
questions at any time or contact the MSU IRB with questions.
Data Analysis
Data analysis included several approaches to confirm the model and address the research
questions. Prior to analysis, descriptive statistics were computed on the sample characteristics
for the following categorical and continuous variables: a) gender, b) age, c) years of work as a
CRC, d) years of other rehabilitation related work, e) race/ethnicity, f) highest level of education,
g) major area of study for highest degree, h) hold other certifications, i) hold counselor licensure,
j) attended in-service EBP training, k) primary practice setting, l) client primary disability types,
and m) caseload size. Data was also examined for relationships between and within factors.
Prior to addressing the research questions, an exploratory factor analysis (EFA) of the
EBP-VR Survey was used to determine the number of components. This included univariate and
46

correlational statistical analyses used to analyze and interpret the data. Following a review and
cleansing of the data, an EFA was conducted. An EFA was performed to determine if the items
on the EBP-VR Survey measured the theoretical constructs of interest and if the items could be
better explained by fewer components (factors) that held common item interrelationships and
significant loadings (Tabachnick & Fidell, 2013).
Subject to item ratios acceptable for EFA vary and there is no one ratio that will work in
all cases (Costello & Osborn, 2005). Costello & Osborne (2005) reviewed 303 factor analysis
studies, finding that most researchers (62.9%) performed analysis with subject to item ratios of
10:1 or less. Given the sample size for this study (n=318), the subject to item ratio of 10:1 was
met.
Strict rules regarding sample size for EFA have mostly disappeared, with studies
revealing that sample size is partly determined by the nature of the data (Fabrigar, Wegener,
MacCallum, & Strahan, 1999; MacCallum, Widaman, Zhang, & Hong, 1999). While no firm
guidelines for EFA sample size adequacy exist, Comfrey & Lee (1992) suggest adequacy of
sample size might be evaluated approximately on the following scale: 50 –very poor, 100- poor,
200 – fair, 300 – good, 500 – very good, 1,000 or more excellent. For this study, a good sample
size (n=318) was obtained.
The Kaiser-Meyer-Olkin (KMO) and Bartlett’s test of sphericity were computed to test
adequacy of sample size and inter-item correlations for factor analysis (Tabachink & Fidell,
2013). To establish reliability of the EBP-VR Survey, the Cronbach alpha statistic was used to
estimate the internal consistency of the items (Pallant, 2010) relative to the concepts that were
measured.
47

Defining the sample of the population of CRCs, descriptive statistics, frequencies, and
percentages were computed for general participant demographic information (i.e. gender, age,
race/ethnicity), professional characteristics (i.e. years of experience as a CRC, highest education
level, major study area, case load size) and practice setting (i.e. state-federal VR program,
community rehabilitation organization, private for profit/workers compensation, and other
practice settings). This data was used to make comparisons among the sample and population
from which the sample was obtained to provide an estimate of this study’s representativeness of
the population (i.e. CRCs in the United States).
A priori power analysis was conducted to pre-determined to detect minimum a medium
(.15) to larger (.35) effect size at power =.80, with an alpha level of .05 (Cohen, 1992). A
minimum sample of 327 was needed to test if significant differences existed between practice
settings of counselor self-efficacy, perceived benefits, perceived barriers, and readiness.
To answer research question one, descriptive statistics, percentages, and frequency tables
were used to summarize the demographic characteristics of the sample. Mean and standard
deviation scores of the CRCs self-efficacy in the use of EBP, perceived benefits of EBP,
perceived barriers to EBP. This data was compiled on four practice settings; a) state-federal VR
program, b) community rehabilitation organizations (CRO), c) private for profit/workers
compensation, and d) “other” practice settings as reported by the participants.
To answer research question two, a one-way ANOVA was used to compare the group
mean differences of self-efficacy and perceived barriers relative to practice settings of the statefederal VR program, CRO and private for profit/workers compensation practice. The “other”
practice setting was removed from the analysis as this variable was confounding containing over
48

sixty different reported practice settings. These settings ranged from hospital settings, high
schools, churches, corrections facilities, corporate offices, and Tribal One Stop settings. The
“other” responses also contained no practice setting responses such as being retired, unemployed,
non-profit consulting firm, and volunteer advocate. Given the very diverse nature of the “other”
practice setting, it was dropped from analysis for research question two. The three primary
practice settings of state-federal VR, CRO and private for profit/workers compensation practice
settings were the focus of the analysis.
To answer research question three, a simultaneous multiple regression was used to
determine predictors of Rehabilitation Counselor Self-Efficacy (RCSE) based on CRC
demographics (i.e. gender, years of practice, practice- setting, etc.). The practice settings used in
the regression equation were the state-federal VR program, CRO and private for profit/workers
compensation practice settings. The “other” practice setting was not included in the multiple
regression analysis as discussed above.
Limitations of the Study
Limitations associated with this study include the use of self-report questionnaires,
sample size and response rate, and researcher perception of CRC knowledge base of EBP.
Participant response bias may have influenced how study participants responded to the survey
items. Given the perceived importance of the study topic, evidence-based practices in VR
service delivery, study participants may have provided responses to confirm the researcher’s
hypotheses or answered the questions in a socially desirable way (i.e., a CRC should be
knowledgeable of EBP in VR service delivery) (Heppner, et al., 1999).

49

Sample size may also be a limitation based on survey response frequency. Current trends
in survey research reflect that refusal and non-response rates have doubled for all surveys,
regardless of type during the past decade (Birnbaum, 2004; Sheehan, 2001; Survey Monkey,
2008; Tourangeau, 2004). Heppner, Kivlingham, and Wampold (1992) reported that survey
research is often published with less than 40% response rates. The overall decline in e-mail
survey response rates has been attributed to the number of people who do not read their e-mail
(Birnbaum, 2004; Welker, 2001).
Finally, a primary assumption of this study depended upon the validity of CRC selfreport and knowledge of EBP, their perceived benefits of EBP, perceived barriers to EBP and
readiness to use EBP. The degree to which these assumptions were accurate of CRC EBP
concepts and practices is unknown.
Summary
A random sample of CRCs for participation was selected for this study from CRCC
membership data base. The selected CRCs were invited to complete the EBP-VR Survey via
email in order to determine rehabilitation counselor self-efficacy, perceived benefits, perceived
barriers and readiness to use EBP. Data was analyzed to include a factor analysis of the EBP-VR
Survey to validate the constructs being measured, rehabilitation counselor self-efficacy,
perceived benefits, perceived barriers and readiness to use EBP. One-way ANOVA was used to
explore differences in counselor self-efficacy and barriers between practice settings, and
simultaneous multiple regression was used to determine predictors of counselor self-efficacy
based on CRC demographics.

50

Chapter 4
RESULTS
The purpose of this study was to explore the relationship between rehabilitation counselor
self-efficacy and work environment factors that influence the use of EBP in VR service delivery
using Bandura’s (1986) Social Cognitive Theory and Prochasha & Norcross’ (1992) Stages of
Change Theory. The results provide a basis of comparison for CRC a) self-efficacy in the use of
EBP, b) perceived benefits of EBP, c) perceived barriers to use of EBP in practice, and d)
readiness to use EBP. These four concepts were measured by four subscales comprising the
EBP-VR Survey.
This chapter will address the characteristics of the participants, how missing data was
handled, results of an exploratory factor analysis (EFA), and data analysis to address each
research question. The IBM Statistical Package for the Social Sciences version 22 (SPSS, 2013)
and Microsoft Excel were used to conduct all data analyses for this study.
Participants
The target population for this study were Certified Rehabilitation Counselors (CRC).
CRCs were chosen to be the population of interest in this study as they have received
professional training from accredited rehabilitation counseling education programs, have passed
the national certification examination and practice in a wide variety of settings. CRCs represent
qualified professionals who provide quality rehabilitation counseling and vocational
rehabilitation services to people with disabilities. More importantly, CRCs are employed in a
variety of settings including private/public agencies, for profit/nonprofit organizations, centers
51

for independent living, and education institutions throughout the United States. The varied
nature of this population was particularly useful for this study given the demographic data
available to investigate whether work environment factors across different practice settings
would yield different results of rehabilitation counselor self-efficacy in the use of evidence-based
practices (Kuo, 2013).
Response Rate
Of the initial 2,200 email addresses obtained from CRCC, five emails were determined to
be unavailable, leaving 2,195 email addresses who were sent an invitation to participate in the
survey. Of the 2,195 emails, 31 failed to deliver and four individuals declined to participate in
the study, leaving 2,160 available to participate. The researcher anticipated a 20% response rate
from the 2,160 CRCs contacted via email. While 421 individuals started the survey (19%), only
324 surveys (15%) were determined to have completed the survey per Qualtrics software.
A review of the 421 surveys that were started revealed a 91% response rate to the
demographic section of the survey. Of the four subscales, 83% provided responses on the selfefficacy subscale, 80% provided responses on the perceived benefits subscale, 78% provided
responses on the perceived barriers subscale, and 78% provided responses to the readiness
subscale. These percentages reflected a high response rate to the demographic section of the
survey, followed by a decreased response rate to the four survey subscales. While specifics as to
the decreased response rate on the four subscales are not know, the researcher feels the number
of subscale items in combination with the 10-point Likert scales for each item, may have
contributed to participant response fatigue. A review of the four subscale responses reflected
subscale partial completion or subscales without any responses. Participants may have started
52

the survey, were interrupted and failed to return to complete the study, or may have decided not
to complete the survey given the number of items and responses required.
Participant Demographics
Of the CRCs (n=318) who provided demographic characteristics, 78.5% (n=249) were
female and 21.5% (n=68) were male. For race/ethnicity, 77.9% were Caucasian (n=247), 10.1%
were African American (n=32), 5.7% were Hispanic/Latino American (n=18), 3.2% were Asian
American (n=10), .65 were American Indian/Native American (n=2), with 2.5% reporting other
(n=8). In terms of gender and race/ethnicity, the study sample is comparable to the race/ethnicity
demographics of the CRCC population. Table 2 is a comparison of the study sample vs the
CRCC population.
Table 2.
Study Sample Gender & Race/Ethnicity vs. CRCC Population Gender & Race/Ethnicity
Gender & Race/Ethnicity
Male
Female
White
African American
Hispanic/Latino
Asian American
American Indian/Native American
Other
Note: Study Sample n=318

Study Sample %
21.5
78.5
77.9
10.1
5.7
3.2
.65
2.5

CRCC Population %
26.2
73.8
78.1
10.4
4.5
2.4
.53
.06

The mean age of the participants was 46.3 years with a range of 25 years old to 77 years
old. In terms of age, the study sample (n=49) contained almost twice as many CRCs under 30
years of age. Table 3 below is a comparison of the participants and CRCC population.

53

Table 3.
Study Sample Age Range vs. CRCC Population Age Ranges
Age Range
Under 30
30-39
40-49
50-59
60+
Note: Study Sample: n=318

Study Sample %

CRCC Population %

15.4
19.5
22.3
22.3
20.4

8.0
19.1
22.3
25.4
25.1

Years of work experience as a CRC had a mean of 11.2 years with a range of 0 (a newly
certified rehabilitation counselor with no work experience at the time of the study) to 40 years
work experience as a CRC. Of interest was the large number of CRCs (n=125) with under five
years work experience as a CRC. This was followed by CRCs (n=66) with six to ten years of
work experience. Table 4 below shows CRC years of work experience.
Table 4.
Study Sample CRC Years of Work Experience
CRC Years of
Work Experience
Frequency

Percentage %

0-5
125
39.6
6-10
66
20.9
11-15
39
12.3
16-20
23
7.3
21-25
24
7.6
26-30
21
6.6
31-35
12
3.8
36-40
6
1.9
Total
316
100
Note: Study Sample: n=316. Two participants did not respond.
In terms of practice setting, the majority of the study participants worked in the Statefederal VR program 43.7% (n=139), followed by the Private for Profit/Workers Compensation
settings 18.9% (n=60), other practice setting 29.6% (n=94), and community rehabilitation
organization 7.9% (n=25). Table 19 in Appendix B contains the study participant practice
54

settings. The study sample was similar to the CRCC population in terms of the number of
participants practicing in CROs and in the private sector. There was a difference in terms of
more study participants practicing in the state-federal VR program and less in the private sector
as compared to the CRCC population. Table 5 below is a comparison of participant practice
setting against the CRCC population practice settings.
Table 5.
Study Sample Practice Settings vs. CRCC Population Practice Settings
Practice Setting
Study Samples
Sample %
CRCC %
State-Federal VR
139
43.7
Community Rehabilitation
Organization (CRO)
25
7.9
Private for Profit/Workers
Compensation
60
18.9
Other Practice Setting
94
29.6
Note: Two participants did not provide responses (n=316).

28.2
5.8
18.2
47.8

Table 20 participant highest education level and Table 21 participant major areas of study
are contained in Appendix C. The majority of participants held a master’s degree in
rehabilitation counseling 92.3% (n=289), followed by a doctorate degree 6.1% (n=19), and
bachelor’s degree 1.6% (n=5). The major area of study was rehabilitation counseling 78%
(n=248), followed by other counseling specialty 7.5% (n=24).
The mean caseload size was 65 cases with a range of 0 cases to 965. There were two
extremely high case load numbers observed in the caseload size data of 965 and 635. The
caseload size of 965 was related to the participant’s reported practice setting as a College
Disability Office. The number may represent the total number of students being served by the
College Disability Office. For caseload size 635, the participant’s reported practice setting is the
County Board of Developmental Disabilities. The number may represent the number of clients
55

being served by the county board. Both values appear to be legitimate representations of the
participants’ practice settings and were retained in the sample.
The participants also reported other certifications and licenses in addition to having the
CRC designation. Other credentials include Certified Vocational Evaluator (n=4; 1.3%),
Certified Case Manager (n=17; 5.3%), Licensed Professional Counselor (N=59; 18.6%), Limited
License Professional Counselor (n=6; 1.9%).
Missing Data
Multiple approaches exist to handle missing data, ranging from case deletion to
imputation techniques to replace missing values. For this study two approaches were used to
address missing data, case deletion and Expectation Maximization (EM). Case deletion will be
discussed first, followed by EM.
As described earlier, of the 421 surveys that were started, the majority of participants
completed the demographic section (91%). This was followed by a decreased response across
the four subscales: a) self-efficacy subscale (83%), b) perceived benefits subscale (80%), c)
perceived barriers subscale (78%), and d) readiness (78%). When the EBP-VR Survey closed,
the data was sorted using Qualtrics to determine the number of completed surveys. Qualtrics
assigns 1 for completed survey and 0 for non-completed surveys. All surveys were downloaded
into Excel and sorted by completed (1) vs. non-completed (0) surveys. A review of the 421
surveys revealed 23% (n=97) were missing values across the four subscales. The missing values
ranged from one up to 8 to12 missing values indicating one or two subscales were not
completed. Given the large amounts of missing data on the subscales, these cases were removed
from the analysis, leaving a total of 324 cases.
56

A further examination of the 324 completed survey revealed 114 missing values (29%)
on the EBP-VR Survey scale. The 324 completed surveys were uploaded into SPSS and a
missing value search was conducted, finding six cases with between 2 to 20 missing values on
the subscales. For example, one case was determined to have 20 missing values on the Perceived
Barriers subscale (8) and Readiness subscale (12). In total, the six identified cases accounted for
58% (66) of the missing values on the EBP-VR Survey scales. In an effort to conserve as many
cases as possible, the researcher chose to remove only these six cases in order to maintain a
sample above 300 for exploratory factor analysis (EFA). When the six cases were removed from
the data, the percentage of missing values on the EBP VR scales decreased to 12%. This
resulted in a sample of n=318 for data analysis.
To replace the missing values remaining in the EBP VR subscales, Expectation
Maximization (EM) was used. EM is considered an effective technique used to in data analysis
to manage missing data (Schafer, 1997) as it overcomes some of the limitations of other
techniques, such as mean substitution or regression substitution. EM is also considered a valid
technique because it produces unbiased parameter estimates when data are missing completely
random at random (MCAR) and less biased parameters when data are missing at random, called
ignorable response (MAR) or systematic (Acock, 1997). EM was used to determine whether
data MCAR or MAR. Using SPSS missing values option, three of the subscales (Self-Efficacy,
Perceived Barriers & Readiness) were determined to have values MCAR. The Perceived
Benefits scale was determined to have values missing at random MAR.

57

Exploratory Factor Analysis of the EBP-VR Survey
An exploratory factor analysis (EFA) was performed to determine if items on the EBPVR Survey measured the theoretical constructs of interest and if the items could be better
explained by fewer components or factors that held common item interrelationships and
significant loadings for each of the respective scales; self-efficacy, perceived benefits, perceived
barriers, and readiness. It was anticipated that the statistical analysis would take place on the
retained factor structure if it could be meaningfully generated and interpreted. Before the EFA
was conducted each EBP-VR subscale was analyzed for normality and inter-item reliability.
EBP-VR Survey Scales
Prior to performing the EFA, each subscale of the EBP-VR Survey was analyzed for
means, standard deviations and scale reliability (Cronbach’s alpha). The results for the four
subscales are as follows: a) self-efficacy subscale: average score for this subscale was 7.71 (SD=
1.54) indicating a moderately highly level of perceived self-efficacy related to EBP. Cronbach’s
alpha was .934 suggesting very good internal consistency reliability for this scale with this
sample, b) perceived benefits subscale: average score for this subscale was 8.04 (SD= 1.48)
indicating a moderately highly level of perceived benefits of EBP. Cronbach’s alpha was .964
suggesting very good internal consistency reliability for this scale with this sample, c) perceived
barriers subscale: average score for this subscale was 4.60 (SD=1.74) indicating a moderate level
of perceived barriers to EBP. Cronbach’s alpha .878 suggesting very good internal consistency
reliability for this scale with this sample, and d) readiness subscale: average score for this
subscale was 6.10 (SD=1.17) indicating a moderate level of readiness to use EBP. Cronbach’s
alpha was .815 suggesting good internal consistency reliability for this scale with this sample.
58

EFA: Self-Efficacy, Perceived Benefits, Perceived Barriers and Readiness Scales
A principle component method was used for factor analysis to extract components that
could explain the item interrelationships among the 39 items on the EBP-VR Survey. The
Kaiser-Meyer-Olkin (KMO) measure confirmed the adequacy of the sample size for the factor
analysis, KMO = .921 (Tabachink & Fidell, 2013) and the Bartlett’s test of sphericity χ2 (561) =
8501.90, p<.001, indicated that inter-item correlations were substantial and adequate.
Using Kasier’s eigenvalue criterion >1 (Pallant, 2010), six factors were initially extracted
for analysis. An analysis of the scree plot was used to determine the number of factors to be
retained (Tabachink & Fidell, 2013). The scree plot analysis reflected between three to six
factors could be retained. An orthogonal rotation (varimax) method was used to assist with
making meaningful interpretations of both the six factor and the factor extraction set at three.
While the six factor solution using Kaiser’s eigenvalue criterion of greater than one
explained 68.03% of the variance, a closer review of the individual item loadings revealed that
the items on the readiness scale dispersed or loaded on the three other scales of self-efficacy,
perceived benefits, and perceived barriers. Table 6 below shows how the readiness items loaded
on to the other scales.
Table 6.
EBP-VR Survey Item Loading Across Factors
Factors
Scale Item Distribution

Readiness Scale Items

Factor 1: Perceived Benefits
Benefit Items: 13
3 Items on Benefits
Factor 2: Self-Efficacy
Self-Efficacy Items: 14
6 Items on Self-Efficacy
Factor 3: Perceived Barriers
Barrier Items: 10
2 Items on Barriers
Note: One of the readiness scale items had no loading on any factors.

59

A careful inspection of all 12 readiness scale items was conducted as to possible
explanations for why the readiness subscale items loaded on the other three scales. It was noted
that one scale item most likely measured a barrier to EBP such as the readiness scale item, “I do
not believe EBP has any practical value in vocational rehabilitation”, while another readiness
scale item made the assumption that rehabilitation counselors enjoy reading empirical research,
“I enjoy reading empirical research articles in the rehabilitation, health, psychology fields”. The
remaining readiness scale items did not specifically explore rehabilitation counselor readiness or
stage of change (i.e. ambivalence towards using EBP vs. action/implementation of EBP).
Rather the remaining items relate more to self-efficacy, “I use best evidence medical,
psychological, and vocational interventions in my rehabilitation practice”, or benefits, “I can see
the value of EBP in vocational rehabilitation”, or barriers, “I do not believe EBP has any
practical value in vocational rehabilitation”. Based on the ambiguous nature of the readiness
scale items, a three factor solution was chosen.
A principle component analysis using a varimax rotation and three factor solution was
used to make meaningful interpretations. Coefficients values for all items were set at .40, since
this value been used as having a loading of interpretive value (Field, 2009). Stevens (2002; as
cited in Field, 2009) suggested that by squaring r (e.g. .40), approximately 16% of the variance
of a given factor can be explained by such an item loading. The three extracted factors are
described below which explained 55.13% of the variance. Table 7 below displays the total
variance explained by the three factor solution containing all EBP-VR Survey items. Table 8 is
the rotated component matrix loadings for all three scales.

60

Table 7.
Total Variance Explained by the Three-Component Solution of All EBP-VR Items
Initial Eigenvalues
Extraction
Rotation
Total - % Var-Cum %
Total - % Var-Cum%
Total
Perceived Benefits
Self-Efficacy
Perceived Barriers

13.521 34.669 34.669
4.556 11.683 46.351
3.423 8.776 55.127

13.521 34.669 34.669 8.885
4.556 11.683 46.351 7.233
3.423 8.776 55.127 5.381

Table 8.
Rotated Component Matrix of Perceived Benefits, Self-Efficacy and Perceived Barriers Scale
Items
Rotated Factor Loadings

1

Increase the probability of identifying best evidence
Improve working relationship (working alliance)
Improve employment rates and employment
Improve psychosocial outcomes for VR clients
Empower clients to exercise knowledgeable
Help identify the most effective and efficient
Improve client satisfaction
Improve efficiency in utilization
Protect clients from ineffective or harmful services
Help keep me abreast with current best evidence
EBP has the potential to help improve
I can see the value of EBP in vocational rehabilitation
I am interested in learning more about EBP
Provide psychosocial interventions
Use current best evidence in making decisions
Read and understand the best evidence information
Critically evaluate the validity and generalizability
Provide VR interventions that have the highest level
Understand basic concepts of rehabilitation research
Search the research databases and search engines
I take research findings into consideration
I use EBP concepts in making decisions
I use best evidence medical, psychological
Use an evidence-based practice approach
I use the internet and academic databases
I am using EBP in my role as a rehabilitation counselor
I have completed in-service training
There is a lack of support and encouragement
There is a lack of collective support
I do not have time to incorporate EBP in my work
My agency does not have the infrastructure and interest
There are no supervisors and counselors

61

2

3

.876
.858
.854
.853
.849
.846
.823
.805
.775
.758
.650
.624
.459
.819
.816
.801
.801
.788
.754
.751
.720
.577
.517
.501
.500
.495
.407
.761
.740
.707
.706
.663

Table 8. (cont’d)
Rotated Factor Loadings

1

2

There is a lack of empirically validated VR interventions
The use of EBP places too much demand on my role
I do not have sufficient training to incorporate EBP
I do not believe EBP has any practical value
Use of treatment/interventions decisions based on clinical experience

3
.648
.642
.633
.467
.451

Note: 1 = Perceived Benefits, 2 = Self-Efficacy, 3 = Perceived Barriers

Factor 1: Perceived Benefits
This factor consists of 13 items measuring rehabilitation counselors’ perceived benefits
of EBP in terms of providing best interventions, improving the working alliance, and improving
client employment outcomes. This is consistent with Graham et al. (2013) who reported
rehabilitation counselors value research for practice, understood how to interpret research
literature and apply the information in their job. The mean inter-item correlation of .62 and
Cronbach’s alpha was .954 suggesting very good internal consistency reliability for this scale
with this sample. The average score for this subscale was 7.97 (SD= 1.72) indicating a
moderately highly level of perceived benefits of EBP.
Factor 2: Rehabilitation Counselor Self-Efficacy
This factor consists of 14 items that measure rehabilitation counselors’ confidence in
their ability to select assessment and interventions for clients based on the best scientific
evidence in their role as a rehabilitation counselor. According to Bandura’s (1982) social
cognitive theory, an individual’s perceptions impact their behaviors and actions. For example, if
a counselor believes they can provide an effective service to their customer(s) (i.e., perceived
competency to deliver evidence-based practices), their thoughts and behaviors are shaped by the

62

perceived competency and they are likely to provide the effective service to their customers. The
mean inter-item correlation of .492 and Cronbach’s alpha was .926 suggesting very good internal
consistency reliability for this scale with this sample. The average score for this subscale was
7.28 (SD= 2.03) indicating a moderately highly level of perceived self-efficacy related to EBP.
Factor 3: Perceived Barriers
This factor consists of 10 items that measured rehabilitation counselors perceived barriers
to the use of EBP in practice. Winch et al. (2005) noted professionals often point to limited
motivation and interest, poor confidence, negative attitudes, and limited understanding of the
value of research as barriers to evidence-based practice. Both organizational and individual
characteristics such as lack of knowledge to properly assimilate evidence-based practice on the
part of service providers, poor leadership, bureaucratic constraints, and a change-averse culture
(Corrigan, Steiner, McCracken, Blaser, & Barr, 2001). The mean inter-item correlation of .404
and Cronbach’s alpha .873 suggesting very good internal consistency reliability for this scale
with this sample. The average score for this subscale was 4.46 (SD=2.12) indicating a moderate
level of perceived barriers to EBP.
As shown in Table 9, study participants rated perceived benefits factor as being important
with a mean of 7.97 (SD = 1.72). The highest rated perceived benefit item was, “Increasing the
probability of identifying best evidence VR interventions consistent with the values and needs of
VR clients” with a mean of 8.06 (SD=1.63). The lowest item on the perceived benefits factor
was “EBP has the potential to help improve the effectiveness of VR service delivery practices”
with a mean 7.37 (SD=1.68).

63

The self-efficacy factor had a mean of 7.28 (SD=2.03) and the highest rated item was
“Use an evidence-based practice approach (e.g., motivational interviewing) in the professional
practice of rehabilitation counseling” with a mean of 8.01 (SD=1.81) indicating high confidence
in their ability to provide such interventions. There were two low items on the self-efficacy
factor, “I am using EBP in my role as a rehabilitation counselor” with a mean of 6.25 (SD=2.38),
and, “I use the internet and academic databases to search for systematic review articles to help
me select promising practices that are helpful to my clients” with a mean of 6.26 (SD=2.62).
The perceived barriers factor had a mean of 4.46 (SD=2.12) with the highest item as
“There are no supervisors and counselors who are experienced in EBP in my agency that I can
talk to” with a mean of 5.33 (SD=2.68). The item with the lowest was “I do not believe EBP has
any practical value in vocational rehabilitation” with a mean of 2.80 (SD=1.94).
Table 9.
Mean and Standard Deviation for Perceived Benefits, Self-Efficacy and Perceived Barriers
Factors
Benefits
Self-Efficacy
Barriers
M

SD

EBP VR

7.97 1.72

Factor 1: Perceived Benefits
Increase the probability of identifying best
Improve working relationship (working alliance)
Improve employment rates and employment
Improve psychosocial outcomes for VR clients
Empower clients to exercise knowledgeable
Help identify the most effective and efficient
Improve client satisfaction
Improve efficiency in utilization
Protect clients from ineffective or harmful
Help keep me abreast with current best evidence
EBP has the potential to help improve
I can see the value of EBP in vocational
I am interested in learning more about EBP

8.06
8.04
7.98
8.04
8.14
8.02
7.84
7.78
8.07
8.37
7.37
7.78
8.04

64

1.63
1.69
1.71
1.64
1.66
1.70
1.83
1.83
1.82
1.50
1.68
1.65
1.76

M

SD

M

SD

7.28

2.03

4.46

2.12

Table 9. (cont’d)
Benefits
M
EBP VR

SD

7.97 1.72

Factor 2: Counselor Self-Efficacy
Use current best evidence in making decisions
Provide psychosocial interventions
Read and understand the best evidence information
Critically evaluate the validity and generalizability
Provide VR interventions that have the highest level
Use an evidence-based practice approach
Understand basic concepts of rehabilitation research
Search the research databases and search engines
I take research findings into consideration
I use EBP concepts in making decisions
I use best evidence medical, psychological
I use the internet and academic databases
I am using EBP in my role as a rehabilitation counselor
I have completed in-service training

Self-Efficacy
M

SD

M

SD

7.28

2.03

4.46

2.12

4.68
4.99
3.90
4.31
5.33
4.46
4.12
5.00
2.80
5.02

2.44
2.29
2.13
2.59
2.68
2.08
2.10
2.61
1.94
1.73

7.98
7.69
7.54
7.41
7.70
8.01
7.20
7.20
6.80
6.91
7.30
6.25
6.25
6.50

Factor 3: Barriers to EBP
There is a lack of support and encouragement
There is a lack of collective support
I do not have time to incorporate EBP in my work
My agency does not have the infrastructure and interest
There are no supervisors and counselors who are experienced
There is a lack of empirically validated VR interventions
The use of EBP places too much demand on my role
I do not have sufficient training to incorporate EBP
I do not believe EBP has any practical value
The use of treatment/interventions decisions based on clinical experience

65

Barriers

1.71
1.90
1.95
2.02
1.83
1.81
2.35
2.35
2.04
2.01
1.78
2.62
2.38
2.64

Supplementary Data Analysis of EBP-VR Survey
As demonstrated by the EFA, items from the readiness subscale loaded on to the other
three factors of perceived benefits, self-efficacy and perceive barriers. A subsequent EFAs were
conducted to compare the three subscales of perceived benefits, self-efficacy and perceived
barriers without the readiness subscale items. A principle component analysis using a varimax
rotation and three factor solution was used to make meaningful interpretations for perceived
benefits, self-efficacy and perceived barriers. Coefficients values for all items were set at .40,
since this value been used as having a loading of interpretive value (Field, 2009). Stevens (2002;
as cited in Field, 2009) suggested that by squaring r (e.g. .40), approximately 16% of the
variance of a given factor can be explained by such an item loading. The three extracted factors
are described below which explained 65.15% of the variance. Table 10 below displays the
variance explained by the three factor solution of perceived benefits, self-efficacy and perceived
barriers. Table 11displays the rotated matrix of components.
Table 10.
Total Variance Explained by Three-Component Solution of Perceived Benefits, Self-Efficacy
and Perceived Barriers
Initial Eigenvalues
Extraction
Rotation
Total - % Var-Cum %
Total - % Var-Cum%
Total
Perceived Benefits
10.339 38.292 38.292
10.339 38.292 38.292 7.619
Self-Efficacy
4.190 15.517 15.517
4.190 15.517 53.809 5.561
Perceived Barriers
3.062 11.341 11.341
3.062 11.341 65.150 4.411

66

Table 11.
Rotated Component Matrix of Perceived Benefits, Self-Efficacy and Perceived Barriers
1

2

Improve employment rates and outcomes
.862
Improve psychosocial outcomes
.866
Improve working relationship
.878
Improve client satisfaction
.857
Help identify the most effective VR interventions .865
Increase the probability of identifying best
.887
Help keep me abreast with current evidence
.757
Empower clients to exercise knowledgeable
.876
Improve efficiency in utilization of resources
.834
Protect clients from ineffective or harm services
.792
Search the research databases
.795
Understand basic concepts of research
.795
Critically evaluate the validity and generalizability
.801
Read and understand the best evidence information
.816
Use and evidence-based practice approach
.748
Provide psychosocial interventions w/ highest level
.819
Use current best evidence in making decisions
.796
The use of EBP places too much demand
I do not have time to incorporate EBP
There is a lack of collective support (colleagues & agency)
There is a lack of support & encouragement (senior mgt.)
I do not have sufficient training
My agency does not have the infrastructure
There is a lack of empirically validated VR interventions
There are no supervisors & counselors who are experienced in EBP
Note: 1 = Perceived Benefits, 2 = Self-Efficacy, 3 = Perceived Barriers

3

.607
.697
.794
.809
.670
.773
.682
.717

Summary
The results of the PCA of the perceived benefits, self-efficacy and perceived barriers
subscale items were consist with the full PCA with all EBP-VR Survey subscales. The full PCA
on all EBP-VR Survey subscales accounted for 55.13% of the total variance, while the PCA on
the perceived benefits, self-efficacy and perceived barriers subscales accounted for 65.15% of

67

the total variance. Both PCAs resulted in the same component order of perceived benefits, selfefficacy and perceived barriers.
It should be noted that one self-efficacy item, “Formulate appropriate clinical questions
about the problems presented by the consumer” did not load on either the full PCA containing all
EBP-VR Survey items, nor the PCA containing items from the EBP-VR Survey subscales of
perceived benefits, self-efficacy and perceived barriers. While study participants responded
favorably to this item in the original survey with a mean 7.95 (SD=1.78), it is unknown why this
particular item did not have any component loading in both PCAs. This item could be removed
from the subscale. However, the conceptual basis for the item, “Formulate appropriate clinical
questions…”, is a critical first step for EBP development and implementation. This item should
be included after consideration is given to new item wording and pilot testing.
The results from the PCA of three EBP-VR Survey subscales of perceived benefits, selfefficacy and perceived barriers (minus the one self-efficacy item above) reflect and measure the
intended concepts of rehabilitation counselor perceived benefits of EBP, rehabilitation counselor
self-efficacy in the use of EBP, and rehabilitation counselor perceived barriers to EBP use at the
organizational, management and practitioner levels. These three subscales could be used for
future research in exploring rehabilitation counselor perceived benefits of EBP, rehabilitation
counselor self-efficacy in EBP use and perceived barriers to EBP interventions.
As described earlier, a careful review of all 12 readiness scale items was conducted by
the researcher as to possible explanations for why the readiness subscale items loaded on the
other three scales. The researcher concluded that the readiness subscale items may have
inadvertently measured concepts associated with the perceived benefits, self-efficacy and
68

perceived barriers subscales. While the intent of the readiness subscale was to specifically
explore rehabilitation counselor readiness or stage of change (i.e. ambivalence towards using
EBP vs. action/implementation of EBP), this was not the case with this particular sample. Given
the sample for this study consistent of participants with advanced pre-service training from
CORE accredited rehabilitation counseling programs, and who also obtain a national
certification, stages of change theory may not have been applicable to this study sample. Stages
of change theory may be more applicable to recent rehabilitation counseling program graduates
and/or new CRCs in terms of measuring their readiness to engage in EBP interventions and
practice with clients. This could be the basis for future research with novice rehabilitation
counselor readiness to use EBP, especially in light of the large number CRCs (n=125; 39.6%)
with less than five years of work experience that participated in this study.
Future research involving the EBP-VR Survey should be limited to the three subscales of
perceived benefits, self-efficacy and perceived barriers. A similar study in the future using the
three subscales to conduct an initial PCA followed by a confirmatory factor analysis (CFA)
could further validate the instrument of use in measuring rehabilitation counselors perceived
benefits of EBP, self-efficacy in the use of EBP, and perceived barriers to EBP interventions.
Research Question 1: What are rehabilitation counselor’s perceived self-efficacy, perceived
benefits, perceived barriers and readiness to use evidence in current VR service delivery
practices?
Descriptive statistics for the three factors are presented for the self-efficacy, perceived
benefits, and perceived barriers of the EBP-VR Survey. The readiness subscale in not included

69

in this analysis. Factor means and reliability statistics are presented below based on the
participants responses (n=318).
Perceived Benefits Factor
The perceived benefits factor of EBP was measured on 13 items indicating the extent to
which they agreed or disagreed with a series of statements describing potential benefits of EBP
for the clients they serve. The average score for this factor was 7.61 (SD= 1.89; α = .898)
indicating a moderately highly level of perceived benefits related to counselors’ perceived
benefits of EBP in service interventions to their clients based on scientific evidence.
Rehabilitation counselor perceived benefits was reflected in item, “Increase the probability of
identifying best evidence VR interventions consistent with the values and needs of VR clients”
with a mean of 8.06 (SD=1.497), indicating a high level of potential benefit in selecting EBP
interventions sensitive to clients diverse backgrounds and values. Other perceived benefits of
EBP included, “Improve the working relationship (working alliance)” with a mean of 8.02
(SD=1.57), and, “Improve employment rates and employment outcomes” with a mean of 8.03
(SD=1.64) indicating a moderately high level of perceived benefits of EBP in determining
appropriate interventions for clients. Overall, the participants reported moderately high selfefficacy in the provision of VR services. Table 12 below shows the EBP-VR Survey Perceived
Benefits Factor Items by Practice Setting.

70

Table 12.
EBP-VR Survey Perceived Benefits Factor Items by Practice Setting
Statement

Increase the probability
of identifying
Improve the working
relationship (working
alliance)
Improve employment rates
and employment outcomes
Improve psychosocial
outcomes for VR clients
Empower clients to
exercise knowledge
Help identify the most
effective and efficient
Improve client satisfaction
Improve efficiency in
utilization
Protect clients from
ineffective or harmful
Help keep me abreast with
current best evidence
EBP has the potential to
help improve
I can see the value of EBP
in vocational rehabilitation
I am interested in learning
more about EBP
Average factor scores:

State Fed VR
M (SD)

CRO
M (SD)

Private/Workers Comp
M (SD)

Other
M (SD)

8.06 (1.63)

8.40 (1.56)

7.53 (2.01)

8.30 (1.53)

8.02 (1.57)

8.44 (1.56)

7.55 (2.10)

8.28 (1.58)

8.03 (1.64)

8.48 (1.61)

7.45 (1.96)

8.13 (1.61)

7.95 (1.61)

8.44 (1.61)

7.63 (1.83)

8.34 (1.51)

8.01 (1.66)

8.68 (1.31)

7.85 (1.86)

8.38 (1.58)

7.94 (1.58)

8.40 (1.44)

7.63 (2.16)

8.28 (1.58)

7.82 (1.78)
7.69 (1.83)

8.24 (1.810
8.12 (1.51)

7.46 (2.11)
7.50 (1.95)

8.00 (1.71)
8.01 (1.81)

7.96 (1.67)

8.64 (1.50)

7.73 (2.18)

8.30 (1.83)

8.12 (1.56)

8.72 (1.28)

8.27 (1.66)

8.71 (1.27)

7.29 (1.78)

7.88 (1.54)

6.75 (1.41)

7.74 (1.66)

7.65 (1.72)

8.32 (1.22)

7.14 (1.53)

8.26 (1.55)

8.06 (1.70)

8.72 (1.51)

7.57 (1.80)

8.13 (1.82)

7.87 (1.66)

8.42 (1.50)

7.54 (1.89)

8.22 (1.62)

Self-Efficacy Factor
Rehabilitation counselor self-efficacy factor was measured on 9 items indicating how
much confidence they have in their ability to select assessment and interventions for consumers
based on the scientific evidence in their role as a rehabilitation counselor. The average score for
this factor was 7.61 (SD= 1.89; α = .898) indicating a moderately highly level of perceived selfefficacy related to counselors’ confidence to select assessments and interventions for clients
71

based on scientific evidence. Rehabilitation counselor self-efficacy was reflected in item, “Use
and evidence-based practice approach (i.e., motivational interviewing) in the professional
practice of rehabilitation counseling” with a mean of 7.69 (SD=1.92), indicating a high level of
self-efficacy in selecting EBP interventions. Self-efficacy factor item, “Provide VR
interventions that have the highest level of scientific evidence and support” had a mean of 7.35
(SD=1.93), indicating a moderately high level of self-efficacy to use EBP in determining
appropriate interventions for their clients. Overall, the participants reported moderately high
self-efficacy in the provision of VR services.
Table 13.
EBP-VR Survey Self-Efficacy Factor Items by Practice Setting
Statement

State Fed VR
M (SD)

CRO
M (SD)

Private/Workers Comp
M (SD)

Use current best evidence in
7.66 (1.85) 8.20 (1.12)
making decisions about the
care of clients consistent
with values and needs of
individuals from diverse
backgrounds
Provide psychosocial
7.14 (1.96)
8.08 (1.23)
interventions that have the
highest level of scientific
evidence and support
Read and understand the best
7.22 (2.01) 7.88 (1.51)
evidence information from
systematic reviews/meta-analysis
Critically evaluate the validity and 7.07 (1.99) 7.68 (1.55)
generalizability of the research
findings to make clinical decisions
Provide VR interventions
7.35 (1.93) 8.00 (1.38)
that have the highest level
of scientific evidence and
support
Use an evidence-based practice
7.69 (1.92) 7.96 (1.34)
approach (i.e. motivational
interviewing) in the professional
practice of rehabilitation counseling
72

Other
M (SD)

8.17 (1.77)

8.26 (1.52)

7.97 (1.81)

8.19 (1.80)

7.70 (1.96)

7.82 (1.90)

7.53 (2.31)

7.75 (1.92)

7.89 (1.77)

7.87 (1.77)

8.05 (1.92)

8.47 (1.59)

Table 13. (cont’d)
Statement

State Fed VR
M (SD)

CRO
M (SD)

Understand basic concepts of
6.68 (2.47)
rehabilitation research, designs,
methods and statistics
Search the research databases and 6.68 (2.47)
search engines (e.g., PsychINFO,
and MEDLINE) to find empirically
supported interventions
I take research findings into
Consideration in helping clients 6.35 (2.03)
I use EBP concepts in making
Decisions regarding services
6.62 (1.94)
I use best evidence medical
7.08 (1.72)
I use the internet
5.56 (2.46)
I am using EBP in my RC role
5.73 (2.37)
I have completed training
6.33 (2.50)
Average Factor Scores:
6.80 (2.12)

Private/Workers Comp
M (SD)

Other
M (SD)

7.48 (2.24)

7.05 (2.43)

7.97 (1.92)

7.48 (2.24)

7.05 (2.43)

7.97 (1.92)

7.24 (1.62)

6.70 (2.24)

7.39 (1.87)

7.36 (1.68)
7.52 (1.90)
6.92 (2.75)
7.20 (1.71)
6.60 (2.57)
7.54 (1.77)

6.40 (2.14)
7.08 (1.83)
6.12 (2.85)
6.07 (2.38)
5.53 (2.86)
7.09 (2.19)

7.55 (1.93)
7.69 (1.77)
7.19 (2.36)
6.86 (2.40)
7.32 (2.51)
7.72 (1.94)

Perceived Barriers Factor
CRCs perceived barriers to EBP was measured on 8 items indicating the extent to which
they agreed or disagreed with a series of statements describing potential barriers to EBP. The
average score for this subscale was 4.61 (SD=2.29; α =.878) indicating rehabilitation counselors
across the three practice settings were in agreement with perceived barriers to EBP.
Rehabilitation counselors perceived barriers to EBP were reflected in item, “There are no
supervisors and counselors who are experienced in EBP in my agency that I can talk to”, with a
mean of 5.78 (SD=2.45) indicating rehabilitation counselors in this study agree there were no
opportunities to discuss EBP with either supervisors or other counselors, which may inhibit their
own use of EBP. Training was also a perceived barrier as reflect in item, “I do not have
sufficient training to incorporate EBP in my practice”, with a mean of 5.66 (SD=2.49) indicating
73

rehabilitation counselors reported not having sufficient training to use EBP. However, this
finding must be interpreted with caution as the finding does not specific at what level
rehabilitation counselors lacked training in EBP.
Overall, the participants reported multiple barriers in the use of EBP. The multiple
barriers range from lacking organizational infrastructure, lack of supervisory and colleague
support, to individual practitioner barriers such as insufficient training in EBP, lack of time to
incorporate EBP and EBP not fitting the demands of their current position.
Table 14.
EBP-VR Survey Perceived Barriers Scale Items by Practice Setting
Statement

State Fed VR
M (SD)

There is lack of support and
5.32 (2.43)
encouragement from senior
management for EBP in the agency
There is lack of collective support for 5.55 (2.42)
the use of EBP among my colleagues
in my agency
I do not have time to incorporate EBP 4.34 (2.31)
in my work
My agency does not have the
4.86 (2.73)
infrastructure and interest (e.g., Internet,
electronic library resources, and agency
policies and procedures) to support and
encourage evidence-based rehabilitation
counseling practice
There are no supervisors
5.78 (2.45)
and counselors who are
experienced in EBP
There is a lack of empirically validated 4.58 (1.97)
VR interventions that I can use in my
work as a VR counselor
The use of EBP places too much
4.47 (2.08)
demand on my role as a
rehabilitation counselor
I do not have sufficient training to
5.66 (2.49)
incorporate EBP in my practice
74

CRO
M (SD)

Private/Workers Comp Other
M (SD)
M (SD)

4.44 (2.29)

4.21 (2.19)

4.10 (2.44)

4.64 (2.49)

4.73 (1.95)

4.42 (2.33)

3.56 (1.58)

3.97 (1.85)

3.29 (2.00)

3.84 (2.38)

3.94 (2.11)

3.84 (2.59)

5.08 (2.74)

5.43 (2.66)

4.67 (2.79)

4.40 (2.10)

4.50 (2.15)

4.28 (2.21)

3.76 (2.01)

4.27 (2.13)

4.44 (2.93)

4.80 (2.51)

3.62 (2.05)

4.31 (2.54)

Table 14. (cont’d)
Statement

I do not believe EBP has any
practical value
The use of interventions based
on clinical experience is more
effective than EBP
Average Factor Scores:

State Fed VR
M (SD)

CRO
M (SD)

Private/Workers Comp Other
M (SD)
M (SD)

3.09 (1.99)

1.92 (1.35)

3.27 (1.98)

2.31 (1.83)

5.14 (1.77)
4.88 (2.26)

4.60 (1.56)
4.07 (2.14)

5.28 (1.73)
4.44 (2.13)

4.78 (1.68)
3.96 (2.25)

Summary
The results of research question one indicate that rehabilitation counselors possess selfefficacy to use EBP in a manner that benefits their clients. Rehabilitation counselors reported
being able to research the literature about the problems presented by their clients, and use an
evidence-based practice approaches in their professional practice of rehabilitation counseling.
Rehabilitation counselors reported they value EBP and could perceived potential benefits for
their clients in terms of providing EBP that meet the clients’ individual VR needs, support
informed choice and protect clients from ineffective our harmful practice. Rehabilitation
counselors also identified barriers to EBP use, such as a lack of guidance from supervisors
knowledgeable in EBP or colleagues with experience to consult with regarding EBP.
Organizational barriers were identified as well including lack of agency resources to support
EBP and rehabilitation counselor role expectations that limited time for EBP use.

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Research Question 2: What is the difference between practice settings and Rehabilitation
Counselor EBP Self- Efficacy (RCSE) and Environmental Factors (EF) that influence the
use of evidence-based service delivery practices: a.) State-Federal VR Program, b.)
Community Rehabilitation Program (CRO), c.) Private for Profit/Worker’s Compensation
Rehabilitation?
Two one-way between groups analysis of variance (ANOVA) were conducted to
determine if differences existed in rehabilitation counselor self-efficacy and perceived barriers to
EBP based on practice setting. The first one way ANOVA was conducted to determine if
differences exist between practice settings and rehabilitation counselor self-efficacy. The second
one way ANOVA was conducted to determine if differences exist between practice settings and
environmental factors (perceived barriers) to EBP. The practice settings used for this analysis
were the state-federal VR program, CROs, and private for profit/workers compensation. The
“Other” practice setting was not used in this analysis due to its’ confounding nature with over
sixty difference practice settings being reported, and some “other” practice settings being
reported as “retired”. The sample size for the two one way ANOVAs was n=224
Self-Efficacy and Practice Setting
A one way between groups ANOVA was conducting to determine if there were
differences between rehabilitation counselor practice settings and self-efficacy. The three
practice settings used for the analysis consisted of the state-federal VR program, CROs and
private for profit/workers compensation. There was no statistically significant difference at the p
< .05 level in self-efficacy for the three groups, F (2, 221) = .723, p =.486

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Table 15.
Self-Efficacy and Practice Setting
Sum of
Squares
Between Groups 473.314
Within Groups
72292.349
Total
72765.664

df
2
221
223

Mean Square F
236.657
.723
327.115

Sig.
.486

Perceived Barriers and Practice Setting
A one way between groups ANOVA was conducting to determine if there were
differences between rehabilitation counselor practice settings and perceived barriers to EBP.
The three practice settings used for the analysis consisted of the state-federal VR program, CROs
and private for profit/workers compensation. There was no statistically significant difference at
the p < .05 level in self-efficacy for the three groups, F (2, 221) = .865, p =.422.

Table 16.
Perceived Barriers and Practice Setting
Sum of
Squares
df
Between Groups 448.885
2
Within Groups
57316.280
221
Total
57765.165
223

Mean Square F
224.443
.865
259.350

Sig.
.422

Summary
The two one-way between groups ANOVA were not statistically significant with no
differences between practice settings and rehabilitation counselor self-efficacy and perceived
barriers to EBP. The non-significance may be related to the certification status of the study
participants (CRCs), who have received professional training from accredited rehabilitation
counseling education programs and have passed the national certification examination. This level
of preparation and training may provide CRCs with the self-efficacy needed to pursue EBP on
behalf of their clients. Additionally, CRCs are employed in a variety of practice settings
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including private/public agencies and for profit/nonprofit organizations. The results above
indicate that the practice setting alone does not deter CRCs engaging in EBP. However, CRCs
the in this study reported similar barriers to EBP across practice settings. The perceived barriers
included lack of support from senior management and supervisors, lack of agency infrastructure
to support EBP, and insufficient training in EBP.
Research Question 3: Are there differences between CRC demographics (i.e. gender, years
of practice, practice setting, etc.) that influence Rehabilitation Counselor EBP Self-Efficacy
(RCSE)?
Research question three examined the relationship between the predictor variables and
rehabilitation counselor self-efficacy. To answer this question, the self-efficacy scale was
regressed on CRC demographics (male, age, years as CRC, other work experience, master’s
degree, doctorate degree, rehabilitation counseling, caseload size, white, state-federal VR, and
private for profit/workers compensation). The following is a description of the model
preparation, followed by a presentation of the results for the full equation and the CRC sample.
Model Preparation
Eleven variables were entered into the model with dummy coding for highest education
level (masters & doctorate), major area of study (rehabilitation counseling), race/ethnicity
(white), and practice setting as individual variables of state-federal VR, CRO or private for
profit/workers compensation. Dummy variables were established for male ( yes =1; no= 0),
master’s degree ( yes =1; no = 0), doctorate degree (yes = 1; no = 0),

78

rehabilitation counseling (yes =1; no = 0), white ( yes =1; no = 0), state-federal VR (yes = 1; no
= 0) and private for profit/workers compensation (yes = 1; no = 0). All demographic variables
were entered simultaneously into the full model.
Model Equation
Yi = µi + β1male + β2age + β3CRC + β4other work experience + β5masters + β6doctorate +
β7rehabcounseling + β8caseload size + β9white + β10state-federal VR + β11private/worker
comp.
Outcome Measure
The outcome variable for this research question is CRC self-efficacy as related to CRC
demographics. Participants responded to a 10-point Likert scale indicating how much
confidence they had in their ability to select assessment and intervention for clients based on the
best scientific evidence in their role as a rehabilitation counselor.
Results
The model accounted for 10% of the variance in self-efficacy. One independent variable
was significant; doctorate (B = 34.32; β = .445; p = .015) as a predictor for self-efficacy as
compared to those with bachelor’s degrees. The remaining independent variables were not
significant and were not predictors of CRCs self-efficacy. This result may be due to the sample
used for this study, e.g. CRCs. Given the level of pre-service training received from CORE
accredited rehabilitation counseling programs and national certification, CRCs self-efficacy
could be attributed to their educational preparation and pre-service training, and not attributed

79

any single demographic variable. Table 17 show the full regression model and Table 18 shows
the correlations for all model predictors and the outcome measure.
Table 17.
Full Model Multiple Regression
Unstandardized
Coefficients

Standardized
Coefficients

Model
B
Std. Error Beta
(Constant)
68.853
15.151
Male
.846
3.265
.021
Age
-.016
.145
-.011
CRC
-.197
.172
-.109
OtherWorkExp .132
.165
.063
Masters
16.090
13.265
.224
Doctorate
34.324
13.935
.445
RehabCoun
-3.602
3.147
-.083
CaseloadSize
.002
.013
.010
White
2.126
3.149
.048
StateFedVR
3.014
4.609
.079
PrivateWork
7.246
4.747
.175
a. Dependent Variable: SEFactorMean

80

t
4.544
.259
-.111
-1.147
.803
1.213
2.463
-1.144
.148
.675
.654
1.526

Sig.
.000
.796
.912
.253
.423
.227
.015
.254
.883
.500
.514
.129

95.0% Confidence
Interval for B
Lower
Upper
Bound
Bound
38.965
98.740
-5.595
7.287
-.302
.270
-.536
.142
-.193
.458
-10.076
42.256
6.836
61.812
-9.810
2.606
-.024
.028
-4.085
8.338
-6.078
12.106
-2.119
16.610

Table 18.
Correlations for All Predictors and Outcome Measure
1

2

3

4

5

6

7

8

9

10

11

-.79

1

1

1

2

.16

1

3

.10

.65

1

4

.08

.42

.17

1

5

-.20

-.11

-.15

-.16

1

6

.15

.07

.09

.16

-.92

1

7

.03

-.10

-.09

-.09

.22

-.16

1

8

.01

.00

-.08

-.11

.11

-.09

.14

1

9

-.02

.01

.15

-.003

.09

-.12

-.002

.02 1

10

.50

.07

-.004 .10

-.09

.06

.007

-.02

.000 1

11

.03

-.40

-.05

.02

-.02

.08

-.06

-.03

-.04

12

.004

-.04

-.08

.09

-.19

.24

-.11

-.02

-.009 -.04

.10

12

1

Note: Data was imputed for missing values; there is no missing data. N=224. 1= male; 2 = age;
3 = CRC; 4 = other work experience; 5 = masters; 6 = doctorate; 7 = rehab counseling; 8 =
caseload size; 9 = white; 10 = state-federal VR; 11 = private for profit/worker comp; 12 = factor
score: self-efficacy.
Summary
Research question three explored CRC demographics obtained in this study that
influenced Rehabilitation Counselor Self-Efficacy (RCSE). Of the CRC demographics one was
significant; doctorate level education (B = 34.32; β = .445; p = .015) as a predictor for selfefficacy. The advanced pre-service training and education of the CRCs in this sample indicate
that no on single demographic characteristic influenced the rehabilitation counselor self-efficacy,
other than a doctorate level of education as compared to those with a bachelor’s degree.

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Chapter 5
DISCUSSION
The intent of this study was to explore rehabilitation counselor self-efficacy and work
environment factors that influence the use of EBP in VR service delivery. To accomplish this,
the EBP-VR Survey was selected to measure rehabilitation counselor self-efficacy, perceived
benefits of EBP, perceived barriers to EBP use, and readiness to use EBP in VR service delivery
and practice. The domains of this instrument were analyzed in an exploratory factor analysis to
see if elements of the theoretical concepts of self-efficacy and stages of change (readiness) were
indeed distinct categories.
EBP-VR Survey: Readiness Scale
Data collected from the EBP-VR Survey provided support for the concept of
rehabilitation counselor self-efficacy, perceived benefits of EBP, and perceived barriers to EBP
use in service delivery and practice. However, the concept of rehabilitation counselor readiness
(stages of change; SOC) was not supported by the data. An EFA of the EBP-VR Survey showed
that of the 12 items readiness scale items, 3 items loaded on factor 1 benefits, 6 items loaded on
factor 2 self-efficacy, and 2 items loaded on factor 3 barriers. A review of the readiness items,
specifically how the items were described, indicates the item may have described another
concept. For example, readiness item number 11, “I do not believe EBP has any practical value
in vocational rehabilitation” describes a barrier to EBP use and loaded on the barriers factor.
Other examples include readiness item number 3, “I can see the value of EBP in vocational
rehabilitation” loaded on the benefits factor and readiness item number 12, “I am using EBP in
my role as a rehabilitation counselor” loaded on the self-efficacy factor.
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The readiness scale items did not describe counselor readiness to use EBP in terms of
SOC with this sample of CRCs. It appears the items on the readiness described associated
concepts of self-efficacy, perceived benefits of EBP and perceived barriers to EBP use in
practice. Potential explanations include the education level of the study participants and whether
SOC is an appropriate theoretical concept to explore CRC readiness to use EBP in VR service
delivery or counseling practice.
It should be noted that the majority of study participants received professional, preservice training from accredited rehabilitation counseling education programs, leading to a
master’s degree in rehabilitation counseling, and have passed the national certification
examination for CRC. Therefore, SOC concepts of “ambivalence” , “pre-contemplation”, and
“contemplation” used in describing individual attitudes towards implementation and action of
certain behaviors (i.e., use of EBP) may not accurately measure CRCs attitudes and/or values
towards EBP. Given the education, training and experience of the participants, results of this
study, and if the SOC stages were applicable, the participants are most likely in the “action” and
“implementation” stages of SOC. Participants acknowledged the benefits of EBP and reported
having the self-efficacy to pursue EBP on behalf of their clients. The participants were also
cognizant of the multiple barriers to the use of EBP at different levels, i.e., organizational,
supervisory, and practitioner levels. Therefore, SOC theory may not accurately reflect CRC
development in the use of EBP and another theory may be more appropriate.

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Relationship with Previous Evidence-Based Research
Certified rehabilitation counselors who participated in this study reported the benefits of
EBP as important in improving vocational rehabilitation outcomes for clients. They also
reported having self-efficacy in developing and implementing EBP, while acknowledging
multiple barriers to EBP use in VR service delivery. These findings are consistent with the
rehabilitation literature that rehabilitation counselors believe the application of evidence-based
practice is necessary, useful and will lead to improved quality of VR service delivery (Bezyak,
Kubota & Rosenthal, 2010; Leahy, et al. 2014). Graham et al. (2013) reported rehabilitation
counselors value research for practice, understood how to interpret research literature and apply
the information in their job.
Tansey, Bezyak, Chan, Leahy & Lui (2014) conducted a study to identify and describe
vocational rehabilitation professional’s perceived self-efficacy, outcome expectancy, barriers and
readiness to use evidence in current practice. The results from rehabilitation counselors from
four state-federal VR agencies reported moderately high self-efficacy in the use of EBP and
outcome expectancy. Bandura (1986) described self-efficacy expectancy as the belief that an
individual is or is not able to perform the necessary actions to reach an intended to goal, while
outcome expectancy is the belief that a certain behavior will have a specific outcome. The CRCs
in this study reported a moderate level of self-efficacy in their ability to provide EBP.
Specifically, CRCs reported the ability to provide psychosocial interventions that have the
highest level of scientific evidence, use current best evidence in making decisions about the care
of their clients consistent with the client’s values, and understand the best evidence information
from systematic reviews/meta-analysis. These results are consistent with Tansey, Bezyak, Chan,

84

Leahy & Lui (2014) findings, as well as demonstrating self-efficacy (Bandura, 1986) in the
provision of EBP.
The study findings are also consistent with previous research regarding barriers to EBP
implementation and use. Both organizational and individual characteristics including lack of
knowledge to properly assimilate evidence-based practice on the part of service providers, poor
leadership, bureaucratic constraints, and a change-averse culture (Corrigan, Steiner, McCracken,
Blaser, & Barr, 2001). Limited training (Jette et al., 2003; Nelson & Steele, 2007) and time
(O’Donnell, 2004) are major barriers to fully implementing evidence-base practice with
practitioners spending at least eight hours each day providing direct service, resulting in limited
time for training of new evidence or practices (Corrigan et al., 2001).
Study Limitations
A major assumption of this study is rehabilitation counselors’ understanding of
evidence-based practices. While it was assumed CRCs, given their level of education and
certification status, would be informed of EBP, this may not be the case. Graham et al. (2013)
asked state-federal VR counselors and other professional rehabilitation staff what they knew
about evidence-based practice and how they use the information. The results indicated that
rehabilitation professionals held multiple definitions of evidence-based practice, “researchbased”, “documented evidence”, “proven effective” and “practice or experience” reflecting a
basic knowledge of EBP. To this researcher’s knowledge, there are no data available describing
how CRCs define evidence-based practices.
Another assumption concerns how EBP is valued by CRCs across the three practice
settings of study, i.e., the state-federal VR program, community rehabilitation organizations, and
85

private for profit/workers compensation rehabilitation settings. While each practice setting
strives to achieve competitive employment outcomes for their clients, program effectiveness and
outcomes are measured differently. RSA standards and indicators are the measurements for the
state-federal VR program and the Commission on Accreditation of Rehabilitation Facilities
(CARF) provides standards for private and community rehabilitation programs. These outcome
measurements drive the VR service delivery process, and may challenge the development and
use of EBP within the different service delivery models. Additionally, each group is accountable
to different stakeholders that hold considerable influence over service delivery efforts. For
example, state-federal VR programs are accountable to RSA, client advocacy organizations and
political entities while private rehabilitation providers are accountable to insurance providers in
order to receive payment for services rendered. To ignore these realities is to neglect
environment and systemic issues that challenge the implementation of EBP in VR service
delivery.
Other potential limitations considered within the framework of this study include the
sample, sample size, and use of electronic surveys and questionnaires. First, this study used a
convenience sample comprised of Commission on Rehabilitation Counselor Certification
(CRCC) members. CRCC members who are employed and belong to a professional organization
may be different than rehabilitation professions who are employed but do not belong to a
professional organization (Zanskas & Strohmer, 2011). CRCs may hold favorable impressions
or attitudes towards the use of EBP, and may be inclined to validate the benefits of EBP by
reporting an elevated sense of self-efficacy in their use of EBP.

86

Sample size may be a limitation based on survey response frequency. Current trends in
survey research reflect that refusal and non-response rates have doubled for all surveys,
regardless of type during the past decade (Birnbaum, 2004; Sheehan, 2001; Survey Monkey,
2008; Tourangeau, 2004). The response rate for this study was 15%, similar to Welker’s (2001)
study of web-based response rates of 900 individuals with fixed email accounts. Welker
reported an overall response rate of 14% and it was determined that over one-third of the random
sample simply did not read their e-mail over a two month period. The CRCs in this sample may
have exhibited similar response behavior by not reading their email for an extended period of
time, thus being unaware of the invitation to participate in this study.
Implications for Rehabilitation Administrators and Counselors
The CRCs who participated in this study provided evidence that multiple barriers exist in
the use of EBP in VR service delivery. The results of this study found barriers to EBP exist at
multiple levels from senior management and supervisor level down to the individual practitioner.
Organizational barriers include lack of infrastructure and lack of support and encouragement to
use EBP, “There is a lack of support and encouragement from senior management for EBP in the
agency”. Lack of supervisory experience in EBP and support for individual counselor use of
EBP was reported, “There are no supervisors and counselors who are experienced in EBP in my
agency that I can talk to”. On the individual practitioner level, some participants reported, “I do
not believe EBP has any practical value in vocational rehabilitation”. Overall, participants
reported a lack of collective support for the use of EBP from management and colleagues in the
agency.

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These barriers must be addressed in order to facilitate the development and
implementation of EBP in VR service delivery. Recently, Del Valle et al. (2014) in a qualitative
case-study of four state-federal VR agencies noted promising service delivery practices that
enhance service delivery at multiple levels within an agency. These practices were a
combination of strategies that freed up counselor time to engage in core job functions, partner
with CROs for service delivery, address employer needs and provide services to specific
populations. These strategies may offer rehabilitation administrators and counselors options with
which to re-focus counselor activities, and facilitate the use of EBP by rehabilitation counselors
within the state-federal VR program. Additionally, Sherman et al. (2014) identified promising
organizational and cultural factors that appear to promote best practices in the public VR
program. The promising practices include specific organizational practices, culture and
structural elements that encourage and support the development of innovative and effective
services delivery practices (Leahy et al., 2014).
As noted by Leahy, et al., (2014), “In this era of empowerment, accountability, and
constrained budgets, state VR agency administrators need to transform the business models of
their agencies by adopting organizational innovations and harnessing advances in information
and communication technologies to deliver outcomes to individuals, communities and society at
large that are of significant value” (p. 148; Ditchman et al., 2013; Technology and
Entrepreneurship Center at Harvard, 2010). Rehabilitation administrators must seriously
consider adopting non-traditional service models to meet the demands of multiple customers,
especially the business community, if the current state-federal VR program is to survive into the
future. Results from this study can be used to address organizational barriers to EBP.

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Implications for Rehabilitation Counselor Educators
One of the perceived barriers noted in this study, “I do not have sufficient training to
incorporate EBP in my practice”, was reported by the participants. However, it does not specify
at what level there is a potential lack of EBP training. It is unknown whether the participants
were referring to pre-service training or training received on the job in conjunction with their
role as a rehabilitation counselor. Rehabilitation counselor educators can address this issue by
incorporating EBP concepts and techniques in pre-service curriculum. They may also develop
and offer in-service EBP training to agencies and rehabilitation counseling professionals who are
interested in learning and incorporating EBP into VR service delivery and individual practice.
Rehabilitation educators can also inform students and other of existing EBP resources available
on the Internet, usually at no cost.
Implications for Disability Advocates and Policymakers
There are external pressures for rehabilitation counselors in state-federal VR programs to
demonstrate that they are using an array of evidence-based interventions in their practice to
improve employment outcomes for customers with significant disabilities (Rubin, Chan &
Thomas, 2003). The National Institute of Disability and Rehabilitation Research (NIDRR) has
emphasized the focus on EBP in all research projects publicly funded through NIDRR (Brannon,
2010), along with a heightened awareness on the meaning of research findings, and translating
and disseminating evidence-based practices so they affect and inform practice and policy (Leahy
& Arokiasamy, 2010).
Given the move to a more data driven state-federal VR service delivery climate (Leahy,
et al., 2014; Del Valle, et al., 2014), there will be a need to balance the demands for data driven
89

outcomes against maintaining client rights of informed choice, active participation in the VR
process, and to ensure the continued provision of individualized VR services that meet specific
client VR needs.
Disability advocates and policymakers must strive to seek a balance that protects
individuals with disabilities by preserving informed choice and active participation in services
while developing policy, based on research, that improve services and employment outcomes.
The emphasis on EBP at the national and state level should be used to enhance services, and not
exclusively to reduce or eliminate existing standards (i.e., qualified providers) or eliminate
services without the opportunity to demonstrate effectiveness. As Tannenbaum (2003) noted
public policy makers equate accountability with numbers. Disability advocates must educate
policy makers as to the value of EBP as a means to improve service provision and outcomes, and
not as method to eliminate programs or reallocation of resources.
Implications for Rehabilitation Researchers: Closing the Gap
As noted earlier, rehabilitation administrators must adopt new business models of service
provision to meet multiple customer demands. This holds true for rehabilitation researchers as
well. As stated by Leahy et al. (2014), “rehabilitation professionals must provide people with
disabilities the most effective psychosocial and vocational services and interventions by
integrating the best scientific evidence, with clinical expertise and client perspectives, to help
them find good-paying jobs with benefits consistent with their abilities and career interests (Chan
et al., 2011; Leahy, Thielsen, Millington, Austin & Fleming, 2009).
Rehabilitation researchers can help close the gap between research and practice by
working with practitioners and individuals with disabilities to provide research findings that
90

improve services, interventions, and employment outcomes. This includes translating and
disseminating EBP from research efforts to the organizational level that will affect and inform
practice and policy (Leahy, et al. 2009). Rehabilitation researchers must focus their efforts on
providing relevant research findings to practitioners that are of practical value and in a format
that is easily accessible to non-researchers for ease of translation and dissemination into practice
at the individual practitioner and client level.
The need for EBP has been established by national research priorities NIDRR and RSA
(Brannon, 2010). Rehabilitation researchers must undertake research efforts to explore the need
and nature of EBP in VR services delivery (Leahy, et al. 2014). The next step for rehabilitation
researchers will be to facilitate EBP into practice at the practitioner level. Knowledge
Translation (KT) efforts are currently underway and have produced multiple, accessible internet
sites were interested stakeholders, practitioners and people with disabilities can reference to find
empirically based EBPs. However, KT does not equate to implementation and use of EBPs at
the organizational and practitioner levels. Rehabilitation researchers can play a critical role in
researching appropriate EBP dissemination and implementation methods that will facilitate the
use of EBP at the organizational and practitioner level. This will be a crucial undertaking if the
current state-federal VR program is to move forward and provide needed services in the future
based on evidence and that demonstrate solid EBP outcomes.
Conclusion
The findings of this study support and expand upon previous research regarding the use
of evidence-based practices in rehabilitation counseling across a variety of practice settings.
Results show that CRCs understand the nature and purpose of EBP, and more importantly the
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potential benefits of using EBPs in VR service delivery. The benefits of EBP included
improving the working alliance, improving employment outcomes, empower clients to exercise
knowledgeable self-determination, and protect clients from harm.
The CRCs who participated in this study also reported a level of self-efficacy that
influence their use of EBP in terms of selecting appropriate interventions and services that
incorporated client values and needs, use an evidence-based practice in their professional
practice, and provide psychosocial/VR interventions based on scientific evidence. This level of
self-efficacy reflects a level of professionalism and commitment to providing the best available
services possible to VR clients. It is a positive reflection of the profession and also speaks to the
need to further encourage the use of EBP in VR services delivery and rehabilitation counseling
practice.
CRCs who participated in this study also acknowledged perceived barriers to the use of
EBP. The barriers exist at multiple levels, from senior management down to the individual
practitioner level in the form of lack of infrastructure to support EBP, lack of collective support
and pragmatic issues such as lack of time and other work demands that prohibited the use of
EBP. Fortunately, these barriers are not insurmountable and must be addressed if the statefederal VR program is to move forward into the future. Rehabilitation administrators are keenly
aware of the need to adopt new business models to meet the demands of multiple customers, and
recognize new methods of conducting the business of VR will be needed for the VR program to
survive.
Finally, the need for EBP has never been greater. The future of the state-federal VR
program, as well as other vocational rehabilitation service provider programs, are at stake.
92

Rehabilitation professionals in all areas, whether public, private or a CRO, need to embrace the
importance and urgency of adopting EBP in order to demonstrate outcomes that are based on
evidence as this will have an impact on future resource allocation. More importantly, people
with disabilities who rely on VR services for employment and other services, need access to the
best services available to meet their individual VR needs. The use of evidence-based practices is
one way to ensure people with disabilities are receiving the level of services required to improve
their employment outcomes and overall quality of life.

93

APPENDICES

94

Appendix A
Evidence-Based Practices in VR Service Delivery Survey
INTRODUCTION
MISSION STATEMENT OF THE RRTC-EBP-VR
The mission of the Rehabilitation Research and Training Center on Evidence-Based Vocational
Rehabilitation (VR) Practice (RRTC-EBP-VR) is to conduct evidence-based research and to
provide VR practitioners with evidence-based knowledge and tools that will improve
employment outcomes and quality of employment for people with disabilities.
PURPOSE OF THIS STUDY
The purpose of this study is to solicit input from state VR counselors regarding the value of
evidence-based practice (EBP) in VR service delivery practices; perceived barriers for EBP; and
their preparation in incorporating EBP in their role as a rehabilitation counselor.
HOW WILL I BENEFIT BY TAKING THIS SURVEY
Information from this study will help us generate research and training materials to support
evidence-based practices. These practices may enable you to provide more effective services
within VR delivery systems, resulting in improved employment outcomes for people with
disabilities. In the coming months, the following resources was available through the RRTCEBP-VR:
* Information and tools related to implementing evidence-based practices in vocational
rehabilitation
* The opportunity to participate in Communities of Practice related to evidence-based practices
in vocational rehabilitation
* Technical assistance from the RRTC to help counselors implement evidence-based practices
and to evaluate the effectiveness of using those practices in their respective states.
Taking this survey involves minimal risks of being identified by your responses and breach of
confidentiality. However, all necessary steps to minimize these risks have been implemented.
WHAT WILL BY PARTICIPATION INVOLVE?
If you decide to participate in this research, you was asked to complete this evidence-based
practice survey. Your participation will last approximately 10 to 15 minutes in total. As long as
you do not lose your Internet browser connection, you should be able to take breaks as you are
completing the survey and go back to change answer if needed. If you experience technical
difficulties while taking this survey, please contact Roy Del Valle at delvalle@msu.edu.
95

HOW WILL MY CONFIDENTIALITY BE PROTECTED?
We will not know your name and will use a random number as ID for each participant. The
computer data file will only include the ID of the participant.
WHOM SHOULD I CONTACT IF I HAVE QUESTIONS?
You may ask any questions about the research at any time. If you have questions about the
research you contact the researcher Roy Del Valle at delvalle@msu.edu. If you are not satisfied
with the response from the researcher have more questions, or want to talk with someone about
your rights as a research participant, you should contact the Michigan State University…
CONSENT TO PARTICIPATE
Your completion of this survey will indicate your consent to participate.
Demographic Information Section
1. What is your gender?
a. Male b. Female
2. What is your age?
3. Years of work experience as a CRC vocational rehabilitation counselor:
4. Years of other rehabilitation related work experience:
5. Race/Ethnicity:
a. Caucasian
b. African American
c. Hispanic/Latino
d. American Indian/Native American
e. Asian American
f. Other:
6. What is your highest education level?
a. High School Diploma
b. Bachelor’s degree
c. Master’s degree
d. Doctorate degree
7. Please indicate your major are of study for your highest degree:
a. Rehabilitation Counseling
b. Rehabilitation Psychology
c. Psychology
d. Social Work
e. Other Counseling Specialty (e.g. Substance Abuse, Mental Health)
f. Other Vocational Rehabilitation Specialty (e.g. Vocational Evaluation)
g. Other (please specify):
8. Do you currently hold a valid certification/license as a rehabilitation counselor?
a. Yes b. No
9. Client primary disability types? Not Frequently Somewhat Frequently Very
Frequently
Frequently
96

a. Sensory Disability
b. Physical Disability
c. Development Disability
d. Psychiatric Disability
e. Other
f. Other (please specify)
10. Have you attended in-service training related to evidence-based practices?
a. Yes b. No
If “Yes”, list the titles for the training you have attended:
11. Work Setting:
a. State-Federal VR program
b. Community Rehabilitation Program
c. Private Rehabilitation Organization
d. Other
12. Caseload Size (Number of clients you are currently serving):
RRTC-EBP-VR Evidence-Based Practice Survey
DePalma (2002) described evidence-based practice (EBP) as a total process beginning with
knowing what clinical question to ask, how to find the best evidence, and how to critically
appraise the evidence for validity and applicability to the particular care situation. The best
evidence then must be applied by a clinician with expertise in considering the patient’s unique
values and needs. The final aspect of the process is evaluation of the effectiveness of care and
the continual improvement of the process.
The of high quality scientific evidence to guide the rehabilitation counseling practices has the
benefits of helping counselors fulfill their ethical obligations to clients by protecting clients from
harm (non-maleficence), improving efficiency in utilization of scarce resources (justice), and
empowering consumers to exercise knowledgeable self-determination and truly informed choice
(autonomy) (Chan, Tarvydas, Blalock, Strauser & Atkins, 2009). Research has indicated that
rehabilitation counselors generally hold positive attitudes towards evidence-based practice.
However, Bezyak, Kubota, and Rosenthal (2010) identified a lack of knowledge and insufficient
academic preparation in evidence-based practice and research utilization as major barriers for
implementation.
In short, evidence-based practice encourages counselors to use assessment and interventions that
are supported by the highest level of scientific evidence possible. Examples of rehabilitation
interventions that have high quality scientific evidence include counseling/psychology,
motivational interviewing, and the Individual Placement and Support (IPS) model for people
with psychiatric disabilities.
11. Part A.
Instructions: Please indicate how much confidence you have in your ability to select assessment
and interventions for consumers based on the best scientific evidence in your role as a
rehabilitation counselor. Use the 0-9 scale below to indicate your degree of confidence
Scale: 0 = No Confidence, 4 = Some confidence, 9 = Complete Confidence
97

How much confidence do you have in your ability to:
Formulate appropriate clinical questions about the problems presented by the consumer.
1. Search the research databases and search engines (e.g., PsycINFO and MEDLINE) to
find empirically supported interventions.
2. Understand basic concepts of rehabilitation research designs, methods, and statistics.
3. Critically evaluate the validity and generalizability of the research findings to make
clinical decisions.
4. Read and understand the best evidence information from systematic reviews/metaanalysis.
5. Use an evidence-based practice approach (e.g., motivational interviewing) in the
professional practice of rehabilitation counseling.
6. Provide psychosocial interventions that have the highest level of scientific evidence
and support.
7. Provide VR interventions that have the highest level of scientific evidence and
support.
8. Use current best evidence in making decisions about the care of clients consistent
with values and needs of individuals from diverse backgrounds.
12. Part B.
Instructions: Using the scale below, please indicate the extent to which you agree or disagree
with each of the following statements.
Scale: 0 = Strongly Disagree, 4 = Unsure, 9 = Strongly Agree
The use of evidence-based practice will:
1. Improve employment rates and employment outcomes for VR clients
2. Improve psychosocial outcomes for VR clients.
3. Improve working relationship (working alliance) with your clients.
4. Improve client satisfaction.
5. Help identify the most effective and efficient VR interventions that are consistent
with the cultural backgrounds of your clients.
6. Increase the probability of identifying best evidence VR interventions consistent with
the values and needs of VR clients.
7. Help keep me abreast with current best evidence related to medical, psychological,
and vocational assessments and interventions.
8. Empower clients to exercise knowledgeable self-determination and truly informed
choice.
9. Improve efficiency in utilization of scarce agency resources.
10. Protect clients from ineffective or harmful services.
13. Part C.
Instructions: Using the scale below, please indicate the extent to which you agree or disagree
with each of the following statements.
Scale for Perceived Barriers:
0 = Strongly Disagree
1
2 = Disagree
3
98

4 = Unsure
5
6 = Agree
7
8
9 = Strongly Agree
1. The use of EBP places too much demand on my role as a rehabilitation counselor.
2. I do not have time to incorporate EBP in my work.
*3. There is a lack of collective support for the use of EBP among my colleagues in my agency.
*4. There is a lack of support and encouragement from senior management for EBP in the
agency.
5. I do not have sufficient training to incorporate EMP in my practice.
*6. My agency does not have the infrastructure and interest (e.g., Internet, electronic library
resources, and agency policies and procedures) to support and encourage evidence-based
rehabilitation counseling practice.
7. There is a lack of empirically validated VR interventions that I can use in my work as a VR
counselor.
*8. There are no supervisors and counselors who are experienced in EBP in my agency that I can
talk to.
The asterisk * mark indicates the questions in which negative wording was substituted for
positive wording. The changes are listed below:
Question 3: “There is sufficient collective support..” to “There is a lack of sufficient support..”
Question 4: “There is strong support..” to “There is a lack of support..”
Question 6: “My agency has the infrastructure..” to “My agency does not have the
infrastructure..”
Question 8: “There are supervisors and counselors..” to “There are no supervisors and
counselors..”
14. Part D.
Instructions: Using the scale below, please indicate the extent to which you agree or disagree
with each of the following statements.
Scale:
0 = Strongly Disagree
1
2 = Disagree
3
4 = Unsure
5
6 = Agree
7
8
9 = Strongly Agree

99

1. The use of treatment/intervention decisions based on clinical experience is more effective than
EBP.
2. EBP has the potential to help improve the effectiveness of VR services delivery practices.
3. I can see the value of EBP in vocational rehabilitation.
4. I enjoy reading empirical research articles in the rehabilitation, health, and psychology fields.
5. I use best evidence medical, psychological, and vocational interventions in my rehabilitation
practice.
6. I am interested in learning more about EBP.
7. I use EBP concepts in making decisions regarding services for my clients.
8. I take research findings into consideration in helping clients choose appropriate treatments and
interventions.
9. I have completed in-service training on topics related to best evidence interventions such as
counseling/therapy, Individual Placement and Support. Assertive Community Treatment, and
Motivational Interviewing.
10. I use the Internet and academic databases to search for systematic review articles to help me
select promising practices that are helpful to my clients.
11. I do not believe EBP has any practical value in vocational rehabilitation.
12. I am using EBP in my role as a rehabilitation counselor.

100

Appendix B
Table 19.
Participant Practice Setting
Frequency Percent
State-Federal VR
139
4.9
Program
Community
Rehabilitation
25
.9
Organization
Private for
Profit/Workers
Compensation
Other
Total

60

2.1

94
318

3.3
11.1

101

Appendix C
Table 20.
Participant Highest Education Level
Frequency Percent
Bachelor's Degree
5
.2
Master's Degree
289
10.1
Doctorate Degree
19
.7
Total
313
10.9
Total
2862
100.0

Table 21.
Participant Major Area of Study
Frequency Percent
Rehabilitation
248
8.7
Counseling
Rehabilitation
12
.4
Psychology
Psychology
4
.1
Social Work
2
.1
Other Counseling
Specialty
Other Vocational
Rehabilitation Specialty
Other
Total

24

.8

6

.2

22
318

.8
11.1

102

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103

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